Caregiving burden of children with chronic diseases

Clinical and socio-demographic profile of children receiving pediatric palliative care in a tertiary hospital of a metropolitan city in India

Pediatric palliative care is a holistic care of children suffering from life-threatening or life-limiting illnesses and encompasses care of a child's body, mind, and spirit and involves giving support to the family. According to the Global Atlas of Palliative Care, 6% of the global need for palliative care is in children. In order to provide palliative care, one needs to identify and diagnose the conditions requiring palliative care. There has always been a confusion in identifying pediatric conditions requiring palliative care. There is a lot of inconsistency in the diagnosis of such conditions particularly in pre-verbal patients. This study attempts to generate more data about the common palliative care conditions and complaints with which the children present to tertiary care hospitals. To study the socio-demographic details, clinical profile, CCC (complex chronic conditions) designation, and the ACT/ RCPCH (Association for Children with Life-threatening or Terminal Conditions and the Royal College of Pediatrics and Child Health) classification of children suffering from chronic conditions requiring palliative care. The study was conducted as a single-center retrospective observational study of pediatric patients enrolled for palliative care at a tertiary care hospital in a metropolitan city in India from 01.06.2021 to 31.06.2022. The total sample size was 400. The socio-demographic data and the clinical profile were recorded from the case records of all the 400 patients. Classification of the conditions was done as per the CCC as well as the ACT/ RCPCH classification system. The mean age in our study was 5.15 years and there was a slighter male (59.5%) preponderance. They presented in OPDs with acute symptoms such as fatigue and fever, and they had other symptoms like tightness of the body, constipation, seizures, and difficulty in swallowing. Majority of the children (55%) were suffering from neurologic and neuromuscular conditions as per CCC followed by hematologic and immunologic conditions (10%). Category 4 (irreversible but non-progressive conditions causing severe disability, leading to susceptibility to health) was reported as the most common category according to the ACT/RCPCH.    Conclusion: Children suffering from chronic disease conditions requiring palliative care usually suffer from multiple symptoms which affect their daily life. As most of the patients belong to category 4 according to ACT/RCPCH which is an irreversible but non-progressive life-limiting condition, the course of the disease is prolonged, therefore requiring comprehensive care and services for a long time. It is necessary to establish more pediatric palliative care units to address the needs of such children. What is known: • Pediatric palliative care is a specialized area within palliative care, which focusses on the needs of children with life-limiting illnesses. • Data on pediatric palliative care has largely been limited to oncological conditions. There is a paucity of literature documenting the needs among children suffering from non-cancerous chronic conditions. What is new: • This study provides vital information with respect to palliative care burden among children mainly suffering from non-oncological conditions. • It also provides clinical and socio-demographic profile of the children suffering from chronic life-limiting conditions requiring palliative care in a tertiary hospital setting in a LMIC (low- or middle-income country).

"I won't ever feel normal": experience reported through photovoice by children with chronic kidney disease

BACKGROUND

Much of the global chronic kidney disease burden is experienced in low- and middle-income countries. Children living with chronic kidney disease (CKD) face medical and social challenges, and they need support at the individual and family levels. This study aimed to explore children's experiences living with kidney replacement therapy (KRT) who attend the largest pediatric nephrology department in Guatemala.

METHODS

This qualitative study used photovoice and asked children to take pictures that represented what is like to live with CKD. Each child and their caregiver underwent an interview where the photos were used to elicit and facilitate discussion. The interviews were recorded, transcribed, and then analyzed using thematic analysis.

RESULTS

Eight children and their mothers participated in the study. Three themes were identified: interactions with the health system, changing and difficult family dynamics, and strains on social interactions. Children face social challenges including self-isolation and alienation. The family dynamics and familial structures often are forced to change, inducing stress. This is all exacerbated by the difficulties that arise in navigating the Guatemalan health system.

CONCLUSIONS

Photovoice techniques are a feasible way to understand the experiences of children and their families who face CKD. The disease affects all aspects of life and recognizing this while advising and administering care can help provide a comprehensive level of care. Health systems need to make efforts aimed at improving the quality of care as well as the multidisciplinary support available to children and their families.

Rural Caregiver Perceptions on the Content and Receipt of a Diabetes Management Telehealth Occupation-Based Coaching Intervention

BACKGROUND

Type 1 diabetes management for young children requires caregiver involvement to prevent serious health complications. Objectives: Explore the lived experience of rural caregivers' health management routines and perceptions of an occupation-based coaching (OBC) intervention.

METHODOLOGY

Following a 12-week, OBC telehealth intervention designed to promote diabetes management and caregiver psychosocial well-being, researchers interviewed eight rural caregivers to explore their perceived quality of life utilizing a phenomenological approach.

FINDINGS

Three themes emerged related to caregivers' OBC intervention needs: occupational deprivation and decreased well-being; longing for connection with social supports; and desire for knowledgeable, relatable, and accessible providers. Two themes emerged related to their experiences postintervention: satisfaction with diabetes management and psychosocial support and renewed hope for childhood normalcy.

CONCLUSION

Despite drastic shift in family routines after a child's T1D diagnosis, caregivers reported acceptability of OBC for improving health management routines in a rural community following OBC intervention.

Care burden, perceived social support, coping attitudes and life satisfaction of mothers with children with cerebral palsy

AIM

This study's aim is to determine the relationship between care burden, perceived social support, coping attitudes and life satisfaction of mothers with children with cerebral palsy (CP).

METHODS

This descriptive study was conducted in Turkey between March and June 2022 to determine the relationship between caregiving burden, perceived social support, coping attitudes and life satisfaction of 122 mothers with CP children. Path analysis was used to evaluate the data.

RESULTS

Correlation analysis showed a positive relationship between mothers' social support perceptions and life satisfaction and coping attitudes, a positive relationship between their life satisfaction and coping attitudes (p < .001). The path analysis showed that the social support perceived by the mothers significantly affected their coping attitudes (β = .257; p < .001) and life satisfaction (β = .081; p < .001). Mothers' care burden (β = .169; p < .001) and coping attitudes (β = .071; p < .05) also had a significant effect on their life satisfaction.

CONCLUSIONS

It is an important finding of this study that mothers' perceptions of social support and coping attitudes have a positive effect on their life satisfaction. Long-term care can cause physical and psychological problems for mothers. Mothers' strong coping strategies and high levels of social support may reduce the occurrence of these problems. Drawing attention to this issue in mothers and revealing the effects of these variables is important in terms of indirectly supporting child outcomes.

Investigating the caregiving burden and stress of mothers with children with special needs

BACGROUND

This research was conducted to examine the caregiving burden and stress situations of mothers with children with special needs.

METHODS

The research, which is descriptive and correlation-seeking, was conducted between September 2022 and September 2023 in special education and rehabilitation centers in a city in eastern Turkey. The population of the research consists of the mothers of 2072 children who received education in the specified Special Education and Rehabilitation Centers between the specified dates. The sample size was determined to be 324 individuals based on the known sampling method. "The Personal Information Form, the Zarit Caregiving Burden Scale, and the Perceived Stress Scale were used to collect the data for this study. The data was analyzed using the SPSS package software. For the interpretation of the data, percentages, means, standard deviations, one-way variance analysis, independent groups t-test, Pearson correlation, and simple linear regression were used.

FINDINGS

Among the mothers, 44% were aged 30-39, 87.0% had a child with a disability, and 51.9% had a child with an intellectual disability. The mean total scores of the mothers were 26.71 ± 8.80 for the Zarit Caregiving Burden Scale and 27.00 ± 11.35 for the Perceived Stress Scale. There is a difference between the mothers' age, education level, income level and the type of disability of their child and the Zarit Caregiving Burden scale score average; It was determined that there was a significant difference between the place of residence and the number of disabled children they had and the average score of the Perceived Stress Scale. A positive correlation was found between Zarit Caregiving Burden Scale scores and Perceived Stress Scale scores of the mothers (p < 0.05).

APPLICATION TO PRACTICE

The study revealed that mothers with children with special needs experienced higher levels of stress as their care burden increased. Providing economic assistance and informing and training mothers about the care of children with special needs were recommended to reduce the care burden of mothers with children with special needs.

Care for the caregiver: an exploration of caregiver burden of children with chronic medical conditions at a tertiary care hospital in Karachi, Pakistan - a mixed-methods study

OBJECTIVES

Caregiver burden often goes unrecognised and can substantially affect caregivers' physical, psychological and financial well-being, thereby impacting quality of care. This study investigates burden among caregivers of children with chronic medical conditions in a tertiary care hospital in Pakistan. The study aims to assess the extent of burden, explore influencing factors and recommendations for interventions.

