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Storch B, Reigada LC. Utilizing a multisystemic model of resilience to synthesize research in youth with inflammatory bowel disease: a narrative review. Transl Gastroenterol Hepatol 2024; 9:45. [PMID: 39091650 PMCID: PMC11292072 DOI: 10.21037/tgh-24-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 04/23/2024] [Indexed: 08/04/2024] Open
Abstract
Background and Objective The study of resilience in youth with inflammatory bowel disease (IBD) is in early stages. The current review aims to illustrate how the use of a multisystemic framework may serve as a developmental and disease-appropriate framework for conceptualizing and designing resilience research for youth with IBD. Methods This is a narrative review; therefore, a comprehensive and systematic literature search was not conducted. Rather, the current paper aims to map selected existing literature to a multisystemic model as exemplars of how the model may be used in youth with IBD. Relevant literature was reviewed, synthesized, and mapped onto the proposed multi-systemic framework. Key Content and Findings The current review considers existing literature across three proposed dimensions of resilience: contexts of risk exposure, protective and promotive factors/processes, and desired outcomes. Review of each dimension includes consideration of selected existing literature to explain what is known about each dimension currently, as well as to propose additional potential future areas to broaden understanding. Specific key takeaways include: (I) understanding risk exposure in young people with IBD requires consideration of disease-specific, demographic, and sociocultural factors; (II) protective and promotive factors and processes for these young people span individual, familial, peer, school, and community levels; and (III) desired outcomes encompass both the absence of negative and the presence of positive indicators. Conclusions A multisystemic approach to the study of resilience in young people with IBD may not only clarify current gaps in the field, but also allow for additional future considerations to best understand how and for whom outcomes characterized as resilient may occur in this population.
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Affiliation(s)
- Barbara Storch
- Health Psychology and Clinical Science Program in Psychology, The Graduate Center, City University of New York, New York, NY, USA
| | - Laura C. Reigada
- Health Psychology and Clinical Science Program in Psychology, The Graduate Center, City University of New York, New York, NY, USA
- Brooklyn College, City University of New York, New York, NY, USA
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Pavel FM, Bungau SG, Tit DM, Ghitea TC, Marin RC, Radu AF, Moleriu RD, Ilias T, Bustea C, Vesa CM. Clinical Implications of Dietary Probiotic Supplement (Associated with L-Glutamine and Biotin) in Ulcerative Colitis Patients' Body Composition and Quality of Life. Nutrients 2023; 15:5049. [PMID: 38140308 PMCID: PMC10745841 DOI: 10.3390/nu15245049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
Patients with ulcerative colitis (UC) are reported to have changes in body structure, with negative impact on the course of disease. This study explored the effects of a standardized nutritional supplement containing five bacterial strains of at least five billion bacteria (Bifidobacterium infantis, Bifidobacterium animalis, Lactobacillus bulgaricus, Lactobacillus helveticus, and Enterococcus faecium), L-glutamine, and biotin on the body composition and quality of life of patients with UC. Ninety-three patients over 18 years of age with a confirmed diagnosis of UC, for whom body composition could be accurately determined, were included in this observational follow-up randomized study. These patients were split into two groups: UC-P (44 patients with dietary counselling and supplement with probiotics) and UC-NP (49 patients with dietary counselling, without supplement). Body composition was assessed using the multifrequency bioelectrical impedance device, and the quality of life related to UC was evaluated by applying the short inflammatory bowel disease questionnaire (SIBDQ). The results showed that the average value of muscular mass (MM) and sarcopenic index (SMI) significantly increased (p = 0.043, respectively, p = 0.001) and a large fraction (p = 0.001) of patients had their SMI levels normalized in the UC-P group compared with UC-NP group. The extracellular water to total body water ratio (ECW/TBW) also had significantly different mean values (p = 0.022), favoring the UC-P group. By testing the differences between the average values of body composition parameters before and after treatment, we obtained significant results in body mass index (BMI) (p = 0.046), fat free mass (FFM) (p < 0.001), and ECW/TBW ratio (p = 0.048). The SIBDQ total score increased significantly (p < 0.001) in the UC-P group and was more strongly associated with changes in body parameters. Supplementation with probiotics associated with L-glutamine and biotin can improve body composition parameters, which in turn implies an increase in the overall quality of life of patients with UC.
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Affiliation(s)
- Flavia Maria Pavel
- Doctoral School of Biological and Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; (F.M.P.); (A.-F.R.); (C.M.V.)
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy of Oradea, University of Oradea, 410073 Oradea, Romania
| | - Simona Gabriela Bungau
- Doctoral School of Biological and Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; (F.M.P.); (A.-F.R.); (C.M.V.)
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania;
| | - Delia Mirela Tit
- Doctoral School of Biological and Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; (F.M.P.); (A.-F.R.); (C.M.V.)
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania;
| | - Timea Claudia Ghitea
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania;
| | | | - Andrei-Flavius Radu
- Doctoral School of Biological and Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; (F.M.P.); (A.-F.R.); (C.M.V.)
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy of Oradea, University of Oradea, 410073 Oradea, Romania
| | - Radu Dumitru Moleriu
- Department of Mathematics, Faculty of Mathematics and Computer Science, West University of Timisoara, 300223 Timisoara, Romania;
| | - Tiberia Ilias
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania;
| | - Cristian Bustea
- Department of Surgery, Oradea County Emergency Clinical Hospital, 410169 Oradea, Romania;
| | - Cosmin Mihai Vesa
- Doctoral School of Biological and Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; (F.M.P.); (A.-F.R.); (C.M.V.)
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy of Oradea, University of Oradea, 410073 Oradea, Romania
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Rayyan YM, Agraib LM, Alkhatib B, Yamani MI, Abu-Sneineh AT, Tayyem RF. Does probiotic supplementation improve quality of life in mild-to-moderately active ulcerative colitis patients in Jordan? A secondary outcome of the randomized, double-blind, placebo-controlled study. Eur J Nutr 2023; 62:3069-3077. [PMID: 37498369 DOI: 10.1007/s00394-023-03207-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 07/10/2023] [Indexed: 07/28/2023]
Abstract
PURPOSE Recent findings revealed a potential effect of a probiotic in improving quality of life (QoL) in ulcerative colitis (UC). In Jordan, there is scarce data about UC patients and QoL. METHODS Twenty-four UC patients were included in the study and were randomly allocated into probiotic (3 × 1010 probiotic capsules containing nine Lactobacillus and five Bifidobacterium species) and placebo control groups (containing polysaccharide supplied in an identical bottle) 3 times daily/6 weeks. A short inflammatory bowel disease questionnaire (SIBDQ) was used to assess the change in the quality of life in both groups at the beginning and the end of the intervention; The study was completed during the COVID-19 pandemic. RESULTS Patients treated with probiotics showed a higher score of social (6.92 ± 0.29, p = 0.019), bowel (6.31 ± 0.46, p = 0.001), emotional (6.47 ± 0.46, p < 0.001), and total SIBDQ scores (6.54 ± 0.29, p < 0.001) compared to the placebo group (5.75 ± 1.57, 4.72 ± 1.34, 4.42 ± 1.67 and 4.96 ± 1.27; respectively). Also, the probiotic group had significantly better scores in the systemic, social, bowel, emotional, and total SIBDQ scores in terms of pre- to post-treatment (p < 0.001). CONCLUSIONS The use of probiotic therapy containing Lactobacillus and Bifidobacterium species had significantly improved the quality of life among UC patients, this was shown by the improvement in the scores of the systemic domain, social domain, bowel domain, emotional domain, and total SIBDQ. This study is part of a registered study at ClinicalTrials.gov with the number NCT04223479.
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Affiliation(s)
- Yaser Mohammed Rayyan
- Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, The University of Jordan, Amman, Jordan.
| | - Lana M Agraib
- Department of Food Science and Nutrition, Faculty of Agriculture, Jerash University, Jerash, Jordan
| | - Buthaina Alkhatib
- Department of Clinical Nutrition and Dietetics, Faculty of Applied Medical Sciences, The Hashemite University, Zarqa, Jordan
| | - Mohammed I Yamani
- Department of Nutrition and Food Technology, Faculty of Agriculture, The University of Jordan, Amman, Jordan
| | - Awni Taleb Abu-Sneineh
- Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, The University of Jordan, Amman, Jordan
| | - Reema F Tayyem
- Department of Nutrition and Food Technology, Faculty of Agriculture, The University of Jordan, Amman, Jordan
- Department of Human Nutrition, College of Health Sciences, Qatar University, Doha, Qatar
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Horvát B, Dávid A, Sallay V, Rafael B, Njers S, Orbán K, Molnár T, Csabai M, Martos T. Improving disease management of patients with inflammatory bowel disease: the potential role of self-concordant health goals. Front Psychol 2023; 14:1115160. [PMID: 37484082 PMCID: PMC10359902 DOI: 10.3389/fpsyg.2023.1115160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 06/13/2023] [Indexed: 07/25/2023] Open
Abstract
Inflammatory bowel diseases (IBD) are chronic gastrointestinal conditions that significantly impact patients' quality of life. Previous research indicates that patients with IBD have a higher prevalence of anxiety compared to the general population and other chronic diseases. This pilot study aimed to investigate the relationships between goal integration, positive and negative emotions, goal self-efficacy, and trait anxiety as the outcome variable, focusing on patients' self-management strategies. Drawing from the Self-Concordance Model (SCM) of Self-Determination Theory (SDT), the study explored how goal integration is associated with more fulfilling and enjoyable experiences and fewer negative emotions, ultimately improving psychological well-being. Health-related goals were evaluated using the Personal Project Analysis technique, while the State-Trait Anxiety Inventory was utilized to measure general anxiety levels. Among the 141 participants with inflammatory bowel disease, 96 reported having health-related goals. Of these, 66 were female (68.75%), and 30 were male participants (31.25%). Path analysis revealed a moderate negative association between self-concordance (SC) and negative emotions, which, in turn, predicted higher levels of trait anxiety. Furthermore, the alternative model tested indicated that trait anxiety predicted a lower level of self-concordance. Setting well-integrated health goals involves an internal capacity, enabling patients to experience less negative emotions during self-management activities. Anxiety can hinder individuals from accessing their inner needs, resulting in less self-concordant aspirations and more negative emotions. These findings may contribute to developing prevention and intervention programs to enhance IBD patients' adherence to lifestyle changes, ultimately improving their overall well-being.
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Affiliation(s)
- Barbara Horvát
- Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary
| | - Anett Dávid
- Department of Medicine, University of Szeged, Szeged, Hungary
| | - Viola Sallay
- Institute of Psychology, University of Szeged, Szeged, Hungary
| | - Beatrix Rafael
- Department of Preventive Medicine, University of Szeged, Szeged, Hungary
| | - Sanela Njers
- Department of Cognitive and Neuropsychology, University of Szeged, Szeged, Hungary
| | - Kata Orbán
- Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary
| | - Tamás Molnár
- Department of Medicine, University of Szeged, Szeged, Hungary
| | - Márta Csabai
- Department of Clinical Psychology, Károli Gáspár University of the Reformed Church, Budapest, Hungary
| | - Tamás Martos
- Institute of Psychology, University of Szeged, Szeged, Hungary
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Norouzkhani N, Faramarzi M, Ghodousi Moghadam S, Karimi MA, Shokri Shirvani J, Bahari A, ShojaeiBaghini M, Eslami S, Tabesh H. Identification of the informational and supportive needs of patients diagnosed with inflammatory bowel disease: a scoping review. Front Psychol 2023; 14:1055449. [PMID: 37251032 PMCID: PMC10211349 DOI: 10.3389/fpsyg.2023.1055449] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 04/11/2023] [Indexed: 05/31/2023] Open
Abstract
Background Inflammatory Bowel Disease (IBD) affects the quality of life. Patient education and support needs are crucial components of comprehensive chronic illness care. The main purposes of this review were to (i) explore the informational and supportive needs of these patients to improve the quality of life in the existing literature and (ii) identify the gaps related to the needs of the patients in articles. Methods The scoping review is based on the Daudt methodological framework, a modified version of Arksey and O'Malley. Electronic databases were extensively searched from January 01, 2000 to April 30, 2022. Four electronic databases (PubMed/Medline, CINAHL, APA PsycInfo, Psychology and Behavioral Sciences Collection, APA PsycArticles, and ProQuest) were searched using controlled vocabulary, and specific keywords. The searched terms were matched to each database. We manually searched two key journals, namely the Journal of Inflammatory Bowel Disease and the Journal of Crohn's and Colitis. Results In the review, 75 studies on the assessment of the information and support needs of patients with IBD were reviewed. In this regard, 62 and 53 studies were regarding information needs and support needs, respectively. Most of the information needs of patients with IBD reported in the studies were related to diet needs, and educational needs were the most essential support needs. Conclusions Health policymakers and managers can develop care and educational programs related to this disease in health centers according to the needs of the patients. Health professionals, especially gastroenterologists, are the primary referral sources for information on patients. Therefore, gastroenterologists can take the lead in planning and educating the patients and sharing their decisions. Systematic review registration OSF, https://doi.org/10.17605/OSF.IO/3MWGJ.
