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Bull KS, Stubley S, Freeman A, Liossi C, Darlington AE, Grootenhuis MA, Hargrave D, Morris C, Walker DA, Kennedy CR. P06.03 Child, parent, and clinician selection of patient-reported outcome measures to use in pediatric neuro-oncology outpatient follow-up clinics. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab180.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Survivors of childhood brain tumours are at risk of poor health-related quality of life (HRQoL). Appropriate and relevant measures can be used to monitor HRQoL so that timely interventions may be made for issues thus identified. We had previously selected patient-reported outcome measures (PROMs) with good psychometric properties that had emerged as well-suited for this use in two systematic reviews. The aim of the present study was to ascertain the views of families regarding the suitability of the selected measures for use in paediatric neuro-oncology follow-up clinics. These views were then used to inform the choice of PROMs for use on the KLIK PROM portal, a website designed to gather HRQoL information from families.
MATERIAL AND METHODS
As part of the PROMOTE study, we used a multi-centre, multi-informant, cross-sectional, qualitative methods research design. Using ‘think aloud’ audio-recorded interviews, children aged 8–17 years diagnosed within the previous five years with a brain tumour, off treatment and receiving outpatient care, and their parents, were shown a total of nine PROMs and asked to express their views on which they preferred. Detailed notes were made of all audio-recordings by two independent researchers. The final choice of PROMs to be included on the KLIK PROM portal was agreed through discussion of the PROMs selected by families with an expert panel of clinicians, researchers, and parent representatives.
RESULTS
16 children and 17 parents participated and of these 2 children and 2 parents did not express a preference. The Pediatric Quality of Life Inventory (PedsQL) Core module was the most popular among the children and parents with 7/14 (50%) of children selecting it as either their 1st or 2nd choice citing that they liked the questions and felt them to be most relevant to them, and 8/15 (53%) of parents citing that it was easy, quick and simple, the wording was easy, and they liked the questions about emotional, social, and school functioning. The least popular questionnaires, with no participants selecting them as first choices, were the Kidscreen-10 and the Health Utilities Index. The latter 2 were selected only as 2nd or lower choices by 1 child and 3 parents respectively.
CONCLUSION
The PROMs that were finally selected for the KLIK PROM portal were the parent- and child-report PedsQL-Core measures of HRQoL due to their good psychometric properties, family and clinician preference and perceived relevance to follow-up care, and for clinical utility on the KLIK PROM portal.
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Affiliation(s)
- K S Bull
- University of Southampton, Southampton, United Kingdom
| | - S Stubley
- De Montfort University, Leicester, United Kingdom
| | - A Freeman
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - C Liossi
- University of Southampton, Southampton, United Kingdom
| | | | - M A Grootenhuis
- Princess Máxima Centre for Paediatric Oncology, Utrecht, Netherlands
| | - D Hargrave
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - C Morris
- University of Exeter, Exeter, United Kingdom
| | - D A Walker
- University of Nottingham, Nottingham, United Kingdom
| | - C R Kennedy
- University of Southampton, Southampton, United Kingdom
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2
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Williams G, Howard RF, Liossi C. [Erratum to: Persistent postsurgical pain in children and young people : Prediction, prevention, and management]. Schmerz 2018; 35:173. [PMID: 30167875 DOI: 10.1007/s00482-018-0317-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- G Williams
- The Anaesthetic Department, Pediatric Anesthesia and PainMedicine, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond St, WC1 3JH, London, Großbritannien.