DESIGN

Mixed-methods study, comprising of an in-person paper-based survey, employing the Zarit Burden Interview scale to assess burden scores. Qualitative component included thematic analysis of semi-structured in-depth interviews with caregivers.

PARTICIPANTS

383 caregivers of children admitted to the inpatient paediatric services at our tertiary care centre were surveyed. In-depth interviews were conducted with 19 caregivers.

RESULTS

The survey revealed a mean burden score of 35.35±15.14, with nearly half of the participants (46%, n=177) experiencing mild burden, while 37% (n=140) reporting moderate-to-severe burden. The most common diagnosis was cancer (24%, n=92), while the highest burden (42.97±15.47) was noted for congenital cardiac disease. Greater burden was significantly associated with lower caregiver education, young age of the child at diagnosis and increased number of hospital visits (p<0.05). Caregivers highlighted financial strain, psychosocial effects and impact on lifestyle and relationships as key challenges. They emphasised the need for improved medical coordination, financial support and enhanced hospital services.

CONCLUSIONS

The study elucidates the multifaceted nature of caregiver burden in the context of paediatric chronic illnesses in Pakistan. Interventions should emphasise financial aid, educational support and development of system-level changes to improve access to resources and medical care coordination. These insights call for policy and practice integration to support caregivers effectively.

Effectiveness of family centred interventions for family caregivers: A systematic review and meta-analysis of randomized controlled trials

AIMS AND OBJECTIVES

To examine the effectiveness of family-centred interventions among family caregivers.

BACKGROUND

Family-centred interventions are an emerging form of intervention that can be effective at improving physical and mental health outcomes for patients and family caregivers. To date, no reviews have examined the effectiveness of family-centred interventions for family caregivers.

DESIGN

A systematic review, including a meta-analysis, was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA 2020) checklist.

METHODS

Seven English and two Chinese electronic databases were compressively searched from the outset to March 2023. Two researchers independently reviewed the abstracts and full texts, extracted the data and assessed the risk of bias independently by using the Cochrane 'Risk of bias assessment tool'.

RESULTS

This systematic review and meta-analysis included 20 articles. The results of the meta-analysis showed that family-centred interventions could significantly improve caregiver burden (p=0.003), quality of life (p = 0.007), depression (p = 0.0002), and stress (p < 0.0001) but not anxiety or family functioning. According to our subgroup analysis, the family-centred empowerment model (p = 0.009) was superior to the other family intervention (p=0.004) in reducing caregiver burden. Family-centred interventions are more effective at reducing the burden of caregiving on family caregivers of adolescent patients (SMD=-0.79, 95% CI[-1.22,-0.36], p = 0.0003) than on adult patients (SMD=-0.37, 95% CI [-0.61,-0.12], p = 0.004).

CONCLUSIONS

Family-centred interventions could enhance family caregivers' burden, quality of life, stress and depression but had no significant impact on anxiety or family functioning.

RELEVANCE TO CLINICAL PRACTICE

Family-centred interventions have the potential to improve the health status and caregiving burden of family caregivers. Rigorous and high-quality evidence is needed to confirm the long-term effects of these interventions on family caregivers.

TRIAL REGISTRATION DETAILS

The protocol has been registered in the PROSPERO international prospective register of systematic reviews (Protocol registration ID: CRD42023453607).

Growth hormone treatment in children with short stature: impact of the diagnosis on parents

OBJECTIVES

This prospective multicenter study aimed (1) to examine changes in parent-reported health-related quality of life (HRQOL) of children with short stature and the effects of the children's condition on parents themselves within the first year of human growth hormone (hGH) treatment and (2) to predict effects on parents based on main and interaction effects of children's HRQOL and increase in height.

METHODS

A total of 110 parents of children aged 4-18 years, diagnosed with idiopathic growth hormone deficiency, small for gestational age, or idiopathic short stature, were recruited from 11 participating German pediatric endocrinologists and asked to fill out the short stature-specific Quality of Life in Short Stature Youth (QoLISSY) Questionnaire before hGH treatment was initiated and one year later.

RESULTS

Negative effects of the children's short stature on the parents decrease over time, independent of diagnosis and treatment status. Furthermore, treatment status and height increase moderated the links between children's improved HRQOL as perceived by their parents and decreased caregiving burden.

CONCLUSIONS

Based on the children's improved HRQOL and the parent's decrease in caregiving burden, patient-reported outcomes that consider parental and child's perspectives should be considered when deciding on hGH treatment for children.

The effect of having a child with hearing impairment on parents

OBJECTIVE

In this study, it was aimed to compare parents of children with hearing impairment (with cochlear implant (CI) or hearing aid) and parents of children with normal hearing (NH) in terms of care burden, self-efficacy and psychological resilience levels.

METHODS

The study participants were parents of children aged 3-12 years. Zarit Care Burden Scale (ZCBS), Parental Self-Efficacy Scale (PSES) and Brief Psychological Resilience Scale (BPRS) were administered to the parents.

RESULTS

The mean BPRS score was statistically significantly higher for the NH group than for the hearing impairment groups. It was found that the mean ZCBS score was statistically significantly higher for CI group than for the other groups (p < 0.05). A statistically significant and positive correlation was found between the PSES and BPRS scores of the CI group.

CONCLUSION

It is thought that the results of this study will contribute to the creation of case-specific intervention/rehabilitation programs.

Methods used to account for caregivers' sex and gender within studies examining the financial burden of caregivers of children and adolescents : Results from a scoping review

Background

Interest in the financial burden of informal caregivers has been growing. Unfortunately, it remains unclear which method(s) should be used when quantifying this burden.

Purpose

We conducted a scoping review aimed at identifying which methods have been used to conduct such work and quantified their performance. We were also interested in examining how sex and gender considerations were considered within selected studies.

Data Sources

Using a standardized approach, we identified studies published between 2012 and 2022 that aimed to document the financial burden of caregivers to child and adolescent patients. Our search strategy was applied to the MEDLINE, Embase, CINHAL, and Academic Search Premier databases.

Study Selection

Manuscript selection was performed by pairs of reviewers.

Data Extraction

Data extraction was performed by one reviewer with a second reviewer performing quality control. Results were reported using a narrative approach.

Data Synthesis

We identified 9801 unique citations, of which 200 were included in our review. Selected studies covered various disease area (eg, infection/parasitic diseases [n = 31, 16%]) and included quantitative (n = 180, 90%), qualitative (n = 4, 2%) and mixed study designs (n = 16, 8%). Most studies (n = 182, 91%) used questionnaires/surveys, either alone or in combination with other methods, to assess caregivers' financial burden. Less than half (n = 93, 47%) of studies reported on caregivers' sex and none reported on their gender.

Conclusion

We conducted an unrestricted review of published studies examining caregiver's financial burden which allowed us to identify general methodological trends observed in this literature. We believe this work may help improve future studies focusing on this important issue.

Problem behaviours and caregiver burden among children with Autism Spectrum Disorder in Kuching, Sarawak

Objective

Caregivers of children with Autism Spectrum Disorder (ASD) often experience emotional and psychological distress, as well as disruptions to family life and employment due to the challenges of caring for children with ASD. This study examines the relationship between problem behaviours and caregiver burden among children with ASD.

Method

A cross-sectional study using convenience sampling recruited 230 caregivers of children with ASD aged 4 to 18 years from selected autism centres in Kuching, Sarawak. The caregivers completed the Aberrant Behaviour Checklist-2 and the Zarit Burden Interview.

Results

Univariate analysis revealed a significant difference in caregiver burden for children with ASD receiving medications (p = 0.013), registered with the Social Welfare Department (p = 0.036), and having siblings with ASD (p = 0.046). About 40% of the children exhibited at least one domain of problem behaviour. More than half of the caregivers (53.9%) experienced burden, with the majority experiencing mild burden. Positive associations were seen between irritability (r = 0.458, p < 0.01), social withdrawal (r = 0.439, p < 0.01), stereotypic behaviour (r = 0.392, p < 0.01), hyperactivity/non-compliance (r = 0.467, p < 0.01), and caregiver burden. Child factors, including the duration of problem behaviour (r = 0.182, p = 0.007), medication use (eta = 0.187, p = 0.005), Social Welfare Department registration (eta = 0.138, p = 0.036), and the presence of siblings with ASD (eta = 0.130, p = 0.046) were associated with caregiver burden. Multiple linear regression showed that hyperactivity/noncompliance significantly predicted caregiver burden.

