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Palla I, Turchetti G, Polvani S. Narrative Medicine: theory, clinical practice and education - a scoping review. BMC Health Serv Res 2024; 24:1116. [PMID: 39334149 DOI: 10.1186/s12913-024-11530-x] [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: 02/01/2024] [Accepted: 09/03/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND The origin of Narrative Medicine dates back to more than 20 years ago at an international level. Narrative Medicine is not an alternative to evidence-based medicine, however these two approaches are integrated. Narrative Medicine is a methodology based on specific communication skills where storytelling is a fundamental tool to acquire, understand and integrate several points of view related to persons involving in the disease and in the healthcare process. Narrative Medicine, henceforth NM, represents a union between disease and illness between the doctor's clinical knowledge and the patient's experience. According to Byron Good, "we cannot have direct access to the experience of others' illness, not even through in-depth investigations: one of the ways in which we can learn more from the experience of others is to listen to the stories of what has happened to other people." Several studies have been published on NM; however, to the best of our knowledge, no scoping review of the literature has been performed. OBJECTIVE This paper aims to map and synthetize studies on NM according to theory, clinical practice and education/training. METHOD The scoping review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) checklist. A search was conducted in PubMed, APA PsycNet and Jstor. Two authors independently assessed the eligibility and methodological quality of the studies and extracted the data. This review refers to the period from 1998 to 2022. RESULTS A total of 843 abstracts were identified of which 274 papers were selected based on the title/abstract. A total of 152 papers in full text were evaluated and 76 were included in the review. Papers were classified according to three issues: ✘ Nineteen studies focused on the definition and concept of NM (Theoretical). ✘ Thirty-eight papers focused on the collection of stories, projects and case reports (Clinical practice). ✘ Nineteen papers focused on the implementation of the Narrative Medicine approach in the education and training of medical doctors (Education and training). CONCLUSIONS This scoping review presents an overview of the state of the art of the Narrative Medicine. It collect studies performed mainly in Italy and in the United States as these are the countries developing the Narrative Medicine approach in three identified areas, theoretical, clinical practice and education and training. This scoping review will help to promote the power of Narrative Medicine in all three areas supporting the development of methods to evaluate and to measure the Narrative Medicine approach using key performance indicators.
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Affiliation(s)
- Ilaria Palla
- Institute of Management, Scuola Superiore Sant'Anna Pisa, Piazza Martiri della Libertà 33, Pisa, 56127, Italy.
| | - Giuseppe Turchetti
- Institute of Management, Scuola Superiore Sant'Anna Pisa, Piazza Martiri della Libertà 33, Pisa, 56127, Italy
| | - Stefania Polvani
- SIMeN, Società Italiana Medicina Narrativa, Arezzo, Italy
- Azienda USL Toscana Sud Est, Arezzo, Italy
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Akazawa M, Sato T, Ebata N, LoPresti M, Nishi R. Factors Related to Treatment Non-Adherence Among Caregivers of Pediatric and Adolescent Growth Hormone Deficiency Patients in Japan. Patient Prefer Adherence 2024; 18:607-622. [PMID: 38476590 PMCID: PMC10929548 DOI: 10.2147/ppa.s446649] [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: 10/26/2023] [Accepted: 02/06/2024] [Indexed: 03/14/2024] Open
Abstract
Background About one-third of caregivers of pediatric or adolescent growth hormone deficiency (pGHD) patients in Japan have reported poor treatment adherence. However, few studies have examined factors related to adherence for that group. Objective The aim of this study is to consider factors related to poor adherence to daily treatment among caregivers of pGHD patients in Japan. Methods A cross-sectional survey was conducted among caregivers of pGHD patients in Japan. Caregivers were asked about demographic and treatment characteristics, health literacy, treatment satisfaction, opinions about treatment, and treatment adherence. Health literacy was assessed using the 14-item health literacy scale (HLS-14). Adherence was assessed using the 8-item Morisky Medication Adherence Scale (MMAS-8). Statistical association with adherence was considered using Chi-square and Student's t-testing. An exploratory factor analysis (EFA) and K-means cluster analysis was conducted to consider the influence of treatment satisfaction and opinions concerning treatment on adherence. Results Responses were collected from 112 caregivers. The caregiver's age being 30-39 years old, the primary caregiver being male, the primary caregiver being employed, and low functional health literacy for the caregiver were associated with poor adherence. Patients being pre-elementary school age was also associated with poor adherence. Low satisfaction with drug treatment and/or their device and communication with healthcare professionals (HCPs), and lack of agreement with the importance of treatment management (eg, keeping injection records, getting informed about the disease/therapy, reporting non-adherence, and sticking to an administration schedule), were also associated with poor adherence. Conclusion Strategies to improve treatment adherence among caregivers of pGHD patients in Japan should consider the age, gender, and employment status of the caregiver - as well as their functional literacy. Improvement in satisfaction with the drug or device used, better communication with HCPs, and greater awareness of the importance of treatment management, may also lead to better adherence.
