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Johns AL, Stock NM, Costa B, Feragen KB, Crerand CE. Psychosocial and Health-Related Experiences of Individuals With Microtia and Craniofacial Microsomia and Their Families: Narrative Review Over 2 Decades. Cleft Palate Craniofac J 2023; 60:1090-1112. [PMID: 35382590 PMCID: PMC10803131 DOI: 10.1177/10556656221091699] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This paper describes 20 years of microtia and craniofacial microsomia (CFM) psychosocial and healthcare studies and suggests directions for clinical care and research. A narrative review of papers January 2000 to July 2021 related to psychosocial and healthcare experiences of individuals with microtia and CFM and their families. Studies (N = 64) were mainly cross-sectional (69%), included a range of standardized measures (64%), and were with European (31%), American (27%), or multinational (23%) samples. Data were generally collected from both patients and caregivers (38%) or patient self-report (35%). Sample sizes were 11 to 25 (21%), 26 to 50 (19%), 51 to 100 (22%), or over 100 (38%). Studies addressed 5 primary topics: (1) Healthcare Experiences, including Medical Care, Hearing Loss/Amplification, Diagnostic Experiences, and Information Preferences; (2) Psychosocial Experiences, including Teasing, Behavioral Adjustment, Psychosocial Support, and Public Perception; (3) Neurocognitive Functioning and Academic Assistance; (4) Pre- and Post-Operative Psychosocial Outcomes of Ear Reconstruction/Canaloplasty; and (5) Quality of Life and Patient Satisfaction. Care involved multiple specialties and was often experienced as stressful starting at diagnosis. Psychosocial and neurocognitive functioning were generally in the average range, with possible risk for social and language concerns. Coping and resiliency were described into adulthood. Satisfaction and positive benefit of ear reconstruction/canaloplasty were high. Care recommendations include increasing: hearing amplification use, microtia and CFM knowledge among providers, efficient treatment coordination, psychosocial support, academic assistance, and advances to minimize surgical scarring. This broad literature overview informs clinical practice and research to improve psychosocial outcomes.
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Affiliation(s)
- Alexis L Johns
- Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Nicola Marie Stock
- Center for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Bruna Costa
- Center for Appearance Research, University of the West of England, Bristol, United Kingdom
| | | | - Canice E Crerand
- Departments of Pediatrics and Plastic Surgery, The Ohio State University College of Medicine, Columbus, OH, USA and Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
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Aleman RM, Martinez MG. Thematic Analysis of Coping Strategies Used by Parents of Children with Cleft Lip and Palate in El Salvador. Cleft Palate Craniofac J 2023; 60:336-343. [PMID: 34859701 DOI: 10.1177/10556656211062839] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE The aim of this study was to describe coping strategies used by parents of children with cleft palate with or without a cleft (CP ± L) during the early development of their children in El Salvador. DESIGN Qualitative interviews were completed with 16 parents of children born with CP ± L who were 6 months to 6 years old. Parents were questioned about their emotions and coping during eight time periods: prenatal, birth, social interaction before the first surgery, the beginning of surgeries, social interaction after the first surgery, early childhood education (ECE), speech-language therapy, and formal education. Thematic analysis (TA) was used to identify coping strategies as conceptualized by Lazarus and Folkman (1984). RESULTS Four major themes emerged: (a) experienced emotions related to diagnosis, (b) interpretations related to the birth of a child with a cleft, (c) seeking and experiencing cleft treatment, and (d) social interaction of the children. During prenatal and birth stages, parents used emotion-focused strategies. A few hours to a week after birth, they used problem-focused strategies, which led them in search of treatment. Some parents used avoidance strategies during periods of social interaction before surgery, ECE, and formal education. Socioeconomic challenges impacted access to speech-language therapy. Sociocultural factors, such as discrimination, religion, and folk beliefs, appeared to influence some of the coping strategies used by parents. CONCLUSIONS Problem-focused strategies appear to be helpful in seeking surgical treatments. The emotion-focused strategy of avoidance seemed to have adverse effects in minimizing opportunities for social interaction prior to surgery and early education.
