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Ames SG, Delaney RK, Delgado-Corcoran C, Houtrow AJ, Alvey J, Watt MH, Murphy N. Impact of disability-based discrimination in healthcare on parents of children with medical complexity. Dev Med Child Neurol 2024; 66:1226-1233. [PMID: 38327250 DOI: 10.1111/dmcn.15870] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 12/26/2023] [Accepted: 01/05/2024] [Indexed: 02/09/2024]
Abstract
AIM To qualitatively assess the impact of disability-based discrimination in healthcare on the parents of children with medical complexity (CMC). METHOD In this qualitative study, we conducted in-depth, semi-structured interviews with the parents of CMC. Data collection and analysis occurred iteratively; constant comparison methods were used to identify themes describing the impact of disability-based discrimination in pediatric healthcare on the parents of CMC. RESULTS Thirty participants from 15 US states were interviewed. Four themes were developed regarding the impact of disability-based discrimination in healthcare on parents. The themes were: (1) discrimination leads to a loss of trust in healthcare providers; (2) discrimination increases the burden of caregiving; (3) discrimination impacts parental well-being; and (4) racism and poverty-based discrimination amplifies disability-based discrimination. INTERPRETATION The experience of discrimination toward their child results in loss of trust and therapeutic relationship between provider and parent, causes increased burden to the family, and contributes to decreased parental well-being. These experiences are magnified in minoritized families and in families perceived to have a lower socioeconomic status based on insurance type.
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Affiliation(s)
- Stefanie G Ames
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Rebecca K Delaney
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | - Amy J Houtrow
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Justin Alvey
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Melissa H Watt
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Nancy Murphy
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
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Sharma P, Kularatna S, Abell B, McPhail SM, Senanayake S. Preferences for Neurodevelopmental Follow-Up Care for Children: A Discrete Choice Experiment. THE PATIENT 2024:10.1007/s40271-024-00717-3. [PMID: 39210193 DOI: 10.1007/s40271-024-00717-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/18/2024] [Indexed: 09/04/2024]
Abstract
INTRODUCTION Identifying and addressing neurodevelopmental delays in children can be challenging for families and the healthcare system. Delays in accessing services and early interventions are common. The design and delivery of these services, and associated outcomes for children, may be improved if service provision aligns with families' needs and preferences for receiving care. The aim of this study is to identify families' preferences for neurodevelopmental follow-up care for children using an established methodology. METHODS We used a discrete choice experiment (DCE) to elicit families' preferences. We collected data from families and caregivers of children with neurodevelopmental needs. The DCE process included four stages. In stage 1, we identified attributes and levels to be included in the DCE using literature review, interviews, and expert advice. The finalised attributes were location, mode of follow-up, out-of-pocket cost per visit, mental health counselling for parents, receiving educational information, managing appointments, and waiting time. In stage 2, we generated choice tasks that contained two alternatives and a 'neither' option for respondents to choose from, using a Bayesian d-efficient design. These choice tasks were compiled in a survey that also included demographic questions. We conducted pre- and pilot tests to ensure the functionality of the survey and obtain priors. In stage 3, the DCE survey was administered online. We received 301 responses. In stage 4, the analysis was conducted using a latent class model. Additionally, we estimated the relative importance of attributes and performed a scenario analysis. RESULTS Two latent classes were observed. More families with full-time employees, higher incomes, postgraduate degrees, and those living in metropolitan areas were in class 1 compared with class 2. Class 1 families preferred accessing local public health clinics, face-to-face follow-up, paying AUD100 to AUD500, mental health support, group educational activities, health service-initiated appointments, and waiting < 3 months. Class 2 families disliked city hospitals when compared with private, preferred paying AUD100 or no cost, and had similar preferences regarding mental health support and wait times as class 1. However, no significant differences were noted in follow-up modality, receiving educational information, and appointment management. The relative importance estimation suggested that location was most important for class 1 (28%), whereas for class 2, cost accounted for nearly half of the importance when selecting an alternative. The expected uptake of follow-up care, estimated under three different hypothetical scenarios, may increase by approximately 24% for class 2 if an 'ideal' scenario taking into account preferences was implemented. CONCLUSION This study offers insights into aspects that may be prioritised by health services and policymakers to improve the design and delivery of neurodevelopmental follow-up care for children. The findings may enhance the organisation and functioning of existing care programmes; and therefore, improve the long-term outcomes of children with neurodevelopmental needs and their families.
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Affiliation(s)
- Pakhi Sharma
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Brisbane, QLD, 4059, Australia.
| | - Sanjeewa Kularatna
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Brisbane, QLD, 4059, Australia
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Bridget Abell
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Brisbane, QLD, 4059, Australia
| | - Steven M McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Brisbane, QLD, 4059, Australia
- Digital Health and Informatics Directorate, Metro South Health, Brisbane, QLD, Australia
| | - Sameera Senanayake
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Brisbane, QLD, 4059, Australia
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
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Van Orne JA, Clutter P, Fredland N, Schultz R. Caring for the child with a tracheostomy through the eyes of their caregiver: A photovoice study. J Pediatr Nurs 2024; 79:59-68. [PMID: 39213803 DOI: 10.1016/j.pedn.2024.08.024] [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: 06/26/2024] [Revised: 08/14/2024] [Accepted: 08/22/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE This qualitative descriptive study aimed to explore the daily experiences of caregivers of children with medical complexity with a tracheostomy at home. METHODS This study used photovoice, a participatory action research methodology. Adult English-speaking caregivers of children with a tracheostomy, living in Texas, with access to a smartphone were recruited. Photographs taken by participants and an interview guide were used to guide semi-structured interviews with caregivers. RESULTS Eight participants were recruited. After analyzing photographs and caregiver interviews, four main themes were identified: role transition, daily challenges, finding support, and thriving in the new normal. CONCLUSIONS Caregivers take on multiple roles, including providing medical care, advocating for their children, and educating others. While facing emotional challenges such as guilt, fear, and exhaustion, caregivers rely on external support systems, emphasizing the need for nurses and healthcare providers to provide comprehensive support and improve the accessibility of home nursing services. PRACTICE IMPLICATIONS The findings of this study can inform nurse-led interventions and advocacy efforts aimed at supporting marginalized children with medical complexity with a tracheostomy and their families. These efforts may include enhancing communication and collaboration between families, healthcare workers, and the public, providing comprehensive, proactive support for caregivers, and improving access to home nursing services.
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Affiliation(s)
- Julie A Van Orne
- Director of Nursing Research and Innovation, Cook Children's Medical Center, 801 7(th) Avenue, Fort Worth, TX 76104, USA.
| | - Paula Clutter
- Texas Woman's University, 6700 Fannin Street, Houston, TX 77030-2897, USA.
| | - Nina Fredland
- Texas Woman's University, 6700 Fannin Street, Houston, TX 77030-2897, USA.
| | - Rebecca Schultz
- Texas Woman's University, 6700 Fannin Street, Houston, TX 77030-2897, USA.
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High MS, Lynch E, Sobotka SA. Parent perspectives on education to support hospital discharge for children with invasive mechanical ventilation. J Pediatr Nurs 2024:S0882-5963(24)00264-1. [PMID: 39025713 DOI: 10.1016/j.pedn.2024.07.002] [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: 01/11/2024] [Revised: 07/02/2024] [Accepted: 07/03/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Children with invasive mechanical ventilation (IMV) often live at home, but for safety, parents must be prepared to assume primary responsibility for all aspects of their child's medically complex care. Prior studies have described discharge education programs, however often without perspectives of parents with lived experience transitioning home. PURPOSE To describe parent perspectives on hospital-based education for discharging home a child with IMV. DESIGN AND METHODS A secondary qualitative analysis of 23 parent interviews between February 2019 to January 2022 on topics related to caring for a child with IMV. Each interview was coded independently and discussed to consensus. Data from codes related to parent education and training were analyzed to identify themes and sub-themes. RESULTS Parents of 23 children with IMV participated in the primary interviews a month after hospital discharge. Four main themes in the secondary dataset were identified: (1) Training context: The hospital can be a stressful and difficult learning environment; (2) Training characteristics: Parents receive thorough training from interdisciplinary providers; (3) Learner characteristics: Parents are motivated learners who independently seek out knowledge; (4) Post-discharge education: Parents gain confidence in their expertise after navigating an emergency. CONCLUSIONS Parents who have transitioned from hospital-to-home describe sufficiently detailed hospital-based education; many felt trained as capably as nurses. However, parents experienced in-hospital training as inflexible and stressful. PRACTICE IMPLICATIONS Parents of children with IMV are eager learners but parent education is not always family-centered. Reforming the hospital learning environment to match parent needs will improve family experiences and training.