Conclusion

Specific problem behaviours in children with ASD were associated with caregiver burden. These results highlight the need for interventions for the child with ASD and their caregivers.

Factors associated with quality of life for cystic fibrosis family caregivers

Cystic Fibrosis (CF) is a genetic and chronic disease affecting 32,100 people in the United States as of 2021, with a life expectancy of 56 years for people with CF (PwCF) born between 2018 and 2022. While there is extensive literature about cystic fibrosis, there are few studies examining the complexity and challenges experienced by family caregivers for PwCF. The aim of this study was to examine the Caregiver Quality of Life Cystic Fibrosis (CQOLCF) scale using data (N = 217) from two separate studies that used the scale to determine if its items represent multiple factors relevant to CF family caregiver QoL. Factor analysis was conducted on the Seven distinct factors were found with analysis of the CQOLCF. Factors were Existential Dread (12%), Burden (11%), Strain (7%), Support (7%), Positivity (6%), Finance (5%) and Guilt (3%). Study findings indicated it is important for healthcare providers and researchers who use the CQOLCF to be knowledgeable and aware of the multiple factors associated with quality of life in this population in addition to an overall quality of life score.

Burden of care and a sense of loneliness in caregivers of children with type 1 diabetes. a cross-sectional study

BACKGROUND

Treatment of type 1 diabetes is a process involving not only sick children, but also their caregivers.

AIM

To assess the burden of care and sense of loneliness in caregivers of children with type 1 diabetes. Also, an analysis was conducted of the connection between sociodemographic factors characterizing caregivers and the clinical factors characterizing sick children and between the burden of care and the sense of loneliness.

MATERIALS AND METHODS

The study included 125 caregivers of children with type 1 diabetes. In order to collect the research data, the Caregiver Burden Scale and the Revised UCLA Loneliness Scale were used.

RESULTS

In the research group, the total result in the caregiving burden scale was 2.14, which remains within the average burden level. Caregivers showed the highest burden level in the General Strain Subscale. The analysis showed that mothers experience a greater burden of care than fathers in the General Strain Subscale and that caregivers of younger children are more burdened with care within the Isolation and Disappointment Subscales. Moderate high degree of loneliness was shown in 4.8% of caregivers. A higher burden of care for caregivers of children with type 1 diabetes is accompanied by a higher sense of loneliness.

CONCLUSIONS

The results of this study may help healthcare professionals plan a holistic, family-centered care program that will take into account factors that increase the burden of care: younger age of the affected child, motherhood, caregiver unemployment, feelings of loneliness, lower education, caregiver unemployment, blood glucose meter measurements, and frequent night-time blood glucose measurements.

Leigh syndrome global patient registry: uniting patients and researchers worldwide

BACKGROUND

Leigh Syndrome (LS) is a rare genetic neurometabolic disorder, that leads to the degeneration of the central nervous system and subsequently, early death. LS can be caused by over 80 mutations in mitochondrial or nuclear DNA. Patient registries are important for many reasons, such as studying the natural history of the disease, improving the quality of care, and understanding the healthcare burden. For rare diseases, patient registries are significantly important as patient numbers are small, and funding is limited. Cure Mito Foundation started a global patient registry for LS in September 2021 to identify and learn about the LS patient population, facilitate clinical trial recruitment, and unite international patients and researchers. Priorities were to allow researchers and industry partners to access data at no cost through a clear and transparent process, active patient engagement, and sharing of results back to the community.

RESULTS

Patient registry platform, survey design, data analysis process, and patient recruitment strategies are described. Reported results include demographics, diagnostic information, symptom history, loss of milestones, disease management, healthcare utilization, quality of life, and caregiver burden for 116 participants. Results show a high disease burden, but a relatively short time to diagnosis. Despite the challenges faced by families impacted by Leigh syndrome, participants, in general, are described as having a good quality of life and caregivers are overall resilient, while also reporting a significant amount of stress.

CONCLUSION

This registry provides a straightforward, no-cost mechanism for data sharing and contacting patients for clinical trials or research participation, which is important given the recruitment challenges for clinical trials for rare diseases. This is the first publication to present results from a global patient registry for Leigh Syndrome, with details on a variety of patient-specific and caregiver outcomes reported for the first time. Additionally, this registry is the first for any mitochondrial disease with nearly 70% of participants residing outside of the United States. Future efforts include continued publication of results and further collaboration with patients, industry partners, and researchers.

Use of Text Messaging to Help Family Caregivers: An Integrative Review

Text messaging is a promising family-centered intervention to promote health and prevent illness among children. Little is known about the effectiveness of texting parents of children with chronic conditions on health outcomes. The aims of this integrative review were to determine what ways texting has been used as an intervention to help family caregivers and examine the outcomes from the use of texting to help family caregivers. Applying Whittemore and Knafl's method of integrative review, 16 studies were reviewed. The majority of studies suggested that text message-based health interventions were feasible and acceptable for parents of children with chronic conditions. Of the studies that examined effectiveness of the interventions, six studies noted effectiveness, four studies noted results signifying no differences, and two studies obtained insignificant results. Although the state of the science regarding health providers' use of text messaging to support parents of children with chronic illness is in its early stage, text messaging demonstrates potential to assist parents to better manage their child's chronic disease. More research is warranted in the future to determine the effectiveness as well as best practices in text messaging.

Caregiver burden among parents of children with chronic diseases: A cross-sectional study

AIMS AND OBJECTIVES

This study aimed to assess the perceived caregiver burden among parents of chronically ill children in Jordan.

BACKGROUND

Although there are few studies on the accurate prevalence of chronic diseases among Jordanian children, there are a few on the burden of caregiving, which is important because most children with chronic illness rely on their caregivers to perform their daily tasks. In Jordan, little is known about the caregiver burden associated with caring for children with chronic diseases.

DESIGN

A cross-sectional design was reported in line with the STROBE guidelines.

METHODS

The Katz Index of Independence was used to determine the children's level of dependence, and the Burden Scale for Family Caregivers was used to measure the caregivers' level of burden.

RESULTS

Nearly, 49.3% of caregivers had a very severe burden, 31.2% of children had a severe functional impairment, 19.6% had a moderate impairment, and 49.3% had full functionality. Based on their children's dependency, caregivers' subjective burden varied greatly (p < .001). Fully functional children had a far lower disease burden than severely and moderately disabled children (p < .001). The caregiver burden score differed significantly across chronic disease categories (p < .001). Unemployed caregivers had a far higher subjective burden than working caregivers (p = .009), and single (divorced/widowed) caregivers had higher burdens than married caregivers.

CONCLUSIONS

Various factors can increase caregiver burden. Therefore, healthcare providers must plan holistic and family-centred interventions to reduce the caregiving burden.

RELEVANCE TO CLINICAL PRACTICE

There is a need to establish support programs to help reduce the level of burden among caregivers of children with chronic diseases.

Health-Related Quality of Life, Stress, Caregiving Burden and Special Needs of Parents Caring for a Short-Statured Child-Review and Recommendations for Future Research

Children with short stature can experience a range of burdens due to their chronic condition. However, little is known about parents' experiences dealing with their child's short stature and the potential caregiving burdens and concerns they may face. We aim to review the literature on health-related quality of life (HRQOL), caregiving burden, and special needs among parents caring for a child with isolated growth hormone deficiency (IGHD) or idiopathic short stature (ISS). Using pre-defined inclusion and exclusion criteria, we systematically searched for literature using PubMed and Web of Science from its inception to December 2022. We identified 15 articles assessing HRQOL, special needs, or caregiving burdens in parents of IGHD/ISS children. The main problems included concerns about the future, organizational issues, side effects from growth hormone treatment, and social stigmatization. Furthermore, two studies assessed parents' special needs to cope with caregiving stress, mainly the dialogue between them and their families or parent support groups. This review outlines parental burdens, needs, and resources when caring for an IGHD/ISS child. Furthermore, it provides information about previously used measures appraising parents' special needs and underlines the need for disease-specific measurements.

Psychometric properties of the caregiving difficulty scale in mothers of children with cerebral palsy

BACKGROUND

The Caregiving Difficulty Scale is used to measure the burden of caregiving experienced by mothers of children with cerebral palsy. This study aimed to identify the psychometric properties of the Caregiving Difficulty Scale using the Rasch model.

METHODS

Data collected from 206 mothers of children with cerebral palsy were analyzed. Unidimensionality, difficulty of item, rating scale appropriateness, and reliability using the separation index of the Caregiving Difficulty Scale were verified. Unidimensionality of all 25 items was identified through the item fit.