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Affiliation(s)
- Manabu Akazawa
- Department of Public Health and Epidemiology, Meiji Pharmaceutical University, Kiyose, Tokyo, Japan
| | - Takahiro Sato
- Medical Affairs, Rare Disease, Pfizer Japan Inc, Shibuya-ku, Tokyo, Japan
| | - Nozomi Ebata
- Medical Affairs, Rare Disease, Pfizer Japan Inc, Shibuya-ku, Tokyo, Japan
| | - Michael LoPresti
- Value & Access, INTAGE Healthcare Inc., Chiyoda-ku, Tokyo, Japan
| | - Ryosuke Nishi
- Value & Access, INTAGE Healthcare Inc., Chiyoda-ku, Tokyo, Japan
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Lackner L, Quitmann J, Kristensen K, Witt S. Health-Related Quality of Life, Stress, Caregiving Burden and Special Needs of Parents Caring for a Short-Statured Child-Review and Recommendations for Future Research. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6558. [PMID: 37623144 PMCID: PMC10454502 DOI: 10.3390/ijerph20166558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 07/13/2023] [Accepted: 08/08/2023] [Indexed: 08/26/2023]
Abstract
Children with short stature can experience a range of burdens due to their chronic condition. However, little is known about parents' experiences dealing with their child's short stature and the potential caregiving burdens and concerns they may face. We aim to review the literature on health-related quality of life (HRQOL), caregiving burden, and special needs among parents caring for a child with isolated growth hormone deficiency (IGHD) or idiopathic short stature (ISS). Using pre-defined inclusion and exclusion criteria, we systematically searched for literature using PubMed and Web of Science from its inception to December 2022. We identified 15 articles assessing HRQOL, special needs, or caregiving burdens in parents of IGHD/ISS children. The main problems included concerns about the future, organizational issues, side effects from growth hormone treatment, and social stigmatization. Furthermore, two studies assessed parents' special needs to cope with caregiving stress, mainly the dialogue between them and their families or parent support groups. This review outlines parental burdens, needs, and resources when caring for an IGHD/ISS child. Furthermore, it provides information about previously used measures appraising parents' special needs and underlines the need for disease-specific measurements.
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Affiliation(s)
| | | | | | - Stefanie Witt
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, W26, 20246 Hamburg, Germany
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Assefi AR, Graham S, Crespo ML, Debicki M, Reston J, Gonzalez J, Jheeta A, Koledova E. Evaluating the TUITEK® patient support program in supporting caregivers of children diagnosed with growth hormone deficiency in Argentina. Front Endocrinol (Lausanne) 2023; 14:1129385. [PMID: 37091843 PMCID: PMC10117813 DOI: 10.3389/fendo.2023.1129385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/28/2023] [Indexed: 04/08/2023] Open
Abstract
IntroductionThe appropriate use of recombinant human growth hormone (r-hGH) treatment provides an opportunity to improve growth outcomes among pediatric patients with growth hormone deficiency (GHD). However, a major challenge in clinical practice is to adequately recognize and address factors that negatively affect treatment adherence. TUITEK® patient support program (PSP) was designed to help caregivers of children diagnosed with GHD to personalize the care pathway, improve adherence, and achieve better outcomes. Effectiveness of TUITEK® PSP has been demonstrated previously in a smaller sample (n = 31) in Taiwanese population. Here, we present the results from Argentina.MethodsTUITEK® PSP was piloted among 76 caregivers of children with GHD administering r-hGH using easypod™ (Merck KGaA, Darmstadt, Germany) auto-injector device in Argentina. Based on TUITEK® personalization questionnaire, caregivers were assigned to high- and low-risk groups across four categories that may influence adherence, including disease and treatment coherence (DTC), self-administration (SA), treatment-related anxiety (TRA), and emotional burden (EB). The caregivers who were included in atleast one high-risk group had the provision of telephone calls with a nurse practitioner every 2 weeks for 3 months. The Wilcoxon signed-rank test was employed to assess changes in questionnaire-based scoring patterns between baseline and follow-up evaluations.ResultsStatistically significant changes (p < 0.05) in questionnaire scores between baseline and follow-up evaluations were observed across the four categories. The mean/median DTC (n = 11) and SA (n = 23) scores changed from 2.45/3 and 2.17/2, respectively, to 4/4, with all the caregivers moving to low-risk group following program completion (100%) for both categories. The mean/median TRA score (n = 40) changed from 3.58/3 to 2.5/2 and 67.5% of patients (27/40) moved to low-risk group. The mean/median EB score (n = 32) changed from 3.69/3 to 3.13/3 however, none of the caregivers moved to low-risk group (0%).ConclusionTUITEK® PSP is a simple, practical, and time-efficient interventional tool that can be used to address key adherence-related issues among caregivers of children with GHD and provide personalized adherence support. Our findings demonstrate that TUITEK® PSP has the potential to improve treatment adherence and self-management, thereby improving growth outcomes in Argentina.