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Affiliation(s)
- Ramon Manuel Aleman
- Evangelical University of El Salvador, Dr Juan Jose Fernandez National Hospital of El Salvador, Chief of Clinica Aleman: Cleft Lip and Palate Center, San Salvador, El Salvador
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Umbaugh HM, Crerand CE, Stock NM, Luquetti DV, Heike CL, Drake AF, Billaud Feragen KJ, Johns AL. Microtia and craniofacial microsomia: Content analysis of facebook groups. Int J Pediatr Otorhinolaryngol 2020; 138:110301. [PMID: 32838996 DOI: 10.1016/j.ijporl.2020.110301] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/03/2020] [Accepted: 08/04/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE An increasing number of patients use social media for health-related information and social support. This study's objective was to describe the content posted on Facebook groups for individuals with microtia and/or craniofacial microsomia (CFM) and their families in order for providers to gain insight into patient and family needs and experiences to inform clinical care. METHODS Two months of posts, images, comments, and "like" responses from two Facebook groups in the US and the UK were recorded and analyzed using content analysis. A secondary analysis identified statements of emotion. RESULTS Posts (N = 254) had a total of 7912 "like" responses, 2245 comments, and 153 images. There were three categories of posts: seeking guidance (43%; 9 themes), promoting events/news (33%; 5 themes), and sharing experiences (24%; 3 themes). Across categories, 16% of posts had emotional content. Most comments were responding to posts seeking guidance, including medical care (20%), surgical care (9%), and hearing aids (5%). Promotional posts often aimed to increase CFM awareness. Posts sharing experiences were generally positive, with the highest number of "likes". CONCLUSIONS Facebook groups members frequently exchanged health-related information, suggesting value placed on input from other families and the convenience of seeking information online. Posts also promoted awareness and shared experiences. Clinical care implications include the need for easily accessible accurate and tailored CFM-related health education. Additionally, providers should demonstrate awareness of health information on social media and may address the potential emotional impact of CFM by facilitating access to resources for social support.
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Affiliation(s)
- Hailey M Umbaugh
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, FOB Suite 3A.1, Columbus, OH, 43205, USA.
| | - Canice E Crerand
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, FOB Suite 3A.1, Columbus, OH, 43205, USA; Department of Pediatrics and Plastic Surgery, The Ohio State University College of Medicine, USA.
| | - Nicola M Stock
- Center for Appearance Research, University of the West of England, Coldharbour Lane, Bristol, BS16 1QY, UK.
| | - Daniela V Luquetti
- Seattle Children's Hospital, Craniofacial Center, Seattle Children's Research Institute, University of Washington, Department of Pediatrics, 1900 Ninth Avenue, Mailstop C9S-5, Seattle, WA, 98101, USA.
| | - Carrie L Heike
- Seattle Children's Hospital, Craniofacial Center, Seattle Children's Research Institute, University of Washington, Department of Pediatrics, 1900 Ninth Avenue, Mailstop C9S-5, Seattle, WA, 98101, USA.
| | - Amelia F Drake
- Department of Otolaryngology/Head and Neck Surgery, Craniofacial Center, University of North Carolina, Chapel Hill, NC, 27599, USA.
| | - Kristin J Billaud Feragen
- Center for Rare Disorders, Oslo University Hospital (Rikshospitalet), Postboks 4950 Nydalen, 0424, Oslo, Norway.
| | - Alexis L Johns
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, 4650 Sunset Blvd, MS#96, Los Angeles, CA, 90027, USA.
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Johns AL, Wallace ER, Collett BR, Kapp-Simon KA, Drake AF, Heike CL, Kinter SL, Luquetti DV, Magee L, Norton S, Sie K, Speltz ML. Behavioral Adjustment of Preschool Children With and Without Craniofacial Microsomia. Cleft Palate Craniofac J 2020; 58:42-53. [PMID: 32783465 DOI: 10.1177/1055665620947987] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The study aim was to assess behavioral adjustment in preschool children with and without craniofacial microsomia (CFM). DESIGN Multisite cohort study of preschoolers with CFM ("cases") or without CFM ("controls"). PARTICIPANTS Mothers (89%), fathers (9%), and other caregivers (2%) of 161 preschoolers. OUTCOME MEASURE Child Behavior Check List (CBCL 1.5-5); linear regressions with standardized effect sizes (ES) adjusted for sociodemographic confounds. RESULTS Child Behavior Check Lists for 89 cases and 72 controls (average age 38.3 ± 1.9 months). Children were male (54%), white (69%), and of Latino ethnicity (47%). Cases had microtia with mandibular hypoplasia (52%), microtia only (30%), or other CFM-associated features (18%). Nearly 20% of cases had extracranial anomalies. Composite CBCL scores were in the average range compared to test norms and similar for cases and controls. On the subscales, cases' parents reported higher Anxious/Depressed scores (ES = 0.35, P = .04), Stress Problems (ES = 0.40, P = .04), Anxiety Problems (ES = 0.34, P = .04), and Autism Spectrum Problems (ES = 0.41, P = .02); however, the autism subscale primarily reflected speech concerns. Among cases, more problems were reported for children with extracranial anomalies and certain phenotypic categories with small ES. CONCLUSIONS Behavioral adjustment of preschoolers with CFM was comparable to peers. However, parental reports reflected greater concern for internalizing behaviors; thus, anxiety screening and interventions may benefit children with CFM. Among cases, more problems were reported for those with more complex presentations of CFM. Craniofacial microsomia-related speech problems should be distinguished from associated psychosocial symptoms during developmental evaluations.