RESULTS

Our analysis of item difficulty indicated that person ability and item difficulty are expressed as a similar logit extend. The use of the 5-point rating scale appeared to be appropriate. Outcome analysis revealed that the reliability was high based on the person and that the item separation level was acceptable.

CONCLUSIONS

This study showed that the Caregiving Difficulty Scale could be a valuable tool for evaluating the caregiving burden in mothers of children with cerebral palsy.

The correlation between caregiver burden with depression and quality of life among informal caregivers of hemodialysis and thalassemia patients during the COVID-19 pandemic: a cross-sectional study

BACKGROUND

Lifelong provision of care to chronically ill patients increase the risk of physical and mental diseases in informal caregivers and adversely affects their quality of life. The present study examined the correlation between caregiver burden, depression, and quality of life among the informal caregivers of thalassemia and hemodialysis patients during the COVID-19 pandemic in southeastern Iran.

METHODS

This cross-sectional correlational study used convenience sampling to select 200 informal caregivers involved in providing direct care for patients undergoing hemodialysis (n = 70) and patients with thalassemia (130) for at least 6 months. A demographic questionnaire, Beck's Depression Inventory (BDI), the Quality-Of-Life Questionnaire (SF-36), and the Zarit Burden Interview were used to collect data in 2021. The data were analyzed with SPSS software (version 19) using frequency, percentage, independent samples t-test, ANOVA, and multivariate regression analysis.

RESULTS

Most of the informal caregivers of the thalassemia and hemodialysis patients (58% and 43%) reported moderate levels of caregiver burden. There were significant correlations between the caregiver burden and depression (P < 0.0001) and between the caregiver burden and the quality of life (P < 0.009). The level of depression in informal caregivers of patients undergoing hemodialysis was higher than that of the informal caregivers of patients with thalassemia, but the quality of life in the informal caregivers of the patient's undergoing hemodialysis was higher than that of the informal caregivers of the patients with thalassemia.

CONCLUSION

Considering the significant correlations between caregiver burden, depression, and quality of life in this study, healthcare providers are recommended to develop educational and supportive interventions to meet informal caregivers' needs, mitigate their emotional distress, fears, and concerns, and prevent caregiver burden in times of greater uncertainty.

Caregiver Expressed Emotion and Pediatric Asthma: A Call for Culturally Specific Adaptations

Background: Expressed emotion is the affective attitudes and behaviors of an individual toward another. In this preliminary study, we described expressed emotion among caregivers of children with asthma living in low-income urban area and evaluated its association with child asthma control. Methods: Forty-one children (90.2% African American/Black) and their caregivers participated. Measures included the Childhood Asthma Control Test and the Five-Minute Speech Sample coded for overall expressed emotion, emotional over-involvement, and criticism. Results: Most caregivers were rated borderline (31.7%) or high (48.8%) for expressed emotion, borderline (31.7%) or high (39.0%) for emotional overinvolvement, and low for criticism (73.2%). The association between criticism and asthma control neared statistical significance [U(Nlow = 30, NB/high = 11) = 100, z = -1.922, P = 0.055]. Conclusion: Findings suggest an examination into expressed emotion coding procedures for caregivers in low-income urban areas, and culturally specific adaptations may be necessary. Future research should confirm findings in a larger sample and consider how parental criticism affects children's asthma management.

Caregiver burden of families of children with corrosive esophageal injuries

This cross-sectional and descriptive study aimed to determine care burden of families of children with corrosive esophageal injuries. The study involved 112 parents who had children with corrosive esophageal injury. Caregiver's Stress Scale and Reactions to Helping Family Members Scale were used to assess care burden of families. Caregiver's Stress Scale median score was 7.0 [interquartile range 5.0], and Reactions to Helping Family Members Scale median score was 45.0 [interquartile range 14.0]. The burden of family caregivers was thus found to be high. Factors affecting the care burden were found to be child's age, parents' age, child's weight, substance type and pH, surgery status, and number of surgeries. Nurses should consider these factors when advising and educating these families. Additionally, initiatives including support groups should be planned with regard to the needs of these families with a high care burden.

Health-Related Quality of Life and Family Functioning of Primary Caregivers of Children with Menkes Disease

BACKGROUND

Menkes disease (MD; OMIM #309400) is a progressive neurodegeneration that results from abnormalities in the copper metabolism which are already present before birth. It is an extremely rare condition. The study was conducted to assess the quality of life of children with MD syndrome and the impact of the disease on family functioning.

METHODS

A cross-sectional questionnaire survey was used. The subjects were 16 parents of children with MD. The method used was the Paediatric Quality of Life Inventory and the PedsQL Family Impact Module and the author's own questionnaire.

RESULTS

Quality of life (QOL) was 29.14 (SD = 14.73), with the lowest for physical functioning (M = 10.55; SD = 10.26) and highest for emotional functioning (M = 48.13; SD = 29.43). The highest score was on the family relationships domain (M = 56.25, SD = 20.38) and the cognitive functioning domain (M = 50.00, SD = 19.24) and the lowest was on the daily activities' domain (M = 32.29, SD = 20.38) and the physical functioning domain (M = 39.84, SD = 14.90). The analysis did not show statistically significant relationships between age (p = 0.193) and the number of epileptic seizures a week (p = 0.641) and the overall QOL of the children studied. No statistically significant relationships were found between treatment with copper histidine and the overall QOL of the children (p = 0.914) and in physical functioning (p = 0.927), emotional functioning (p = 0.706), and social functioning (p = 0.751). The presence of comorbidities did not have an influence on the overall QOL.

CONCLUSIONS

MD has a moderate impact on the functioning of the families of the affected children. The age of the child, number of epileptic seizures a week, feeding method (oral feeding or feeding via a PEG tube), and treatment with copper histidine do not have a significant impact on the QOL of children with MD.

Correlations between caregiver competence, burden and health-related quality of life among Chinese family caregivers of elderly adults with disabilities: a cross-sectional study using structural equations analysis

OBJECTIVE

To examine the relationship between caregiver competence and health-related quality of life (HRQoL) among family caregivers of disabled elderly adults, and to evaluate the role of caregiver burden as a potential mediator of that relationship.

DESIGN

Cross-sectional study.

SETTING

Two general hospitals in Shanghai, China.

PARTICIPANTS

Study participants were 135 family caregivers of disabled elderly adults listed on a roster for outpatient and emergency services utilisation from January to March 2022.

DATA ANALYSIS AND OUTCOME MEASURES

We used stratified linear regression and structural equation model analysis. HRQoL was the main outcome, measured using the Medical Outcomes Study 36-Item Short form Health Survey. Caregiver competence was assessed using the Family Caregiver Task Inventory, and caregiver burden was assessed with the Zarit Burden Interview.

RESULTS

Caregivers of moderately and severely disabled elderly adults showed poorer scores in Physical Component Summary (F=20.463, p<0.05) and Mental Component Summary (F=17.062, p<0.05) compared with caregivers of older adults with mild disabilities. At the same time, those caregivers showed higher scores on the caregiving burden (F=19.533, p<0.05) and caregiving difficulties (F=16.079, p<0.05). A structural equation model was performed and successfully adjusted (χ²/df=1.175, p=0.261, NFI=0.970, RFI=0.949, IFI=0.995, CFI=0.995, GFI=0.963, TLI=0.992, AGFI=0.920, RMSEA=0.036). The total effect of Family Caregiver Task Inventory scores on HRQoL scores was -0.980, with a direct effect of -0.645. The mediating effect on HRQoL scores through the intermediate variable of caregiver burden scores was -0.335.

CONCLUSIONS

Family caregivers' HRQoL is closely related to caregiver difficulties and burdens. Early identification and targeted measures are needed to reduce the burden and problems in caregiving.