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Affiliation(s)
- Aria Reza Assefi
- Medical Department, Merck S.A. (an affiliate of Merck KGaA, Darmstadt, Germany), Buenos Aires, Argentina
| | | | - María Lourdes Crespo
- Medical Department, Merck S.A. (an affiliate of Merck KGaA, Darmstadt, Germany), Buenos Aires, Argentina
| | - Matías Debicki
- Medical Department, Merck S.A. (an affiliate of Merck KGaA, Darmstadt, Germany), Buenos Aires, Argentina
| | | | - Judit Gonzalez
- Medical Department, Merck S.A. (an affiliate of Merck KGaA, Darmstadt, Germany), Buenos Aires, Argentina
| | | | - Ekaterina Koledova
- Global Medical Affairs Cardiometabolic and Endocrinology, Merck KGaA, Darmstadt, Germany
- *Correspondence: Ekaterina Koledova,
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Lackner L, Quitmann JH, Witt S. Caregiving burden and special needs of parents in the care of their short-statured children - a qualitative approach. Front Endocrinol (Lausanne) 2023; 14:1093983. [PMID: 37008922 PMCID: PMC10064859 DOI: 10.3389/fendo.2023.1093983] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/30/2023] [Indexed: 03/19/2023] Open
Abstract
Purpose To explore caregiving burden, health-related quality of life (HRQOL), stress, and individual resources of parents in the care of children with isolated growth hormone deficiency (IGHD) or idiopathic short stature (ISS). Methods Focused interview analysis of previously, within the Quality of Life in Short Stature Youth (QoLISSY) project, conducted structured focus group discussions (n=7) with parents (n=33) of children with IGHD/ISS aged 4 to 18 years were performed. Results 26 out of the 33 parents reported mental stress due to their child's growth disorder. Social pressure and stigmatization were also mentioned as being demanding. Some parents reported having trouble with human growth hormone (hGH) treatment. Several parents wished for parent support groups with other like-minded parents of short-statured children. Conclusion For physicians, it is essential to understand the parents' caregiving burden, stress, and individual resources in caring for IGHD/ISS children. If an impaired HRQOL is detected, psychological intervention for these parents may be scheduled, and coping mechanisms may be discussed. Furthermore, it seems essential for parents to be educated by their healthcare provider about the possible side effects of hGH treatment or to know where to find evidence-based information about it.
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Chesi P, Mencacci C, Balestrieri M, Pompili M, Varia S, Sagripanti U, Reale L, Marini MG. Multicentre narrative research on major depression to integrate the experiences of patients, their caregivers and healthcare providers in Italy. BMJ Open 2022; 12:e052744. [PMID: 36216417 PMCID: PMC9557264 DOI: 10.1136/bmjopen-2021-052744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE This research aimed to investigate the experience of major depression by integrating the perspectives of patients, caregivers and healthcare providers through narrative-based medicine (NBM) to provide new insights to improve care relationships. DESIGN AND SETTING The research was conducted in 2019 and involved five Italian psychiatric centres and targeted adult patients, their caregivers and healthcare providers to address data source triangulation. A sociodemographic survey and a narrative plot, based on Natural Semantic Metalanguage were collected. Narratives were analysed through NBM classifications, NVivo software and interpretative coding. PARTICIPANTS Thirty-six patients with a diagnosis of major depression, 27 caregivers and 33 healthcare providers participated in the research. RESULTS Among the 96 collected narratives, 'lonely' was the word patients used most frequently, while 'sad' and 'lifeless' were used most respectively by caregivers and healthcare providers. A positive care relationship was crucial for 84% of patients in relation to their care pathway, and nature (36%) and the arts (28%) were the most frequent resources. Caregivers expressed feelings of powerlessness and inadequacy, and 21% of them reported a declining social life while providing care to a loved one with depression. Thirty-one percent of mental health professionals experienced difficulties in their first encounter with patients; however, their emotions progressively moved towards trust and satisfaction. Furthermore, 89% of patients and healthcare providers and 58% of caregivers evaluated writing the narrative to be a positive experience. CONCLUSION Findings suggested the possible role for language in understanding major depression, thereby improving care relationships between patients and physicians. Care pathways might also be more attentive to caregivers, to reduce their risk of burnout. Finally, narrative medicine could be integrated with the care pathway as an additional space of expression, dialogue, reflection and development of empathy.
