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Phelps EE, Tutton E, Costa ML, Achten J, Moscrop A, Perry DC. Protecting my injured child: a qualitative study of parents' experience of caring for a child with a displaced distal radius fracture. BMC Pediatr 2022; 22:270. [PMID: 35549910 PMCID: PMC9097445 DOI: 10.1186/s12887-022-03340-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/28/2022] [Indexed: 11/10/2022] Open
Abstract
Background Childhood fractures can have a significant impact on the daily lives of families affecting children’s normal activities and parent’s work. Wrist fractures are the most common childhood fracture. The more serious wrist fractures, that can look visibly bent, are often treated with surgery to realign the bones; but this may not be necessary as bent bones straighten in growing children. The children’s radius acute fracture fixation trial (CRAFFT) is a multicentre randomised trial of surgery versus a cast without surgery for displaced wrist fractures. Little is known about how families experience these wrist fractures and how they manage treatment uncertainty. This study aimed to understand families’ experience of this injury and what it is like to be asked to include their child in a clinical trial. Methods Nineteen families (13 mothers, 7 fathers, 2 children) from across the UK participated in telephone interviews. Interviews were audio recorded, transcribed and analysed using reflexive thematic analysis. Results Our findings highlight parents’ desire to be a good parent through the overarching theme “protecting my injured child”. To protect their child after injury, parents endeavoured to make the right decisions about treatment and provide comfort to their child but they experienced ongoing worry about their child’s recovery. Our findings show that parents felt responsible for the decision about their child’s treatment and their child’s recovery. They also reveal the extent to which parents worried about the look of their child’s wrist and their need for reassurance that the wrist was healing. Conclusion Our findings show that protecting their child after injury can be challenging for parents who need support to make decisions about treatment and confidently facilitate their child’s recovery. They also highlight the importance of providing information about treatments, acknowledging parents’ concerns and their desire to do the right thing for their child, reassuring parents that their child’s wrist will heal and ensuring parents understand what to expect as their child recovers.
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Affiliation(s)
- E E Phelps
- Kadoorie, Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
| | - E Tutton
- Kadoorie, Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - M L Costa
- Kadoorie, Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - J Achten
- Kadoorie, Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - A Moscrop
- Parent Representative, Liverpool, UK
| | - D C Perry
- Kadoorie, Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Phelps EE, Tutton E, Costa M, Hing C. Unattainable equipoise in randomized controlled trials : staff views of a feasibility study of surgical treatments for segmental tibial fractures. Bone Jt Open 2021; 2:486-492. [PMID: 34236209 PMCID: PMC8325976 DOI: 10.1302/2633-1462.27.bjo-2021-0055.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Aims To explore staff experiences of a multicentre pilot randomized controlled trial (RCT) comparing intramedullary nails and circular frame external fixation for segmental tibial fractures. Methods A purposeful sample of 19 staff (nine surgeons) involved in the study participated in an interview. Interviews explored participants’ experience and views of the study and the treatments. The interviews drew on phenomenology, were face-to-face or by telephone, and were analyzed using thematic analysis. Results The findings identify that for the treatment of segmental tibial fractures equipoise was a theoretical ideal that was most likely unattainable in clinical practice. This was conveyed through three themes: the ambiguity of equipoise, where multiple definitions of equipoise and a belief in community equipoise were evident; an illusion of equipoise, created by strong treatment preferences and variation in collective surgical skills; and treating the whole patient, where the complexity and severity of the injury required a patient-centred approach and doing the best for the individual patient took priority over trial recruitment. Conclusion Equipoise can be unattainable for rare injuries such as segmental tibial fractures, where there are substantially different surgical treatments requiring specific expertise, high levels of complexity, and a concern for poor outcomes. Surgeons are familiar with community equipoise. However, a shared understanding of factors that limit the feasibility of RCTs may identify instances where community equipoise is unlikely to translate into practice. Cite this article: Bone Jt Open 2021;2(7):486–492.