Consistency of pediatric pain ratings between dyads: an updated meta-analysis and metaregression

Accurate assessment of pediatric pain remains a challenge, especially for children who are preverbal or unable to communicate because of their health condition or a language barrier. A 2008 meta-analysis of 12 studies found a moderate correlation between 3 dyads (child-caregiver, child-nurse, and caregiver-nurse). We updated this meta-analysis, adding papers published up to August 8, 2021, and that included intraclass correlation/weighted kappa statistics (ICC/WK) in addition to standard correlation. Forty studies (4,628 children) were included. Meta-analysis showed moderate pain rating consistency between child and caregiver (ICC/WK = 0.51 [0.39-0.63], correlation = 0.59 [0.52-0.65], combined = 0.55 [0.48-0.62]), and weaker consistency between child and health care provider (HCP) (ICC/WK = 0.38 [0.19-0.58], correlation = 0.49 [0.34-0.55], combined = 0.45; 95% confidence interval 0.34-0.55), and between caregiver and HCP (ICC/WK = 0.27 [-0.06 to 0.61], correlation = 0.49 [0.32 to 0.59], combined = 0.41; 95% confidence interval 0.22-0.59). There was significant heterogeneity across studies for all analyses. Metaregression revealed that recent years of publication, the pain assessment tool used by caregivers (eg, Numerical Rating Scale, Wong-Baker Faces Pain Rating Scale, and Visual Analogue Scale), and surgically related pain were each associated with greater consistency in pain ratings between child and caregiver. Pain caused by surgery was also associated with improved rating consistency between the child and HCP. This updated meta-analysis warrants pediatric pain assessment researchers to apply a comprehensive pain assessment scale Patient-Reported Outcomes Measurement Information System to acknowledge psychological and psychosocial influence on pain ratings.

Achondroplasia in Latin America: practical recommendations for the multidisciplinary care of pediatric patients

Background

Achondroplasia is the most common bone dysplasia associated with disproportionate short stature, and other comorbidities, such as foramen magnum stenosis, thoracolumbar kyphosis, lumbar hyperlordosis, genu varum and spinal compression. Additionally, patients affected with this condition have higher frequency of sleep disorders, ear infections, hearing loss and slowed development milestones. Considering these clinical features, we aimed to summarize the regional experts’ recommendations for the multidisciplinary management of patients with achondroplasia in Latin America, a vast geographic territory with multicultural characteristics and with socio-economical differences of developing countries.

Methods

Latin American experts (from Argentina, Brazil, Chile and Colombia) particiáted of an Advisory Board meeting (October 2019), and had a structured discussion how patients with achondroplasia are followed in their healthcare centers and punctuated gaps and opportunities for regional improvement in the management of achondroplasia.

Results

Practical recommendations have been established for genetic counselling, prenatal diagnosis and planning of delivery in patients with achondroplasia. An outline of strategies was added as follow-up guidelines to specialists according to patient developmental phases, amongst them neurologic, orthopedic, otorhinolaryngologic, nutritional and anthropometric aspects, and related to development milestones. Additionally, the role of physical therapy, physical activity, phonoaudiology and other care related to the quality of life of patients and their families were discussed. Preoperative recommendations to patients with achondroplasia were also included.

Conclusions

This study summarized the main expert recommendations for the health care professionals management of achondroplasia in Latin America, reinforcing that achondroplasia-associated comorbidities are not limited to orthopedic concerns.

Perceptions and Treatment of Precocious Puberty: A Questionnaire Survey among Caregivers in South Korea

This study aims to provide the basis for developing complementary and alternative treatment approaches for precocious puberty (PP) by examining caregivers' awareness, along with their preferences and expectations from various treatments. It included data collected between July 2019 and March 2020, from 175 caregivers of children who were undergoing or had undergone treatment for PP. The questionnaire comprised 53 questions on the awareness, acquisition of information, perceptions of treatments, and concerns about PP, as well as awareness of habit management (HM) and children's actual habits. The collected data were analysed using the Chi-square test, t-tests, and one-way analysis of variance. The caregivers responded that PP could be recognized on the basis of breast development (79.8%) in girls and hair and body odor (73.1%) in boys. However, 86.9% of respondents were getting inaccurate information from the Internet. With respect to PP treatment approaches, 16% of respondents hoped to manage PP through conventional treatment (CT), 21.1% preferred traditional Korean medicine (TKM), and 62.3% preferred HM. Expectations of the effectiveness were highest in HM, followed by CT and TKM. Only the TKM group had statistically significant higher expectations than the nontreatment experience group (F = 4.566, p=0.004). The caregivers were concerned about the side effects and high costs of CT. Around 43% of respondents had difficulties with the management of their children's diet, 64.6% with exercise, and 57.1% with smart device usage. Clinicians should be aware of caregivers' information acquisition patterns, preferences and expectations of various treatments, and their concerns. Considering these results, clinicians should try to establish more appropriate treatment plans for children with PP.

Experiences and Needs of Families Caring for Children and Adolescents With Chronic Kidney Disease: A meta-Synthesis

PROBLEM

Families struggle to care for children and adolescents with chronic kidney disease (CKD). They face extensive burden of care and altered family dynamics.

ELIGIBILITY CRITERIA

A meta-synthesis review was conducted to explore the experiences and needs of families caring for children and adolescents with CKD using seven electronic databases (CINAHL, EMBASE, ProQuest Dissertations and Theses, PsycINFO, PubMed, Scopus, and Web of Science). The inclusion criteria are (1) qualitative English studies from January 2010 to December 2020 that (2) report personal experiences or needs of (3) family members caring for children and adolescents aged 19 years and below who have been diagnosed with CKD of any stage (4) across all settings. Quality appraisal was done using the Critical Appraisal Skill Program checklist. Data was synthesised using Sandelowski & Barroso's (2007) method.

SAMPLE

2,236 records were identified and 13 eligible studies were included. Family members involved mothers (n = 190), fathers (n = 83), siblings (n = 5), and grandparents (n = 2).

RESULTS

Three themes emerged: (1) demands of caregiving, (2) support systems, and (3) defining and making sense of new reality.

CONCLUSIONS

Family caregivers experience overwhelming demands of caregiving and unmet support needs to cope. Appropriate interventions are needed to alleviate their burden.

IMPLICATIONS

Knowledge of learning and support needs of families caring for children with CKD may shape nursing education and practice to cultivate more effective communication for better psychosocial family support.

The psychosocial challenges of mothers of children with thalassemia: A qualitative study

BACKGROUND

Caring for the children suffering from thalassemia is a stressful experience with various aspects making the mothers face various challenges. Thus, the present study aimed to explain the psychosocial challenges of mothers with thalassemia children based on their lived experience.

MATERIALS AND METHODS

In this qualitative study, which was conducted using the phenomenological method, 14 mothers with thalassemia children were selected from two thalassemia treatment centers in Hamadan and Babol (Iran) in 2020 using the purposive sampling method. Data were collected using in-depth and semi-structured interviews and were analyzed by van Manen's phenomenological methodology.

RESULTS

In the first stage of data analysis, 534 initial codes were extracted, which were reduced to 290 by comparison and integration. The primary themes turned into 24 secondary themes after clustering. By comparing the secondary themes, three main themes (i.e., "psychological distress," "bodily burnout," and "mothers' need to empathy and support") with 7 secondary themes (i.e., "emotional exhaustion," "mental strain," "social stigma," "acute psychosomatic reactions," "long-term psychosomatic consequences," "expectation of family support," and support needs outside the family) were extracted.

CONCLUSION

The results indicated that mothers with thalassemia children experience several challenges in various aspects. Therefore, they require care interventions and psychosocial support.

The Burden of Primary Caregivers of Spinal Muscular Atrophy Patients and Their Needs

Aim:

This study aims to reveal the problems faced by families of children with spinal muscular atrophy (SMA), by evaluating their care burden, needs, and expectations.

Materials and Methods:

The participants were the primary caregivers of 34 children between the ages of 0 and 18 years diagnosed with SMA. Thirteen children were diagnosed with type 1, 13 children with type 2 and 8 children with type 3 SMA. Data on the medical history, functional levels of the participants, and the characteristics of families were collected. The childrens’ parents completed the Family Needs Survey and the Zarit Caregiver Burden Scale.

Results:

According to the results of the Family Needs Survey, it was found that information was the most common requirement, and this was independent of the level of education. According to the Caregiver Burden Scale, it was recorded that 64.7% of the caregivers were under mild/moderate burden. While there was a moderate correlation (r = 0.574; P < .001) between the Caregiver Burden Scale and the Family Needs Survey, it was observed that the functional level of the child was not associated with family needs and caregiver burden.

Conclusions:

Our study suggests that the needs of families of SMA patients, especially related to income level, have changed. The caregivers’ burden is not directly related to the income level or the functional level of the child. Families’ need for information should also be prioritized within the rehabilitation program.