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Affiliation(s)
- Paola Chesi
- Healthcare Area, Fondazione ISTUD, Baveno, Italy
| | - Claudio Mencacci
- Neuroscience Department, ASST Fatebenefratelli Sacco, Milano, Italy
| | | | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, University of Rome La Sapienza, Roma, Italy
- Suicide Prevention Center, Sant'Andrea Hospital, Roma, Italy
| | - Salvatore Varia
- Mental Health Department, Azienda Sanitaria Provinciale di Palermo, Palermo, Italy
| | - Ubaldo Sagripanti
- Mental Health Department, ASUR 8 Civitanova Marche, Civitanova Marche, Italy
| | - Luigi Reale
- Healthcare Area, Fondazione ISTUD, Baveno, Italy
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Orso M, Polistena B, Granato S, Novelli G, Di Virgilio R, La Torre D, d’Angela D, Spandonaro F. Pediatric growth hormone treatment in Italy: A systematic review of epidemiology, quality of life, treatment adherence, and economic impact. PLoS One 2022; 17:e0264403. [PMID: 35213607 PMCID: PMC8880399 DOI: 10.1371/journal.pone.0264403] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 02/09/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives This systematic review aims to describe 1) the epidemiology of the diseases indicated for treatment with growth hormone (GH) in Italy; 2) the adherence to the GH treatment in Italy and factors associated with non-adherence; 3) the economic impact of GH treatment in Italy; 4) the quality of life of patients treated with GH and their caregivers in Italy. Methods Systematic literature searches were performed in PubMed, Embase and Web of Science from January 2010 to March 2021. Literature selection process, data extraction and quality assessment were performed by two independent reviewers. Study protocol has been registered in PROSPERO (CRD42021240455). Results We included 25 studies in the qualitative synthesis. The estimated prevalence of growth hormone deficiency (GHD) was 1/4,000–10,000 in the general population of children; the prevalence of Short Stature HOmeoboX Containing gene deficiency (SHOX-D) was 1/1,000–2,000 in the general population of children; the birth prevalence of Turner syndrome was 1/2,500; the birth prevalence of Prader-Willi syndrome (PWS) was 1/15,000. Treatment adherence was suboptimal, with a range of non-adherent patients of 10–30%. The main reasons for suboptimal adherence were forgetfulness, being away from home, pain/discomfort caused by the injection. Economic studies reported a total cost for a complete multi-year course of GH treatment of almost 100,000 euros. A study showed that drug wastage can amount up to 15% of consumption, and that in some Italian regions there could be a considerable over- or under-prescribing. In general, patients and caregivers considered the GH treatment acceptable. There was a general satisfaction among patients with regard to social and school life and GH treatment outcomes, while there was a certain level of intolerance to GH treatment among adolescents. Studies on PWS patients and their caregivers showed a lower quality of life compared to the general population, and that social stigma persists. Conclusion Growth failure conditions with approved GH treatment in Italy constitute a significant burden of disease in clinical, social, and economic terms. GH treatment is generally considered acceptable by patients and caregivers. The total cost of the GH treatment is considerable; there are margins for improving efficiency, by increasing adherence, reducing drug wastage and promoting prescriptive appropriateness.
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Affiliation(s)
- Massimiliano Orso
- C.R.E.A. Sanità (Centre for Applied Economic Research in Healthcare), Rome, Italy
- * E-mail:
| | - Barbara Polistena
- C.R.E.A. Sanità (Centre for Applied Economic Research in Healthcare), Rome, Italy
- University of Rome Tor Vergata, Rome, Italy
| | | | - Giuseppe Novelli
- Health Economics & Outcomes Research, Pfizer Italia, Rome, Italy
| | | | - Daria La Torre
- Global Medical Affairs, Pfizer Rare Disease, Rome, Italy
| | - Daniela d’Angela
- C.R.E.A. Sanità (Centre for Applied Economic Research in Healthcare), Rome, Italy
- University of Rome Tor Vergata, Rome, Italy
| | - Federico Spandonaro
- C.R.E.A. Sanità (Centre for Applied Economic Research in Healthcare), Rome, Italy
- San Raffaele University, Rome, Italy
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Su PH, Malik S, Jheeta A, Lin YF, Su SH, Koledova E, Graham S. Investigating the Impact of the TUITEK ® Patient Support Programme, Designed to Support Caregivers of Children Prescribed Recombinant Human Growth Hormone Treatment in Taiwan. Front Endocrinol (Lausanne) 2022; 13:897956. [PMID: 35600589 PMCID: PMC9120661 DOI: 10.3389/fendo.2022.897956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 04/07/2022] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Poor adherence to recombinant human growth hormone (r-hGH) treatment presents a significant barrier to achieving optimal growth outcomes. It is important to identify and address the treatment adherence-related needs of children prescribed r-hGH treatment, and develop new approaches to improve adherence. We aimed to measure the impact of the TUITEK® patient support programme, a multi-component personalized service intervention, on caregivers' knowledge, beliefs, and perceptions of short stature and adherence to its treatment. PATIENTS AND METHODS The evaluation of the TUITEK® patient support programme was conducted among 31 caregivers of children with short stature and receiving r-hGH treatment via the easypod™ auto-injector device in Taiwan. Caregivers within the 'high risk' category for knowledge, beliefs and perception factors influencing adherence to r-hGH treatment (disease and treatment coherence, emotional burden, self-administration, and treatment-related anxiety) were identified via the TUITEK® personalization questionnaire and followed up with bi-weekly telephone calls by a nurse practitioner over a 3-month period. A Wilcoxon signed-rank test was used to compare changes in questionnaire-based scoring patterns between baseline and follow-up. RESULTS Between baseline and follow-up, the percentage of caregivers scoring as 'high risk' for emotional burden reduced by 37%; there was an improvement in confidence of self-administration by 57% and the percentage of caregivers scoring as 'high risk' for treatment-related anxiety reduced by 52%. At follow-up, all caregivers classified as 'high risk' within the disease and treatment coherence item at baseline moved into the 'low risk' category. Statistically significant changes in questionnaire scores between baseline and follow-up for disease and treatment understanding, emotional burden, self-administration, and treatment-related anxiety were also observed. CONCLUSION These findings indicate that the TUITEK® patient support programme can positively address disease and treatment-related barriers amongst caregivers regarding optimal adherence of their children to r-hGH treatment, which has the potential to positively impact on adherence levels and patient clinical health outcomes.
