Experience of Uncertainty in Patients with Thalassemia Major: A Qualitative Study

Health-Related Quality-of-Life Impacts Associated with Transfusion-Dependent β-Thalassemia in the USA and UK: A Qualitative Assessment

BACKGROUND

Individuals living with transfusion-dependent β-thalassemia (TDT) experience reduced health-related quality of life due to fatigue and chronic pain, which cause disruptions to daily life. Currently, limited qualitative data exist that describe these impacts.

OBJECTIVE

This study aimed to examine the ways in which symptoms and current treatments of TDT impact health-related quality of life, to holistically describe the humanistic burden of TDT, and to identify the unmet needs of individuals living with TDT.

METHODS

Adults (aged ≥ 18 years) with TDT and caregivers of adolescents (aged 12‒17 years) with TDT participated in semi-structured one-on-one virtual interviews and focus group discussions. Interviews were conducted in the USA and UK and lasted approximately 60 minutes. After transcription, the interviews were analyzed thematically using a framework approach.

RESULTS

A total of ten interviews/focus group discussions (six interviews and four focus group discussions) were conducted with 14 adults with TDT and two caregivers of adolescents with TDT. A framework analysis revealed five themes describing health-related quality of life (negative impacts on daily activities, social life, family life, work and education, and psychological well-being) and three themes describing the lived experience of TDT (impact of red blood cell transfusions and iron chelation therapy, treatment, and stigma). Physical, psychological, and treatment-related factors contributed to negative impacts on daily activities, social and family life, and work and education. Concerns about reduced lifespan, relationships and family planning, and financial independence were detrimental to participants' mental well-being. Participants reported having high resilience to the many physical and psychological challenges of living with TDT. A lack of TDT-specific knowledge among healthcare professionals, particularly regarding chronic pain associated with the disease, left some participants feeling ignored or undermined. Additionally, many participants experienced stigma and were reluctant to disclose their disease to others.

CONCLUSIONS

Individuals living with TDT experience substantial negative impacts on health-related quality of life that disrupt their daily lives, disruptions that are intensified by inadequate healthcare interactions, demanding treatment schedules, and stigma. Our study highlights the unmet needs of individuals living with TDT, especially for alternative treatments that reduce or eliminate the need for red blood cell transfusions and iron chelation therapy.

The mediating role of anxiety in disease uncertainty and acute stress in acute ischaemic stroke patients in the post-epidemic era

Objective

To analyse the influencing factors of anxiety, disease uncertainty and acute stress response in patients with acute ischaemic stroke, and to verify the mediating role of anxiety in the post-epidemic era.

Methods

240 patients with acute ischaemic stroke were selected from a tertiary hospital in Wuhan City and investigated by questionnaire and convenience sampling methods.

Results

The total anxiety score, disease uncertainty and acute stress reaction were at moderate levels. Anxiety was positively correlated with illness uncertainty, and anxiety and acute stress response were negatively correlated. Multiple linear regression analysis showed that Sickness uncertainty, acute stress response, age, and work status influenced anxiety. Anxiety mediated the prediction of Sickness uncertainty and acute stress response, with the mediating effect accounting for 35.6% of the total effect.

Conclusion

Disease uncertainty in patients with acute ischaemic stroke in the post-epidemic era directly affects the acute stress response and indirectly through anxiety.

Uncertainty and its related coping strategies in systemic lupus erythematosus. Life in the fog

BACKGROUND

One of the most prevalent problems of patients with systemic lupus erythematosus (SLE) is the uncertainty over an indefinite future. Uncertainty has significant effects on quality of life. The aim of this study was to explore uncertainty and personal strategies to cope with it among patients with SLE.

MATERIALS AND METHODS

This qualitative study was conducted in 2020-2021 using conventional content analysis. Participants were 21 patients with SLE who were purposefully selected from rheumatology clinics in Kashan, Kerman, and Bandar Abbass in Iran. Data collection was performed using face-to-face, in-depth, semi-structured interviews and was continued up to data saturation. Data were analyzed concurrently with data collection through conventional content analysis approach proposed by Graneheim and Lundman.

RESULTS

Two main themes, namely, "life in the fog" and "attempt to find peace" emerged from patients' experiences of illness uncertainty of SLE. Life in the fog included three main categories of "perception of threat to health", "challenge of doubt and certainty," and "indefinite future." Attempt to find peace included three main categories of "spirituality," "reflection," and "attempt to acquire SLE-related knowledge.

CONCLUSIONS

Uncertainty is a major psychological stress for patients with SLE. Healthcare providers should therefore consider the challenges and concerns faced by patients and, through utilizing appropriate training and communicational practices, plan interventions and strategies to empower patients for coping with uncertainty.

Aftermath of the COVID-19 Pandemic on Mental Health and Well-Being of Patients With Thalassemia Major in Pakistan: A Qualitative Study

Background and aim Chronic patients with thalassemia major were mainly recognized as more prone to poor mental health during this global pandemic. This study aims to evaluate causal relationships leading to poor outcomes and how they manage to tackle this. Methods In-depth face-to-face semi-structured interviews were conducted with 21 thalassemia patients selected through probability consecutive sampling from Pakistan Thalassemia Welfare Society Centers. The following criteria served as the basis for the interview: (1) solitude at home, (2) interruption of transfusion services, (3) alteration of appetite and interests, (4) lack of control and uncertainty, (5) extensive media coverage, (6) deterioration of pre-existing health issues, difficulty in sleeping, (7) practicing gratitude, (8) participation in activities and hobbies, (9) connectivity with others, and (10) ability to recognize social support. All interviews were recorded, transcribed, and analyzed with reflexive thematic analysis. Results The commonly described mental health conditions were depression and concern about the overall health status. The following seven elements associated with the pandemic contributed to the deterioration of mental health: (1) isolation at home, (2) disruption in transfusion services, (3) change in appetite and interests, (4) lack of control and uncertainty, (5) intensive media reporting, (6) worsening of pre-existing health problems, and (7) difficulty in sleeping. The following four coping strategies were identified for maintaining mental issues: (1) practicing gratitude, (2) involvement in activities and hobbies, (3) connectivity with others, and (4) discerning social support. Conclusions Thalassemia major patients had been negatively affected during the pandemic. Only a small number of people modified their management techniques to maintain steady well-being.