| | - R F Howard
- The Anaesthetic Department, Pediatric Anesthesia and PainMedicine, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond St, WC1 3JH, London, Großbritannien
| | - C Liossi
- Pediatric Psychology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, Großbritannien.,Pediatric Psychology, University of Southampton, Southampton, Großbritannien
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3
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Holley S, Walker D, Knibb R, Latter S, Liossi C, Mitchell F, Radley R, Roberts G. Barriers and facilitators to self-management of asthma in adolescents: An interview study to inform development of a novel intervention. Clin Exp Allergy 2018; 48:944-956. [PMID: 29573024 DOI: 10.1111/cea.13141] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 02/01/2018] [Accepted: 02/09/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND OBJECTIVE Despite literature that spans twenty years describing the barriers to asthma self-management in adolescents, successful, clinically based interventions to address this important issue are lacking. Given the limitations of some of the previous studies, we conducted a study that aimed to gain a broader insight into barriers and facilitators to self-management of asthma by adolescents, not just adherence to treatment, and triangulated their views with those of their parents and healthcare professionals. METHODS Focus groups and interviews were conducted separately for 28 adolescents with asthma aged 12-18 years, 14 healthcare professionals and 12 parents. Focus groups and interviews were audio-recorded, and transcripts from each participant group were analysed separately using inductive thematic analysis. We triangulated the three perspectives by comparing themes that had emerged from each analysis. RESULTS Adolescents', parents' and healthcare professionals' views were summarized into ten related themes that included forgetting and routines, knowledge, embarrassment and confidence, communication with healthcare professionals, triggers, support at school, apathy and taking responsibility. We found that adolescents, parents and healthcare professionals raised similar barriers and facilitators to self-management and our results provide further validation for previous studies. CONCLUSION AND CLINICAL RELEVANCE Our study highlights that healthcare professionals may need to consider a range of psychological and contextual issues influencing adolescents' ability to effectively self-manage their asthma, in particular, how they implement treatment routines and the understanding that adolescents have of their condition and treatments. Crucially, healthcare professionals need to consider how this information is communicated and ensure they facilitate open, inclusive, two-way consultations. From this more comprehensive understanding, we have developed interventional strategies that healthcare professionals can utilize to empower adolescents to improve their asthma self-management.
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Affiliation(s)
- S Holley
- Clinical and Experimental Sciences and Human Development in Health Academic Units, Faculty of Medicine, University of Southampton, Southampton, UK
| | - D Walker
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - R Knibb
- Aston University, Birmingham, UK
| | - S Latter
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - C Liossi
- School of Psychology, University of Southampton, Southampton, UK.,Department of Paediatric Psychology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - F Mitchell
- The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport, UK
| | - R Radley
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - G Roberts
- Clinical and Experimental Sciences and Human Development in Health Academic Units, Faculty of Medicine, University of Southampton, Southampton, UK.,The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport, UK.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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4
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Huntington C, Newton JT, Donaldson N, Liossi C, Reynolds PA, Alharatani R, Hosey MT. Lessons learned on recruitment and retention in hard-to-reach families in a phase III randomised controlled trial of preparatory information for children undergoing general anaesthesia. BMC Oral Health 2017; 17:122. [PMID: 28882136 PMCID: PMC5590238 DOI: 10.1186/s12903-017-0411-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 08/13/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recruitment and retention are documented as two of the most difficult elements of conducting clinical trials. These issues are even more challenging in paediatric trials, particularly when the families being recruited and retained are deemed 'hard to reach'. METHODS Through the authors' own reflection on the conduct of the trial this paper examines recruitment and retention with hard to reach families from the perspective of a recently completed clinical trial on preparatory information for children undergoing general anaesthesia for tooth extractions in which approximately 83% of those approached and eligible agreed to participate. RESULTS The lessons learned for recruitment include: the importance of children's assent; maximising limited resources when screening and approaching potential participants; valuing families' time; and developing effective professional relationships. The retention rate was 83-85.5% at follow up time points up to 3.5 weeks following recruitment, insights into how this was accomplished include: ensuring continuity of care; determination to connect via telephone; valuing families' time; and close monitoring of appointment date changes. CONCLUSIONS Implications for future paediatric trials with hard to reach families are discussed. TRIAL REGISTRATION ISRCTN18265148 ; NIHR Portfolio 10,006. Date of Registration: 29 November 2013. The trial was registered after commencement but before completion of data collection.
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Affiliation(s)
- C Huntington
- King's College London Dental Institute, Bessemer Road, London, SE5 9RS, UK.