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Affiliation(s)
- Michelle S High
- Department of Nursing, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; College of Nursing, Rush University, Chicago, IL, USA.
| | - Emma Lynch
- Section of Developmental and Behavioral Pediatrics, Department of Pediatrics, University of Chicago, Chicago, IL, USA
| | - Sarah A Sobotka
- Section of Developmental and Behavioral Pediatrics, Department of Pediatrics, University of Chicago, Chicago, IL, USA
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Koob C, Griffin SF, Stuenkel M, Cartmell K, Rennert L, Sease K. Bridging the gaps in pediatric complex healthcare: the case for home nursing care among children with medical complexity. BMC Health Serv Res 2024; 24:814. [PMID: 39010079 PMCID: PMC11251302 DOI: 10.1186/s12913-024-11235-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 06/23/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Children with medical complexity (CMC) comprise < 1% of the pediatric population, but account for nearly one-third of healthcare expenditures. Further, while CMC account for up to 80% of pediatric inpatient hospital costs, only 2% of Medicaid spending is attributed to home healthcare. As a result, the current health system heavily relies on family caregivers to fill existing care gaps. This study aimed to: (1) examine factors associated with hospital admissions among CMC and (2) contextualize the potential for home nursing care to improve outcomes among CMC and their families in South Carolina (SC). METHODS This mixed-methods study was conducted among CMC, their family caregivers, and physicians in SC. Electronic health records data from a primary care clinic within a large health system (7/1/2022-6/30/2023) was analyzed. Logistic regression examined factors associated with hospitalizations among CMC. In-depth interviews (N = 15) were conducted among physicians and caregivers of CMC statewide. Patient-level quantitative data is triangulated with conceptual findings from interviews. RESULTS Overall, 39.87% of CMC experienced ≥ 1 hospitalization in the past 12 months. CMC with higher hospitalization risk were dependent on respiratory or neurological/neuromuscular medical devices, not non-Hispanic White, and demonstrated higher healthcare utilization. Interview findings contextualized efforts to reduce hospitalizations, and suggested adaptations related to capacity and willingness to provide complex care for CMC and their families. CONCLUSIONS Findings may inform multi-level solutions for accessible, high-quality home nursing care among CMC and their families. Providers may learn from caregivers' insight to emphasize family-centered care practices, acknowledging time and financial constraints while optimizing the quality of medical care provided in the home.
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Affiliation(s)
- Caitlin Koob
- Department of Public Health Sciences, Clemson University, 501 Epsilon Zeta Dr. (Edwards Hall), Clemson, SC, 29634, USA.
| | - Sarah F Griffin
- Department of Public Health Sciences, Clemson University, 501 Epsilon Zeta Dr. (Edwards Hall), Clemson, SC, 29634, USA
| | | | - Kathleen Cartmell
- Department of Public Health Sciences, Clemson University, 501 Epsilon Zeta Dr. (Edwards Hall), Clemson, SC, 29634, USA
| | - Lior Rennert
- Department of Public Health Sciences, Clemson University, 501 Epsilon Zeta Dr. (Edwards Hall), Clemson, SC, 29634, USA
| | - Kerry Sease
- Prisma Health (Bradshaw Institute for Community Child Health and Advocacy), 255 Enterprise Blvd #110, Greenville, SC, 29615, USA
- Furman University, Greenville, SC, 29613, USA
- Executive Director of the Institute for Advancement of Community Health, Greenville, SC, 29613, USA
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Bansal S, Molloy EJ, Rogers E, Bidegain M, Pilon B, Hurley T, Lemmon ME. Families as partners in neonatal neuro-critical care programs. Pediatr Res 2024:10.1038/s41390-024-03257-6. [PMID: 38886506 DOI: 10.1038/s41390-024-03257-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 04/07/2024] [Accepted: 04/15/2024] [Indexed: 06/20/2024]
Abstract
Parents of neonates with neurologic conditions face a specific breadth of emotional, logistical, and social challenges, including difficulties coping with prognostic uncertainty, the need to make complex medical decisions, and navigating new hopes and fears. These challenges place parents in a vulnerable position and at risk of developing mental health issues, which can interfere with bonding and caring for their neonate, as well as compromise their neonate's long-term neurodevelopment. To optimize neurologic and developmental outcomes, emerging neonatal neuro-critical care (NNCC) programs must concurrently attend to the unique needs of the developing newborn brain and of his/her parents. This can only be accomplished by embracing a family-centered care environment-one which prioritizes effective parent-clinician communication, longitudinal parent support, and parents as equitable partners in clinical care. NNCC programs offer a multifaceted approach to critical care for neonates at-risk for neurodevelopmental impairments, integrating expertise in neonatology and neurology. This review highlights evidence-based strategies to guide NNCC programs in developing a family-partnered approach to care, including primary staffing models; staff communication, implicit bias, and cultural competency trainings; comprehensive and tailored caregiver training; single-family rooms; flexible visitation policies; colocalized neonatal and maternal care; uniform mental health screenings; follow-up care referrals; and connections to peer support. IMPACT: Parents of neonates with neurologic conditions are at high-risk for experiencing mental health issues, which can adversely impact the parent-neonate relationship and long-term neurodevelopmental outcomes of their neonates. While guidelines to promote families as partners in the neonatal intensive care unit (NICU) have been developed, no protocols integrate the unique needs of parents in neonatal neurologic populations. A holistic approach that makes families true partners in the care of their neonate with a neurologic condition in the NICU has the potential to improve mental and physical well-being for both parents and neonates.
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Affiliation(s)
- Simran Bansal
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Eleanor J Molloy
- Paediatric Research Laboratory, Trinity Translational Medicine Institute (TTMI), St. James' Hospital, Dublin, Ireland
- Discipline of Paediatrics, Dublin Trinity College, The University of Dublin, Dublin, Ireland
- Trinity Research in Childhood Centre (TriCC), Children's Health Ireland & Coombe Hospital, Dublin, Ireland
| | - Elizabeth Rogers
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Margarita Bidegain
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | | | - Tim Hurley
- Paediatric Research Laboratory, Trinity Translational Medicine Institute (TTMI), St. James' Hospital, Dublin, Ireland
- Discipline of Paediatrics, Dublin Trinity College, The University of Dublin, Dublin, Ireland
| | - Monica E Lemmon
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA.
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
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Spratling R, Tennant MN, Lee J. Symptom and Technology Management Intervention Usefulness for Caregivers of Children With Tracheostomies and Feeding Tubes. West J Nurs Res 2024; 46:366-373. [PMID: 38545957 DOI: 10.1177/01939459241240422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
BACKGROUND Caregivers of children who require medical technology of tracheostomies and feeding tubes provide intensive and specialized care at home. They have extensive training in the hospital prior to their child's discharge; however, there is limited education about their child's care once they are at home. The Creating Opportunities for Personal Empowerment: Symptom and Technology Management Resources intervention focused on commonly experienced symptoms and technology used at home by caregivers. OBJECTIVE We present the findings from the intervention exit interviews to gain insight about the intervention from caregiver perspectives, notably their perceptions of usefulness, ease of use, and acceptability. METHODS A qualitative descriptive design was used to examine caregivers' perceptions of the intervention in exit interviews. These interviews were conducted upon completion of the intervention as part of feasibility testing. RESULTS Sixteen caregivers completed the study and participated in exit interviews. Caregivers described the themes of the best that you can do, a reminder that I am doing it the right way, and I wish I had these when my child first had the tracheostomy and feeding tube. Caregivers also provided feedback about the intervention's usefulness and suggestions for further refinement and future adaptations of the intervention. CONCLUSIONS Caregivers provided valuable insights about the intervention, describing its usefulness to them, the potential for usefulness for other caregivers of these children, and their experiences with care of their children at home. Future plans include efficacy testing and modifications to enhance the intervention based on caregiver feedback.
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Affiliation(s)
- Regena Spratling
- School of Nursing, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, GA, USA
| | - Monica Nelson Tennant
- School of Nursing, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, GA, USA
| | - Jiwon Lee
- School of Nursing, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, GA, USA
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Stock NM, Costa B, Parnell J, Johns AL, Crerand CE, Billaud Feragen K, Stueckle LP, Mills A, Magee L, Hotton M, Tumblin M, Schefer A, Drake AF, Heike CL. A Conceptual Thematic Framework of Psychological Adjustment in Caregivers of Children with Craniofacial Microsomia. Cleft Palate Craniofac J 2024:10556656241245284. [PMID: 38584503 DOI: 10.1177/10556656241245284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024] Open
Abstract
OBJECTIVE Children with craniofacial microsomia (CFM) have complex healthcare needs, resulting in evaluations and interventions from infancy onward. Yet, little is understood about families' treatment experiences or the impact of CFM on caregivers' well-being. To address this gap, the NIH-funded 'Craniofacial microsomia: Accelerating Research and Education (CARE)' program sought to develop a conceptual thematic framework of caregiver adjustment to CFM. DESIGN Caregivers reported on their child's medical and surgical history. Narrative interviews were conducted with US caregivers (n = 62) of children aged 3-17 years with CFM. Transcripts were inductively coded and final themes and subthemes were identified. RESULTS Components of the framework included: 1) Diagnostic Experiences, including pregnancy and birth, initial emotional responses, communication about the diagnosis by healthcare providers, and information-seeking behaviors; 2) Child Health and Healthcare Experiences, including feeding, the child's physical health, burden of care, medical decision-making, surgical experiences, and the perceived quality of care; 3) Child Development, including cognition and behavior, educational provision, social experiences, and emotional well-being; and 4) Family Functioning, including parental well-being, relationships, coping strategies, and personal growth. Participants also identified a series of "high" and "low" points throughout their journey and shared their priorities for future research. CONCLUSIONS Narrative interviews provided rich insight into caregivers' experiences of having a child with CFM and enabled the development of a conceptual thematic framework to guide clinical care and future research. Information gathered from this study demonstrates the need to incorporate evidence-based psychological support for families into the CFM pathway from birth onward.