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Affiliation(s)
- Alexis L Johns
- Division of Plastic and Maxillofacial Surgery, 5150Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Erin R Wallace
- Center for Child Health, Behavior, and Development, 145793Seattle Children's Research Institute, Seattle, WA, USA
| | - Brent R Collett
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Kathleen A Kapp-Simon
- Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA.,24183Shriners Hospitals for Children, Chicago, IL, USA
| | - Amelia F Drake
- Otolaryngology, 2331University of North Carolina, Chapel Hill, NC, USA
| | - Carrie L Heike
- Craniofacial Center, 7274Seattle Children's Hospital, Seattle, WA, USA
| | - Sara L Kinter
- Pediatrics, University of Washington, Seattle, WA, USA
| | | | - Leanne Magee
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Susan Norton
- Department of Otolaryngology, University of Washington, Seattle, WA, USA
| | - Kathleen Sie
- Department of Otolaryngology, University of Washington, Seattle, WA, USA
| | - Matthew L Speltz
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
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Johns AL, Luquetti DV, Brajcich MR, Heike CL, Stock NM. In Their Own Words: Caregiver and Patient Perspectives on Stressors, Resources, and Recommendations in Craniofacial Microsomia Care. J Craniofac Surg 2018; 29:2198-2205. [PMID: 30334912 PMCID: PMC6224304 DOI: 10.1097/scs.0000000000004867] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This study describes stressors, resources, and recommendations related to craniofacial microsomia (CFM) care from the perspective of caregivers of children with CFM and adults with CFM to inform improved quality of healthcare delivery. A mixed method design was used with fixed-response and open-ended questions from an online survey in English. The survey included demographics, CFM phenotypic information, and items about CFM-related experiences across settings. Themes were identified by qualitative analysis of responses to open-ended questions. Respondents (n = 51) included caregivers (n = 42; 90% mothers) and adults with CFM (n = 9; 78% female), who had a mean age of 45 ± 6 years. Most children were male (71%) with an average age of 7 ± 4 years. Respondents were primarily white (80%), non-Hispanic (89%), from the United States (82%), had a college degree (80%), and had private health insurance (80%). Reflecting the high rate of microtia (84%) in the sample, themes centered on the impact of hearing difficulties across settings with related language concerns. Negative social experiences were frequently described and school needs outlined. Multiple medical stressors were identified and corresponding suggestions included: providers need to be better informed about CFM, treatment coordination among specialists, and preference for a family-centered approach with reassurance, empathy, and clear communication. Advice offered to others with CFM included positive coping strategies. Overall, caregivers' and patients' responses reflected the complexity of CFM treatment. Incorporating these perspectives into routine CFM care has the potential to reduce family distress while improving their healthcare.
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Affiliation(s)
- Alexis L. Johns
- Division of Plastic and Maxillofacial Surgery; Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - Daniela V. Luquetti
- Seattle Children’s Hospital, Craniofacial Center; Seattle Children’s Research Institute; University of Washington, Department of Pediatrics, Seattle, WA, USA
| | | | - Carrie L. Heike
- Seattle Children’s Hospital, Craniofacial Center; Seattle Children’s Research Institute; University of Washington, Department of Pediatrics, Seattle, WA, USA
| | - Nicola M. Stock
- Centre for Appearance Research, University of the West of England, Bristol, UK
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