| | - J Timothy Newton
- King's College London Dental Institute, Bessemer Road, London, SE5 9RS, UK
| | - N Donaldson
- King's College London Dental Institute, Bessemer Road, London, SE5 9RS, UK
| | - C Liossi
- University of Southampton and Great Ormond Street Hospital for Children NHS Trust, Southampton, UK
| | - P A Reynolds
- King's College London Dental Institute, Bessemer Road, London, SE5 9RS, UK
| | - R Alharatani
- King's College London Dental Institute, Bessemer Road, London, SE5 9RS, UK
| | - M T Hosey
- King's College London Dental Institute, Bessemer Road, London, SE5 9RS, UK
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Abstract
BACKGROUND Little is known about the communication of everyday pain between young children and their parents, i.e. when children experience pain resulting from minor injury or illness that occur in everyday life. This study aimed to gain an in-depth understanding of how parents make sense of their young children's expression of everyday pains and how they respond. METHODS Parents (n = 48) of children (1-5 years inclusive) participated in focus group discussions at seven children's centres across England where they were asked to describe their children's communication of everyday pain. Thematic analysis was used to analyse the data. RESULTS Six main themes were identified in the parents' discourse. Parents described children's pain communication as (1) sharing common elements, but unique to each child; (2) having multifaceted pain and non-pain-related purposes; (3) challenging to interpret; (4) influenced by their own pain-related communication; (5) requiring a variety of pharmacological, psychological and physical strategies to manage. The sixth theme that emerged from the data related to parents' dissatisfaction with health care providers, particularly general practitioners' sometimes quick dismissal of parental concerns about their children's pain and illness complaints. CONCLUSIONS These findings suggest that parents have well developed, although personal, ways of recognizing and responding to their children's communication of pain, but also experience uncertainty in their judgments. Parents would benefit from information about the developmental aspects of pain and should be included as active partners in their children's pain assessment and management.
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Affiliation(s)
- C Liossi
- University of Southampton, UK; Great Ormond Street Hospital for Children, London, UK; UCL Institute of Child Health, London, UK.
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6
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Schoth D, Godwin H, Liversedge S, Liossi C. Eye movements during visual search for emotional faces in individuals with chronic headache. Eur J Pain 2014; 19:722-32. [DOI: 10.1002/ejp.595] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2014] [Indexed: 11/10/2022]
Affiliation(s)
- D.E. Schoth
- Academic Unit of Psychology; University of Southampton; UK
| | - H.J. Godwin
- Academic Unit of Psychology; University of Southampton; UK
| | | | - C. Liossi
- Academic Unit of Psychology; University of Southampton; UK
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7
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Schoth D, Williams S, Liossi C. Attentional bias for pain- and period-related symptom words in healthy women who experienced a recent painful period. Eur J Pain 2014; 19:745-51. [DOI: 10.1002/ejp.597] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2014] [Indexed: 11/11/2022]
Affiliation(s)
- D.E. Schoth
- Academic Unit of Psychology; University of Southampton; UK
| | - S. Williams
- Academic Unit of Psychology; University of Southampton; UK
| | - C. Liossi
- Academic Unit of Psychology; University of Southampton; UK
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Maillard S, Liossi C, Schoth D, Howard R, Walker S. Factors associated with pain in children with hypermobility – a pilot study. Pediatr Rheumatol Online J 2014. [PMCID: PMC4184168 DOI: 10.1186/1546-0096-12-s1-p100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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9
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Reynolds PA, Donaldson N, Huntington C, Liossi C, Newton TC, Hosey MT. Scott and the logs: design and data capture in a preparatory online package for children undergoing GA for dental procedures. Bull Group Int Rech Sci Stomatol Odontol 2013; 51:e23-e24. [PMID: 25461125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 05/08/2013] [Indexed: 06/04/2023]
Affiliation(s)
- P A Reynolds
- Dental Institute, King’s College London, London WC2R 2LS, UK.
| | - N Donaldson
- Dental Institute, King’s College London, London WC2R 2LS, UK
| | - C Huntington
- Dental Institute, King’s College London, London WC2R 2LS, UK
| | - C Liossi
- School of Psychology, Faculty of Medicine, Health and Life Sciences, University of Southampton, SO17 1BJ, UK
| | - T C Newton
- Dental Institute, King’s College London, London WC2R 2LS, UK
| | - M T Hosey
- Dental Institute, King’s College London, London WC2R 2LS, UK
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10
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Franck L, Noble G, Liossi C. Translating the tears: parents' use of behavioural cues to detect pain in normally developing young children with everyday minor illnesses or injuries. Child Care Health Dev 2010; 36:895-904. [PMID: 20637021 DOI: 10.1111/j.1365-2214.2010.01130.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The objectives of this paper were to (i) identify the behavioural cues used by parents to detect young children's transient pain from minor illnesses or injuries ('everyday pain'); and (ii) perform an initial psychometric evaluation of the Parents' Post-operative Pain Measure (PPPM) in the context of children's everyday pain. METHOD Cross-sectional Internet survey. RESULTS One thousand seven hundred sixteen parents of children (1-6 years) completed the survey. The parents reported more behaviours when children had pain from minor illnesses than from minor injuries (9.6 ± 3.9 vs. 2.5 ± 2.3, P < 0.001). Principal component analysis of the PPPM revealed a two-factor solution for illness-related pain and a three-factor solution for injury-related pain. Behavioural cues varied with characteristics of children (age, gender and prior hospital experience) and parents (gender, age and parenting experience). CONCLUSIONS The PPPM is a promising tool for parental assessment of children's pain in everyday situations. Further research is needed to determine its utility in facilitating communication between parents and healthcare professionals, and in improving the management of young children's pain.