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Affiliation(s)
- Nicola M Stock
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Bruna Costa
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Jade Parnell
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Alexis L Johns
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | | | | | - Laura P Stueckle
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Angela Mills
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Leanne Magee
- Buerger Center for Advanced Pediatric Care, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Matthew Hotton
- Oxford Institute of Clinical Psychology Training and Research, University of Oxford, Oxford, England
| | - Melissa Tumblin
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Amy Schefer
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Amelia F Drake
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel School of Medicine, Chapel Hill, NC, USA
| | - Carrie L Heike
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA
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Houlihan BV, Coleman C, Kuo DZ, Plant B, Comeau M. What Families of Children With Medical Complexity Say They Need: Humanism in Care Delivery Change. Pediatrics 2024; 153:e2023063424F. [PMID: 38165241 DOI: 10.1542/peds.2023-063424f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 01/03/2024] Open
Abstract
There is growing consensus that centering lived experience is needed to meaningfully transform the burdensome systems of care for children with medical complexity (CMC) and their families. The Collaborative Improvement and Innovation Network to Advance Care for Children with Medical Complexity quality improvement initiative, co-led with family colleagues, illuminates a critical real-world view of systems change to address unintended bias and demystify the medical model of care. We share candid themes in which families describe the need for systems to counteract widespread misconceptions and bias to achieve meaningful system change. We held family-designed, family-led focus groups (N = 127 across 27 groups) within 10 diverse state teams. Families were asked about CMC quality of life and family wellbeing. We transcribed and coded the responses to uncover salient themes. We uncovered 2 major themes from families with direct applicability to systems of care: "What's Missing - Human Dignity" and "What Families Really Need and Recommend in Care." Families shared that valuing each child and creating opportunities for the child and family to enjoy their lives were most important in addressing human dignity in systems of care. They recommended centering the whole child, building relationships of trust and communication, and valuing family-to-family supports to transform the system of care aligned to humanism in care. Families express an urgency for systems to uphold dignity, valuing their child as a whole human being whose quality of life holds meaning and joy, not just as a diagnosis. The highly untenable cost of navigating dehumanizing systems of care reduces quality of life and wellbeing and must be transformed.
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Affiliation(s)
- Bethlyn Vergo Houlihan
- Boston University School of Social Work, Center for Innovation in Social Work & Health, Boston, Massachusetts
| | | | - Dennis Z Kuo
- Department of Pediatrics, University of Rochester, Rochester, New York
| | - Benjamin Plant
- Boston University School of Social Work, Center for Innovation in Social Work & Health, Boston, Massachusetts
| | - Meg Comeau
- Boston University School of Social Work, Center for Innovation in Social Work & Health, Boston, Massachusetts
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Graaf G, Hughes PM, deJong NA, Thomas KC. Family Support Services and Reported Parent Coping Among Caregivers of Children with Emotional, Behavioral, or Developmental Disorders. J Dev Behav Pediatr 2024; 45:e54-e62. [PMID: 38127916 PMCID: PMC10922057 DOI: 10.1097/dbp.0000000000001230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/12/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE Caregivers of children with special health care needs (CSHCN) experience substantial strain caring for their child's special needs because of high needs for health and other support services. Caregivers of CSHCN with emotional, behavioral, or developmental problems (EBDPs) report stress and poor mental health at higher rates than caregivers of other CSHCN. Although family support services are associated with caregiver mental health and well-being among families of CSHCN, the association of these factors with caregiver coping has been underexamined. METHOD Using the Double ABCX Model of Family Adaptation to guide variable selection, this study uses 2016 to 2019 data from the National Survey of Children's Health. Univariate, bivariate, and multivariate logistic analyses examined the association between caregivers' receipt of adequate care coordination and emotional support services and their reported coping with the day-to-day strains of parenting. These relationships are compared between caregivers of CSHCN with and without EBDPs. RESULTS Receipt of adequate care coordination was associated with higher rates of caregiver-reported positive coping for all caregivers of CSHCN who have no source of emotional support. Receipt of emotional support services was associated with increased reports of positive coping for caregivers for all CSHCN as well. Caregivers reporting only informal sources of emotional support, however, also reported higher rates of positive coping when compared with caregivers with no source of emotional support. CONCLUSION Mobilization of resources that can aid caregivers in coordinating care and provide emotional support may play a key role in positive caregiver coping for families of CSHCN.
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Affiliation(s)
- Genevieve Graaf
- School of Social Work, University of Texas at Arlington; 211 South Cooper Street, Box 19129, Arlington, TX 76019
| | - Phillip M Hughes
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill
| | - Neal A deJong
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Kathleen C Thomas
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC
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11
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Hirt E, Wright A, Kehring A, Wang Y, Toraño V, Boles J. "Fitting the Pieces Together": The Experiences of Caregivers of Children With Medical Complexity. Hosp Pediatr 2023; 13:1056-1066. [PMID: 37916264 DOI: 10.1542/hpeds.2022-007112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
BACKGROUND AND OBJECTIVES Families of children with medical complexity manage a multitude of care responsibilities that must be carefully coordinated alongside typical family roles and activities. Currently, little is known about this experience from the perspectives of caregivers; therefore, the purpose of this study was to explore the experience of caregiving for a child with medical complexity while identifying unmet medical and psychosocial needs. METHODS Nineteen caregivers were recruited from the pediatric complex care clinic at an academic medical center in the United States. Each participant completed an in-depth, narrative interview that was audio-recorded and transcribed; transcripts were analyzed using an inductive coding approach. RESULTS Participants described their caregiving experiences along 4 themes: (1) the many responsibilities of caregiving, (2) insufficient respite care and skilled support, (3) financial limitations and costs of care, and (4) challenges with mental health and wellbeing. Participants identified unmet needs in 6 dimensions: (1) transition stress, (2) communication across teams, (3) learning to be an advocate, (4) purposefully inclusive environments, (5) finding connections and community, and (6) the challenges of coronavirus disease 2019. CONCLUSIONS Caregivers of children with medical complexity identify a host of experiences and unmet needs that challenge the physical, emotional, and psychosocial wellbeing of themselves and their families. With more attention to the holistic experience of caregiving for this population, providers and teams can better anticipate needs and provide services and programs that enhance caregiver and family wellbeing simultaneously.
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Affiliation(s)
- Elise Hirt
- Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Alyssa Wright
- Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Allysa Kehring
- Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Yinuo Wang
- Vanderbilt University, Nashville, Tennessee
| | | | - Jessika Boles
- Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee
- Vanderbilt University, Nashville, Tennessee
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12
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Thomas R, Pesut B, Siden H, Treschow M, Puurveen G. Developing competencies for volunteer navigators to support caregivers of children living with medical complexity: a mixed-method e-Delphi study. Palliat Care Soc Pract 2023; 17:26323524231209060. [PMID: 37954463 PMCID: PMC10634257 DOI: 10.1177/26323524231209060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/04/2023] [Indexed: 11/14/2023] Open
Abstract
Background Providing specially trained volunteer navigators is one promising strategy for supporting the increasing number of family caregivers who are caring for children living with medical complexity. Objective The objective of this study was to develop consensus on the role and competencies required for volunteer navigators who support caregivers of children living with medical complexity. Design This was a mixed-method study using modified e-Delphi and focus group methods. In phase 1, a modified e-Delphi survey with 20 family caregivers and a focus group with 4 family caregivers were conducted to develop consensus on their unmet needs and the potential roles of a volunteer to meet those needs. In phase 2, a modified e-Delphi survey was conducted with experts to develop consensus on the volunteer competencies required to meet the roles identified by family caregivers in phase 1. Results Findings from phase 1 resulted in 36 need-related items over 8 domains: communication, daily life and chores, emotional support, information and knowledge, respite, support with decision-making, and sharing the caregiving experience. Concerns about the volunteer role included the potential lack of commitment in the absence of remuneration, the complexity of the child's condition that was beyond the role of a volunteer, and a preference for support from individuals they knew. Findings from the phase 2 Delphi survey with professionals resulted in 22 competencies, derived from the roles identified in phase 1, that would be required of volunteers who wished to support these family caregivers. Conclusion This study provides insight into a role for volunteers in meeting the needs of family caregivers of children living with medical complexity. A volunteer with lived experience and adequate preparation can assist with meeting some of these important needs. Further research is required to better understand the feasibility and acceptability of such a role.