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Affiliation(s)
- Emma Elizabeth Phelps
- Kadoorie, Oxford Trauma and Emergency Care, Nuffield Department Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Elizabeth Tutton
- Kadoorie, Oxford Trauma and Emergency Care, Nuffield Department Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,Trauma and MTC, Oxford University NHS Foundation Hospital Trust, John Radcliffe, Oxford, UK
| | - Matthew Costa
- Kadoorie, Oxford Trauma and Emergency Care, Nuffield Department Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Caroline Hing
- Department of Trauma and Orthopaedics, St George's University Hospitals NHS Foundation Trust, London, UK
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Phelps EE, Tutton E, Griffin X, Baird J. A qualitative study of patients' experience of recovery after a distal femoral fracture. Injury 2019; 50:1750-1755. [PMID: 31371167 DOI: 10.1016/j.injury.2019.07.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 07/01/2019] [Accepted: 07/19/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE This qualitative study was conducted as part of a feasibility study for TrAFFix, (ISRCTN92089567), a randomised controlled trial that will compare two surgical interventions used to fix distal femoral fractures. Our aim was to understand patients' experiences of treatment and the early phase of recovery after a distal femoral fracture. While, much is known about the experience of recovery from hip fracture, little is known about whether patients with other lower limb fragility fractures experience the same concerns and challenges. MATERIALS AND METHODS Semi-structured interviews were conducted with 11 patients participating in TrAFFix or their relative. Interviews were conducted face to face or by telephone. With agreement from participants, interviews were audio recorded and transcribed. Transcripts were analysed inductively using thematic analysis. As part of the user involvement for TrAFFix, we held a focus group with PPI representatives who had experience or knowledge of lower limb fractures, to learn about factors that might influence patients' recovery after a fragility facture. Data from the focus group relevant to themes from our thematic analysis are also presented. RESULTS Three themes were identified within patients' accounts of their experience. Our data revealed that: i) being informed about treatment and recovery was important to patients; ii) patients muddled through and found ways to manage at home, often needing the support of others; and iii) rehabilitation was arduous for patients who received limited rehabilitative support and at times lacked confidence to follow the instructions that they were given. CONCLUSIONS Our findings highlight the struggle patients endure while recovering after a distal femoral fracture and the limited rehabilitative support they receive after discharge from hospital. They reinforce the need to ensure a patient feels informed about their treatment and recovery and the need for greater support for patients to manage at home and move with confidence.
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Affiliation(s)
- Emma Elizabeth Phelps
- Oxford Trauma, Nuffield Department Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Kadoorie Centre, John Radcliffe Hospital, Oxford, UK.
| | - Elizabeth Tutton
- Oxford Trauma, Nuffield Department Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Kadoorie Centre, John Radcliffe Hospital, Oxford, UK; Warwick Research in Nursing, Warwick Medical School, University of Warwick, Coventry, UK; Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Xavier Griffin
- Oxford Trauma, Nuffield Department Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Kadoorie Centre, John Radcliffe Hospital, Oxford, UK; Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Phelps EE, Tutton E, Griffin X, Baird J. Facilitating trial recruitment: A qualitative study of patient and staff experiences of an orthopaedic trauma trial. Trials 2019; 20:492. [PMID: 31399134 PMCID: PMC6688236 DOI: 10.1186/s13063-019-3597-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 12/06/2018] [Accepted: 07/18/2019] [Indexed: 11/10/2022] Open
Abstract
Background Qualitative research has been used to explore patients’ and healthcare professionals’ experiences of surgical randomised controlled trials (RCTs). From this research, reasons why patients accept or decline participation and barriers to engaging clinicians in trials have been identified. In a trauma setting, recruitment to surgical trials can be particularly difficult as patients may require urgent treatment and their ability to consider their options, ask questions and reach a decision may be hindered by the impact of their injury. Little research, however, has explored patients’ and healthcare professionals’ experiences of surgical RCTs in a trauma setting. This study aimed to understand patients’ and staff’s experiences of an orthopaedic trauma trial. Methods We carried out semi-structured interviews with 11 patients and 24 staff (10 surgeons and 14 research associates) participating in a UK multi-centre feasibility trial comparing intramedullary nails versus distal locking plates for fractures of the distal femur (TrAFFix). Interviews explored patients’ experience of TrAFFix and their reason for participating and staffs' experience of recruiting to TrAFFix and trauma trials more generally. Interviews were audio recorded and transcribed verbatim. Transcripts were analysed using thematic analysis. Results Three themes were identified. These were i) navigating research with patients after orthopaedic trauma, ii) knowing that it is the right decision and iii) making it work. These themes reflect: i) how research associates supported and guided patients through the consent process enabling them to participate, ii) the difficulty in engaging surgeons in a trial when individual equipoise and experience of the interventions are low despite the presence of community equipoise and iii) the way in which research teams worked together and encouraged the development of a research culture within the clinical teams in order to facilitate recruitment. Conclusions Our findings highlight the pivotal role of research associates (RAs) in facilitating trial recruitment. RAs supported patients to enable them to make a decision about participation and assisted in developing a research culture within the team by promoting studies and communicating research to clinical staff. Our findings also reinforce surgeons’ difficulty with equipoise and suggest that accepting community equipoise could facilitate recruitment.