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Affiliation(s)
- L Franck
- UCL Institute of Child Health, London, UK.
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11
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Franck L, Noble G, Liossi C. From tears to words: the development of language to express pain in young children with everyday minor illnesses and injuries. Child Care Health Dev 2010; 36:524-33. [PMID: 20345397 DOI: 10.1111/j.1365-2214.2010.01084.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Little is known about the development of language to express pain in the young or how children and parents verbally communicate when young children have everyday minor illnesses and injuries. METHODS UK parents of children between the ages of 1 and 6 were invited to complete an Internet survey on children's pain language during everyday situations of minor illness or injury. RESULTS Of the 1716 parents completing the survey, 45% reported their child had at least one word to express pain by 17 months of age, increasing to 81% by 23 months of age. Children used different words based on their age and in the contexts of minor illnesses and injuries, with words for expressing pain related to illness emerging slightly later. Children's language was purposeful in describing causes of pain and requesting specific forms of assistance from parents even in the very youngest age groups. Parents' communicated with their children primarily to gain further information about the source and nature of pain and to direct children's behaviour. CONCLUSIONS Children rapidly develop an extensive vocabulary to describe pain between 12 and 30 months of age, with words for pain from injury emerging first and reflecting the development of normal speech acquisition. The differences in verbal expressions in the context of minor illnesses and injuries suggest that children make a cognitive distinction between the origins and sensory aspects of pain. These findings can help parents, childcare and healthcare professionals to appreciate the early communication capabilities of young children and to engage in more effective pain assessment and management for young children.
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Affiliation(s)
- L Franck
- UCL Institute of Child Health, London, UK.
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12
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Abstract
BACKGROUND Existing evidence suggests that neurobehavioural disability is a frequent legacy of serious head trauma and has a major impact on the psychological well-being of relatives and friends of people with brain injuries. OBJECTIVE To explore which neurobehavioural legacies of serious head trauma have the greatest impact on personal relationships and increase the risk of relationship breakdown. METHOD Forty-eight partners of people who had suffered serious head trauma were asked to complete a 12-item measure to rate how different neurobehavioural characteristics had adversely affected their relationship with the brain injured person. Twenty-three couples who had divorced or separated from their injured partner in the years following injury comprised the 'separated' group, 25 still in the relationship at the time data were collected comprised the 'together' group. RESULTS Even though many neurobehavioural characteristics of brain injury were reported by partners of both the separated and the together group as placing a strain on the relationship only mood swings accounted for a significant between groups difference [t(40.13) = 3.33, p = 0.002]. The magnitude of the difference in the means was large (712 = 0.19). CONCLUSIONS Unpredictable patterns of behaviour, as perceived by partners of brain injured individuals, impose the greatest burden on personal relationships and may contribute to relationship breakdown.
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Affiliation(s)
- R L Wood
- Department of Psychology,University of Wales Swansea, Singleton Park, Swansea SA2 8PP, UK.
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Liossi C, Hatira P. Clinical hypnosis versus cognitive behavioral training for pain management with pediatric cancer patients undergoing bone marrow aspirations. Int J Clin Exp Hypn 1999; 47:104-16. [PMID: 10208073 DOI: 10.1080/00207149908410025] [Citation(s) in RCA: 116] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
A randomized controlled trial was conducted to compare the efficacy of clinical hypnosis versus cognitive behavioral (CB) coping skills training in alleviating the pain and distress of 30 pediatric cancer patients (age 5 to 15 years) undergoing bone marrow aspirations. Patients were randomized to one of three groups: hypnosis, a package of CB coping skills, and no intervention. Patients who received either hypnosis or CB reported less pain and pain-related anxiety than did control patients and less pain and anxiety than at their own baseline. Hypnosis and CB were similarly effective in the relief of pain. Results also indicated that children reported more anxiety and exhibited more behavioral distress in the CB group than in the hypnosis group. It is concluded that hypnosis and CB coping skills are effective in preparing pediatric oncology patients for bone marrow aspiration.