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Affiliation(s)
- Narges Norouzkhani
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahbobeh Faramarzi
- Fatemeh Zahra Infertility and Reproductive Health Research Center, Babol University of Medical Sciences, Babol, Iran
| | - Sara Ghodousi Moghadam
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Technology, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Mohammad Amin Karimi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Ali Bahari
- Department of Internal Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahdie ShojaeiBaghini
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Saeid Eslami
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Pharmaceutical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Hamed Tabesh
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Yoo L, Tsai CS, Heitkemper M, Kamp K. Systematic review: Individual-level factors and social determinants of health impacting sleep health in individuals with inflammatory bowel disease. J Adv Nurs 2023; 79:1650-1663. [PMID: 36756952 PMCID: PMC10182249 DOI: 10.1111/jan.15576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 12/13/2022] [Accepted: 01/20/2023] [Indexed: 02/10/2023]
Abstract
AIM To examine the individual-level factors and social determinants of health (SDOH) linked to sleep health among individuals with inflammatory bowel disease (IBD). DESIGN Systematic review without meta-analysis. DATA SOURCES Four databases (PubMed, Web of Science, CINAHL and PsycINFO) were searched in February 2022. REVIEW METHODS Databases were searched with keywords related to IBD and sleep. The review was conducted per the PRISMA protocol. The checklist for analytical cross-sectional studies published by the Joanna Briggs Institute was used for quality appraisal. Factors were organized by individual, social and societal levels according to the social-ecological model of sleep health. RESULTS In the review, 45 studies were identified and synthesized. All studies examined individual-level factors with sleep, with age being the most common factor studied. Only nine studies considered a social determinant of health which included marital status, number of children, education level, annual income, employment status, work tenure, type of employment, area of residence, minority status/ethnicity and COVID-19. However, the source of information for the social determinant of health was not clearly defined for more than half of these studies. CONCLUSION Although IBD sleep research has explored individual-level factors (i.e. age) that impact sleep health, there is a lack of information on the SDOH that can contribute to sleep health. IMPACT This review provides insight into the different factors that have been examined in IBD sleep research. By determining the SDOH that impact sleep, nursing research can inform sustainable and tailored interventions that focus on changing behaviour and improving sleep of individuals of varying backgrounds and life experiences. There is a continued need for nurses in practice and research to explore the SDOH that influence health outcomes and the daily lives of those with IBD.
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Affiliation(s)
- Linda Yoo
- University of Washington, Seattle, Washington, USA
| | | | | | - Kendra Kamp
- University of Washington, Seattle, Washington, USA
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Scholz KAM, Thomann AK, Teich N, Baumann H, Walldorf J, Büning C, Rosania R, Canbay A, Arnim UV. Validation of the German Inflammatory Bowel Disease Fatigue (IBD-F) Questionnaire. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2023; 61:164-171. [PMID: 35533686 DOI: 10.1055/a-1797-2688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Fatigue is a common symptom in patients with inflammatory bowel diseases (IBD). To date, there is no instrument to assess IBD-specific fatigue in German. The aim of this study was to translate the IBD Fatigue (IBD-F) scale and to test its psychometric properties in a German IBD population. METHODS After completing the translation process, 20 IBD patients participated in a pilot testing phase. For further analyses, 180 IBD patients with fatigue answered the IBD-F (Sections I, II, III) and the IBD Questionnaire (IBDQ-D). Reliability was tested by using Cronbach's alpha and corrected item-total correlation. Exploratory factor analyses (EFA) were carried out. Spearman's correlation was calculated between the IBD-F and IBDQ-D . 78 patients could be included to calculate the test-retest reliability. RESULTS The German version of the IBD-F shows high face and content validity. Internal consistency was excellent, with a Cronbach's alpha of 0.93-0.98. Corrected item-total correlations ranged from 0.51 to 0.89. The correlation between the IBD-F and the IBDQ-D was statistically significant for Section I (rs=-0.59; p<0.01) and Section II (rs=-0.76; p<0.01) of the IBD-F. The EFA identified one relevant factor for each section. Test-retest reliability was acceptable for Section I (intraclass correlation coefficient (ICC)=0.73) and Section II (ICC=0.84). CONCLUSION The German version of the IBD-F is a reliable and valid tool to assess fatigue in IBD.
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Affiliation(s)
| | - Anne Kerstin Thomann
- Department of Medicine II, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Niels Teich
- Internal medicine practice for Digestive and Metabolic Diseases, Leipzig, Germany
| | - Hartmut Baumann
- Gastroenterological practice Gardelegen, Gardelegen, Germany
| | - Jens Walldorf
- Department of Internal Medicine I, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
| | - Carsten Büning
- Department of Internal Medicine, Hospital Waldfriede, Berlin-Zehlendorf, Germany
| | - Rosa Rosania
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Magdeburg, Magdeburg, Germany
| | - Ali Canbay
- Department of Medicine, Knappschaftskrankenhaus, Ruhr University Bochum, Bochum, Germany
| | - Ulrike von Arnim
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Magdeburg, Magdeburg, Germany
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Corradi G, Leon L, Theirs C, García-Garzón E, Clemente D, Barrada JR. Negative experiences with public bathrooms and chronic illness-related shame. Neurourol Urodyn 2023; 42:539-546. [PMID: 36524789 DOI: 10.1002/nau.25118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/02/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The use of public bathrooms is a challenge for everyone, but especially for those who are affected by a bathroom-dependent condition. Being dependent on bathrooms is linked with different negative emotions. One of them is a clinically relevant emotion: shame associated with the chronic condition. MATERIALS AND METHODS In a cross-sectional survey study (n = 193) of people who suffer a bathroom-dependent condition we asked about health conditions, well-being, and shame related to chronic condition outcomes. RESULTS We show a link between negative public bathroom experiences, and diminished well-being and feelings of shame related to chronic illness. We found that this relationship between negative experiences with public bathrooms and shame is not specific to the different conditions. CONCLUSION We conclude that the negative experiences which people with different gastrointestinal illnesses face is an environmental stressor associated with more embarrassment as a result of the condition suffered.
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Affiliation(s)
- Guido Corradi
- Health Sciences Faculty, Universidad Camilo Jose Cela, Madrid, Spain
| | - Leticia Leon
- Health Sciences Faculty, Universidad Camilo Jose Cela, Madrid, Spain.,IDISSC, Hospital Universitario Clinico San Carlos, Madrid, Spain
| | - Cecilia Theirs
- Health Sciences Faculty, Universidad Camilo Jose Cela, Madrid, Spain
| | | | - Daniel Clemente
- Pediatric Rheumatology Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
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Glynn H, Knowles SR. A Phenomenological Investigation of Trauma in 18 Adults Living With Inflammatory Bowel Disease. Clin Nurs Res 2023; 32:159-170. [PMID: 35156407 DOI: 10.1177/10547738221075649] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
While trauma is recognized as being common in Inflammatory Bowel Disease (IBD) cohorts, limited research has explored how trauma impacts the lived experience of IBD. The aim of this study was to develop an understanding of how trauma impacts the experience of living with IBD and its subsequent management. An interpretative phenomenological analysis with thematic analysis was conducted. Eighteen adults with IBD participated in this qualitative research study. Key themes identified included: (1) Trauma was associated with the journey of IBD; (2) the impact of IBD and trauma, and (3) coping strategies. Pre-existing non-IBD trauma was prevalent, with several participants reporting links between traumatic events and their IBD diagnosis. Experiences of IBD trauma were described by participants across all stages of their illness journey. The study can assist healthcare professionals to better understand the experience of living with IBD and trauma and the factors that can contribute to traumatic responses.
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Affiliation(s)
- Heidi Glynn
- Swinburne University of Technology, Melbourne, Australia
| | - Simon R Knowles
- Swinburne University of Technology, Melbourne, Australia.,St Vincent's Hospital, Melbourne, Australia.,Department of Medicine, The University of Melbourne, Australia
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10
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Heisler C, Rohatinsky N, Mirza RM, Kits O, Zelinsky S, Veldhuyzen van Zanten S, Nguyen G, McCurdy J, MacMillan M, Lakatos PL, Targownik L, Fowler S, Rioux K, Jones J. Patient-Centered Access to IBD Care: A Qualitative Study. CROHN'S & COLITIS 360 2022; 5:otac045. [PMID: 36777367 PMCID: PMC9825304 DOI: 10.1093/crocol/otac045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Indexed: 11/30/2022] Open
Abstract
Background Canada has the highest global age-adjusted incidence and prevalence rates of inflammatory bowel disease (IBD). Due to IBD patient volumes and limited resources, challenges to timely access to specialty care have emerged. To address this gap, the aim of this paper was to understand the experiences and perspectives of persons living with IBD with a focus on accessing health care. Methods Using a qualitative descriptive approach, patients diagnosed with IBD (≥18 years of age) were purposively sampled from rural and urban gastroenterology clinics and communities across Canada. Co-facilitated by a researcher and patient research partner, 14 focus groups were recorded, transcribed, and coded for themes. Thematic analysis was used to ascertain the congruence or discordance of IBD specialty care access experiences. Results A total of 63 individuals participated in the study. The majority of participants were female (41/63, 65%) and from urban/suburban regions (33/63, 52%), with a mean age of 48.39 (range 16-77 years). The analysis generated three main themes: (1) need for patient to be partner, (2) adapting IBD care access to individual context, and (3) patient-defined care priorities should guide access to IBD care. Conclusions The complexity of specialty care access for IBD patients cannot be underestimated. It is vital to possess a robust understanding of healthcare system structures, processes, and the impact of these factors on accessing care. Using a patient-centered exploration of barriers and facilitators, IBD specialty care access in Canada can be better understood and improved on provincial and national levels.
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Affiliation(s)
- Courtney Heisler
- QEII Health Sciences Centre, Division of Digestive Care & Endoscopy, Halifax, Canada
| | - Noelle Rohatinsky
- QEII Health Sciences Centre, Division of Digestive Care & Endoscopy, Halifax, Canada
| | - Raza M Mirza
- University of Saskatchewan, College of Nursing, Saskatoon, Canada
| | - Olga Kits
- University of Toronto, Institute for Life Course and Aging, Toronto, Canada
| | - Sandra Zelinsky
- Dalhousie University, Research Methods Unit, Halifax, Canada
| | | | - Geoffrey Nguyen
- University of Alberta, Faculty of Medicine and Dentistry, Edmonton, Canada
| | | | | | | | - Laura Targownik
- University of Alberta, Faculty of Medicine and Dentistry, Edmonton, Canada
| | | | - Kevin Rioux
- University of Saskatchewan, Saskatoon, Canada
| | - Jennifer Jones
- Address correspondence to: Jennifer Jones, MD, MSc, FRCPC, Room 932 Victoria Building, QEII Health Sciences Center, 1276 South Park Street, Halifax, Nova Scotia, B3H 2Y5 ()
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11
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Stemmer M, Parmet Y, Ravid G. Identifying Patients With Inflammatory Bowel Disease on Twitter and Learning From Their Personal Experience: Retrospective Cohort Study. J Med Internet Res 2022; 24:e29186. [PMID: 35917151 PMCID: PMC9382547 DOI: 10.2196/29186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 10/29/2021] [Accepted: 05/20/2022] [Indexed: 11/25/2022] Open
Abstract
Background Patients use social media as an alternative information source, where they share information and provide social support. Although large amounts of health-related data are posted on Twitter and other social networking platforms each day, research using social media data to understand chronic conditions and patients’ lifestyles is limited. Objective In this study, we contributed to closing this gap by providing a framework for identifying patients with inflammatory bowel disease (IBD) on Twitter and learning from their personal experiences. We enabled the analysis of patients’ tweets by building a classifier of Twitter users that distinguishes patients from other entities. This study aimed to uncover the potential of using Twitter data to promote the well-being of patients with IBD by relying on the wisdom of the crowd to identify healthy lifestyles. We sought to leverage posts describing patients’ daily activities and their influence on their well-being to characterize lifestyle-related treatments. Methods In the first stage of the study, a machine learning method combining social network analysis and natural language processing was used to automatically classify users as patients or not. We considered 3 types of features: the user’s behavior on Twitter, the content of the user’s tweets, and the social structure of the user’s network. We compared the performances of several classification algorithms within 2 classification approaches. One classified each tweet and deduced the user’s class from their tweet-level classification. The other aggregated tweet-level features to user-level features and classified the users themselves. Different classification algorithms were examined and compared using 4 measures: precision, recall, F1 score, and the area under the receiver operating characteristic curve. In the second stage, a classifier from the first stage was used to collect patients' tweets describing the different lifestyles patients adopt to deal with their disease. Using IBM Watson Service for entity sentiment analysis, we calculated the average sentiment of 420 lifestyle-related words that patients with IBD use when describing their daily routine. Results Both classification approaches showed promising results. Although the precision rates were slightly higher for the tweet-level approach, the recall and area under the receiver operating characteristic curve of the user-level approach were significantly better. Sentiment analysis of tweets written by patients with IBD identified frequently mentioned lifestyles and their influence on patients’ well-being. The findings reinforced what is known about suitable nutrition for IBD as several foods known to cause inflammation were pointed out in negative sentiment, whereas relaxing activities and anti-inflammatory foods surfaced in a positive context. Conclusions This study suggests a pipeline for identifying patients with IBD on Twitter and collecting their tweets to analyze the experimental knowledge they share. These methods can be adapted to other diseases and enhance medical research on chronic conditions.