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Affiliation(s)
- Pen-Hua Su
- School of Medicine, Chung-Shan Medical University, Taichung City, Taiwan
- Department of Pediatrics and Genetics, Chung Shan Medical University Hospital, Taichung City, Taiwan
| | | | | | - Yen-Fan Lin
- Medical Affairs Department, Merck Ltd., Taiwan, An Affiliate of Merck KGaA, Darmstadt, Germany, Taipei City, Taiwan
| | - Su-Huei Su
- Department of Pediatrics and Genetics, Chung Shan Medical University Hospital, Taichung City, Taiwan
| | - Ekaterina Koledova
- Empowered Health, Global Medical Affairs Cardiometabolic and Endocrinology, Merck KGaA, Darmstadt, Germany
- *Correspondence: Ekaterina Koledova,
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Graham S, Neo S, Auyeung V, Weinman J. What Potentially Modifiable Factors are Associated With Treatment Nonadherence in Pediatric Growth Hormone Deficiency? A Quantitative Study. Endocr Pract 2021; 27:146-151. [PMID: 33563559 DOI: 10.4158/ep-2020-0543] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 08/29/2020] [Accepted: 09/10/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE A recent systematic review reported that up to 71% of patients with growth hormone deficiency and their families are nonadherent to treatment as prescribed. Nonadherence to growth hormone treatment presents a substantial and costly problem for the patient, health care provider, and health care system. The current study uniquely investigated the potentially modifiable factors associated with treatment nonadherence in this endocrine disorder. METHODS The cross-sectional study was conducted among 82 parent/caregivers of children with growth hormone deficiency who were receiving growth hormone treatment. Self-report questionnaires investigated parent/caregiver perceptions and experiences of their child's condition and prescribed treatment, in addition to their perceived relationship with their health care professional. The 8-item Morisky medication adherence scale was used for the assessment of treatment adherence. RESULTS Sixty-two percent of parents/caregivers were found to be nonadherent to growth hormone treatment as prescribed. Illness perceptions (consequences, identity, and coherence) and treatment concerns were found to be significantly associated with treatment adherence, as was the quality of the health care professional-parent/caregiver relationship. CONCLUSION The study confirmed the extent of the adherence problem evident among the pediatric growth hormone deficiency population. In addition, it presented an insight into the explanatory factors that underpin nonadherence to growth hormone treatment. Our findings can be used to inform the development of adherence-focused interventions, with the purpose of supporting patients and their families and improving the use of prescribed growth hormone treatment within endocrine clinical practice.
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Affiliation(s)
- Selina Graham
- School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom.
| | - Samantha Neo
- Health Psychology Section, King's College London, London, United Kingdom
| | - Vivian Auyeung
- School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - John Weinman
- School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
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Testa M, Cappuccio A, Latella M, Napolitano S, Milli M, Volpe M, Marini MG. The emotional and social burden of heart failure: integrating physicians', patients', and caregivers' perspectives through narrative medicine. BMC Cardiovasc Disord 2020; 20:522. [PMID: 33308152 PMCID: PMC7733244 DOI: 10.1186/s12872-020-01809-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 12/02/2020] [Indexed: 11/24/2022] Open
Abstract
Background The The Roadmap Using Story Telling project used a narrative medicine (NM) framework to assess the perspectives of people with heart failure (HF), their informal caregivers and HF specialists of the impact of HF on the daily life of patients and their carers. Methods Italian HF specialists participated on a voluntary basis, completing their own narratives, and inviting patients and their caregivers to write anonymously about their experiences, all on a dedicated online platform. The narratives were analyzed according to standard NM methodology. Results 82 narratives were collected from patients, 61 from caregivers, and 104 from HF specialists. Analysis of the three points of view revealed the extent of the burden of illness on the entire family, particularly that of the caregiver. The impact was mainly experienced as emotional and social limitations in patients’ and their caregivers’ daily lives. The analysis of all three points of view highlighted a strong difference between how HF is perceived by patients, caregivers, and HF specialists. Conclusions This NM project illustrates the complex issues of living with HF and gave insights to integrate three different perspectives into the HF pathway of care.