Caregiver strain and its predictors among parents of autistic children: a cross-sectional study

Objective: This study estimates the frequency and predictors of caregiver strain (CGS) among parents of autistic children.Methods: Demographic details and CGS were collected through a validated tool from 403 parents of autistic children in Karachi, Pakistan. Regression modelling was performed to report associations between social, behavioural, and communication problems and socioeconomic predictors of CGS. Results were reported using adjusted beta-coefficients with 95% confidence intervals.Results: In total, 88.3% of the parents reported moderate to severe CGS. A high family income (β = -4.31, 95% CI -7.55, -0.11), and caregiver's higher level of education (β = -4.73, 95% CI -8.84, -0.61), along with care-recipient age group (β = -9.35, 95% CI -15.17, -3.52) significantly predicted lower CGS. Diagnosis of more than 5 years (β = 7.57, 95% CI 2.36, 12.79), tendency to self-harm (β = 10.75, 95% CI 6.62, 14.88), and social withdrawal in the care-recipient (β = 4.56, 95% CI 1.68, 7.44) were significantly associated with higher CGS.Conclusion: Parents of children on the autistic spectrum suffer from high CGS. There is a need to introduce tailored parenting interventions at the individual and community levels to help parents reduce the CGS, ultimately benefiting their child.

A comparative study of perceived burden in parent caregivers of adolescents with epilepsy in a resource-restricted setting: Investigating the explanatory factors of perceived burden

OBJECTIVE

Parent caregivers often play vital roles in the care of adolescents with epilepsy (AWE) in resource-restricted settings; however, little is known about the burden borne by these parents. This study investigated the burden perceived by parents of AWE and described the explanatory factors.

METHODS

An equal number (n = 121) of age- and gender-matched parent caregivers of AWE (cases) and parents of adolescents with sickle cell disease (comparison group) were interviewed with the Parent Illness Intrusiveness Rating Scale to assess disruptions in their relationships and lifestyle. Parents of AWE were assessed for psychological distress with the 12-item General Health Questionnaire, and AWE were interviewed with the Hospital Depression-Anxiety Scale.

RESULTS

The majority of the cases and the comparison group were mothers (76%), with mean (SD) ages of 44.11 (SD = 6.92) versus 43.59 (SD = 6.39) years, respectively. The prevalence rate of psychological distress in cases was 38%, and depressive-anxiety symptom was prevalent in 39.7% of AWE. The level of perceived burden was significant in all parent caregivers, albeit higher in cases relative to the comparison group across multiple domains, including relationship/personal development, intimacy, instrumental and global. A high level of burden in parents of AWE was predicted by a poor family financial and material support to the adolescents, increased contact hours with adolescents, psychological distress in the parent caregivers, and anxiety-depressive symptoms in AWE after controlling for cofounders.

CONCLUSION

The study findings underscore the need for psychosocial support to bolster resilience and adaptive coping styles in parents of AWE, particularly in resource-restricted settings. A culturally sensitive interdisciplinary blueprint of locally viable actions model for psychosocial support for parent caregivers of AWE is strongly suggested. Future studies are indicated to shed more light on the modifiable risks of perceived burden, and the effectiveness of psychosocial interventions in parents of AWE.

Factor Structure of the Brief Coping Orientation to Problems Experienced Inventory in Chinese (Brief-COPE-C) in Caregivers of Children with Chronic Illnesses

PURPOSE

This study aimed to translate and evaluate the factor structure of the Chinese version of the Brief Coping Orientation to Problems Experienced Inventory (Brief-COPE-C) among the caregivers of children with chronic illnesses.

DESIGN AND METHODS

In this cross-sectional study, we recruited 217 caregivers, aged 18 years and older and cared for children with chronic illnesses. All participants were recruited from two local hospitals in Hong Kong using convenience sampling. We excluded caregivers diagnosed with major psychiatric diseases, such as major depression or schizophrenia.

RESULTS

The Brief-COPE-C had good validity and three factors were identified: active coping, distraction, and dysfunctional coping. The content validity index was 0.97, and the item content validity index ranged from 0.83-1 for all 28 items. The Brief-COPE-C had adequate internal consistency. The Cronbach's alpha for the overall scale was 0.89, while the Intraclass Correlation Coefficient (ICC) was 0.876.

CONCLUSIONS

The Brief-COPE-C is a valid, reliable, and culturally appropriate tool for measuring coping in caregivers of children with chronic illnesses.

PRACTICE IMPLICATIONS

Use of the Brief-COPE-C to assess coping responses of caregivers can facilitate clinicians' and researchers' understanding of how these individuals cope. Hence, appropriate interventions can be implemented to improve caregivers' physical and psychological outcomes.

Integrating a problem-solving intervention with routine care to improve psychosocial functioning among mothers of children with sickle cell disease: A randomized controlled trial

OBJECTIVE

To assess the feasibility of a problem-solving skills training intervention in improving psychological outcomes in mothers of infants with sickle cell disease (SCD).

DESIGN AND METHODS

This parallel randomized controlled trial recruited 64 babies with SCD, 6 to 12 months of age, and their mothers. Baseline measurements assessed mothers' coping and problem-solving skills, depression, and parental stress before random assignment to intervention or control groups (n = 32 each). Problem-solving skills intervention was delivered through 6 monthly sessions, when babies attended for routine penicillin prophylaxis. All measurements were repeated for both groups at the end of the intervention period. Intention to treat analysis used repeated measures mixed models with the restricted estimation maximum likelihood approach.

RESULTS

The problem-solving intervention had no significant effect on mothers' problem-solving skills (adjusted treatment effect: -1.69 points (95% CI:-5.62 to 2.25)), coping behaviours (adjusted treatment effect: 0.65 points (95% CI:- -7.13 to 8.41)) or depressive symptoms (adjusted treatment effect: -0.41 (95% CI: -6.00 to 5.19)). It reduced mothers' level of difficulty in managing stressful events by 9.5 points (95% CI (-16.86 to -2.16); effect size: 0.21 SD). In the subgroup of mothers at risk of depression (n = 31 at baseline), the intervention reduced depression scores with treatment effect of 10.4 points (95%CI: -18.83 to -1.88; effect size: 0.67 SD).

CONCLUSION

This problem-solving skills intervention study suggests feasibility and possible efficacy in improving some maternal outcomes. Further refinement and culturally appropriate adaptations of the intervention could lead to stronger effects.

Challenges Facing Family Caregivers of Children With Disabilities During COVID-19 Pandemic in Palestine

BACKGROUND

COVID-19 has caused great changes in all aspects of life which affected all people especially vulnerable groups such as children with disabilities (CWD) and their families.

OBJECTIVE

This study aimed to examine the challenges facing caregivers of CWD during the pandemic, and to explore these challenges from various physical, social, psychological, and financial aspects.

METHODS

A cross-sectional design was conducted in Palestine, a total of 130 caregivers of CWD completed a survey consisting of demographic and clinical characteristics questionnaire and the short version of the burden scale for family caregivers (BSFC-s) between March and May 2021.

RESULTS

Most of the caregivers were mothers (76.9%), the mean age of the children was (6.09 ± 3.43 years). The majority (88.5%) of the caregivers felt physically exhausted, about (75.4%) had decreased living standards, and (86.2%) indicated that caregiving is taking their strength. A high burden score was recorded, the mean BSFC-s score was 20.17 ± 5.57. Significant differences in BSFC-s scores were recorded based on the type of disability, and child's ability to take care of oneself, P < .05. The total scores of the BSFC-s were positively correlated with the physical, social, psychological, and financial challenges facing the caregivers (P < .001).

CONCLUSIONS

COVID-19 has caused increased burdens on the caregivers of CWD and a negative impact on the child's mobility accompanying a lack of access to health and rehabilitation services. Vital factors are to be considered in developing strategic health and rehabilitative plans for promoting better care for caregivers and their CWD during lockdown restrictions time.

Association Between Caregivers' Family Management and Quality of Life in Children with Chronic Disease in Southern Thailand

PURPOSE

Caring for children with chronic diseases, caregivers have to manage their child's daily life to prevent complications and improve their quality of life. This study investigated family management of children with chronic diseases, quality of life of children, and correlation between family management of caregivers and quality of life of children as perceived by the caregivers.

PATIENTS AND METHODS

This cross-sectional study collected data from 200 pairs of caregivers and children with asthma, anemia, and thalassemia aged 5 to 12 years after receiving treatment and follow-up in the pediatric outpatient department of the tertiary hospital, June to November 2020. Research instruments comprised a Family Management Measure (FaMM) and the Pediatric Quality of Life Inventory (PedsQL 4.0). Data were analyzed using descriptive and Spearman rank correlation coefficient statistics.

RESULTS

The caregivers of children obtained a mean score on family management of 166.88 (S.D.= 11.32). The quality of life of children with chronic illness had a mean score of 66.59 (S.D.= 18.63). Correlation analysis revealed that easy family management of the caregivers had a positive correlation with the quality of life of children with chronic diseases. On the contrary, difficulty in family management negatively correlated with the quality of life of the children.