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Affiliation(s)
- Maya Stemmer
- Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yisrael Parmet
- Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Gilad Ravid
- Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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12
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Su S, Marrie RA, Bernstein CN. Factors Associated With Social Participation in Persons Living With Inflammatory Bowel Disease. J Can Assoc Gastroenterol 2022; 5:59-67. [PMID: 35368323 PMCID: PMC8972209 DOI: 10.1093/jcag/gwab022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/29/2021] [Indexed: 12/25/2022] Open
Abstract
Background Inflammatory bowel disease (IBD) including Crohn’s disease (CD) and ulcerative colitis (UC) imposes a significant burden on health-related quality of life, particularly in social domains. We sought to investigate the factors that limit social participation in patients with IBD. Methods We assessed a cohort of 239 Manitobans with IBD. We collected sociodemographic information, medical comorbidities, disease phenotype, symptom activity and psychiatric comorbidity (using the Structured Clinical Interview for DSM-IV). Participants completed the eight-item Ability to Participate in Social Roles and Activities (APSRA) questionnaire, which assesses participation restriction, including problems experienced in social interaction, employment, transportation, community, social and civic life. Results Poorer social participation scores were associated with earning less than $50,000 CAD income annually (P < 0.001), actively smoking (P = 0.006), higher symptom scores (P < 0.001 for CD, P = 0.004 for UC), and having an increasing number of chronic medical conditions (R = −0.30). History of depression (P < 0.001) and anxiety (P = 0.001) and having active depression (P < 0.001) and anxiety (P = 0.001) all predicted poor social participation scores. IBD phenotype or disease duration was not predictive. Based on multivariable linear regression analysis, significant predictors of variability in social participation were medical comorbidity, psychiatric comorbidity, psychiatric symptoms and IBD-related symptoms. Conclusions The factors that predict social participation by IBD patients include income, smoking, medical comorbidities, IBD symptom burden, and psychiatric comorbidities. Multivariable linear regression suggests that the most relevant factors are medical comorbidity, psychiatric comorbidity, psychiatric symptoms and IBD symptoms.
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Affiliation(s)
- Samuel Su
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ruth Ann Marrie
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Charles N Bernstein
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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13
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Goren G, Schwartz D, Friger M, Banai H, Sergienko R, Regev S, Abu-Kaf H, Greenberg D, Nemirovsky A, Ilan K, Lerner L, Monsonego A, Dotan I, Yanai H, Eliakim R, Ben Horin S, Slonim-Nevo V, Odes S, Sarid O. Randomized Controlled Trial of Cognitive-Behavioral and Mindfulness-Based Stress Reduction on the Quality of Life of Patients With Crohn Disease. Inflamm Bowel Dis 2022; 28:393-408. [PMID: 33847758 DOI: 10.1093/ibd/izab083] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Patients with Crohn disease have debilitating psychological symptoms, mental fatigue, and poor quality of life. Psychological intervention may improve these symptoms. METHODS We performed a randomized parallel-group physician-blinded trial of cognitive-behavioral and mindfulness-based stress reduction (COBMINDEX) on quality of life and psychological symptoms in adults with mild-moderate Crohn disease. COBMINDEX was taught by social workers in one-on-one video conferences over 3 months; quotidian home practice was mandated. RESULTS Fifty-five COBMINDEX and 61 waitlist control patients completed the study; mean age was 33 years and 65% of participants were women. At 3 months, COBMINDEX patients had significantly reduced disease activity (per Harvey-Bradshaw Index score, C-reactive protein level, and calprotectin level), increased quality of life (Short Inflammatory Bowel Disease Questionnaire [SIBDQ] score increased from baseline 41 to 50; P < 0.001), decreased psychological symptoms (Global Severity Index [GSI], 0.98-0.70; P < 0.001), reduced fatigue (Functional Assessment of Chronic Illness Therapy-Fatigue, 26-33; P < 0.001), and increased mindfulness disposition (Freiburg Mindfulness Inventory, 33-38; P < 0.001). Waitlist patients had a significant but small change in Harvey-Bradshaw Index, SIBDQ, and GSI scores, without improvement in fatigue or mindfulness. There were significant correlations (0.02 > P < 0.002) in COBMINDEX patients between baseline SIBDQ, GSI, Freiburg Mindfulness Inventory, and Functional Assessment of Chronic Illness Therapy-Fatigue scores with a relative change (baseline to 3 months) of the SIBDQ score, but none among waitlist patients. Predictors of relative change of the SIBDQ score in COBMINDEX patients included the GSI score (90% quantile; coefficient 0.52; P < 0.001), somatization (90%; 0.20; P = 0.001), depression (75%; 0.16; P = 0.03), and phobic anxiety (75%; 0.31; P = 0.008). CONCLUSIONS COBMINDEX was effective in increasing patients' quality of life and reducing psychological symptoms and fatigue. Patients with severe baseline psychological symptoms benefited the most from COBMINDEX.
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Affiliation(s)
- Ganit Goren
- Spitzer Department of Social Work, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Doron Schwartz
- Department of Gastroenterology and Hepatology, Soroka Medical Center, Beer Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Michael Friger
- Department of Public Health, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Hagar Banai
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ruslan Sergienko
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Shirley Regev
- Spitzer Department of Social Work, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Heba Abu-Kaf
- Department of Gastroenterology and Hepatology, Soroka Medical Center, Beer Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Dan Greenberg
- Department of Health Systems Management, School of Public Health, Guilford Glazer Faculty of Business and Management, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Anna Nemirovsky
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Karny Ilan
- The Shraga Segal Department of Microbiology and Immunology, Faculty of Health Sciences, The National Institute for Biotechnology in the Negev, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Livnat Lerner
- The Shraga Segal Department of Microbiology and Immunology, Faculty of Health Sciences, The National Institute for Biotechnology in the Negev, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Alon Monsonego
- The Shraga Segal Department of Microbiology and Immunology, Faculty of Health Sciences, The National Institute for Biotechnology in the Negev, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Iris Dotan
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Henit Yanai
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rami Eliakim
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel
| | - Shomron Ben Horin
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel
| | - Vered Slonim-Nevo
- Spitzer Department of Social Work, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Shmuel Odes
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Orly Sarid
- Spitzer Department of Social Work, Ben-Gurion University of the Negev, Beer Sheva, Israel
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14
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The Experience of Self-conscious Emotions in Inflammatory Bowel Disease: A Thematic Analysis. J Clin Psychol Med Settings 2021; 29:344-356. [PMID: 34950988 PMCID: PMC9184437 DOI: 10.1007/s10880-021-09778-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2021] [Indexed: 11/01/2022]
Abstract
Few studies have investigated emotional experiences in people living with inflammatory bowel disease (IBD). However, self-conscious emotions, including embarrassment and shame, are indicated as a key factor in delayed help-seeking for bowel symptoms, which can result in poorer health outcomes. This study aimed to explore experiences of self-conscious emotions among people with IBD. Fifteen participants were recruited from outpatient IBD clinics and patient groups, and engaged in semi-structured interviews about their experiences of IBD-related self-consciousness. Data were analysed using thematic analysis following an inductive, semantic approach and conducted from a critical realist position. The analysis generated two themes, each with three sub-themes, which captured self-conscious emotions in relation to experiences which threatened participants' preferred identities. The first theme, 'Lack of control' encapsulated participants' distress relating to fundamental alteration in self-perception, and their attempts to mitigate this. The second, 'Lack of understanding' captured distress associated with awareness of being unfairly judged by other people. Clinical implications are identified, including consideration of therapeutic approaches which target self-conscious emotions such as shame, and continued societal efforts to educate others about invisible disabilities such as IBD. Experiences which threatened participants' identities were implicated in the generation of self-conscious emotions; these should be considered in work with clients with IBD. Future research should target further investigation of these constructs.
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15
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Koliouli F, Issari P, Mitrou A. Lived experiences of Idiopathic Inflammatory Bowel Disease (IBD) patients and the perceived impact of the COVID-19 pandemic. J Health Psychol 2021; 27:1379-1393. [PMID: 34875898 DOI: 10.1177/13591053211059382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The aim of this qualitative, experiential study is to explore the lived experiences of Idiopathic Inflammatory Bowel Disease (IBD) patients related to psycho-emotional, social, and professional dimensions of their lives in general and, secondly, how they are affected by the COVID-19 pandemic. Semi-structured interviews were conducted online on a sample of 10 IBD Greek-speaking patients by the end of the first lockdown period in Greece (June 2020). Thematic Analysis was employed. Research findings include participant psycho-emotional experiences, perceived social and work-related implications of the IBD disease, social support, and perceived positive outcomes in patients' lives, before and during the COVID-19 pandemic.
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Affiliation(s)
| | - Philia Issari
- National and Kapodistrian University of Athens, Greece
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16
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Muse K, Johnson E, David AL. A Feeling of Otherness: A Qualitative Research Synthesis Exploring the Lived Experiences of Stigma in Individuals with Inflammatory Bowel Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158038. [PMID: 34360327 PMCID: PMC8345596 DOI: 10.3390/ijerph18158038] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 07/21/2021] [Accepted: 07/22/2021] [Indexed: 12/18/2022]
Abstract
Inflammatory bowel disease (IBD) consists of Crohn’s disease and ulcerative colitis, chronic conditions involving inflammation and ulceration of the gastrointestinal tract. Individuals with IBD may be susceptible to experiencing health-related stigma: experienced, perceived, or internalised social exclusion, rejection, blame, or devaluation resulting from negative social judgements based on the disease. This qualitative research synthesis draws together findings from 38 studies describing lived experiences to develop a unified interpretative account of the experience of stigma in IBD. Analysis developed two categories: ‘The IBD journey’ explores the dynamic ways in which having IBD impacted on individuals’ self-identity and ‘a need to be understood’ examines the tension between wanting to be understood whilst feeling their true experiences needed to be hidden from or were misjudged by the social sphere. The overarching concept ‘feeling of otherness’ highlights that, rather than a static, binary experience, individuals moved across a continuum ranging from the excluding experience of feeling stigmatised and othered, to the inclusive experience of integration. Individuals fluctuated along this continuum across different physical, social, and health contexts. Psychological adjustment to IBD, drawing on experience of adaptive coping, and reconnecting with valued others through illness disclosure strengthened stigma resistance during more challenging times.
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Affiliation(s)
- Kate Muse
- School of Psychology, University of Worcester, Worcester WR2 6AJ, UK
- Correspondence:
| | - Emma Johnson
- Children’s Psychological Medicine, Oxford Children’s Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK; (E.J.); (A.L.D.)
| | - Annabel L. David
- Children’s Psychological Medicine, Oxford Children’s Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK; (E.J.); (A.L.D.)