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Affiliation(s)
- Marco Testa
- Cardiology Unit, Sant'Andrea Hospital, Rome, Italy
| | - Antonietta Cappuccio
- Area Sanità e Salute di Fondazione ISTUD, via Paolo Lomazzo 19, 20124, Milan, Italy.
| | | | - Silvia Napolitano
- Area Sanità e Salute di Fondazione ISTUD, via Paolo Lomazzo 19, 20124, Milan, Italy
| | - Massimo Milli
- Cardiology Unit, Santa Maria Nuova Firenze Hospital, Florence, Italy
| | - Massimo Volpe
- School of Medicine and Psychology, University of Rome "Sapienza", Rome, Italy.,IRCCS Neuromed, Pozzilli, Italy
| | - Maria Giulia Marini
- Area Sanità e Salute di Fondazione ISTUD, via Paolo Lomazzo 19, 20124, Milan, Italy
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Ragusa L, Crinò A, Grugni G, Reale L, Fiorencis A, Licenziati MR, Faienza MF, Wasniewska M, Delvecchio M, Franzese A, Rutigliano I, Fusilli P, Corica D, Campana G, Greco D, Chiarito M, Sacco M, Toscano S, Marini MG. Caring and living with Prader-Willi syndrome in Italy: integrating children, adults and parents' experiences through a multicentre narrative medicine research. BMJ Open 2020; 10:e036502. [PMID: 32764084 PMCID: PMC7412587 DOI: 10.1136/bmjopen-2019-036502] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES Prader-Willi syndrome (PWS) significantly impacts health-related quality of life; however, its relational and existential aspects remain unknown in Italian clinical and social debate. The project aimed to investigate the impact of PWS on illness experience through narrative medicine (NM) to understand the daily life, needs and resources of patients with PWS and their caregivers, and to furnish insights for clinical practice. DESIGN AND SETTING The project involved 10 medical centres of the Italian Network for Rare Diseases and PWS family associations and targeted underage and adult patients with PWS and their caregivers. Written interviews, composed by a sociodemographic survey and a narrative, were collected through the project's website. Three dedicated illness plots employed evocative and open words to facilitate individual expression and to encourage reflection. Narratives were analysed through NVivo software. Researchers discussed the results with the project's steering committee. PARTICIPANTS Twenty-one children and adolescents and 34 adults with PWS joined the project, as well as 138 caregivers. A PWS diagnosis or the caregiving of a patient with PWS older than 5 years represented the eligibility criteria, as well as the willingness to share their illness experience by writing and the ability to communicate in Italian. RESULTS The analysis of narratives led to understanding the PWS social and relational issues concerning diagnosis and current management, PWS daily experiences and social contexts, PWS implications in the working sphere and participants' future perspectives. Narratives demonstrated that PWS management affects relationships and work-life balance and that social stigma remains present. CONCLUSION The project represented the first effort to investigate the impact of PWS on illness experience in Italy through NM while considering the perspectives of patients with PWS and their caregivers. The findings indicated that a multiprofessional approach is fundamental to ensure adequate treatment and provided elements for its improvement.
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Affiliation(s)
- Letizia Ragusa
- Unit of Paediatrics and Medical Genetics, OASI Maria SS Research Institute, Troina, Enna, Italy
| | - Antonio Crinò
- Autoimmune Endocrine Diseases Unit, Bambino Gesù Paediatric Hospital-Palidoro Research Institute, Rome, Italy
| | - Graziano Grugni
- Department of Auxology, Istituto Auxologico Italiano, Verbania, Italy
| | - Luigi Reale
- Healthcare Area, Fondazione ISTUD, Baveno, Verbano-Cusio-Ossola, Italy
| | | | - Maria Rosaria Licenziati
- Obesity and Endocrine Disease Unit, Department of Neuroscience, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Maria Felicia Faienza
- Pediatrics Unit, Department of Biomedical Sciences and Human Oncology, Universita degli Studi di Bari Aldo Moro, Bari, Italy
| | - Malgorzata Wasniewska
- Department of Human Pathology of Adulthood and Childhood 'G Barresi', University of Messina, Messina, Italy
| | - Maurizio Delvecchio
- Metabolic Diseases, Clinical Genetics and Diabetology Unit, Giovanni XXIII Children's Hospital, Bari, Italy
| | - Adriana Franzese
- Department of Translational Medical Sciences, University of Naples Federico II, Napoli, Campania, Italy
| | - Irene Rutigliano
- Department of Pediatrics, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Paola Fusilli
- UOC Neonatologia, Ospedale 'Spirito Santo', Pescara, Italy
| | - Domenico Corica
- Department of Human Pathology of Adulthood and Childhood 'G Barresi', University of Messina, Messina, Italy
| | - Giuseppina Campana
- Obesity and Endocrine Disease Unit, Department of Neuroscience, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Donatella Greco
- Unit of Paediatrics and Medical Genetics, OASI Maria SS Research Institute, Troina, Enna, Italy
| | - Mariangela Chiarito
- Department of Biomedical Sciences and Human Oncology, University of Bari 'A Moro', Bari, Italy
| | - Michele Sacco
- Department of Pediatrics, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Silvia Toscano
- Department of Translational Sciences, University Federico II, Naples, Italy
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Graham S, Auyeung V, Weinman J. Exploring Potentially Modifiable Factors That Influence Treatment Non-Adherence Amongst Pediatric Growth Hormone Deficiency: A Qualitative Study. Patient Prefer Adherence 2020; 14:1889-1899. [PMID: 33116433 PMCID: PMC7569171 DOI: 10.2147/ppa.s268972] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 08/11/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION A recent systematic review found that up to 71% of children with growth hormone deficiency and their families are non-adherent to treatment as prescribed. A key way to better understanding the complex issue of pediatric non-adherence is to explore the perceptions and experiences of the parent/caregiver. Our study is the first to look specifically at the potentially modifiable factors that influence non-adherence to rhGH treatment amongst parents/caregivers of children with this endocrine disorder. METHODS Fourteen semi-structured telephone interviews were conducted to explore parents/caregivers' perceptions and experiences of their child's condition and prescribed treatment, in addition to their perceived relationship with their healthcare professional. The findings were thematically analyzed and narratively synthesized, in line with the qualitative approach of Braun and Clarke (2006). RESULTS Potentially modifiable factors that influence non-adherence to growth hormone treatment were grouped under four themes: 1. Device Burdens, 2. Treatment Considerations, 3. Logistical Interferences and 4. Interpersonal Influences. CONCLUSION Our exploratory study presents the wide range of potentially modifiable factors that influence the way in which growth hormone treatment is used. These findings can, in turn, be used to inform and promote the development of targeted, adherence-focused interventions, to support growth hormone deficient children and their families and optimize the use of prescribed growth hormone treatment within endocrine clinical practice.