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Affiliation(s)
- Robyn Thomas
- The University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Barbara Pesut
- The University of British Columbia Okanagan, 1147 Research Way, Kelowna, BC V1V 1V7, Canada
| | - Hal Siden
- The University of British Columbia, Canuck Place Children’s Hospice and BC Children’s Hospital, Vancouver, BC, Canada
| | - Michael Treschow
- The University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Gloria Puurveen
- The University of British Columbia Okanagan, Kelowna, BC, Canada
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13
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Vasan A, Kyle MA, Venkataramani AS, Kenyon CC, Fiks AG. Inequities in Time Spent Coordinating Care for Children and Youth With Special Health Care Needs. Acad Pediatr 2023; 23:1526-1534. [PMID: 36918094 PMCID: PMC10495536 DOI: 10.1016/j.acap.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVE In the United States, caregivers of children and youth with special health care needs (CYSHCN) must navigate complex, inefficient health care and insurance systems to access medical care. We assessed for sociodemographic inequities in time spent coordinating care for CYSHCN and examined the association between time spent coordinating care and forgone medical care. METHODS This cross-sectional study used data from the 2018-2020 National Survey of Children's Health, which included 102,740 children across all 50 states. We described the time spent coordinating care for children with less complex special health care needs (SHCN) (managed through medications) and more complex SHCN (resulting in functional limitations or requiring specialized therapies). We examined race-, ethnicity-, income-, and insurance-based differences in time spent coordinating care among CYSHCN and used multivariable logistic regression to examine the association between time spent coordinating care and forgone medical care. RESULTS Over 40% of caregivers of children with more complex SHCN reported spending time coordinating their children's care each week. CYSHCN whose caregivers spent ≥ 5 h/wk on care coordination were disproportionately Hispanic, low-income, and publicly insured or uninsured. Increased time spent coordinating care was associated with an increasing probability of forgone medical care: 6.7% for children whose caregivers spent no weekly time coordinating care versus 9.4% for< 1 hour; 11.4% for 1 to 4 hours; and 15.8% for ≥ 5 hours. CONCLUSIONS Reducing time spent coordinating care and providing additional support to low-income and minoritized caregivers may be beneficial for pediatric payers, policymakers, and health systems aiming to promote equitable access to health care for CYSHCN.
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Affiliation(s)
- Aditi Vasan
- Department of Pediatrics (A Vasan, CC Kenyon, and AG Fiks), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; PolicyLab and Center for Pediatric Clinical Effectiveness (A Vasan, CC Kenyon, and AG Fiks), Children's Hospital of Philadelphia, Pa; Leonard Davis Institute of Health Economics (A Vasan, AS Venkataramani, CC Kenyon, and AG Fiks), University of Pennsylvania, Philadelphia, Pa.
| | - Michael Anne Kyle
- Department of Health Care Policy (MA Kyle), Harvard Medical School and Dana Farber Cancer Institute, Boston, Mass.
| | - Atheendar S Venkataramani
- Leonard Davis Institute of Health Economics (A Vasan, AS Venkataramani, CC Kenyon, and AG Fiks), University of Pennsylvania, Philadelphia, Pa; Department of Medical Ethics and Health Policy (AS Venkataramani), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Calif.
| | - Chén C Kenyon
- Department of Pediatrics (A Vasan, CC Kenyon, and AG Fiks), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; PolicyLab and Center for Pediatric Clinical Effectiveness (A Vasan, CC Kenyon, and AG Fiks), Children's Hospital of Philadelphia, Pa; Leonard Davis Institute of Health Economics (A Vasan, AS Venkataramani, CC Kenyon, and AG Fiks), University of Pennsylvania, Philadelphia, Pa.
| | - Alexander G Fiks
- Department of Pediatrics (A Vasan, CC Kenyon, and AG Fiks), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; PolicyLab and Center for Pediatric Clinical Effectiveness (A Vasan, CC Kenyon, and AG Fiks), Children's Hospital of Philadelphia, Pa; Leonard Davis Institute of Health Economics (A Vasan, AS Venkataramani, CC Kenyon, and AG Fiks), University of Pennsylvania, Philadelphia, Pa.
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14
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Bansal S, Willis R, Barks MC, Pollak KI, Brandon D, Kaye EC, Lemmon ME. Supporting Disclosure of Unmet Mental Health Needs among Parents of Critically Ill Infants. J Pediatr 2023; 262:113596. [PMID: 37399922 PMCID: PMC10757990 DOI: 10.1016/j.jpeds.2023.113596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/11/2023] [Accepted: 06/26/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVE To characterize (1) the prevalence of mental health discussion and (2) facilitators of and barriers to parent disclosure of mental health needs to clinicians. STUDY DESIGN Parents of infants with neurologic conditions in neonatal and pediatric intensive care units participated in a longitudinal decision-making study from 2018 through 2020. Parents completed semi-structured interviews upon enrollment, within 1 week after a conference with providers, at discharge, and 6 months post-discharge. We used a conventional content analysis approach and NVIVO 12 to analyze data related to mental health. RESULTS We enrolled 61 parents (n = 40 mothers, n = 21 fathers) of 40 infants with neurologic conditions in the intensive care unit. In total, 123 interviews were conducted with 52 of these parents (n = 37 mothers, n = 15 fathers). Over two-thirds of parents (n = 35/52, 67%) discussed their mental health in a total of 61 interviews. We identified two key domains when approaching the data through the lens of mental health: (1) self-reported barriers to communicating mental health needs: parents shared uncertainty about the presence or benefit of support, a perceived lack of mental health resources and emotional support, and concerns about trust; (2) self-reported facilitators and benefits of communicating mental health needs: parents described the value of supportive team members, connecting to peer support, and speaking to a mental health professional or neutral third party. CONCLUSIONS Parents of critically ill infants are at high risk of unmet mental health needs. Our results highlight modifiable barriers and actionable facilitators to inform interventions to improve mental health support for parents of critically ill infants.
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Affiliation(s)
- Simran Bansal
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Rheaya Willis
- Department of Psychiatry, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA
| | - Mary C Barks
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Kathryn I Pollak
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC; Duke Cancer Institute, Durham, NC
| | - Debra Brandon
- Department of Pediatrics, Duke University School of Medicine, Durham, NC; Duke University School of Nursing, Durham, NC
| | - Erica C Kaye
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | - Monica E Lemmon
- Department of Pediatrics, Duke University School of Medicine, Durham, NC; Department of Population Health Sciences, Duke University School of Medicine, Durham, NC.
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15
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Sharp EA, Wang L, Hall M, Berry JG, Forster CS. Frequency, Characteristics, and Outcomes of Patients Requiring Early PICU Readmission. Hosp Pediatr 2023; 13:678-688. [PMID: 37476936 PMCID: PMC10375031 DOI: 10.1542/hpeds.2022-007100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
OBJECTIVES Readmission to the PICU is associated with worse outcomes, but factors associated with PICU readmission within the same hospitalization remain unclear. We sought to describe the prevalence of, and identify factors associated with, early PICU readmission. METHODS We performed a retrospective analysis of PICU admissions for patients aged 0 to 26 years in 48 tertiary care children's hospitals between January 1, 2016 and December 31, 2019 in the Pediatric Health Information System. We defined early readmission as return to the PICU within 2 calendar days of floor transfer during the same hospitalization. Generalized linear mixed models were used to analyze associations between patient and clinical variables, including complex chronic conditions (CCC) and early PICU readmission. RESULTS The results included 389 219 PICU admissions; early PICU readmission rate was 2.5%. Factors with highest odds of early PICU readmission were CCC, with ≥4 CCCs (reference: no CCC[s]) as highest odds of readmission (adjusted odds ratio [95% confidence interval]: 4.2 [3.8-4.5]), parenteral nutrition (2.3 [2.1-2.4]), and ventriculoperitoneal shunt (1.9 [1.7-2.2]). Factors with decreased odds of PICU readmission included extracorporeal membrane oxygenation (0.4 [0.3-0.6]) and cardiopulmonary resuscitation (0.8 [0.7-0.9]). Patients with early PICU readmissions had longer overall length of stay (geometric mean [geometric SD]: 18.2 [0.9] vs 5.0 [1.1] days, P < .001) and increased odds of mortality (1.7 [1.5-1.9]). CONCLUSIONS Although early PICU readmissions within the same hospitalization are uncommon, they are associated with significantly worse clinical outcomes. Patients with medical complexity and technology dependence are especially vulnerable.
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Affiliation(s)
- Eleanor A. Sharp
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Li Wang
- Clinical and Translational Science Institute, Office of Clinical Research, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Matt Hall
- Children’s Hospital Association, Lenexa, Kansas
| | - Jay G. Berry
- Complex Care, Division of General Pediatrics, Department of Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Catherine S. Forster
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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16
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McLorie EV, Hackett J, Fraser LK. Understanding parents' experiences of care for children with medical complexity in England: a qualitative study. BMJ Paediatr Open 2023; 7:e002057. [PMID: 37550084 PMCID: PMC10407344 DOI: 10.1136/bmjpo-2023-002057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/14/2023] [Indexed: 08/09/2023] Open
Abstract
OBJECTIVES To understand parents' experiences of receiving care for their child with medical complexity. DESIGN Qualitative semi-structured interviews with parents of children with medical complexities across England analysed using reflexive thematic analysis. RESULTS Twenty parents from four hospital sites in England took part in the study, a total of 17 interviews were completed, 3 joint and 14 single parent interviews. Four themes were developed: parents feel abandoned; continuity of care (made up of three subthemes); equipment barriers; and charities fill the gaps. CONCLUSIONS The perceived quality of healthcare provided to this population was found to be inconsistent, positive examples referred to continuity of care; communication, clinical management and long-lasting relationships. However, many experienced challenges when receiving care for their children; many of these challenges have been highlighted over the past two to three decades but despite the children's needs becoming more complex, little progress appears to have been made. Parents were seen as adopting significant additional roles beyond being a parent, but they still find themselves left without support across all areas. These families require more structured support. Policy makers and commissioners need to prioritise the needs of families to enable health and social care services to provide the support required.