CONCLUSION

Most caregivers could have easy family management in caring for the children. In summary, easy family management will allow children with chronic illness to receive decent care from their caregivers, contributing to improved quality of life.

Telessaúde em um centro de referência em Diabetes Mellitus: uma análise transversal

Resumo Objetivo Analisar uma ferramenta de telessaúde de um centro de referência em Diabetes Mellitus sob a ótica dos cuidadores. Método Estudo transversal, com abordagem quantitativa, desenvolvido em um centro de referência em Diabetes Mellitus, com cuidadores de crianças e adolescentes que utilizaram a Hot-Line e responderam ao questionário online, no período de novembro de 2018 a fevereiro de 2019. Resultados A amostra foi constituída de 90 participantes, sendo 76 (84,4%) do sexo feminino, tendo como o maior parentesco o materno 68 (75,6%). Quanto aos motivos das ligações, 31 (34,4%) referem-se às orientações gerais, 41 (45,6%) ao ajuste de dose de insulina, 6 (6,7%) à hipoglicemia aguda, 6 (6,7%) à hiperglicemia aguda, 2 (2,2%) aos dias de doença e 4 (4,4%) referem-se aos resultados de exames. Os participantes apresentaram um alto índice de satisfação com o uso da linha telefônica. Conclusão e implicações práticas O teleatendimento produz benefícios imediatos aos pacientes, sendo resolutivo no manejo da doença. Cabe ressaltar que o uso da telessaúde como forma de promoção da saúde contribui para a prevenção de agravos de maneira rápida, satisfatória e sem o deslocamento do paciente e sua família.

Quality of life, caregiver burden and mental health disorders in primary caregivers of patients with Cirrhosis

BACKGROUND AND AIMS

Caregivers are needed for cirrhotic patients as there is progressive decline in cognition and self-care. We intend to study the quality of life (QOL), psychosocial burden and prevalence of mental health disorders among caregivers.

METHODS

Cross-sectional study where caregivers, defined as person who takes responsibility of providing care to patient, of cirrhotic patients were included. Short form 36 health survey (SF-36) to assess QOL, Zarit Burdern Index12 (ZBI) for caregiver burden (CB). Patient Health Questionnaire (PHQ) identified depression and Generalized Anxiety Disorder (GAD-7) questionnaires, anxiety.

RESULTS

Of 132 caregivers, mean age of caregiver was 41.2 ± 10.3 years, with female preponderance. Mean MELD was 21.4 ± 7, majority belonged to CHILD C. Comparing the SF36 score of caregivers to normal population showed lower level of QOL for caregivers. Mean ZBI score - 14 ± 5.8. Mean GAD score - 8.1 ± 5.1, 54 (41%) had anxiety. Mean PHQ score - 7.8 ± 5.2, 45 (34%) had depression.

REGRESSION ANALYSIS

Alcoholic cirrhosis, history of hepatic encephalopathy (HE), Anxiety, Depression and recidivism predicted CB. Treatment costs (ODDS-1.15), alcoholic cirrhosis (ODDS -8.9), history of HE (ODDS-7.5) and caregiver duration (ODDS-0.25) predicted anxiety. Treatment costs (ODDS-1.5), caregiver age (ODDS-0.87), spouse as caregiver (ODDS-10.9) and higher education (ODDS-0.79) predicted depression.

CONCLUSIONS

Caregivers of cirrhotic patients have high prevalence of CB with low QOL and high incidence of anxiety and depression, compared with the general population. Alcoholism in patients precipitates while higher education helps cope up with these disorders.

How do parents deal with their children's chronic kidney disease? A qualitative study for identifying factors related to parent's adaptation

Background

Parents’ adaptation affects the health outcomes of children with chronic kidney diseases (CKD). Identifying factors that affect parents’ adaptation is necessary to understand their adaptation status. This study aims to explore factors related to the adaptation of parents who have children with CKD.

Methods

This was a qualitative study with a content analysis approach. Seventeen parents of children with CKD were selected by using purposive sampling. The leading researcher performed semi-structured, in-depth, face-to-face interviews to collect data. Conventional content analysis was used to analyze data.

Results

Two main categories extracted from the data were “adaptation facilitators” and “adaptation barriers.” Adaptation facilitators were supported by three sub-categories: “social support”, “family capability” and “spiritual beliefs”. Four sub-categories of “adaptation barriers” were revealed as: “family-related barriers,” “mental stress by others,” “the chronic nature of the disease,” and “unfavorable treatment conditions.”

Conclusions

Identifying the factors influencing parental adaptation helps the medical staff to make the necessary interventions to support the parents. According to this study, increasing parent access to the required information, supporting them financially and emotionally, and helping them identify support resources can facilitate their adaptation to their child’s chronic illness. Also, identifying and eliminating adaptation barriers can help parents deal better with their child’s chronic disease.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12882-020-02170-4.

Coping with Wolf-Hirschhorn syndrome: quality of life and psychosocial features of family carers

BACKGROUND

Wolf-Hirschhorn Syndrome (WHS) is a rare, congenital disease characterized by a distinctive facial phenotype, seizures, intellectual disability and developmental delay, and pre and postnatal growth requiring lifelong care. The psychosocial status of the family caregivers of children diagnosed with WHS is unknown. This study aims to characterize the sociodemographic and psychosocial profile of WHS caregivers and analyze how these variables impact their quality of life (QoL) and well-being.

RESULTS

The sociodemographic and clinical profile of 22 Spanish caregivers of children with WHS and the characteristics of those affected have been described. Significant relationships were found between sociodemographic and psychosocial characteristics among caregivers. The impact on the parents' QoL and negative relationship with the symptomatology were assessed. The use of engagement strategies such as problem focused coping was associated with improved psychological QoL and social support.

CONCLUSIONS

WHS caregivers share similarities in their profile and needs with caregivers of children with other rare diseases. Pychosocial support groups involving parents caring for children with the same disease could improve caregivers' well-being and QoL by strengthening their social support network and using positive coping styles.

Factors associated with caregiver burden among adult (19-64 years) informal caregivers - An analysis from Dutch Municipal Health Service data

Due to the ageing population and the rising prevalence of chronic diseases, it is expected that the demand on informal caregivers will increase. Many informal caregivers experience burden, which can have negative consequences for their own health and that of the care recipient. To prevent caregiver burden, it is important to investigate factors associated with this burden. We aimed to identify factors associated with caregiver burden in adult informal caregivers. Among a sample of adult informal caregivers (n = 1,100) of the Dutch region of Zaanstreek-Waterland, perceived caregiver burden, demographic factors, caregiving situation, health-related factors and socio-financial factors were measured as part of the national Health Survey in 2016. Using univariate and multivariate logistic regression analysis, for which a backward selection method was applied, associations with caregiver burden were studied. In the multivariate model, time spent providing informal care was significantly associated with perceived caregiver burden, with an odds ratio (OR) [95% confidence interval] of 7.52 [3.93-14.39] for those spending >16 hr compared to 1-2 hr on informal care. Also providing care to their child(ren) (OR: 2.55 [1.51-4.31]), poor perceived health (OR: 1.80 [1.20-2.68]) and loneliness of the caregiver (OR: 2.05 [1.41-2.99]) were significantly associated with caregiver burden. To possibly prevent and reduce informal caregiver burden, factors associated with such burden should be intervened on. As such, special attention should be paid to caregivers who provide many hours of care or provide care to their child(ren), as well as those who have a poor perceived health themselves and/or experience feelings of loneliness.

Quality of life and parental care burden in cochlear implanted children: A case-control study

OBJECTIVES

Cochlear implantation is a widely accepted and effective surgical method used to treat severe hearing loss. What's more, it affects the lives of both cochlear implanted children and their parents. This study aims to compare cochlear-implanted children (CIC) and their parents with healthy counterparts and their parents in terms of the quality of life (QOL) and parental care burden (CB).

METHODS

This study was conducted between February and December 2018 in Turkey after receiving approval from the ethics committee. The Case Group included 34 children between 3 and 7 years of age, who received a CI due to bilateral prelingual sensorineural hearing loss and were using it for at least 1 year, and their parents. The Control Group consisted of 68 healthy children and their parents. The data were collected using disease and age-specific quality of life scales and burden interview. Normally distributed variables were analysed using parametric tests while non-normally distributed variables were analysed using nonparametric tests. The odds ratio (OR) and confidence interval (95%) were also calculated. Results were evaluated at significance level of p < 0.05.