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Affiliation(s)
- Selina Graham
- School of Cancer and Pharmaceutical Sciences, King’s College London, London, UK
- Correspondence: Selina Graham School of Cancer and Pharmaceutical Sciences, King’s College London, Franklin-Wilkins Building, London, UK Email
| | - Vivian Auyeung
- School of Cancer and Pharmaceutical Sciences, King’s College London, London, UK
| | - John Weinman
- School of Cancer and Pharmaceutical Sciences, King’s College London, London, UK
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Alsaigh R, Coyne I. Mothers' Experiences of Caring for Children Receiving Growth Hormone Treatment. J Pediatr Nurs 2019; 49:e63-e73. [PMID: 31575443 DOI: 10.1016/j.pedn.2019.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/20/2019] [Accepted: 09/05/2019] [Indexed: 01/15/2023]
Abstract
PURPOSE To achieve understanding of the meanings of mothers' experiences of caring for children receiving growth hormone treatment (GHT). BACKGROUND Children generally begin GHT at a very early age which means parents have significant responsibilities and often endure a complex and difficult pathway with GHT. DESIGN AND METHODS Hermeneutic interpretive phenomenology based on the approach of Gadamer that adhered to the consolidated criteria for reporting qualitative research (COREQ) guidelines. See Supplementary File 1. Data collected through interviews and diaries with mothers (n = 16). RESULTS Mothers' experiences were framed by three concepts: uncertainty, normalisation and stigma. These concepts were used to elaborate on the four major meanings encapsulating their experience of caring for their children receiving GHT: (1) "It's the right thing to do" (Striving for the security and the wellbeing of the child), (2) "Doubting yourself constantly" (Constant uncertainty), (3) "But then you just get used to it I suppose" (Adhering to GHT and lifestyle changes - the new normal), (4) "I hadn't been told anything about it" (Information behaviour; looking for normality and certainty). CONCLUSION Mothers experienced significant challenges coping with the uncertainties associated with GHT and needed more information and support. The felt stigma of restricted growth, rare medical condition and GHT appeared to hinder some mothers from seeking support. PRACTICE IMPLICATIONS Healthcare professionals and policy makers need to ensure that services for children receiving GHT include the necessary continuous practical and emotional support for parents along the treatment journey.
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Affiliation(s)
- Rasha Alsaigh
- College of Nursing, Department of Maternity and Child Nursing, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Imelda Coyne
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland.
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Graham S, Weinman J, Auyeung V. Identifying Potentially Modifiable Factors Associated with Treatment Non-Adherence in Paediatric Growth Hormone Deficiency: A Systematic Review. Horm Res Paediatr 2019; 90:221-227. [PMID: 30522126 DOI: 10.1159/000493211] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 08/22/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Despite the developments of recombinant growth hormone (rhGH) treatment and the benefits in long-term clinical health outcomes, evidence has shown that many children with growth hormone deficiency (GHD) still fail to achieve their target adult height. Suboptimal outcomes have been largely attributed to treatment non-adherence. METHODS A search of 11 electronic databases was undertaken to identify relevant articles, published in English, between 1985 and 2018. Additional search strategies included hand-searching topic review articles to identify eligible studies. Articles were screened against the inclusion eligibility criteria and data on sample characteristics, study design, outcomes, and key findings was extracted. The results were narratively synthesised and categorised using the COM-B theoretical framework. RESULTS Twenty-one full-text articles were assessed for eligibility, of which 6 articles met the inclusion criteria. The prevalence of non-adherence in the included studies varied from 7 to 71%. Potentially modifiable factors associated with rhGH non-adherence were categorised within the COM-B framework; key factors included: a lack of knowledge and understanding of the condition and treatment, discomfort and pain associated with injections, and the quality of the healthcare professional-patient relationship. CONCLUSION This review highlights the scope of the adherence problem evident amongst the paediatric GHD population and in addition presents the wide range of potentially modifiable factors that explain this health-related behaviour.