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Affiliation(s)
- C Liossi
- University of Sunderland, United Kingdom
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14
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Mystakidou K, Befon S, Liossi C, Vlachos L. Comparison of the efficacy and safety of tropisetron, metoclopramide, and chlorpromazine in the treatment of emesis associated with far advanced cancer. Cancer 1998; 83:1214-23. [PMID: 9740088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND A single institution, prospective, randomized trial was performed in terminal cancer patients to compare tropisetron (TRO), metoclopramide (MET), and chlorpromazine (CHL) in the management of nausea and emesis. Patients had far advanced cancer, were far removed from chemotherapy or radiotherapy, and their nausea and emesis was not due to bowel obstruction, drug intake, or cranial, electrolytic, or metabolic causes. The effects of antiemetic treatments were evaluated from Days 1-15. METHODS Two hundred and eighty patients were randomized to receive 1) MET+ dexamethasone (DEX) (10 mg*4 and 2 mg*1, respectively, orally), 2) TRO (5 mg*1, orally), 3) TRO + MET (5 mg*1 and 10 mg*2, respectively, orally), 4) TRO + MET + DEX (5 mg*1, 10 mg*2, and 2 mg*1, respectively, orally), 5) CHL + DEX (25 mg*2 and 2 mg*1, respectively, orally), 6) TRO + CHL (5 mg*1 and 12.5 mg*2, respectively, orally), or 7) TRO + CHL + DEX (5 mg*1, 12.5 mg*2, and 2 mg*1, respectively, orally). Total control was defined as no nausea or emesis. RESULTS By the end of the 15th day, total control of emesis was obtained in 23.6% (9 of 38) of MET + DEX patients, 78.9% (30 of 38) of TRO patients, 84.2% (32 of 38) of TRO + MET patients, 92.3% (36 of 39) of TRO + MET + DEX patients, 33.3 (13 of 39) of CHL + DEX patients, 84.6% (33 of 39) of TRO + CHL patients, and 92.5% (37 of 40) of TRO + CHL + DEX patients. Total control of nausea was achieved in 18.4% (7 of 38) of MET + DEX patients, 65.7% (25 of 38) of TRO patients, 73.6% (28 of 38) of TRO + MET patients, 87.1% (34 of 39) of TRO + MET + DEX patients, 17.9% (7 of 39) of CHL + DEX patients, 74.3% (29 of 39) of TRO + CHL patients, and 85% (34 of 40) of TRO + CHL + DEX patients. When comparing MET + DEX versus TRO; MET + DEX versus TRO + MET; MET + DEX versus TRO + MET + DEX; MET + DEX versus TRO + CHL; MET + DEX versus TRO + CHL + DEX; CHL + DEX versus TRO; CHL + DEX versus TRO + MET; CHL + DEX versus TRO + MET + DEX; CHL + DEX versus TRO + CHL; and CHL + DEX versus TRO + CHL + DEX, significant differences were noted. All antiemetic drugs were well tolerated with no severe side effects observed in any treatment arm. CONCLUSIONS These data suggest that 5-HT3 receptor antagonists such as tropisetron clinically are more effective in the control of emesis of patients with far advanced cancer than previously used agents. This study raises important issues when attempting to decide which antiemetic therapy to choose for an individual patient with far advanced disease.