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Affiliation(s)
| | - Julia Hackett
- Department of Health Sciences, University of York, York, UK
| | - Lorna Katharine Fraser
- Cicely Saunders Institute, Department of Women and Children's Health, King's College London, London, UK
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17
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Gallegos C, Cacchillo N. Experiences of Parents of Children With Medical Complexity in the Pediatric Intensive Care Unit: A Scoping Review. Crit Care Nurse 2023; 43:20-28. [PMID: 37524368 DOI: 10.4037/ccn2023774] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
BACKGROUND Medical advances and decreased mortality rates in the pediatric intensive care unit have increased the number of children surviving illnesses they may not have survived previously. The term child with medical complexity is poorly defined. OBJECTIVES The purposes of this scoping review were to examine the experiences of parents of children with medical complexity in the pediatric intensive care unit and describe strategies to help support these parents. RESULTS Eight studies were eligible for inclusion. All were published from 2009 through 2021. One study was a quantitative observational study, 2 were mixed-methods studies, and 5 had a qualitative design. Parents experienced significant stress and depression. Sources of stress were parenting a child with complex chronic illness in the pediatric intensive care unit, uncertainty, communication between family members and clinicians, and lack of subspecialty communication. Strategies to assist parents included respecting parents' expertise and providing consistent and clear communication with family members and among subspecialty clinicians. CONCLUSION This review is the first to examine the experiences of parents of children with medical complexity in the pediatric intensive care unit. The study was limited by lack of available research and lack of consensus for the definition of child with medical complexity. However, this review describes strategies that nurses may find useful when caring for parents of children with medical complexity.
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Affiliation(s)
- Cara Gallegos
- Cara Gallegos is an associate professor in the School of Nursing at Boise State University, Boise, Idaho
| | - Natalie Cacchillo
- Natalie Cacchillo is a nursing student and an undergraduate research assistant in the School of Nursing at Boise State University
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18
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Nogueira AJ, Ribeiro MT. "The Key Is to Value Every Little Achievement": A Qualitative Study of the Psychological Experience of Parent Caregivers in Paediatric Palliative Care. Clin Pract 2023; 13:670-683. [PMID: 37366931 DOI: 10.3390/clinpract13030062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 06/28/2023] Open
Abstract
In Europe, Portugal has been identified as the country with the most rapid evolution of paediatric palliative care provision, which is a highly complex experience for families. The present descriptive-exploratory study seeks to contribute to the understanding of the psychological experience of life-limiting conditions in parent caregivers. A total of 14 families completed a sociodemographic and clinical data sheet and answered a structured online interview based on an incomplete narrative resulting from the Unwanted Guest Metaphor. A thematic analysis of the various narratives was performed through an inductive-deductive process. The results provide a holistic view of 10 essential dimensions in the parental psychological experience and contribute to the design of intervention methodologies in an eco-systemic approach. The importance of clear communication with health professionals, an awareness of the unpredictability of the disease, the desire for more self-care, the difficulty in understanding their children's needs and the threat implicit in everyday life are some of the main findings. This research emphasizes the importance of having opportunities of emotional expression and psychoeducation about anxiety' management, enhancing the perception of positive characteristics in children with palliative needs and creating time for the couple. The study has some limitations, such as the small sample size, and suggests that further research should explore the father's experience.
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19
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Sadler EM, Okito O, Soghier L. Addressing caregiver mental health in the neonatal ICU. Curr Opin Pediatr 2023; 35:390-397. [PMID: 36974450 DOI: 10.1097/mop.0000000000001242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
PURPOSE OF REVIEW The neonatal ICU (NICU) setting is a unique opportunity to not only detect major changes in caregiver mental health through universal perinatal mood and anxiety disorder (PMAD) screening but also intervene with specialized support. We review evidence for addressing caregiver mental health in the NICU, explore current guidelines and models for integrated behavioural health programmes, and describe challenges specific to NICUs, particularly in standalone paediatric hospitals. RECENT FINDINGS Parents of infants admitted to the NICU are at an increased risk for developing PMADs at rates well above the general postpartum community. Select NICUs within the United States and internationally have recognized the importance of having an embedded psychologist to address caregiver PMADs. However, organizational structures within paediatric healthcare systems are not equipped to manage the logistical, ethical, legal and practical needs of comprehensive caregiver mental health programmes. SUMMARY To properly address caregiver mental health in NICU settings, clinical and administrative teams must work together to ensure seamless service provision. Systems that facilitate the development of unique parent medical records at the onset of paediatric care are likely to significantly reduce potential liability risks and solve several challenges related to caregiver-focused mental health support in the NICU. VIDEO ABSTRACT http://links.lww.com/MOP/A70.
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Affiliation(s)
- Erin M Sadler
- Division of Psychology and Behavioral Health
- Department of Pediatrics
- Department of Psychiatry and Behavioral Sciences, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Ololade Okito
- Division of Neonatology, Children's National Hospital
- Department of Pediatrics
| | - Lamia Soghier
- Division of Neonatology, Children's National Hospital
- Department of Pediatrics
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20
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Teicher J, Moore C, Esser K, Weiser N, Arje D, Cohen E, Orkin J. The Experience of Parental Caregiving for Children With Medical Complexity. Clin Pediatr (Phila) 2023; 62:633-644. [PMID: 36475307 PMCID: PMC10676025 DOI: 10.1177/00099228221142102] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Children with medical complexity (CMC) have complex chronic conditions with significant functional impairment, contributing to high caregiving demand. This study seeks to explore impacts of parental caregiving for CMC. Fifteen caregivers of CMC followed at a tertiary care hospital participated in semi-structured interviews. Interviews were concurrently analyzed using a qualitative description framework until thematic saturation was reached. Codes were grouped by shared concepts to clarify emergent findings. Four affected domains of parental caregiver experience with associated subthemes (in parentheses) were identified: personal (identity, physical health, mental health), family (marriage, siblings, family quality of life), social (time limitations, isolating lived experience), and financial (employment, medical costs, accessibility costs). Despite substantial challenges, caregivers identified two core determinants of personal resilience: others' support (hands-on, interpersonal, informational, material) and a positive outlook (self-efficacy, self-compassion, reframing expectations). Further research is needed to understand the unique needs and strengths of caregivers for this vulnerable population.
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Affiliation(s)
- Jessica Teicher
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Clara Moore
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, SickKids Research Institute, Toronto, ON, Canada
| | - Kayla Esser
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, SickKids Research Institute, Toronto, ON, Canada
| | - Natalie Weiser
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, SickKids Research Institute, Toronto, ON, Canada
| | - Danielle Arje
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, SickKids Research Institute, Toronto, ON, Canada
| | - Eyal Cohen
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, SickKids Research Institute, Toronto, ON, Canada
- Division of Paediatric Medicine, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
- Edwin S.H. Leong Centre for Healthy Children, Toronto, ON, Canada
| | - Julia Orkin
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, SickKids Research Institute, Toronto, ON, Canada
- Division of Paediatric Medicine, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
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21
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Dewan T, Birnie K, Drury J, Jordan I, Miller M, Neville A, Noel M, Randhawa A, Zadunayski A, Zwicker J. Experiences of medical traumatic stress in parents of children with medical complexity. Child Care Health Dev 2023; 49:292-303. [PMID: 35947493 PMCID: PMC10087969 DOI: 10.1111/cch.13042] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 05/25/2022] [Accepted: 08/07/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Parents of children with medical complexity (CMC) experience high levels of stress and adverse mental health outcomes. Pediatric medical traumatic stress (PMTS) could be an important contributor that has not yet been explored. PMTS describes parents' reactions to their child's illness and medical treatment and can lead to post-traumatic stress symptoms. This is the first study to describe the experiences and impact of PMTS among parents of CMC. METHODS We conducted semi-structured interviews with 22 parents of CMC. Reflexive thematic analysis was used to generate themes that described the experiences of PMTS and potential contributing factors in the healthcare setting. Themes were validated by study participants. RESULTS Parents experienced a spectrum of events and circumstances that impacted PMTS. These corresponded to three major themes: (a) the distinctive context of being the parent of a CMC, (b) interactions with healthcare providers that can hurt or heal and (c) system factors that set the stage for trauma. The consequences of repeated PMTS were a common point of emphasis among all the themes. Parents identified numerous changes that could mitigate PMTS such as acknowledgement of trauma and provision of proactive mental health support. CONCLUSIONS Our study highlights the issue of PMTS among parents of CMC and presents opportunities to mitigate their traumatic experiences. Supporting the integration of trauma-informed care practices, increasing awareness of PMTS and advocating for parental mental health services could better support parents and families.