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17
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Volpato E, Bosio C, Previtali E, Leone S, Armuzzi A, Pagnini F, Graffigna G. The evolution of IBD perceived engagement and care needs across the life-cycle: a scoping review. BMC Gastroenterol 2021; 21:293. [PMID: 34261434 PMCID: PMC8278693 DOI: 10.1186/s12876-021-01850-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 06/21/2021] [Indexed: 12/22/2022] Open
Abstract
Background The chronic and progressive evolution of Inflammatory Bowel Diseases (IBD), with its prototypical fluctuating trend, creates a condition of psycho-social discomfort, impacting the quality of life in terms of personal, working, and interpersonal. Aims In this article, we want to identify the nature and extent of the research evidence on the life experiences, the perceived engagement, the psychological, social care and welfare needs of people affected by IBD across the lifecycle. Methods Following the approach set out by Arksey and O’Malley and the PRISMA extension for scoping reviews, we conducted a scoping review in March 2019 and closed the review with an update in October 2019. It was performed using electronic databases covering Health and Life Sciences, Social Sciences and Medical Sciences, such as PubMed, Medline, Embase, Scopus, Cochrane, Web of Science, PsycInfo. Results We identified 95 peer-reviewed articles published from 2009 to 2019, that allowed to detection the main needs in children (psychological, need to be accepted, physical activity, feeding, parent style, support, social needs), adolescents (to understand, physical and psychological needs, protection, relational, gratitude, respect, and engagement) and adults (information, medical, psychological, social, work-related, practical, future-related, engagement). Although the literature confirms that the majority of the IBD units have planned provision for the different types of transitions, the quality and appropriateness of these services have not been assessed or audited for all the kinds of challenges across the life cycle. Conclusions The literature shows the relevance of organizing a flexible, personalized health care process across all the critical phases of the life cycle, providing adequate benchmarks for comparison in a multidisciplinary perspective and ensuring continuity between hospital and territory. Supplementary Information The online version contains supplementary material available at 10.1186/s12876-021-01850-1.
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Affiliation(s)
- E Volpato
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 1, 20123, Milan, Italy. .,IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy.
| | - C Bosio
- EngageMinds Hub Consumer, Food and Health Research Center, Università Cattolica del Sacro Cuore, Milan, Cremona, Italy
| | - E Previtali
- AMICI Onlus, Associazione nazionale per le Malattie Infiammatorie Croniche dell'Intestino, Milan, Italy
| | - S Leone
- AMICI Onlus, Associazione nazionale per le Malattie Infiammatorie Croniche dell'Intestino, Milan, Italy
| | - A Armuzzi
- Università Cattolica del Sacro Cuore di Roma, Rome, Italy.,IRCCS Policlinico Gemelli, Rome, Italy
| | - F Pagnini
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 1, 20123, Milan, Italy.,Department of Psychology, Harvard University, 33 Kirkland Street, Cambridge, MA, 02138, USA
| | - G Graffigna
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 1, 20123, Milan, Italy.,EngageMinds Hub Consumer, Food and Health Research Center, Università Cattolica del Sacro Cuore, Milan, Cremona, Italy
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18
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Avery P. Using e-health tools and PROMs to support self-management in patients with inflammatory bowel disease. ACTA ACUST UNITED AC 2021; 30:394-402. [PMID: 33830794 DOI: 10.12968/bjon.2021.30.7.394] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND The use of digital health or e-health is growing. The potential positive impact on IBD care from supported self-management using these tools emerged from a literature review carried out in preparation for a service improvement project. A patient-reported outcomes measure (PROM) with validation across IBD sub-types was already available for use. This internationally recognised tool has potential for use with existing or new e-health systems. AIMS In order to test the concept of using PROMs to support practice and follow up a small-scale pilot study was designed. The aim of the study was to understand if empowering patients to undertake supported self-management could lead in turn to improved flow through outpatient services. METHODS An audit was carried out of PROMs looking at quality of life (QoL) as well as disease activity using an electronic platform in real time at the point of patient contact. The disease activity indices used were the Harvey Bradshaw Index and the Simple Clinical Colitis Activity Index, due to the author's familiarity with these tools. RESULTS Of the 15 participants, 10 reported themselves as 'well' or 'well with questions' all participants reported an acceptance of supported remote self-management using e-health. CONCLUSION This evaluation led to PROMs being captured on a tablet in the outpatient setting in the pre-pandemic period. Allowing patients to use the PROM as a tool in the outpatient setting has led to longitudinal data being added to the e-health system for each individual. Well patients could be managed remotely, freeing capacity in outpatient clinics.
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Affiliation(s)
- Pearl Avery
- Patient Safety Practitioner, Dorset County Hospital Foundation Trust, Dorchester
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19
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Psychological Challenges for Patients With Inflammatory Bowel Disease During the COVID-19 Pandemic. Psychosom Med 2021; 83:397-398. [PMID: 33234778 DOI: 10.1097/psy.0000000000000888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Popov J, Farbod Y, Chauhan U, Kalantar M, Hill L, Armstrong D, Halder S, Marshall JK, Moayyedi P, Kaasalainen S. Patients' Experiences and Challenges in Living with Inflammatory Bowel Disease: A Qualitative Approach. Clin Exp Gastroenterol 2021; 14:123-131. [PMID: 33953591 PMCID: PMC8088978 DOI: 10.2147/ceg.s303688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 03/26/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Inflammatory bowel disease (IBD) significantly impacts patients' quality of life and imposes a considerable psychological, social, and financial burden. While the relationship between disease activity and quality of life is well established, the subjective challenges of living with IBD are more difficult to assess, and suggestions for improving patient experiences are lacking. The aim of this paper was to explore the various challenges patients encounter in living with IBD and to propose suggestions for overcoming them. PATIENTS AND METHODS This study utilized a qualitative descriptive design with thematic content analysis. Patients were recruited from the Gastroenterology Clinic at McMaster University Medical Centre from December 2014 to April 2015. Data were collected over the course of 5 focus group interviews using a semi-structured interview guide. RESULTS Seventeen patients aged 25 to 77 years old (mean age 43 years, SD 17 years) were interviewed. Fifteen patients were diagnosed with Crohn's disease and 2 patients were diagnosed with ulcerative colitis. Findings were categorized into 18 subthemes which were grouped into 4 broader themes: awareness factor, psychosocial impacts, financial burden, and quality of care. CONCLUSION IBD is associated with complex personal challenges across various demographics. Identifying and meeting the unique needs of individual patients may be achieved through improving communication between patients and their healthcare providers. Family-based education approaches, individualized psychotherapy with therapists familiar with IBD, awareness initiatives addressed to important stakeholders, and patient involvement in community support groups may improve overall IBD care.
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Affiliation(s)
- Jelena Popov
- Hamilton Health Sciences, Adult Digestive Diseases, Hamilton, Ontario, Canada
- University College Cork, College of Medicine and Health, Cork, Ireland
| | - Yasamin Farbod
- Hamilton Health Sciences, Adult Digestive Diseases, Hamilton, Ontario, Canada
| | - Usha Chauhan
- Hamilton Health Sciences, Adult Digestive Diseases, Hamilton, Ontario, Canada
| | - Mona Kalantar
- Hamilton Health Sciences, Adult Digestive Diseases, Hamilton, Ontario, Canada
- University College Cork, College of Medicine and Health, Cork, Ireland
| | - Lee Hill
- Department of Pediatrics, McMaster University Medical Centre, Hamilton, Ontario, Canada
| | - David Armstrong
- Department of Medicine (Division of Gastroenterology) and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Smita Halder
- Department of Medicine (Division of Gastroenterology) and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - John K Marshall
- Department of Medicine (Division of Gastroenterology) and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Paul Moayyedi
- Department of Medicine (Division of Gastroenterology) and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
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21
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Whelan K, Murrells T, Morgan M, Cummings F, Stansfield C, Todd A, Sebastian S, Lobo A, Lomer MCE, Lindsay JO, Czuber-Dochan W. Food-related quality of life is impaired in inflammatory bowel disease and associated with reduced intake of key nutrients. Am J Clin Nutr 2021; 113:832-844. [PMID: 33677550 DOI: 10.1093/ajcn/nqaa395] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 11/24/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Inflammatory bowel disease (IBD) may impact the extent to which food, eating, and drinking bring satisfaction and enjoyment to peoples' lives, and this may impact dietary intake. The prevalence of an impaired food-related quality of life (FR-QoL), its associated factors, and its impact on diet have not been explored. OBJECTIVES To measure the prevalence and nature of the burden of impaired FR-QoL in people with IBD, the factors associated with these, and their associations with nutrient intake. METHODS We recruited 1576 outpatients with IBD (≥16 years old) in person from 7 IBD centers across the United Kingdom. Patients completed validated questionnaires to measure their FR-QoL, quality of life (QoL), distress, fatigue, anxiety, and depression. Dietary intake was recorded using the European Prospective Investigation into Cancer FFQ. A health professional recorded disease activity, Montreal classification, blood results, BMI, and malnutrition risk. FR-QoL was regressed onto explanatory variables using univariable and multivariable analyses. RESULTS Data from 1221 patients were available (77.4% response; Crohn's disease, 65%; ulcerative colitis, 35%). The FR-QoL mean (± SD) score was 80.8 ± 26.9, with wide ranges (minimum, 29; maximum, 145). Following multivariable regression, the strongest associations with FR-QoL were the number of recent disease flares (5 flares β = -12.7; P < 0.001), the IBD-specific QoL (β = 0.33; P < 0.001), and IBD-related distress (β = -0.26; P < 0.001). Patients with poorer FR-QoL had lower intakes of fiber (nonstarch polysaccharide; Q1 to Q5 difference = 2.1 g/d; 95% CI: 0.4-3.8; P = 0.048), calcium (192.6 mg/d; 95% CI: 112.5-272.6; P < 0.001), phosphorus (167 mg/d; 95% CI: 58-276; P = 0.041), and magnesium (34.4 mg/d; 95% CI: 9.3-59.4; P = 0.041). CONCLUSIONS Impaired FR-QoL is prevalent in IBD and is associated with recurrent disease flares, a reduced IBD-specific QoL, and greater IBD-related distress. A poorer FR-QoL was associated with lower intakes of key nutrients of importance to IBD, including those relating to gut health and bone mineralization.
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Affiliation(s)
- Kevin Whelan
- Department of Nutritional Sciences, King's College London, London, United Kingdom
| | - Trevor Murrells
- Florence Nightingale Faculty of Nursing, Midwifery, and Palliative Care, King's College London, London, United Kingdom
| | - Myfanwy Morgan
- Institute of Pharmaceutical Science, King's College London, London, United Kingdom
| | - Fraser Cummings
- University Southampton Hospital National Health Service (NHS) Foundation Trust, Southampton, United Kingdom
| | | | - Anne Todd
- NHS Forth Valley, Forth Valley Royal Hospital, Larbert, United Kingdom
| | - Shaji Sebastian
- Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
- Hull York Medical School, Hull, United Kingdom
| | - Alan Lobo
- Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, United Kingdom
| | - Miranda C E Lomer
- Department of Nutritional Sciences, King's College London, London, United Kingdom
- Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - James O Lindsay
- Bart's Health NHS Trust, London, United Kingdom
- Queen Mary University of London, Blizard Institute, London, United Kingdom
| | - Wladyslawa Czuber-Dochan
- Department of Nutritional Sciences, King's College London, London, United Kingdom
- Florence Nightingale Faculty of Nursing, Midwifery, and Palliative Care, King's College London, London, United Kingdom
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22
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Schulz-Kuhnt A, Neurath MF, Wirtz S, Atreya I. Innate Lymphoid Cells as Regulators of Epithelial Integrity: Therapeutic Implications for Inflammatory Bowel Diseases. Front Med (Lausanne) 2021; 8:656745. [PMID: 33869257 PMCID: PMC8044918 DOI: 10.3389/fmed.2021.656745] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 03/05/2021] [Indexed: 02/06/2023] Open
Abstract
The occurrence of epithelial defects in the gut relevantly contributes to the pathogenesis of inflammatory bowel diseases (IBD), whereby the impairment of intestinal epithelial barrier integrity seems to represent a primary trigger as well as a disease amplifying consequence of the chronic inflammatory process. Besides epithelial cell intrinsic factors, accumulated and overwhelmingly activated immune cells and their secretome have been identified as critical modulators of the pathologically altered intestinal epithelial cell (IEC) function in IBD. In this context, over the last 10 years increasing levels of attention have been paid to the group of innate lymphoid cells (ILCs). This is in particular due to a preferential location of these rather newly described innate immune cells in close proximity to mucosal barriers, their profound capacity to secrete effector cytokines and their numerical and functional alteration under chronic inflammatory conditions. Aiming on a comprehensive and updated summary of our current understanding of the bidirectional mucosal crosstalk between ILCs and IECs, this review article will in particular focus on the potential capacity of gut infiltrating type-1, type-2, and type-3 helper ILCs (ILC1s, ILC2s, and ILC3s, respectively) to impact on the survival, differentiation, and barrier function of IECs. Based on data acquired in IBD patients or in experimental models of colitis, we will discuss whether the different ILC subgroups could serve as potential therapeutic targets for maintenance of epithelial integrity and/or mucosal healing in IBD.