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Affiliation(s)
- Selina Graham
- Institute of Pharmaceutical Science, King's College London, London, United Kingdom,
| | - John Weinman
- Institute of Pharmaceutical Science, King's College London, London, United Kingdom
| | - Vivian Auyeung
- Institute of Pharmaceutical Science, King's College London, London, United Kingdom
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15
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Palandri F, Benevolo G, Iurlo A, Abruzzese E, Carella AM, Paoli C, Palumbo GA, Bonifacio M, Cilloni D, Andriani A, Guarini A, Turri D, Elli EM, Falcone A, Anaclerico B, Musto P, Di Renzo N, Tiribelli M, Zambello R, Spinosa C, Ricco A, Raucci L, Martino B, Annunziata M, Pascale S, Liberati AM, La Nasa G, Maffioli M, Breccia M, Pugliese N, Betti S, Giglio G, Cappuccio A, Reale L. Life for patients with myelofibrosis: the physical, emotional and financial impact, collected using narrative medicine-Results from the Italian 'Back to Life' project. Qual Life Res 2018. [PMID: 29520559 DOI: 10.1007/s11136-018-1827-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE Myelofibrosis (MF) is a chronic myeloproliferative neoplasm characterised by an aggressive clinical course, with disabling symptoms and reduced survival. Patients experience a severely impaired quality of life and their families face the upheaval of daily routines and high disease-related financial costs. The aim of this study was to investigate the perceptions of Italian patients and their caregivers about living with MF and the burden of illness associated with MF. METHODS A quali-quantitative questionnaire and a prompted written narrative survey were administered to patients affected by primary or post-essential thrombocythemia/post-polycythaemia vera MF and their primary caregiver in 35 Italian haematological centres. RESULTS In total, 287 questionnaires were returned by patients and 98 by caregivers, with 215 and 62, respectively, including the narrative. At the time of diagnosis, the most commonly expressed emotional states of patients were fear, distress and anger, confirming the difficulty of this phase. A high level of emotional distress was also reported by caregivers. Along the pathway of care, the ability to cope with the disease differed according to the quality of care received. The mean cost to each patient attributable to MF was estimated as €12,466 per year, with an estimated average annual cost of loss of income of €7774 per patient and €4692 per caregiver. CONCLUSIONS Better understanding of the personal life of MF patients and their families could improve the relationships between health workers and patients, resulting in better focused healthcare pathways and more effective financial support to maintain patients in their social roles.
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Affiliation(s)
- Francesca Palandri
- Seràgnoli Institute of Hematology and Medical Oncology, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Giulia Benevolo
- Hematology, City of Health and Science Hospital and University, Torino, Italy
| | - Alessandra Iurlo
- Hematology Division IRCCS Ca' Granda-Maggiore Policlinico Hospital Foundation, Milan, Italy
| | | | - Angelo M Carella
- Centro Polispecialistico Pacini, Milan, Italy.,Clinica Villa Pia, Rome, Italy
| | - Chiara Paoli
- Department of Experimental and Clinical Medicine, CRIMM Centre for Research and Innovation on Myeloproliferative Diseases, Careggi Hospital, University of Firenze, Florence, Italy
| | | | | | - Daniela Cilloni
- Department of Clinical and Biological Sciences, University of Torino, Turin, Italy
| | | | - Attilio Guarini
- Haematology, IRCCS "Giovanni Paolo II" National Cancer Research Centre, Bari, Italy
| | - Diamante Turri
- Ematologia 1 con TMO, A. O. R. Villa Sofia- Cervello, Palermo, Italy
| | | | - Antonietta Falcone
- Unità Operativa di Ematologia San Giovanni Rotondo, IRCCS, Casa Sollievo della Sofferenza, Foggia, Italy
| | | | - Pellegrino Musto
- Scientific Direction, IRCCS-CROB, Referral Cancer Center of Basilicata, Rionero in Vulture, Potenza, Italy
| | - Nicola Di Renzo
- Hematology and Stam Cells Transplant Department, "Vito Fazzi" Hospital, Lecce, Italy
| | - Mario Tiribelli
- Division of Hematology and BMT, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | | | - Caterina Spinosa
- Ematologia con Trapianto, Ospedale San Giuseppe Moscati, Taranto, Italy
| | - Alessandra Ricco
- Hematology and Transplant, Department of Emergency and Organ Transplant, Bari, Italy
| | | | - Bruno Martino
- Hematology, Bianchi Melacrino Morelli Hospital, Reggio Calabria, Italy
| | | | | | | | - Giorgio La Nasa
- Hematology, Department of Medical Sciences, University of Cagliari, Cagliari, Italy
| | | | - Massimo Breccia
- Department of Cellular Biotechnology and Hematology, Sapienza University, Rome, Italy
| | | | - Silvia Betti
- Institute of Hematology, Catholic University, Rome, Italy
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