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Affiliation(s)
- K Mystakidou
- Pain Relief and Palliative Care Unit, Areteion Hospital, University of Athens, Greece
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Mystakidou K, Befon S, Liossi C, Vlachos L. Comparison of tropisetron and chlorpromazine combinations in the control of nausea and vomiting of patients with advanced cancer. J Pain Symptom Manage 1998; 15:176-84. [PMID: 9564119 DOI: 10.1016/s0885-3924(97)00349-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The single-institution, prospective, randomized trial was performed to evaluate the efficacy of tropisetron and chlorpromazine in the management of nausea and vomiting of terminal cancer patients. Patients had no recent chemotherapy or radiotherapy, and emesis was not due to bowel obstruction, electrolytic or metabolic disturbances, drug intake, or intracranial disease. One hundred and sixty patients randomly received either (a) chlorpromazine (CLO) (50 mg/day) plus dexamethasone (DEX) (2 mg/day), (b) chlorpromazine (25 mg/day) plus tropisetron (TRO) (5 mg/day), (c) chlorpromazine (25 mg/day plus tropisetron (5 mg/day) plus dexamethasone (2 mg/day), or (d) tropisetron (TRO) (5 mg/day). Patients were monitored from day 1 to day 15. No nausea or vomiting was defined as "total" control. On day 15, total vomiting control was achieved in 33.3% of the patients receiving CLO + DEX, 84.6% of the patients receiving CLO + TRO, 92.5% of the patients receiving CLO + TRO + DEX, and 78.9% of the patients receiving TRO. Total control of nausea was achieved in 18.0% of the patients receiving CLO + DEX, 74.4% of the patients receiving (CLO + TRO), 85.0% of the patients receiving CLO + TRO + DEX, and 65.8% of the patients receiving TRO. Tropisetron-containing combinations produced significant control of nausea and vomiting from the third day onward. All antiemetic drugs were well tolerated. These data suggest that tropisetron-containing combinations or tropisetron as a single agent are much more effective in the control of emesis in patients with advanced cancer than the conventional antiemetic combination of chlorpromazine plus dexamethasone. Tropisetron is well tolerated and may be the best choice for controlling persistent nausea and vomiting in terminal cancer patients.
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Affiliation(s)
- K Mystakidou
- Pain Relief and Palliative Care Unit, Athens, Greece
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Mystakidou K, Liossi C, Fragiadakis K, Georgaki S, Papadimitriou J. What do Greek physicians know about managing cancer pain? J Cancer Educ 1998; 13:39-42. [PMID: 9565860 DOI: 10.1080/08858199809528509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
BACKGROUND Pain is prevalent in cancer patients. Although the World Health Organization has issued guidelines for treating pain in cancer patients, pain is often not treated optimally. Numerous barriers have been identified that prevent health care professionals from providing effective treatment for pain. The knowledge and attitudes of health care professionals with regard to pain and its impact on the patient are among them. The purpose of the present study was to evaluate knowledge about and attitudes toward cancer pain and its management among Greek oncologists, surgeons, anesthesiologists, and general practitioners. METHOD Knowledge of the principles and methods of cancer pain treatment was assessed by a questionnaire distributed to a representative sample of 1,200 Greek physicians. RESULTS The study results highlight very substantial knowledge deficits in the treatment of cancer pain by the evaluated physicians. CONCLUSIONS Cancer pain management in Greece is still developing, and the latest knowledge is spreading slowly but steadily.
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Affiliation(s)
- K Mystakidou
- Cancer Pain Relief and Palliative Care Unit, Areteion Hospital, University of Athens, Greece
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Abstract
A genogram is a format for drawing a family tree that records information about family members and their relationships over at least three generations. The genogram has been widely promoted as a useful tool for gathering, recording and displaying family information in order to practice family-oriented health care. We present a format for constructing the genogram and to outline the principles underlying its interpretation and application in clinical practice, so as to facilitate its use by physicians, nurses, psychologists, family therapists, and other professionals working with families in palliative care. Finally, the future potential of the genogram as a research and clinical tool in palliative care is discussed.
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Affiliation(s)
- C Liossi
- Pain Relief and Palliative Care Unit, Areteion Hospital, University of Athens, Greece
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Abstract
Truth-telling to cancer patients is controversial. The aim of the present study was to investigate oncologists', radiotherapists', and palliative care specialists' attitudes and truth-telling practices in Greece. A postal survey of a representative sample of 300 oncologists, radiotherapists, and palliative care specialists was made in February 1993. A total of 228 doctors completed and returned the questionnaires. It appears that withholding the truth from cancer patients remains very common in Greece.
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Affiliation(s)
- K Mystakidou
- Cancer Pain Relief and Palliative Care Unit, University of Athens, Areteion Hospital, Greece
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Hawkins PJ, Liossi C, Ewart BW, Hatira P, Kosmidis VH, Varvutsi M. Hypnotherapy for control of anticipatory nausea and vomiting in children with cancer: Preliminary findings. Psychooncology 1995. [DOI: 10.1002/pon.2960040203] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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