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Affiliation(s)
- Anja Schulz-Kuhnt
- Department of Medicine 1, University Hospital of Erlangen, Erlangen, Germany
| | - Markus F. Neurath
- Department of Medicine 1, University Hospital of Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Erlangen, Germany
| | - Stefan Wirtz
- Department of Medicine 1, University Hospital of Erlangen, Erlangen, Germany
| | - Imke Atreya
- Department of Medicine 1, University Hospital of Erlangen, Erlangen, Germany
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Mukherjee S, Beresford B, Atkin K, Sebastian S. The Need for Culturally Competent Care Within Gastroenterology Services: Evidence from Research with Adults of South Asian Origin Living with Inflammatory Bowel Disease. J Crohns Colitis 2021; 15:14-23. [PMID: 32577761 DOI: 10.1093/ecco-jcc/jjaa117] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIMS It is widely acknowledged that the incidence of inflammatory bowel disease [IBD] is rising within South Asian populations, yet research into the experiences of this group of patients is rare. In this study the lived experiences of UK South Asian adults with IBD, including support from gastroenterology services, was investigated. METHODS A sample of 33 patients representing the diversity of the UK South Asian population were recruited through five gastroenterology clinics in England. In-depth semi-structured interviews were conducted, audio-recorded, transcribed and analysed using the Framework approach. RESULTS Although many experiences align with those of the general IBD population, participants believed that South Asian cultures and/or religions can lead to additional challenges. These are linked to: family and friends' understanding of IBD; self and family attributions regarding IBD; stigma surrounding ill health; the taboo of bowel symptoms; managing 'spicy food'; beliefs about food and ill health; roles within the family; living with extended family; the use of complementary and alternative therapies; and visits to family overseas. Religious faith helped many to cope with having IBD, but symptoms could hamper their ability to practise faith. Gastroenterology services were viewed positively, but unmet needs were identified, some of which were culturally specific. CONCLUSION Gastroenterology services have an important role to play in helping patients to overcome the challenges they encounter in their everyday life, both by providing individual patients with culturally appropriate care and advice, and via interventions to increase awareness and understanding of IBD within wider South Asian communities.
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Affiliation(s)
| | | | - Karl Atkin
- Health Sciences, University of York, York, UK
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Richard L, Noller G, Derrett S, Sullivan T, Doolan-Noble F, McCombie A, Schultz M, Ho C, Stokes T. Patients' accounts of living with and managing inflammatory bowel disease in rural Southern New Zealand: a qualitative study. BMJ Open 2020; 10:e041789. [PMID: 33184085 PMCID: PMC7662529 DOI: 10.1136/bmjopen-2020-041789] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To explore how adults living with inflammatory bowel disease (IBD) in rural New Zealand manage their condition and engage with healthcare providers. DESIGN Qualitative exploratory design with semi-structured interviews analysed thematically. SETTING AND PARTICIPANTS Interviews were conducted with 18 people living with IBD in the Otago region of the South Island. RESULTS Five important constructs were identified: (1) journey to confirming and accepting diagnosis; (2) importance of the relationship with the healthcare team; (3) support from others; (4) learning how to manage IBD and (5) care at a distance-experiences of rurality. Pathways to confirming diagnosis involved two contrasting journeys: a long and slow process where diagnosis remained unclear for a prolonged period, and a more acute process where diagnosis typically came as a shock. Central to the acceptance process was acknowledging the chronicity of the condition, which involved feelings of grief but also the fear of judgement and stigma. Building a strong relationship with the specialist was central to medical management, particularly in the initial stage following diagnosis. Support from others was critical, enabling participants to progress through acceptance of the disease and developing confidence in its everyday management. Participants shared different strategies on how to manage IBD, describing a 'trial and error' process of 'finding what is right' at different stages of the condition. Managing IBD rurally involved challenges of access to specialist care, with perceptions of delayed referrals and concerns about disparities in specialist access compared with urban counterparts. Rural living also had financial implications-cost of time and cost of mobilising resources for long travels to the urban centre for treatments. CONCLUSIONS Findings from this study provide a rich understanding of the complex health journeys of people living with IBD and the challenges of managing the condition rurally.
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Affiliation(s)
- Lauralie Richard
- Department of General Practice & Rural Health, Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Geoff Noller
- Department of General Practice & Rural Health, Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Sarah Derrett
- Department of Preventive & Social Medicine, Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Trudy Sullivan
- Department of Preventive & Social Medicine, Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Fiona Doolan-Noble
- Department of General Practice & Rural Health, Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Andrew McCombie
- Department of Medicine, Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Michael Schultz
- Department of Medicine, Otago Medical School, University of Otago, Dunedin, New Zealand
- Department of Gastroenterology, Southern District Health Board, Dunedin, New Zealand
| | - Christine Ho
- Department of Gastroenterology, Southern District Health Board, Dunedin, New Zealand
| | - Tim Stokes
- Department of General Practice & Rural Health, Otago Medical School, University of Otago, Dunedin, New Zealand
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Towards understanding how individuals with inflammatory bowel disease use contemporary social media platforms for health-related discourse. COMPUTERS IN HUMAN BEHAVIOR 2020. [DOI: 10.1016/j.chb.2020.106463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Ma S, Veysey M, Ersser S, Mason-Jones A, Galdas P. The impact of inflammatory bowel disease on sexual health in men: A scoping review. J Clin Nurs 2020; 29:3638-3651. [PMID: 32668025 DOI: 10.1111/jocn.15418] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 06/09/2020] [Accepted: 07/10/2020] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To review the literature on the impact of inflammatory bowel disease on the sexual health of men and make recommendations for nursing practice and research. BACKGROUND Inflammatory bowel disease is a chronic condition of the gastrointestinal tract, causing symptoms that may impact upon sexual health. Specialist nurses are well positioned to assess and manage sexual health, but there is a lack of clinical guidance, especially in relation to men. DESIGN A systematic scoping review following the Arksey and O'Malley (International Journal of Social Research Methodology, 8, 2005, 19) framework reported in line with the PRISMA-ScR checklist (Tricco et al., Annals of Internal Medicine, 169, 2018, 467). METHODS OVID MEDLINE ALL [R], OVID EMBASE [R], OVID PsychINFO, EBSCO CINAHL Complete, The Cochrane Library and ProQuest were searched. Inclusion and exclusion criteria were applied independently by two reviewers. Data were extracted, charted and summarised from eligible studies. RESULTS Thirty-one studies met the inclusion criteria. These were synthesised under three categories: mediators, moderators and descriptors of sexual health. Depression, disease activity and surgery were the most commonly cited disease-related factors to affect sexual health in men. The most commonly used assessment tool was The International Index of Erectile Function. Descriptors of function included frequency of intercourse, libido and the ability to maintain a desired sexual role. CONCLUSIONS The effect of inflammatory bowel disease on sexual health in men involves a complex interaction of physical and psychosocial factors. Researchers must explore areas outside of erectile function to understand how the disease impacts sexuality, sexual well-being and masculinity. This can be achieved through qualitative exploration of patient, partner and health professional experiences. RELEVANCE TO CLINICAL PRACTICE A holistic nursing assessment of men with inflammatory bowel disease should include sexual health. Developing understanding of how the disease influences sexual interaction and expression will facilitate support that is relevant, accessible and of value to men living with the disease.
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Affiliation(s)
- Sara Ma
- Department of Health Sciences, University of York, York, UK.,Gastroenterology Department, York Teaching Hospital NHS Foundation Trust, York, UK
| | - Martin Veysey
- Gastroenterology Department, York Teaching Hospital NHS Foundation Trust, York, UK.,Hull York Medical School, University of Hull, Hull, UK
| | - Steven Ersser
- Department of Nursing Science, Bournemouth University, Poole, UK
| | | | - Paul Galdas
- Department of Health Sciences, University of York, York, UK
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Schliep M, Chudy-Onwugaje K, Abutaleb A, Langenberg P, Regueiro M, Schwartz DA, Tracy JK, Ghazi L, Patil SA, Quezada S, Russman K, Horst S, Beaulieu D, Quinn C, Jambaulikar G, Cross RK. TELEmedicine for Patients With Inflammatory Bowel Disease (TELE-IBD) Does Not Improve Depressive Symptoms or General Quality of Life Compared With Standard Care at Tertiary Referral Centers. CROHN'S & COLITIS 360 2020; 2:otaa002. [PMID: 32201859 PMCID: PMC7067223 DOI: 10.1093/crocol/otaa002] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Depression is common in patients with inflammatory bowel disease (IBD) and contributes to poor quality of life (QoL). The use of information technology for the remote management of patients with IBD is growing, but little is known about its impact on depressive symptoms (DS) and QoL. We aimed to evaluate the impact of telemedicine on DS and generic QoL in IBD patients. METHODS We analyzed data from the Telemedicine for Patients with IBD (TELE-IBD) study. During this 12-month clinical trial, patients were randomized to receive text message-based telemedicine weekly (TELE-IBD W), every other week (TELE-IBD EOW), or to standard care. Depressive symptoms and QoL were assessed over time with the Mental Health Inventory 5 (MHI-5) and the Short Form 12 (SF-12), respectively. We compared the change in MHI-5 and SF-12 (with separate physical (PCS) and mental component summary (MCS) scores) between the study arms. RESULTS A total of 217 participants were included in this analysis. After 1 year, there was no significant difference in the change in MHI-5 (TELE-IBD W +3.0 vs TELE-IBD EOW +0.7 vs standard care +3.4; P = 0.70), MCS (TELE-IBD W +1.4 vs TELE-IBD EOW +1.0 vs standard care +2.5; P = 0.89), and PCS scores (TELE-IBD W +0.4 vs TELE-IBD EOW +0.6 vs standard care +3.7; P = 0.06) between the groups. CONCLUSIONS Text message-based telemedicine does not improve DS or QoL when compared with standard care in IBD patients treated at tertiary referral centers. Further studies are needed to determine whether telemedicine improves DS or QoL in settings with few resources.
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Affiliation(s)
- Matthew Schliep
- School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Kenechukwu Chudy-Onwugaje
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Ameer Abutaleb
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Patricia Langenberg
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, Maryland, USA
| | - Miguel Regueiro
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, Ohio, USA
| | - David A Schwartz
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - J Kathleen Tracy
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, Maryland, USA
| | - Leyla Ghazi
- Department of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Seema A Patil
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Sandra Quezada
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Katharine Russman
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Sara Horst
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Dawn Beaulieu
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Charlene Quinn
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, Maryland, USA
| | - Guruprasad Jambaulikar
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Raymond K Cross
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland, Baltimore, Maryland, USA,Address correspondence to: Raymond K. Cross, MD, MS, 685 West Baltimore Street, Suite 8-00, Baltimore, MD 21201, Phone: 410-706-3387, Fax: 410-706-4430,
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Ma S. Nurses should recognise that focusing only on the resolution of physical symptoms may not be enough to overcome the psychosocial implications of living with a chronic disease. Evid Based Nurs 2020; 24:6. [PMID: 31959724 DOI: 10.1136/ebnurs-2019-103245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Sara Ma
- Inflammatory Bowel Disease Specialist Nurses, York Teaching Hospital NHS Foundation Trust, York, UK
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Toye F, Barker KL. A meta-ethnography to understand the experience of living with urinary incontinence: 'is it just part and parcel of life?'. BMC Urol 2020; 20:1. [PMID: 31941470 PMCID: PMC6964106 DOI: 10.1186/s12894-019-0555-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 11/08/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Urinary incontinence (UI) is highly prevalent and affects the lives of many men and women. We aimed to conduct a qualitative evidence synthesis (QES) to explore the experience of living with UI and to develop a conceptual model that can help us to understand this experience, and the potential barriers to appropriate healthcare. METHODS We used the methods of meta-ethnography developed by Noblit and Hare and recently refined for larger studies. Meta-ethnography involves identifying concepts from the studies and abstracting these concepts into a line of argument. We searched for studies that explored the experience of adults with UI. We used the GRADE-CERQual framework to assess confidence in review findings. RESULTS We screened 2307 titles, 429 abstracts, 107 full texts and included 41 studies (36 unique samples) in the synthesis. We organised the concepts into 26 conceptual categories, which we further abstracted into 6 themes: (1) Am I ill or is this normal? (2) It effects who I am and how I feel; (3) I feel stigmatised, ashamed and guilty; (4) talking can be difficult but it can help; (5) keeping incontinence under control; (6) have I got to the point that I need help? Our model conceptualises living with UI as navigating antagonists: Is UI normal or am I ill? Do I need help or am I managing? Do I keep UI to myself (and manage alone) or do I tell other people (and get the support that I need)? Do I use control strategies that focus on concealing (avoid risky situations, wear pads) versus, I use strategies that focus on improving the bodily function to improve continence. Our model highlights the experience of stigma, shame and guilt which exert a pull towards concealment. CONCLUSIONS The culture of secrecy and profound sense of shame is barrier to seeking help. An environment which reduces the shame and stigma of UI may help people to switch the focus to strategies that will improve continence, rather than conceal incontinence.