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Affiliation(s)
- Tammie Dewan
- Department of Pediatrics, University of Calgary, Calgary, Canada.,Alberta Children's Hospital Research Institute, Calgary, Canada
| | - Katie Birnie
- Department of Anesthesia and Pain Medicine, University of Calgary, Calgary, Canada
| | | | | | - Megan Miller
- Rotary Flames Children's Hospice and Palliative Care Service, Calgary, Canada
| | | | - Melanie Noel
- Department of Psychology, University of Calgary, Calgary, Canada
| | - Alam Randhawa
- Department of Pediatrics, University of Calgary, Calgary, Canada
| | - Anna Zadunayski
- Department of Pediatrics, University of Calgary, Calgary, Canada
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Cardenas A, Esser K, Wright E, Netten K, Edwards A, Rose J, Vigod S, Cohen E, Orkin J. Caring for the Caregiver (C4C): An Integrated Stepped Care Model for Caregivers of Children With Medical Complexity. Acad Pediatr 2023; 23:236-243. [PMID: 35680082 DOI: 10.1016/j.acap.2022.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 05/19/2022] [Accepted: 06/01/2022] [Indexed: 11/23/2022]
Abstract
Children with medical complexity (CMC) are a medically fragile subset of children who rely on parental caregivers for substantial care needs. Caregivers of CMC often experience adverse health outcomes such as depression and anxiety, sleep deprivation, financial hardships, and social isolation. Caregivers of CMC are at risk of premature mortality, which is thought to be mediated by chronic and elevated stress, as well as psychiatric morbidity risk. Access to mental health care, where the needs of both the caregiver and child are considered, can enable caregivers to meet high caregiving demands and improve both child and caregiver outcomes. We describe the Caring for the Caregiver (C4C) model, a novel integrated stepped care model consisting of collaboration between a psychiatrist and a pediatric complex care program. This model provides support in 3 steps: 1) early identification of distress, 2) social work assessment, intervention and psychotherapy, and 3) psychiatric care, including diagnosis or medication initiation, for caregivers of CMC. This innovative model will be the first to embed support for the mental health needs of caregivers of CMC within a pediatric team, facilitating access to psychiatric care and serving as a foundation for future integrated stepped care models.
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Affiliation(s)
- Analyssa Cardenas
- Child Health Evaluative Sciences (A Cardenas, K Esser, E Cohen, and J Orkin), The Hospital for Sick Children, Toronto, ON, Canada
| | - Kayla Esser
- Child Health Evaluative Sciences (A Cardenas, K Esser, E Cohen, and J Orkin), The Hospital for Sick Children, Toronto, ON, Canada
| | - Elisabeth Wright
- Department of Psychiatry (E Wright, S Vigod), Women's College Hospital, Toronto, ON, Canada; Department of Psychiatry (E Wright, S Vigod), University of Toronto, Toronto, ON, Canada
| | - Kathy Netten
- Division of Pediatric Medicine (K Netten, A Edwards, E Cohen, and J Orkin), The Hospital for Sick Children, , Toronto, ON, Canada
| | - Ashley Edwards
- Division of Pediatric Medicine (K Netten, A Edwards, E Cohen, and J Orkin), The Hospital for Sick Children, , Toronto, ON, Canada
| | - Julie Rose
- SickKids Family Advisory Network (J Rose), The Hospital for Sick Children, Toronto, ON, Canada
| | - Simone Vigod
- Department of Psychiatry (E Wright, S Vigod), Women's College Hospital, Toronto, ON, Canada; Department of Psychiatry (E Wright, S Vigod), University of Toronto, Toronto, ON, Canada
| | - Eyal Cohen
- Child Health Evaluative Sciences (A Cardenas, K Esser, E Cohen, and J Orkin), The Hospital for Sick Children, Toronto, ON, Canada; Division of Pediatric Medicine (K Netten, A Edwards, E Cohen, and J Orkin), The Hospital for Sick Children, , Toronto, ON, Canada; Department of Pediatrics (E Cohen, J Orkin), University of Toronto, Toronto, ON, Canada; Edwin S.H. Leong Centre for Healthy Children (E Cohen), University of Toronto, Toronto, ON, Canada
| | - Julia Orkin
- Child Health Evaluative Sciences (A Cardenas, K Esser, E Cohen, and J Orkin), The Hospital for Sick Children, Toronto, ON, Canada; Division of Pediatric Medicine (K Netten, A Edwards, E Cohen, and J Orkin), The Hospital for Sick Children, , Toronto, ON, Canada; Department of Pediatrics (E Cohen, J Orkin), University of Toronto, Toronto, ON, Canada.
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23
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Hsu NM, Morris K, Banaag A, Koehlmoos TP. TRICARE Extended Care Health Option Program: Prevalence of pediatric ECHO enrollees and healthcare service utilization in the Military Health System. Disabil Health J 2023:101451. [PMID: 36941191 DOI: 10.1016/j.dhjo.2023.101451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 12/01/2022] [Accepted: 02/17/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND The Extended Care Health Option (ECHO) Program is a TRICARE program aimed at reducing the disabling effects of chronic medical conditions for beneficiaries of the Department of Defense (DoD) healthcare program. However, little is known about military-connected children enrolled in the program. OBJECTIVE/HYPOTHESIS The aim of this study was to examine the demographic makeup of pediatric ECHO beneficiaries and their healthcare claims data. This is the first study to evaluate healthcare utilization of this subset of military dependents. METHODS A cross-sectional study was performed evaluating ECHO enrolled pediatric beneficiaries and their health service utilization during 2017-2019. TRICARE claims and military treatment facility (MTF) encounter data were utilized to evaluate health service utilization and identify the most frequently reported ICD-10-CM and CPT codes associated with care for this population. RESULTS Of the 2,001,619 dependents aged 0-26 years who received medical care in the Military Health System (MHS) during 2017-2019, 21,588 individuals (1.1%) were enrolled in ECHO. The majority of encounters (65.4%) were provided in the MTFs. Inpatient visits, therapeutic services, and in-home nursing care were the top utilized private sector care services. Outpatient visits encompassed 94.8% of healthcare encounters, and neurodevelopmental disorders were the top principal diagnoses among ECHO beneficiaries. CONCLUSIONS With the increasing prevalence of children with medical complexity and developmental delay, the pediatric TRICARE beneficiaries eligible for ECHO will likely continue to rise. Improving services and supports for military children with special healthcare needs is needed to maximize their developmental trajectory.
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Affiliation(s)
- Nicole M Hsu
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
| | - Kyla Morris
- Center for Health Services Research, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; The Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Amanda Banaag
- Center for Health Services Research, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; The Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Tracey P Koehlmoos
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Center for Health Services Research, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
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Sonsteng-Person M, García-Pérez J, Copeland V, Liévano-Karim L, Abrams D, Jarman B, Marquardt R, Taitingfong S, Van Leeuwen J, Valdez R. "What I Would Do to Take Away Your Pain": A Photovoice Project Conducted by Mothers of Children With Medical Complexity. QUALITATIVE HEALTH RESEARCH 2023; 33:204-219. [PMID: 36704955 DOI: 10.1177/10497323221146047] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Research identifies that families of children with medical complexities in the United States have diverse and complex needs. Despite research emphasizing that families demonstrate higher needs that are not being met, limited research focuses solely on mothers of children with medical complexities. Specifically, how mothers understand and identify themselves, understand and define their role in coordinating care, and how they view their own mental and physical health. As such, this study provides a better understanding of how mothers in San Diego, CA, navigate the day-to-day psychological, social, and physical realities of having a child with medical complexities. Through the use of the participatory action research method photovoice, mothers conducted a critical analysis of their daily lives. Findings identify mothers' main concerns about the conditions of their lives as well as the strengths they employ to care for themselves and their children successfully. Implications provide recommendations for hospitals working with mothers of children with medical complexities.
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Ortinau CM, Smyser CD, Arthur L, Gordon EE, Heydarian HC, Wolovits J, Nedrelow J, Marino BS, Levy VY. Optimizing Neurodevelopmental Outcomes in Neonates With Congenital Heart Disease. Pediatrics 2022; 150:e2022056415L. [PMID: 36317967 PMCID: PMC10435013 DOI: 10.1542/peds.2022-056415l] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 11/05/2022] Open
Abstract
Neurodevelopmental impairment is a common and important long-term morbidity among infants with congenital heart disease (CHD). More than half of those with complex CHD will demonstrate some form of neurodevelopmental, neurocognitive, and/or psychosocial dysfunction requiring specialized care and impacting long-term quality of life. Preventing brain injury and treating long-term neurologic sequelae in this high-risk clinical population is imperative for improving neurodevelopmental and psychosocial outcomes. Thus, cardiac neurodevelopmental care is now at the forefront of clinical and research efforts. Initial research primarily focused on neurocritical care and operative strategies to mitigate brain injury. As the field has evolved, investigations have shifted to understanding the prenatal, genetic, and environmental contributions to impaired neurodevelopment. This article summarizes the recent literature detailing the brain abnormalities affecting neurodevelopment in children with CHD, the impact of genetics on neurodevelopmental outcomes, and the best practices for neonatal neurocritical care, focusing on developmental care and parental support as new areas of importance. A framework is also provided for the infrastructure and resources needed to support CHD families across the continuum of care settings.