RESULTS

The mean age of the children and their parents in both Case and Control Groups was 63.9 months and 33.8 years, and 61.3 months and 36.6 years, respectively. There was a positive correlation between PPQ social relationship subscale and KINDL subscale scores in CIC (p < 0.05). The Case Group obtained lower mean scores from the subscales of KINDL and WHOQOL-BREF (p < 0.001, p < 0.01). The ZBI mean scores of the parents in Case and Control Groups were 43.18 and 27.54, respectively (p = 0.000).

CONCLUSION

It was determined that the QOL of the Case Group was lower than QOL of the Control Group, while the CB of the Case Group was higher than CB of the Control Group.

The Impact of Celiac Disease on Caregivers' Well-being: An Integrative Review

OBJECTIVES

A diagnosis of celiac disease (CD) requires individuals to adopt a strict gluten-free diet. As children with CD must rely on their caregivers for guidance and support with managing the gluten-free diet, CD may challenge the caregiver's emotional and social well-being. The primary objective of this mixed-methods systematic review was to synthesize research investigating the impact of CD on caregiver's well-being.

METHODS

Five databases were systematically searched from 1990 to 2018 to identify all empirical studies that assessed well-being in caregivers of children (0-18 years) with CD. Qualitative and quantitative data were extracted separately before being integrated to explore key themes across the studies.

RESULTS

Twelve studies were identified that explored the well-being of caregivers of children with CD (3 qualitative, 9 quantitative), reporting on 665 caregivers. The quality of evidence was limited across studies. Synthesis of results revealed 3 themes (Caregiver Responsibility, Caregiver Well-Being and Concern for Child's Health, Implications for the Family) describing the impact of a child with CD on caregiver well-being.

CONCLUSIONS

Caregivers of children with CD may experience difficulties that impact their well-being; specific difficulties identified included the impact of caregivers' social activities, finances, and anxiety. The findings detailed in this review point toward factors that may guide health care personnel to provide support for the caregivers of children with CD.

A critical review of patient and parent caregiver oriented tools to assess health-related quality of life, activity of daily living and caregiver burden in spinal muscular atrophy

The positive outcome of different therapeutic approaches for spinal muscular atrophy (SMA) in clinical trials and in clinical practice have highlighted the need to establish if functional changes are associated with possible changes of patient health-related quality of life or have an effect on activities of daily living and caregiver burden. The aim of this paper is to provide a critical review of the tools previously or currently used to measure quality of life, activity of daily living, and caregiver burden in SMA. We identified 36 measures. Only 6 tools were specifically developed for SMA while the others had been used and at least partially validated in wider groups of neuromuscular disorders including SMA. Twelve of the 36 focused on health-related quality of life, 5 on activities of daily living and 9 on caregiver burden. Ten included a combination of items. The review provides a roadmap of the different tools indicating their suitability for different SMA types or age groups. Scales assessing activities of daily living and care burden can provide patients and carers perspective on functional changes over time that should be added to the observer rated scales used in clinic.

A comparative study of socioeconomic status, perceived social support and psychological distress of mothers of children with and without disabilities

Background/Aims

Quality of life has been defined as a measure of a person's physical wellbeing, psychological state, and social relationships. However, comparisons of psychological distress, socioeconomic status, and social support between mothers of children with and without disabilities have been limited, particularly in Saudi Arabia. The aim of this study is to comparatively evaluate the socioeconomic status, perceived social support, and psychological distress of mothers of children with and without disabilities.

Methods

The Socio-Demographic Information Form, the Multidimensional Scale of Perceived Social Support, and the Depression Anxiety Stress Scales were completed by 200 mothers of children with cerebral palsy or Down's syndrome and 100 mothers of children without disabilities.

Results

Welch's test indicated significant differences between the two groups on the total Depression Anxiety Stress Scales and all its subscales (<0.01) and the Multidimensional Scale of Perceived Social Support Friends subscale (0.02).

Conclusions

Mothers of children with disabilities perceived high levels of overall social support, which might have reduced their psychological distress. It is recommended for rehabilitation centres to organise support groups for family members. It will also be beneficial for families of children with disabilities, if heath sector policy makers can review and develop effective socioeconomic policies to improve their standards of living.

First-year predictors of health-related quality of life changes in short-statured children treated with human growth hormone

PURPOSE

Little attention has been directed towards examining the impact of predictors on change in health-related quality of life (HRQOL) within the course of growth hormone (GH) treatment in pediatric short stature. We aimed to assess changes in HRQOL and its sociodemographic, clinical and psychosocial predictors in children and adolescents diagnosed with growth hormone deficiency (GHD), and born short for gestational age (SGA) before and 12-month after start of GH treatment from the parents' perspective. Results were compared with an untreated group with idiopathic short stature (ISS). In this prospective multicenter study, 152 parents of children/adolescents (aged 4-18 years) provided data on their children's HRQOL at baseline and at 12-month follow-up.

METHOD

Repeated-measures multivariate analyses of covariance were performed to examine parent-reported HRQOL changes from baseline to 1-year after treatment and hierarchical linear regressions to identify the predictors of HRQOL changes.

RESULTS

Results showed that parents of children that were treated with GH report an increase in their children's HRQOL after 1 year. Changes in HRQOL were mostly explained by psychosocial predictors followed by sociodemographic and clinical variables. Specifically, the diagnosis SGA significantly predicted a greater increase in parent-reported HRQOL. Furthermore, a lower caregiving burden significantly predicted a decrease in parent-reported HRQOL.

CONCLUSION

In conclusion, a substantial percentage of explained variance in HRQOL relates to psychosocial and sociodemographic predictors. However, there appears to be other important factors that are predictors of HRQOL, which need to be determined in large, population-based samples.

Quality of life of children with achondroplasia and their parents - a German cross-sectional study

Background

Achondroplasia is the most common form of disproportionate short stature and might affect not only the quality of life of the affected child but also that of the parents.

Objectives

We aimed to investigate the quality of life of children with achondroplasia from child- and parent perspective as well as the parental quality of life.

Methods

Forty-seven children with achondroplasia and 73 parents from a German patient organization participated. We assessed children’s quality of life using the generic Peds QL 4.0™ as self-reports for children aged 8–14 and parent-reports for children aged 4–14 years. Parental quality of life we assessed using the short-form 8-questionnaire.

Results

Children with achondroplasia showed significantly lower quality of life scores compared to a healthy reference population from both the child- and parent-report (p = ≤.01), except the child-report of the emotional domain (t (46) = − 1.73, p = .09). Parents reported significantly lower mental health in comparison with a German reference population (t (72) = 5.64, p ≤ .01) but no lower physical health (t (72) = .20, p = .85). While the parental quality of life was a significant predictor of parent-reported children’s quality of life (F (6,66) = 2.80, p = .02), it was not for child-reported children’s quality of life (F (6,66) = .92, p = .49).

Conclusions

Achondroplasia is chronically debilitating. Thus special efforts are needed to address patients’ and parent’s quality of life needs. This special health condition may influence the daily life of the entire family because they have to adapt to the child’s particular needs. Therefore, clinicians should not only focus on the child’s quality of life but also those of the parents.

Reliability and validity of the revised impact on family scale (RIOFS) in the hospital context

BACKGROUND

The lack of formal instruments to measure Burden in primary caregivers of Children in a hospital context is limited because mostly of published instruments are related to cancer survivors, ambulatory environment or general context for children with chronic conditions, but none of them adapted property to prolonged hospitalization context. This leaves the rising population of hospitalized chronic children's caregivers without a proper assessment. The aim of this study was to develop a version of the Revised Impact on Family Scale adapted to primary caregivers of chronic hospitalized children. A cross-sectional study with two main stages was conducted. The first one describes the linguistic and contextual adaptation process of the instrument, and the second refers to the psychometric testing and analysis..

RESULTS

Less than 15% of the participants expressed problems with some adapted items in the scale. Eighty-six caregivers were evaluated at Josefina Martinez Hospital, mostly female (34.2 ± 11.6 years old). Majority of participants were graduated from high school, salaried employee and mothers of the chronic child. The scale exhibits a high level of internal consistency (Cronbach's alpha 0.73), excellent intra-observer reliability (Intraclass Correlation Coefficient 0.9), acceptable empirical evaluation of content validity and low and negative construct validity (Pearson's correlation coefficient - 0.23).

CONCLUSIONS

This adapted version of the Revised Impact on Family Scale to the hospital context is a reliable, valid, self-administered and simple instrument to implement in order to assess the burden of primary caregivers with chronic hospitalized children.