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Affiliation(s)
- Francine Toye
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Windmill Road, Oxford, OX3 7HE UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Karen L. Barker
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Windmill Road, Oxford, OX3 7HE UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
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Sattoe JNT, Peeters MAC, Haitsma J, van Staa A, Wolters VM, Escher JC. Value of an outpatient transition clinic for young people with inflammatory bowel disease: a mixed-methods evaluation. BMJ Open 2020; 10:e033535. [PMID: 31911522 PMCID: PMC6955474 DOI: 10.1136/bmjopen-2019-033535] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Developing and evaluating effective transition interventions for young people (16-25 years) with inflammatory bowel disease (IBD) is a high priority. While transition clinics (TCs) have been recommended, little is known about their operating structures and outcomes. This study aimed to gain insight into the value of a TC compared with direct handover care. DESIGN Controlled mixed-methods evaluation of process outcomes, clinical outcomes and patient-reported outcomes. SETTING Two outpatient IBD clinics in the Netherlands. PARTICIPANTS Data collection included: semistructured interviews with professionals (n=8), observations during consultations with young people (5×4 hours), medical chart reviews of patients transferred 2 to 4 years prior to data collection (n=56 in TC group; n=54 in control group) and patient questionnaires (n=14 in TC group; n=19 in control group). OUTCOMES Data were collected on service structures and daily routines of the TC, experienced barriers, facilitators and benefits, healthcare use, clinical outcomes, self-management outcomes and experiences and satisfaction of young people with IBD. RESULTS At the TC, multidisciplinary team meetings and alignment of care between paediatric and adult care providers were standard practice. Non-medical topics received more attention during consultations with young people at the TC. Barriers experienced by professionals were time restrictions, planning difficulties, limited involvement of adult care providers and insufficient financial coverage. Facilitators experienced were high professional motivation and a high case load. Over the year before transfer, young people at the TC had more planned consultations (p=0.015, Cohen's d=0.47). They showed a positive trend in better transfer experiences and more satisfaction. Those in direct handover care more often experienced a relapse before transfer (p=0.003) and had more missed consultations (p=0.034, Cohen's d=-0.43) after transfer. CONCLUSION A TC offer opportunities to improve transitional care, but organisational and financial barriers need to be addressed before guidelines and consensus statements in healthcare policy and daily practice can be effectively implemented.
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Affiliation(s)
- Jane N T Sattoe
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Mariëlle A C Peeters
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Jannie Haitsma
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - AnneLoes van Staa
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Victorien M Wolters
- Department of Pediatric Gastroenterology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Johanna C Escher
- Department of Pediatric Gastroenterology, Erasmus Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands
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Cao Q, Huang YH, Jiang M, Dai C. The prevalence and risk factors of psychological disorders, malnutrition and quality of life in IBD patients. Scand J Gastroenterol 2019; 54:1458-1466. [PMID: 31791216 DOI: 10.1080/00365521.2019.1697897] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background: Inflammatory bowel disease (IBD) patients show an increased risk for psychological disorders, malnutrition and impaired quality of life (QoL), which can result in adverse clinical outcomes. The aim of this study is to explore the prevalence and risk factors of psychological disorders, malnutrition and QoL in IBD patients.Methods: All participants were recruited to fill out the questionnaires including inflammatory bowel disease questionnaire (IBDQ), perceived social support scale, HADS (Hospital Anxiety and Depression Scale), Cohen Perceived Stress Scale, NRS2002 (Nutritional Risk Screening 2002), Crohn's disease activity index, Modified Truelove and Witts Activity Index, dietary beliefs and behaviors. Demographic and clinical characteristics were extracted from electronic medical records. Multivariate regression model was performed to identify the risk factors for psychological disorders, malnutrition and QoL.Results: A total of 78 inpatients were enrolled in this study, 76 (97.4%) of IBD patients had anxiety, 71 (91%) had depressive. Forty six (59.0%) were screened at risk of malnutrition. The mean score of IBDQ was 131.51 ± 36.136. In the multivariate analysis, higher disease activity and history treated with steroids in the last year were associated with anxiety; higher disease activity was related to depressive. Higher disease activity and avoiding certain foods during disease flares were associated with high risk of malnutrition. Unemployment/no schooling status, higher disease activity and lower social support were associated with lower IBDQ score.Conclusions: The high prevalence of psychological disorders and malnutrition were found in IBD patients, and thereby negatively affect QoL. Disease activity was significantly associated with psychological disorders, risk of malnutrition and impaired QoL. And avoiding certain foods was related to risk of malnutrition.
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Affiliation(s)
- Qin Cao
- Department of Gastroenterology, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, China
| | - Yu-Hong Huang
- Department of Gastroenterology, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, China
| | - Min Jiang
- Department of Gastroenterology, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, China
| | - Cong Dai
- Department of Gastroenterology, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, China
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van den Brink G, Stapersma L, Bom AS, Rizopolous D, van der Woude CJ, Stuyt RJL, Hendriks DM, van der Burg JAT, Beukers R, Korpershoek TA, Theuns-Valks SDM, Utens EMWJ, Escher JC. Effect of Cognitive Behavioral Therapy on Clinical Disease Course in Adolescents and Young Adults With Inflammatory Bowel Disease and Subclinical Anxiety and/or Depression: Results of a Randomized Trial. Inflamm Bowel Dis 2019; 25:1945-1956. [PMID: 31050763 PMCID: PMC7006993 DOI: 10.1093/ibd/izz073] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Anxiety and depressive symptoms are prevalent in patients with inflammatory bowel disease (IBD) and may negatively influence disease course. Disease activity could be affected positively by treatment of psychological symptoms. We investigated the effect of cognitive behavioral therapy (CBT) on clinical disease course in 10-25-year-old IBD patients experiencing subclinical anxiety and/or depression. METHODS In this multicenter parallel group randomized controlled trial, IBD patients were randomized to disease-specific CBT in addition to standard medical care (CBT + care us usual [CAU]) or CAU only. The primary outcome was time to first relapse in the first 12 months. Secondary outcomes were clinical disease activity, fecal calprotectin, and C-reactive protein (CRP). Survival analyses and linear mixed models were performed to compare groups. RESULTS Seventy patients were randomized (CBT+CAU = 37, CAU = 33), with a mean age of 18.3 years (±50% < 18 y, 31.4% male, 51.4% Crohn's disease, 93% in remission). Time to first relapse did not differ between patients in the CBT+CAU group vs the CAU group (n = 65, P = 0.915). Furthermore, clinical disease activity, fecal calprotectin, and CRP did not significantly change over time between/within both groups. Exploratory analyses in 10-18-year-old patients showed a 9% increase per month of fecal calprotectin and a 7% increase per month of serum CRP in the CAU group, which was not seen in the CAU+CBT group. CONCLUSIONS CBT did not influence time to relapse in young IBD patients with subclinical anxiety and/or depression. However, exploratory analyses may suggest a beneficial effect of CBT on inflammatory markers in children.
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Affiliation(s)
- Gertrude van den Brink
- Department of Pediatric Gastroenterology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Luuk Stapersma
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Anna Sophia Bom
- Department of Pediatric Gastroenterology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, the Netherlands
| | | | | | - Rogier J L Stuyt
- Department of Gastroenterology, Haga Hospital, Den Haag, the Netherlands
| | - Danielle M Hendriks
- Department of Pediatrics, Juliana Children’s Hospital, Den Haag, the Netherlands
| | | | - Ruud Beukers
- Department of Gastroenterology, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Thea A Korpershoek
- Department of Gastroenterology, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | | | - Elisabeth M W J Utens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, the Netherlands
- Research Institute of Child Development and Education, University of Amsterdam, the Netherlands
- Academic Center for Child Psychiatry the Bascule/Department of Child and Adolescent Psychiatry, Academic Medical Center, Amsterdam, the Netherlands
| | - Johanna C Escher
- Department of Pediatric Gastroenterology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, the Netherlands
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Byron C, Cornally N, Burton A, Savage E. Challenges of living with and managing inflammatory bowel disease: A meta-synthesis of patients' experiences. J Clin Nurs 2019; 29:305-319. [PMID: 31631440 DOI: 10.1111/jocn.15080] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 07/31/2019] [Accepted: 09/29/2019] [Indexed: 12/28/2022]
Abstract
AIMS AND OBJECTIVES To examine qualitative studies which reported on patients' challenges of living with and managing inflammatory bowel disease (IBD). BACKGROUND There is a growing body of qualitative research focusing on the subjective experiences of patients with IBD. This research points to the daily challenges that patients experience which can relate to their physical and psychological health, as well as their social well-being, and may impact negatively on their lives. To date, there has been little attempt to synthesise these studies, and little is known about how patients manage the challenges they experience. DESIGN A meta-synthesis was conducted, based on guidelines developed by Sandelowski and Barroso (Handbook for synthesizing qualitative research, Springer, New York, NY, 2007) and PRISMA (Int J Surg, 8, 2009, 336). METHODS Searches were conducted within the CINAHL, MEDLINE, PsycINFO, Psychology and Behavioural Sciences Collection and SocINDEX databases to locate qualitative and mixed methodology studies. The retrieved articles were screened against predetermined inclusion criteria. Quality appraisal was assessed using the Joanna Briggs Institute critical appraisal tool for qualitative research (Int J Evid Based Healthc, 13, 2015, 179). RESULTS Thematic analysis resulted in three themes: the unpredictability of living with IBD, the emotional turmoil of living with IBD and striving to maintain a normal life in managing IBD. CONCLUSION The greatest challenges for patients identified in this meta-synthesis were the physical symptoms associated with IBD. These impacted negatively on their psychological and social well-being and reduced their quality of life. There is a notable gap in research on patient experiences of managing the challenges identified in everyday life and to what extent they receive support from healthcare professionals. RELEVANCE TO CLINICAL PRACTICE The results of this meta-synthesis offer insights into how the physical challenges of living with IBD, particularly in relation to symptoms, impact adversely on patients' psychological and social well-being. These insights are clinically relevant to healthcare professionals as a basis for supporting patients to manage their challenges.
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Affiliation(s)
- Clodagh Byron
- Cork University Hospital, University College Cork, Cork, Ireland.,University College Cork, Cork, Ireland
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Abstract
BACKGROUND Inflammatory bowel disease (IBD) is an incurable autoimmune disease causing overwhelming physical distress and psychological adaptation. PURPOSE To explore the associations between foundational influences and personal characteristics predictors to the achievement of mastery of health in patients with IBD. THEORY Orem's Theory of Self-Care, Resnick's Theory of Self-Efficacy, and Pearlin and Schooler's study of the structure of coping guided this study. The conceptual framework used was the Functional Mastery of Health Ownership (FMHO) model. METHODS A predictive correlational study design using self-administered questionnaires was used. A convenience sample of 151 adults with a diagnosis of IBD for at least 1 year was recruited from the patient population of a gastroenterology medical practice. RESULTS Data were analyzed using multiple regression with standard entry factor loading. Portions of the model were found to be significant and account for 44% of the variance (p < .001; R 2 = .44, Adjusted R 2 = .41). Significant relationships were found among mastery and IBD self-efficacy, perception of mastery, and current health status. Females had higher mastery scores than males. SIGNIFICANCE These findings support the use of a modified FMHO model to predict needs that enable individualized stewardship of health for patients with IBD.
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Kamp K, Dudley-Brown S, Heitkemper M, Wyatt G, Given B. Symptoms among emerging adults with inflammatory bowel disease: a descriptive study. Res Nurs Health 2019; 43:48-55. [PMID: 31599462 DOI: 10.1002/nur.21985] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 09/19/2019] [Indexed: 12/13/2022]
Abstract
Individuals with inflammatory bowel disease (IBD) are commonly diagnosed when they are between the ages of 18-29, a developmental period known as emerging adulthood. Typically, emerging adults are subsumed into the category of adults even though emerging adults have unique developmental needs. In this descriptive study of IBD in emerging adults, the aims were to (a) determine the prevalence of symptoms; (b) describe the severity of symptoms and their interference with daily activities; and (c) examine the association between individual symptom severity and presence of fatigue. Emerging adults with IBD were recruited using web-based convenience sampling. Sixty-one individuals met the inclusion criteria. They had a mean age of 24.7 and a disease duration of 6.4 years. The most prevalent symptoms reported were: fatigue (n = 44, 72.1%), abdominal cramps (n = 39, 63.9%), abdominal pain (n = 39, 63.9%), and diarrhea (n = 38, 62.3%). The symptom with the greatest severity and interference with daily activities was fatigue. Abdominal cramps, abdominal pain, diarrhea, passing gas, and abdominal tenderness were associated with fatigue when controlling for age, emerging adulthood, gender, time since diagnosis, and current steroid use. Among emerging adults with IBD, fatigue is the most prevalent symptom and is the symptom with the greatest severity and interference with daily activities. These results suggest a need for interventions aimed at reducing both fatigue and gastrointestinal symptoms among emerging adults with IBD.