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Affiliation(s)
- Cynthia M. Ortinau
- Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri
| | - Christopher D. Smyser
- Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri
| | - Lindsay Arthur
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Erin E. Gordon
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Haleh C. Heydarian
- Department of Pediatrics, University of Cincinnati College of Medicine, Division of Cardiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Joshua Wolovits
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jonathan Nedrelow
- Department of Neonatology, Cook Children’s Medical Center, Fort Worth, Texas
| | - Bradley S. Marino
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Divisions of Cardiology and Critical Care Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago
| | - Victor Y. Levy
- Department of Pediatrics, Stanford University School of Medicine, Lucile Packard Children’s Hospital, Palo Alto, California
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Yu JA, Bayer ND, Beach SR, Kuo DZ, Houtrow AJ. A National Profile of Families and Caregivers of Children With Disabilities and/or Medical Complexity. Acad Pediatr 2022; 22:1489-1498. [PMID: 36002069 DOI: 10.1016/j.acap.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/10/2022] [Accepted: 08/13/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Provide an up-to-date description of the well-being of families and caregivers of children with disability and medical complexity at the national level. METHODS We performed a secondary analysis of the 2016-2019 National Survey of Children's Health and divided the sample based on a child's disability and medical complexity status: children with no special health care needs (non-CSHCN), children with special health care needs (CSHCN), CSHCN with significant disabilities (CSHCN-SD), and children with medical complexity (CMC). Outcomes included survey items assessing 1) caregiver emotional well-being, 2) family functioning, and 3) economic adversity. We conducted multivariable logistic regression analyses to examine associations between child disability and medical complexity status with study outcomes. RESULTS Among 131,774 survey responses, CSHCN-SD (weighted n = 4.2 million) and CMC (n =1.1 million) disproportionately reported adverse outcomes for every measure of well-being. Notably, caregivers of CSHCN-SD and CMC were more likely to report frequently feeling bothered (aOR 5.0 and 6.3, respectively) and angry (aOR 3.0 and 3.1) with their child than non-CSHCN caregivers. Families of CSHCN-SD and CMC had 40% lower odds of endorsing all aspects of family resilience and more likely to report three or more adverse childhood experiences (aOR 3.3 and 3.7) than non-CSHCN families. CSHCN-SD and CMC families were also more likely to experience difficulty covering basics (aOR, 2.6 and 3.3) and report caregivers changing jobs due to their child's care (aOR, 3.1 and 5.0). CONCLUSIONS Development and testing of interventions specifically targeting the well-being of CSHCN-SD and CMC families and caregivers is needed.
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Affiliation(s)
- Justin A Yu
- Department of Pediatrics, Divisions of Palliative Care and Pediatric Hospital Medicine (JA Yu), University of Pittsburgh School of Medicine and UPMC Children's Hospital, Pittsburgh, Pa.
| | - Nathaniel D Bayer
- Department of Pediatrics, Division of Pediatric Hospital Medicine (ND Bayer), University of Rochester Medical Center and Golisano Children's Hospital, Rochester, NY
| | - Scott R Beach
- University Center for Social and Urban Research (SR Beach), University of Pittsburgh, Pittsburgh, Pa
| | - Dennis Z Kuo
- Department of Pediatrics, Division of Developmental and Behavioral Pediatrics (DZ Kuo), University of Rochester Medical Center and Golisano Children's Hospital, Rochester, NY
| | - Amy J Houtrow
- Division of Pediatric Rehabilitation Medicine, Department of Physical Medicine & Rehabilitation (AJ Houtrow), University of Pittsburgh School of Medicine, Pittsburgh, Pa
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Salley CG, Axelrad M, Fischer E, Steuer KB. But parents need help! Pathways to caregiver mental health care in pediatric hospital settings. Palliat Support Care 2022; 21:1-7. [PMID: 36300295 DOI: 10.1017/s1478951522001353] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Research and clinical expertise have emphasized the mental health needs of parents and caregivers of medically complex children. Evidence-based interventions are available for adult mental health, including those designed specifically for caregivers caring for children with a variety of health-care needs. This paper describes practical and legal considerations of 3 possible pathways for psychologists to address the needs of caregivers within pediatric hospital settings. METHODS Literature regarding the mental health needs of caregivers of children with medical conditions, evidence-based interventions, and pediatric subspecialty psychosocial guidelines was reviewed. Relevant legal and ethical obligations for psychologists were also summarized. RESULTS The mental health needs of caregivers of medically complex children are often high, yet programmatic, institutional, legal, and ethical barriers can limit access to appropriate care. SIGNIFICANCE OF THE RESULTS Integration of screening and treatment of caregivers' mental health within the pediatric hospital setting is one pathway to addressing caregivers' needs. The development of programs for caregiver mental health screening and treatment within pediatric hospital settings will enhance the well-being of children and families and reduce legal and ethical risks for pediatric psychologists. Consultation with institutional compliance, legal/risk, and medical records departments and the creation of electronic medical records for the caregiver may be useful and practical opportunities for integration.
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Affiliation(s)
- Christina G Salley
- Department of Child and Adolescent Psychiatry, Hassenfeld Children's Hospital at NYU Langone and NYU School of Medicine, New York, NY, USA
| | - Marni Axelrad
- Division of Psychology, Texas Children's Hospital and Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Elizabeth Fischer
- Division of Pediatric Psychology and Behavioral Medicine, Children's Wisconsin and Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Katherine B Steuer
- Managing Counsel, Health Affairs, St. Jude Children's Research Hospital, Memphis, TN, USA
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Smiley Y, Silberholz E, Bekele E, Brodie N. Caregiver stress and social determinants of health in key populations: immigrant parents, parents of children with medical complexity, and adolescent parents. Curr Opin Pediatr 2022; 34:521-530. [PMID: 35993274 DOI: 10.1097/mop.0000000000001163] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To examine the five domains of social determinants of health - economic stability, education access, healthcare access and quality, neighborhood and built environment, and social and community context - and how these relate to caregiver stress in under-resourced populations. RECENT FINDINGS Socioeconomic and family factors are increasingly understood as drivers of child health. Caregiver stress can impact family stability and child wellbeing. Immigrant parents, caregivers of children with medical complexity, and adolescent parents experience stressors due to the unique needs of their families. These groups of parents and caregivers also face various challenges identified as social determinants of health. Interventions to mitigate these challenges can promote resilience, care coordination, and community-based supports. SUMMARY Current research describes caregiver stress in key populations, how caregiver stress affects children, and approaches to minimize and mitigate these effects. Pediatric providers can implement best practices to support families who are navigating stress due to caregiving and social determinants of health.
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Affiliation(s)
- Yael Smiley
- Division of General and Community Pediatrics, Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Elizabeth Silberholz
- Division of General Pediatrics, Boston Children's Hospital; Harvard Medical School, Boston, Massachusetts, USA
| | - ElShadey Bekele
- Division of General and Community Pediatrics, Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Nicola Brodie
- Division of General and Community Pediatrics, Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
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Lewis H, Trowbridge A, Jonas D, Rosenberg AR, Bogetz JF. A Qualitative Study of Clinicians and Parents of Children with Severe Neurological Impairment on Tools to Support Family-Centered Care. J Palliat Med 2022; 25:1338-1344. [PMID: 35593900 PMCID: PMC9639233 DOI: 10.1089/jpm.2021.0579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2022] [Indexed: 11/12/2022] Open
Abstract
Background: Children with severe neurological impairment (SNI) have complex conditions and require family-centered care, yet, this is challenging in the hospital. Objectives: To describe themes related to building parent-clinician rapport and to examine ways to promote family-centered care for children with SNI. Design: Post hoc secondary analysis of data from a qualitative cross-sectional study. Setting/Subjects: Semistructured interviews conducted between August 2019 and February 2020 with parents of children with SNI and interprofessional clinicians at a single tertiary children's hospital in the United States. Measurement: Data from codes pertaining to strategies to promote therapeutic alliance were extracted for inductive thematic analysis and to collate ideas for tools suggested by participants. The research team iteratively discussed each proposed tool, developed an example representative depiction, and expanded upon potential opportunities and limitations of the tools' practical implementation. Results: Twenty-five parents/legal guardians and 25 interprofessional clinicians participated. The median age of parents/legal guardians was 38 [interquartile range 35,48]. Sixty-eight percent (n = 17) identified as mothers and 68% (n = 17) identified as white. Clinicians were predominantly female (84%, n = 21) and represented 8 professions and 15 specialties. Themes and suggested tools included (1) continuity of previous decision-making conversations and the decision roadmap tool, (2) maintaining family communication preferences and the relational handoff tool, and (3) recognizing the abilities of each individual child and the developmental inventory tool. Conclusions: Family-centered care for parents of children with SNI may be bolstered by continuity in decision making, maintaining parents' communication preferences, and appreciating the child's individual abilities. Clinical tools may provide opportunities to promote these concepts.