Predictors of health state utility values using SF-6D for Chinese adult patients with β-thalassemia major

Background

Patients with β-thalassemia major (β-TM), predominantly adult patients, are associated with physical, mental, and social problems, that result in decreased quality of life (QoL). However, there is a paucity of data on QoL and health status utility (HSU) among adult patients with β-TM in mainland China. Our study aimed to evaluate the QoL by short form 36 questionnaire (SF-36) of adult patients with β-TM in mainland China and to estimate their HSU by SF-6D. In addition, we aimed to identify predictors of HSU.

Methods

In this cross-sectional descriptive study, a total of 75 adult patients with β-TM were included by the snowball sampling method that applied involving seven provinces with a relatively high prevalence of thalassemia across mainland China between September 1, 2021 and January 31, 2022. The collected information included social-demographic characteristics, health conditions, treatment, social support (social support rating scale), caregiver burden (Zarit burden interview), and QoL (SF-36). HSU scores were calculated for each adult patient from their SF-36 responses using the SF-6D algorithm with Hong Kong's tariff. The frequency of participants' responses to the SF-6D for each item of the options was described. Mean HSU scores between different subgroups were calculated. Ordinary least squares (OLS) regression modeling was performed to identify factors associated with HSU.

Results

A total of 75 adult patients with β-TM were included in this study. The mean SF-36 score was 50.2 ± 10.70, of which physical and mental scores were 47.57 ± 11.28 and 52.85 ± 14.21, respectively. In addition, the mean SF-6D utility score was estimated to be 0.598 ± 0.112, ranging from 0.391 to 0.962. Univariate analyses showed that interruption of iron chelation treatment significantly affected HSU values (P = 0.038); diagnosis with comorbidity very slightly affected HSU values (P = 0.0996). In the multivariate analysis, diagnosis with comorbidity (P = 0.042) was significantly negatively associated with HSU values; the minimum pre-transfusion hemoglobin concentration (P = 0.047) and social support (P = 0.068) were positively associated with HSU values.

Conclusion

This study presents poor QoL and HSU outcomes in Chinese adult patients with β-TM. The study also highlights the importance of social support and treatment compliance, which can increase hemoglobin content and reduce comorbidities, further to ensure the QoL of patients. These findings can be used for future clinical and economic studies.

Coping Strategy of Family in Treating Children with Thalassemia Mayor aged 6–12 Years in the Urban Area of Indonesia

BACKGROUND: Thalassemia is a genetic blood disorder and has not been cured. Thalassemia children need special attention from the family as one of the efforts in treating children with thalassemia depends on coping strategies owned by the family. AIM: This research aimed to discover and deeply explore coping family strategies in caring for children with thalassemia major aged 6–12 years. METHODS: This study used quantitative and qualitative approaches (mixed methods). For quantitative study we used total sampling technique(66 samples). furthermore, for qualitative study, we used six participants with in depth-interview technique. The instrument was used the revised ways of coping scale questionnaire and interview guidelines. RESULTS: The study showed that 62. 2% of respondents had a positive coping strategy, and (37.8%) had a negative coping mechanism. Furthermore, the qualitative analysis showed that age, education, employment status, and the number of childreninfluenced individual coping strategies. The interview results show three themes, namely the process of grieving, fear of stigma, and an increase in spiritual activity. It is recommended for families to follow health education on caring for children with thalassemia.

Impact of Primary Immunodeficiency Diseases on the Life Experiences of Patients in Malaysia From the Caregivers' Perspective: A Qualitative Study

Introduction

Primary immunodeficiency diseases (PIDs) are chronic diseases that affect the various aspects of a patient's life. However, the impact of living with PIDs is poorly described.

Objective

This study aimed to explore the living experience challenges among the Malaysian caregivers of the patients with PID who underwent a follow-up in the Universiti Sains Malaysia or those registered members of the Malaysian PIDs Society.

Methodology

The study was conducted from March 1 to May 30, 2021. The parents of children with PIDs were invited to participate for a semi-structured in-depth interview at the PID clinics in the USM. The estimated time of each interview was 30 min. The semi-structured interview was performed via a telephone call because of COVID-19 pandemic restrictions. The audio recording of each interview was transcribed and translated from Malay to English. Subsequently, a thematic analysis utilizing the ATLAS.ti software was performed.

Results

The thematic analysis revealed five main themes, which are living with fear and anxiety with four sub-themes (sickness, psychological issues, fear of infections and hereditary issues), PID healthcare support struggles with four sub-themes (PID health system, treatment, diagnosis and financial issues), knowledge with two sub-themes (educational issues and disease understanding), social constraint with two sub-themes (relationships and social isolations) and coping with three sub-themes (acceptance, child health improvement and emotional hygiene).

Conclusion

Living with fear and anxiety is a major theme impacting the living experiences of Malaysian patients with PIDs. Improvements in healthcare delivery and disease education are needed to ensure optimal quality of life.