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Affiliation(s)
- Kendra Kamp
- Division of Gastroenterology, University of Washington, Seattle, Washington
| | | | - Margaret Heitkemper
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, Washington
| | - Gwen Wyatt
- School of Nursing, Michigan State University, East Lansing, Michigan
| | - Barbara Given
- School of Nursing, Michigan State University, East Lansing, Michigan
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Modelo de intervención psicológica para pacientes con enfermedad inflamatoria intestinal. REVISTA MÉDICA CLÍNICA LAS CONDES 2019. [DOI: 10.1016/j.rmclc.2019.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Leone D, Gilardi D, Corrò BE, Menichetti J, Vegni E, Correale C, Mariangela A, Furfaro F, Bonovas S, Peyrin-Biroulet L, Danese S, Fiorino G. Psychological Characteristics of Inflammatory Bowel Disease Patients: A Comparison Between Active and Nonactive Patients. Inflamm Bowel Dis 2019; 25:1399-1407. [PMID: 30689871 DOI: 10.1093/ibd/izy400] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIMS The role of new psychological factors such as psychopathological patterns and defense mechanisms in the care of inflammatory bowel disease (IBD) has been poorly investigated. We aimed to assess the psychological characteristics and defense mechanisms of IBD patients. METHODS This was a single-center, observational, cross-sectional study. Consecutive adult IBD patients were enrolled and stratified according to disease activity. Sociodemographic and clinical data were collected, and validated questionnaires (Symptom Checklist-90-R [SCL-90-R]) for psychological distress, Defense Mechanism Inventory (DMI) for psychological defense mechanisms, and Inflammatory Bowel Disease Questionnaire (IBDQ) for quality of life (QoL) were administered. RESULTS Two hundred one patients were enrolled: 101 in remission and 100 with active disease. The mean score for IBDQ was below the cutoff level (156.8 ± 37.8), with a significantly greater impairment of QoL in subjects with flares (136.5 vs 177.5, P < 0.001). Lower scores were associated with female gender. No patients had psychological scores above the cutoff for normality. Statistically higher SCL-90-R scores were found in active patients for obsessive-compulsive disorder (P = 0.026), depression (P = 0.013), anxiety (P = 0.013), phobic anxiety (P = 0.002), psychoticism (P = 0.007), global severity index (GSI) (P = 0.005) and positive symptom total (PST) (P = 0.001). A significantly increased probability of higher global indexes was associated with Crohn's disease and disease flares. None of the defensive Defense Mechanism Inventory (DMI) styles resulted above the cutoff in our cohort. CONCLUSIONS Further data are needed to demonstrate the potential key role of psychological intervention in the therapeutic strategies utilized for IBD patients, and the identification of specific psychological patterns based on the patients profile is necessary to optimize psychological intervention.
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Affiliation(s)
- Daniela Leone
- Department of Clinical Psychology, University of Milan, Milan, Italy
| | - Daniela Gilardi
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Institute, Rozzano, Milan, Italy
| | - Bianca E Corrò
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Institute, Rozzano, Milan, Italy
| | - Julia Menichetti
- Department of Clinical Psychology, University of Milan, Milan, Italy
| | - Elena Vegni
- Department of Clinical Psychology, University of Milan, Milan, Italy
| | - Carmen Correale
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Institute, Rozzano, Milan, Italy
| | - Allocca Mariangela
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Institute, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
| | - Federica Furfaro
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Institute, Rozzano, Milan, Italy
| | - Stefanos Bonovas
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Institute, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
| | | | - Silvio Danese
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Institute, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
| | - Gionata Fiorino
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Institute, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
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Cury DB, Oliveira R, Cury MS. Inflammatory bowel diseases: time of diagnosis, environmental factors, clinical course, and management - a follow-up study in a private inflammatory bowel disease center (2003-2017). J Inflamm Res 2019; 12:127-135. [PMID: 31213873 PMCID: PMC6543909 DOI: 10.2147/jir.s190929] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The governmental program of Brazilian Unified National Health System has already published studies on the incidence of inflammatory bowel diseases (IBD), but up until now, there have been no epidemiological studies in private centers in Brazil. However, these diseases tend to affect people from a higher socioeconomic class, mainly in the capital of MS state that has the third highest GDP in Brazil. OBJECTIVES The aim was to analyze an observational, descriptive study of an IBD database in a private center including: the side, behavior of the disease and medical management, the association of extra-intestinal manifestations, and the main clinical symptoms which led to the investigation and diagnosis of IBD. PATIENTS AND METHODS A cohort study was developed in which data of all patients with IBD were analyzed with SPSS software in a constructed electronic database. RESULTS Of 329 patients, 212 (64.4%) had Crohn's disease (CD) and 117 (35.6%) had ulcerative colitis (UC). Average age at diagnosis of CD was 36.19 (±14.33) and of UC was 41.61 (±15.37). An amount of 50.05% of the patients with CD and 72.7% (P<0.001) with UC were female. We have observed that concerning the first symptoms, diahrrea and blood feces corresponded to 70% in UC while in CD 50% of the patients presented diahrrea with blood feces, loss of weight corresponded to 50% and only diahrrea 25%. (P<0.001). Anti-TNFs corresponded to 56.2% being more frequent in CD 0.001%. CD patients used biologic therapy and antibiotics more frequently than those with UC. In conclusion, IBD is also frequent in private health care centers in Brazil; women are most affected. Symptoms such as diarrhea and bleeding, as well as diarrhea and weight loss, must be taken as warning signs to investigate for inflammatory disease. The use of biologic therapies is frequent in referral centers when patients have severe disease.
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Affiliation(s)
- D B Cury
- Inflammatory Bowel Disease Center, Scope Clinic, Campo Grande/MS, Brazil,
| | - R Oliveira
- Biostatistics, UNESP, Botucatu, São Paulo, SP, Brazil
| | - M S Cury
- Advanced Endoscopy Center, Scope Clinic, Campo Grande/MS, Brazil
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Probiotics for improving quality of life in ulcerative colitis: Exploring the patient perspective. PHARMANUTRITION 2019. [DOI: 10.1016/j.phanu.2018.100139] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Bakula DM, Sharkey CM, Perez MN, Espeleta HC, Hawkins M, Chaney JM, Mullins LL. The Role of Stigma in the Relationship Between Illness Intrusiveness and Adjustment in Adolescents and Young Adults: A Path Model. J Pediatr Psychol 2019; 44:611-619. [DOI: 10.1093/jpepsy/jsz004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 01/12/2019] [Accepted: 01/18/2019] [Indexed: 11/13/2022] Open
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An Exploratory Study of Inflammatory Bowel Disease and the Psychosocial Factors Affecting Health-Related Quality of Life. Med Sci (Basel) 2019; 7:medsci7020018. [PMID: 30691020 PMCID: PMC6409541 DOI: 10.3390/medsci7020018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 01/19/2019] [Accepted: 01/21/2019] [Indexed: 12/15/2022] Open
Abstract
Health-related quality of life (HRQoL) is a multidimensional concept that assesses an individual’s personal satisfaction with his/her daily life while coping with a medical condition and/or its consequent therapy. This study aims to determine the psychosocial needs most commonly affected among inflammatory bowel disease (IBD) patients. Psychosocial needs which were pertinent to the IBD community were assessed using a questionnaire designed by the gastrointestinal team at the Port of Spain General Hospital, Trinidad after getting ethical approval. The chi-squared test was used to assess for statistically significant associations. Of the total 115 participants who completed the survey, a majority of 73 (63%) were females and 70 (61%) were in the 18 to 40-year age group. A majority of 66 (57%) were diagnosed with ulcerative colitis and 66 (57%) were on non-biologic drug therapy. Diet was the need most prevailingly affected, with 87% of participants indicating such. Ability to maintain good hygiene was the need least affected, with 32% of participants identifying concern. We found a significant association between participant’s illness perception (IP) and each of the ten psychosocial variables. The participants’ IP was in turn strongly associated with the ability to cope with the illness while not being associated with the demographic or clinical details of the participants. The results can be used to improve the quality of care delivered to patients living with IBD.
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Palant A, Himmel W. Are there also negative effects of social support? A qualitative study of patients with inflammatory bowel disease. BMJ Open 2019; 9:e022642. [PMID: 30670504 PMCID: PMC6347904 DOI: 10.1136/bmjopen-2018-022642] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 10/03/2018] [Accepted: 10/19/2018] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE Social support is considered an important resource in coping with chronic conditions. By conducting a series of interviews with people who suffer from inflammatory bowel disease (IBD), we received the impression that social support in face-to-face or online communication could also be a source of stress and strain. The aim of our study was to better understand and describe possible negative effects of social support. DESIGN This is a secondary analysis of narrative interviews. The interviewees were selected using a maximum-variation sampling approach. Grounded theory and the 'OSOP' (one sheet of paper) method were applied to categorise those parts of the interviews that touched on the negative effects of social support. SETTING The open-end interview collection took place throughout Germany from September 2011 to June 2012. Most of the participants were interviewed in their homes, some in the Department of General Practice in Göttingen. PARTICIPANTS 42 patients with IBD. RESULTS Two interrelated categories emerged: (1) unwanted confrontation and (2) undesirable reactions. The interviewees perceived social support as negative, especially if they felt overwhelmed and/or if they had not asked for it. Consequently, some of our interview partners developed strategies to prevent coming into social contact with others or stopped talking entirely about their disease. CONCLUSION While social support is usually conceptualised and perceived as a positive resource in chronic disease, it sometimes turns into a negative experience and may end in social isolation and deteriorate health. This process also happens in online support groups and increases anxiety when exchanging with other people on the internet. Before motivating ill people to seek contact with others, they should know about the negative effects of social support.
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Affiliation(s)
- Alexander Palant
- Department of General Practice, University Medical Center, Göttingen, Germany
| | - Wolfgang Himmel
- Department of General Practice, University Medical Center, Göttingen, Germany
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Duncanson E, Chur-Hansen A, Jesudason S. Psychosocial consequences of gastrointestinal symptoms and dietary changes in people receiving automated peritoneal dialysis. J Ren Care 2018; 45:41-50. [PMID: 30585418 DOI: 10.1111/jorc.12265] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Gastrointestinal (GI) symptoms are associated with poor psychosocial wellbeing among people receiving peritoneal dialysis (PD). The mind-gut axis represents one possible explanatory mechanism for this relationship. Despite existing evidence, the individual's experience of GI symptoms and their potential psychosocial consequences have not been explored. OBJECTIVE To understand the experiences of people receiving peritoneal dialysis regarding their gastrointestinal health and psychosocial wellbeing. METHOD Ten people undergoing automated PD (five females, five males) aged 31-77 years (Mean = 59.3, SD = 15.67) participated in a single one-on-one qualitative interview. Interviews ceased at thematic saturation. Transcripts were analysed using the framework approach. RESULTS A central theme of Autonomy emerged from the data representing participants' experiences of the psychosocial consequences of dialysis, GI symptoms, and dietary changes. This overarched two main themes: 1) Loss of Autonomy [Sub-themes: Interference to Daily Life (Dialysis process and sleep, Impacts on relationships), Powerlessness, Frustration, Food Aversion, and Restriction (Friendships and social life, Impacts on partner)] and 2) Attempts to Gain Autonomy (Sub-themes: Coping Well, Pragmatism, and Maintaining Normality). A related sub-theme of Partner as a Carer emerged as part of Loss of Autonomy. CONCLUSION GI symptoms and diet and fluid restrictions have psychosocial consequences resulting in multiple losses of autonomy for people receiving PD, who employ strategies to attempt to regain autonomy in the face of these issues. Dietary and GI symptom management advice should aim to enhance patient autonomy within the confines of PD therapy and thus reduce its psychosocial impacts.