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Affiliation(s)
- Hannah Lewis
- Treuman Katz Center for Bioethics, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Amy Trowbridge
- Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Hospital and Research Institute, Seattle, Washington, USA
| | - Danielle Jonas
- Silver School of Social Work, New York University, New York, New York, USA
| | - Abby R. Rosenberg
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Hospital and Research Institute, Seattle, Washington, USA
- Division of Hematology/Oncology, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Jori F. Bogetz
- Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Hospital and Research Institute, Seattle, Washington, USA
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Belzer LT, Wright SM, Goodwin EJ, Singh MN, Carter BS. Psychosocial Considerations for the Child with Rare Disease: A Review with Recommendations and Calls to Action. CHILDREN (BASEL, SWITZERLAND) 2022; 9:933. [PMID: 35883917 PMCID: PMC9325007 DOI: 10.3390/children9070933] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/10/2022] [Accepted: 06/11/2022] [Indexed: 01/07/2023]
Abstract
Rare diseases (RD) affect children, adolescents, and their families infrequently, but with a significant impact. The diagnostic odyssey undertaken as part of having a child with RD is immense and carries with it practical, emotional, relational, and contextual issues that are not well understood. Children with RD often have chronic and complex medical conditions requiring a complicated milieu of care by numerous clinical caregivers. They may feel isolated and may feel stigmas in settings of education, employment, and the workplace, or a lack a social support or understanding. Some parents report facing similar loneliness amidst a veritable medicalization of their homes and family lives. We searched the literature on psychosocial considerations for children with rare diseases in PubMed and Google Scholar in English until 15 April 2022, excluding publications unavailable in full text. The results examine RD and their psychosocial ramifications for children, families, and the healthcare system. The domains of the home, school, community, and medical care are addressed, as are the implications of RD management as children transition to adulthood. Matters of relevant healthcare, public policies, and more sophisticated translational research that addresses the intersectionality of identities among RD are proposed. Recommendations for interventions and supportive care in the aforementioned domains are provided while emphasizing calls to action for families, clinicians, investigators, and advocacy agents as we work toward establishing evidence-based care for children with RD.
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Affiliation(s)
- Leslee T. Belzer
- Division of Developmental and Behavioral Health, Section of Pediatric Psychology, Children’s Mercy Kansas City, Kansas City, MO 64108, USA
- Department of Pediatrics, School of Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA; (S.M.W.); (E.J.G.); (B.S.C.)
- Division of General Academic Pediatrics, The Beacon Program, Children’s Mercy Kansas City, Kansas City, MO 64111, USA
| | - S. Margaret Wright
- Department of Pediatrics, School of Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA; (S.M.W.); (E.J.G.); (B.S.C.)
- Division of General Academic Pediatrics, The Beacon Program, Children’s Mercy Kansas City, Kansas City, MO 64111, USA
- School of Medicine, University of Kansas, Kansas City, KS 66160, USA
| | - Emily J. Goodwin
- Department of Pediatrics, School of Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA; (S.M.W.); (E.J.G.); (B.S.C.)
- Division of General Academic Pediatrics, The Beacon Program, Children’s Mercy Kansas City, Kansas City, MO 64111, USA
- School of Medicine, University of Kansas, Kansas City, KS 66160, USA
| | - Mehar N. Singh
- Department of Psychology, Clinical Child Psychology Program, University of Kansas, Lawrence, KS 66045, USA;
| | - Brian S. Carter
- Department of Pediatrics, School of Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA; (S.M.W.); (E.J.G.); (B.S.C.)
- Department of Medical Humanities & Bioethics, University of Missouri-Kansas City, Kansas City, MO 64108, USA
- Bioethics Center, Children’s Mercy Kansas City, Kansas City, MO 64108, USA
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McCarthy SR, Golembiewski EH, Gravholt DL, Clark JE, Clark J, Fischer C, Mulholland H, Babcock K, Montori VM, Jones A. Documentation of Psychosocial Distress and Its Antecedents in Children with Rare or Life-Limiting Chronic Conditions. CHILDREN 2022; 9:children9050664. [PMID: 35626841 PMCID: PMC9139272 DOI: 10.3390/children9050664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/21/2022] [Accepted: 04/29/2022] [Indexed: 11/16/2022]
Abstract
Children with rare or life-limiting chronic conditions and their families are at high risk of psychosocial distress. However, despite its impact on patient and family health and functioning, psychosocial distress and its antecedents may not routinely be captured in medical records. The purpose of this study was to characterize current medical record documentation practices around psychosocial distress among children with rare or life-limiting chronic conditions and their families. Medical records for patients with rare or life-limiting chronic conditions (n = 60) followed by a pediatric complex care program were reviewed. Study team members extracted both structured data elements (e.g., diagnoses, demographic information) and note narratives from the most recent visit with a clinician in the program. Psychosocial topics were analyzed using a mixed quantitative (i.e., frequency counts of topics) and qualitative approach. Topics related to psychosocial distress that were documented in notes included child and parent emotional problems, parent social support, sibling emotional or physical problems, family structure (e.g., whether parents were together), and financial concerns. However, 35% of notes lacked any mention of psychosocial concerns. Although examples of psychosocial concerns were included in some notes, none were present in over one-third of this sample. For both patients with rare or life-limiting chronic conditions and their caregivers, more active elicitation and standard documentation of psychosocial concerns may improve the ability of healthcare providers to identify and intervene on psychosocial concerns and their risk factors.
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Affiliation(s)
- Sarah R. McCarthy
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, USA
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN 55905, USA; (E.H.G.); (D.L.G.); (V.M.M.)
- Correspondence: ; Tel.: +1-507-284-2933
| | - Elizabeth H. Golembiewski
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN 55905, USA; (E.H.G.); (D.L.G.); (V.M.M.)
| | - Derek L. Gravholt
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN 55905, USA; (E.H.G.); (D.L.G.); (V.M.M.)
| | - Jennifer E. Clark
- Department of Endocrinology, Diabetes, and Metabolism, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN 55905, USA;
| | - Jeannie Clark
- Mayo Clinic Children’s Center, Mayo Clinic, Rochester, MN 55905, USA; (J.C.); (C.F.)
| | - Caree Fischer
- Mayo Clinic Children’s Center, Mayo Clinic, Rochester, MN 55905, USA; (J.C.); (C.F.)
| | - Hannah Mulholland
- Section of Social Work, Mayo Clinic, Rochester, MN 55905, USA; (H.M.); (K.B.)
| | - Kristina Babcock
- Section of Social Work, Mayo Clinic, Rochester, MN 55905, USA; (H.M.); (K.B.)
| | - Victor M. Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN 55905, USA; (E.H.G.); (D.L.G.); (V.M.M.)
- Department of Endocrinology, Diabetes, and Metabolism, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN 55905, USA;
| | - Amie Jones
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905, USA;
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Dahan S, Bourque CJ, Reichherzer M, Prince J, Mantha G, Savaria M, Janvier A. Community, Hope, and Resilience: Parental Perspectives on Peer Support in Neonatology. J Pediatr 2022; 243:85-90.e2. [PMID: 34843711 DOI: 10.1016/j.jpeds.2021.11.060] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 11/15/2021] [Accepted: 11/23/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To describe the perspective of parents who participated in peer-to-peer support meetings with parents of children in a neonatal intensive care unit (NICU) and veteran resource parents with previous NICU experience. STUDY DESIGN During a longitudinal evaluation in a tertiary care NICU, participating parents were asked to evaluate meetings; with open-ended questions, they were asked about their perspectives. Results were analyzed using mixed methods. RESULTS Forty-five NICU parents participated over a 10-week study period. They were followed longitudinally after attending at least 1 of the 10 meetings offered; 95% of parents (43 of 45) reported that the meeting was useful to them and gave an overall evaluation of 8.7 out of 10 (average). For each meeting, all the subjects on the checklist of the moderators (veteran resource parents) were discussed with new parents. When describing why and how the meetings were useful to them in their answers to open-ended questions, NICU parents reported 3 major themes: (1) decreasing isolation and being a community (73%), (2) hope and resilience (63%), and (3) getting practical "parent" information (32%). Sharing stories with parents who also had experienced loss, sadness, and grief, NICU parents trusted that it was possible to adapt and thrive. The meetings normalized parents' emotions (92%), decreased negative emotions (eg, anger, sadness, guilt), empowered them in their parental role, and helped them communicate with loved ones and providers. CONCLUSIONS Peer support meetings are a unique and useful means to support parents. Future investigations will investigate whether and how this type of intervention can improve clinical outcomes.
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Affiliation(s)
- Sonia Dahan
- CHU Sainte-Justine Research Center, Montreal, Quebec, Canada; Unité d'éthique clinique, CHU Sainte-Justine, Montreal, Quebec, Canada; Division of Neonatology, CHU Sainte-Justine, Montreal, Quebec, Canada; Espace Éthique Méditerranéen, Aix-Marseille University/EFS/CNRS, UMR 7268 ADÉS, Marseille, France
| | - Claude Julie Bourque
- CHU Sainte-Justine Research Center, Montreal, Quebec, Canada; Unité d'éthique clinique, CHU Sainte-Justine, Montreal, Quebec, Canada; Centre d'excellence en éthique et partenariat, CHU Sainte-Justine, Montreal, Quebec, Canada; Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada
| | | | | | | | - Melissa Savaria
- Division of Neonatology, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Annie Janvier
- CHU Sainte-Justine Research Center, Montreal, Quebec, Canada; Unité d'éthique clinique, CHU Sainte-Justine, Montreal, Quebec, Canada; Division of Neonatology, CHU Sainte-Justine, Montreal, Quebec, Canada; Centre d'excellence en éthique et partenariat, CHU Sainte-Justine, Montreal, Quebec, Canada; Préma-Québec, Quebec, Quebec, Canada; Bureau de l'Éthique Clinique, University of Montreal, Montreal, Quebec, Canada; Unité de soins palliatifs, CHU Sainte-Justine, Montreal, Quebec, Canada.
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33
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Shriver J. Cost of Caregiving on Parents of Children With Medical Complexity and Life-Limiting Conditions. Pediatrics 2021; 148:peds.2021-050222. [PMID: 34155133 DOI: 10.1542/peds.2021-050222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/10/2021] [Indexed: 11/24/2022] Open
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