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Affiliation(s)
- Emily Duncanson
- School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, South Australia, 5005, Australia.,Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), South Australia, 5001, Australia
| | - Anna Chur-Hansen
- School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, South Australia, 5005, Australia
| | - Shilpanjali Jesudason
- Central and Northern Adelaide Renal and Transplantation Service (CNARTS), Royal Adelaide Hospital, South Australia, 5000, Australia.,Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, South Australia, 5005, Australia.,Kidney Health Australia, South Australia, 5000, Australia
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Fourie S, Jackson D, Aveyard H. Living with Inflammatory Bowel Disease: A review of qualitative research studies. Int J Nurs Stud 2018; 87:149-156. [DOI: 10.1016/j.ijnurstu.2018.07.017] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 07/23/2018] [Accepted: 07/30/2018] [Indexed: 12/12/2022]
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Duff W, Haskey N, Potter G, Alcorn J, Hunter P, Fowler S. Non-pharmacological therapies for inflammatory bowel disease: Recommendations for self-care and physician guidance. World J Gastroenterol 2018; 24:3055-3070. [PMID: 30065553 PMCID: PMC6064965 DOI: 10.3748/wjg.v24.i28.3055] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 04/23/2018] [Accepted: 06/01/2018] [Indexed: 02/06/2023] Open
Abstract
We performed a scoping review on sought-after complementary therapies for patients with inflammatory bowel disease (IBD), specifically diet, physical activity and exercise (PA/E), and psychotherapy. We aim to update patients with IBD on therapies for self-care and provide physicians with guidance on how to direct their patients for the management of IBD. A search of MEDLINE, EMBASE, and PUBMED was completed in Sept 2016. Studies on diet, PA/E, or psychotherapy in patients with IBD were included. Medical Subject Heading terms and Boolean operators were used. The search was limited to full-text English articles describing an adult population. This review included 67 studies: Diet (n = 19); PA/E (n = 19); and psychotherapy (n = 29). We have made the following recommendations: (1) Diet: Consumption of diets rich in vegetables, fruit and soluble fiber may be beneficial in IBD. A trial of a low FODMAP diet can be considered in those patients with functional gastrointestinal symptoms. Restrictive diets are lacking in evidence and should be avoided; (2) PA/E: Regular low-moderate intensity activity, including cardiovascular and resistance exercise, has been shown to improve quality of life (QOL) and may improve inflammation; and (3) psychotherapy: Therapies such as cognitive-behavioural interventions, mindfulness, hypnosis, and stress management have been shown to improve QOL, but evidence is limited on their impact on anxiety, depression, and disease activity. Overall, these complementary therapies are promising and should be used to treat patients with IBD from a more holistic perspective.
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Affiliation(s)
- Whitney Duff
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan S7N 5B2, Canada
| | - Natasha Haskey
- Irving K Barber School of Arts and Science, University of British Columbia-Okanagan, Kelowna, British Columbia V1V 1V7, Canada
| | - Gillian Potter
- Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan S7N 5A5, Canada
| | - Jane Alcorn
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan S7N 5E5, Canada
| | - Paulette Hunter
- St Thomas More College, University of Saskatchewan, Saskatoon, SK S7N 0W6, Canada
| | - Sharyle Fowler
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan S7N 0W8, Canada
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Milovanovic S, Scaldaferri F, Canarecci S, Kheiraoui F, Ciancarella G, de Waure C, Collamati A, Schiavoni E, Gasbarrini A, Boccia S, Poscia A. Therapy experiences and preferences among patients with anemia: Results of a cross-sectional survey among Italian patients with inflammatory bowel disease. Dig Liver Dis 2017; 49:1098-1103. [PMID: 28778820 DOI: 10.1016/j.dld.2017.06.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 06/16/2017] [Accepted: 06/28/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Anemia represents one of the most common and often the least treated complications of inflammatory bowel disease (IBD). AIMS Our study investigates experiences and preferences concerning anemia treatment in patients with IBD. METHODS IBD patients previously diagnosed with anemia were invited to participate in an anonymous survey between July and September 2015, which assessed demographic and clinical data, and experiences regarding anemia treatment. RESULTS A total of 118 IBD patients were invited to participate in the study, of which 100 (85%) were included in the analysis. Seventy-five percent of patients reported a high personal burden related to intravenous therapy, while the majority of companions (76%) declared a moderate burden. The increased importance assigned to the possibility of a single session treatment was significantly associated with age (Beta=0.01; p=0.03), working status (Beta=0.02; p=0.04), anemia severity (severe vs. mild, Beta=0.42; p=0.03), and intravenous treatment (Beta=0.44; p=0.001). CONCLUSIONS Most patients reported a high personal and a moderate companions' burden. Having the possibility of effective single dose intravenous therapy was of great importance. Patients' perspective provides key information for evaluating the indirect costs of anemia treatment in IBD which, according to the health technology assessment approach, could be useful in a patient centered decision making process.
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Affiliation(s)
- Sonja Milovanovic
- Institute of Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, Largo F.Vito 1, 00168 Rome, Italy
| | - Franco Scaldaferri
- Gastroenterology Unit, University Hospital "Agostino Gemelli", Largo F.Vito 1, 00168 Rome, Italy.
| | | | - Flavia Kheiraoui
- Institute of Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, Largo F.Vito 1, 00168 Rome, Italy
| | - Giulia Ciancarella
- Gastroenterology Unit, University Hospital "Agostino Gemelli", Largo F.Vito 1, 00168 Rome, Italy
| | - Chiara de Waure
- Institute of Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, Largo F.Vito 1, 00168 Rome, Italy
| | - Agnese Collamati
- Institute of Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, Largo F.Vito 1, 00168 Rome, Italy
| | - Elisa Schiavoni
- Gastroenterology Unit, University Hospital "Agostino Gemelli", Largo F.Vito 1, 00168 Rome, Italy
| | - Antonio Gasbarrini
- Gastroenterology Unit, University Hospital "Agostino Gemelli", Largo F.Vito 1, 00168 Rome, Italy
| | - Stefania Boccia
- Institute of Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, Largo F.Vito 1, 00168 Rome, Italy; Fondazione Policlinico "A. Gemelli", Largo F. Vito 1, 00168 Rome, Italy
| | - Andrea Poscia
- Institute of Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, Largo F.Vito 1, 00168 Rome, Italy
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Jordan C, Ohlsen R, Hayee B, Chalder T. A qualitative study exploring the experience of people with IBD and elevated symptoms of anxiety and low mood and the type of psychological help they would like. Psychol Health 2017; 33:634-651. [PMID: 28948842 DOI: 10.1080/08870446.2017.1381958] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND People with inflammatory bowel disease (IBD) are at increased risk of developing anxiety and low mood. We sought to explore the experience of people with IBD and moderate-severe symptoms of anxiety/low mood to identify psychological processes which could be targeted in psychological interventions, as well as the kind of psychological support preferred. METHODS Twenty-five participants with IBD and moderate-severe symptoms of anxiety/low mood were recruited for interview. Template analysis was utilised to analyse interview data. We explored the situations, cognitions and behaviour linked to symptoms of anxiety and low mood by people with IBD, as well as the kind of psychological help preferred. RESULTS Two themes were identified within participants accounts of symptoms of anxiety; 'under performance' and 'preventing an accident'. Two further themes were identified for symptoms of low mood; 'lack of understanding' and 'stigma'. Expertise and understanding was the main theme identified for the type of psychological help desired. CONCLUSION The analysis highlights situations, cognitions and behaviour linked to anxiety and low mood by people with IBD and the type of psychological support desired. Our findings link to the knowledge and competencies set for psychological therapist working with long-term conditions.
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Affiliation(s)
- Cheryl Jordan
- a Faculty of Nursing and Midwifery , King's College London , London , UK
| | - Ruth Ohlsen
- a Faculty of Nursing and Midwifery , King's College London , London , UK
| | - Bu'Hussain Hayee
- b Department of Gastroenterology , King's College Hospital , London , UK
| | - Trudie Chalder
- c Department of Psychological Medicine , King's College London, Weston Education Centre , London , UK
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Langbrandtner J, Hüppe A, Jessen P, Büning J, Nikolaus S, Raspe H, Bokemeyer B. Quality of care in inflammatory bowel disease: results of a prospective controlled cohort study in Germany (NET IBD). Clin Exp Gastroenterol 2017; 10:215-227. [PMID: 28919797 PMCID: PMC5590680 DOI: 10.2147/ceg.s135346] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Background/aims Patients with inflammatory bowel disease (IBD) need comprehensive, interdisciplinary and cross-sectoral health care. In Germany, evidence-based care pathways have been developed to improve the quality of care of IBD patients. We aimed to evaluate the effects of the implementation of some of these recommendations on patient-related outcomes. Methods In a region of North Germany, outpatients with IBD were recruited by gastroenterologists (intervention group). Three activities based on the recommendations of the IBD pathways were implemented, namely, 1) patient participation in a questionnaire-based assessment of 22 somatic and psychosocial problems combined with individualized care recommendations (patient activation procedure); 2) patient invitation to participate in a 2-day patient education program and 3) invitation to their gastroenterologists to participate in periodic interdisciplinary case conferences. For the control group, IBD patients receiving standard care at gastroenterology practices outside the specified region were recruited by their doctors. At baseline, 6- and 12-month follow-up, study patients were invited to complete questionnaires. Generic health-related quality of life, social participation and self-management skills were the main outcomes. Results At baseline, 349 patients were included in the study (intervention group: 189; control group: 160); 142 patients from the former and 140 from the latter group returned completed questionnaires at the 12-month follow-up. Over time, improvement in health-related quality of life and social participation was similar in both groups. Participants of the intervention group demonstrated improved self-management skills and more often followed steroid-free medication regimens. Conclusion In a real-world clinical context, patient activation procedure combined with patient education and case conferences was less effective than expected. The observed beneficial effects, however, encourage the evaluation of more intensive and addressee-centered activities.
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Affiliation(s)
- Jana Langbrandtner
- Institute of Social Medicine and Epidemiology, University of Luebeck, Ratzeburger Allee, Luebeck
| | - Angelika Hüppe
- Institute of Social Medicine and Epidemiology, University of Luebeck, Ratzeburger Allee, Luebeck
| | - Petra Jessen
- Gastroenterology Practice Altenholz-Kiel, Erdbeerfeld, Altenholz
| | - Jürgen Büning
- Department of Internal Medicine I, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee, Luebeck
| | - Susanna Nikolaus
- Department of Internal Medicine I, University Hospital Schleswig-Holstein, Campus Kiel, Schittenhelmstraße, Kiel
| | - Heiner Raspe
- Center for Population Medicine and Health Services Research, University of Luebeck, Ratzeburger Allee, Luebeck
| | - Bernd Bokemeyer
- Gastroenterology Practice Minden, Uferstraße, Minden, Germany
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McMullan C, Pinkney TD, Jones LL, Magill L, Nepogodiev D, Pathmakanthan S, Cooney R, Mathers JM. Adapting to ulcerative colitis to try to live a 'normal' life: a qualitative study of patients' experiences in the Midlands region of England. BMJ Open 2017; 7:e017544. [PMID: 28827271 PMCID: PMC5724065 DOI: 10.1136/bmjopen-2017-017544] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To provide a framework that is able to categorise whether patients are able to adapt to and lead a 'normal' life with ulcerative colitis (UC) and to detail the factors that influence this. DESIGN Qualitative research study using in-depth semi-structured interviews. SETTING Four clinical sites in the West and East Midlands regions of England. PARTICIPANTS 28 adult patients diagnosed with UC for years between 1 and 22. RESULTS Medication was rarely sufficient for patients to adapt to UC and live as 'normal' a life as possible. Virtually all patients tested and adopted non-medical adaptation methods to improve physical and psychological well-being, to help them carry on working and to prevent embarrassment. In addition, some patients benefited from outside support providing them with practical, emotional and/or financial help. In conjunction with adaptation strategies and the time to adapt, this meant that some patients with severe clinical disease were able to maintain a sense of normality in life. Patients reported that clinicians were not always receptive to discussion of the broader context of life with UC. CONCLUSIONS Patients' experience of UC and their ability to adapt in order to maintain a sense of normality in life is a complex interplay of symptoms, adaptation strategies and outside support. Over time patients test out a variety of non-medical adaptation strategies. Awareness of this may help clinicians and researchers to understand patients' views on the role of medical and other therapies. Further research around the utility of this framework in clinical practice and research is now required. TRIAL REGISTRATION NUMBER ISRCTN56523019, results.
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Affiliation(s)
- Christel McMullan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Thomas D Pinkney
- Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | - Laura L Jones
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Laura Magill
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Dmitri Nepogodiev
- Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | - Shri Pathmakanthan
- Department of Gastroenterology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Rachel Cooney
- Department of Gastroenterology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jonathan M Mathers
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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