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Affiliation(s)
- Emma Elizabeth Phelps
- NDORMS, Kadoorie Centre, level 3, John Radcliffe Hospital, University of Oxford, Oxford, OX3 9DU, UK
| | - Elizabeth Tutton
- NDORMS, Kadoorie Centre, level 3, John Radcliffe Hospital, University of Oxford, Oxford, OX3 9DU, UK. .,Oxford University Hospitals NHS Foundation Trust, Oxford, UK. .,Warwick Research in Nursing, University of Warwick, Coventry, UK.
| | - Xavier Griffin
- NDORMS, Kadoorie Centre, level 3, John Radcliffe Hospital, University of Oxford, Oxford, OX3 9DU, UK
| | - Janis Baird
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16 6YD, UK
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Armoiry X, Sturt J, Phelps EE, Walker CL, Court R, Taggart F, Sutcliffe P, Griffiths F, Atherton H. Digital Clinical Communication for Families and Caregivers of Children or Young People With Short- or Long-Term Conditions: Rapid Review. J Med Internet Res 2018; 20:e5. [PMID: 29305339 PMCID: PMC5775486 DOI: 10.2196/jmir.7999] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 09/15/2017] [Accepted: 11/04/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The communication relationship between parents of children or young people with health conditions and health professionals is an important part of treatment, but it is unclear how far the use of digital clinical communication tools may affect this relationship. OBJECTIVE The objective of our study was to describe, assess the feasibility of, and explore the impact of digital clinical communication between families or caregivers and health professionals. METHODS We searched the literature using 5 electronic databases. We considered all types of study design published in the English language from January 2009 to August 2015. The population of interest included families and caregivers of children and young people aged less than 26 years with any type of health condition. The intervention was any technology permitting 2-way communication. RESULTS We included 31 articles. The main designs were randomized controlled trials (RCTs; n=10), cross-sectional studies (n=9), pre- and postintervention uncontrolled (pre/post) studies (n=7), and qualitative interview studies (n=2); 6 had mixed-methods designs. In the majority of cases, we considered the quality rating to be fair. Many different types of health condition were represented. A breadth of digital communication tools were included: videoconferencing or videoconsultation (n=14), and Web messaging or emails (n=12). Health care professionals were mainly therapists or cognitive behavioral therapists (n=10), physicians (n=8), and nurses (n=6). Studies were very heterogeneous in terms of outcomes. Interventions were mainly evaluated using satisfaction or acceptance, or outcomes relating to feasibility. Clinical outcomes were rarely used. The RCTs showed that digital clinical communication had no impact in comparison with standard care. Uncontrolled pre/post studies showed good rates of satisfaction or acceptance. Some economic studies suggested that digital clinical communication may save costs. CONCLUSIONS This rapid review showed an emerging body of literature on the use of digital clinical communication to improve families' and caregivers' involvement in the health management of children or young people. Further research with appropriate study designs and longer-term outcome measures should be encouraged. TRIAL REGISTRATION PROSPERO CRD42016035467; http://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD 42016 035467(Archived by WebCite at http://www.webcitation.org/6vpgZU1FU).
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Affiliation(s)
- Xavier Armoiry
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Kings College London, London, United Kingdom
| | | | | | - Rachel Court
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Frances Taggart
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Paul Sutcliffe
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Frances Griffiths
- Warwick Medical School, University of Warwick, Coventry, United Kingdom.,Centre for Health Policy, University of the Witwatersrand, Johannesburg, South Africa
| | - Helen Atherton
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
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Phelps EE, Wellings R, Griffiths F, Hutchinson C, Kunar M. Do medical images aid understanding and recall of medical information? An experimental study comparing the experience of viewing no image, a 2D medical image and a 3D medical image alongside a diagnosis. Patient Educ Couns 2017; 100:1120-1127. [PMID: 28081938 DOI: 10.1016/j.pec.2016.12.034] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 12/06/2016] [Accepted: 12/29/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE This study compared the experience of viewing 3D medical images, 2D medical images and no image presented alongside a diagnosis. METHODS We conducted two laboratory experiments, each with 126 healthy participants. Participants heard three diagnoses; one accompanied by 3D medical images, one accompanied by 2D medical images and one with no image. Participants completed a questionnaire after each diagnosis rating their experience. In Experiment 2, half of the participants were informed that image interpretation can be susceptible to errors. RESULTS Participants preferred to view 3D images alongside a diagnosis (p<0.001) and reported greater understanding (p<0.001), perceived accuracy (p<0.001) and increased trust (p<0.001) when the diagnosis was accompanied by an image compared to no image. There was no significant difference in trust between participants who were informed of errors within image interpretation and those who were not. CONCLUSION When presented alongside a diagnosis, medical images may aid patient understanding, recall and trust in medical information. PRACTICAL CONSIDERATIONS Medical images may be a powerful resource for patients that could be utilised by clinicians during consultations.
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Affiliation(s)
| | | | | | - Charles Hutchinson
- Warwick Medical School, University of Warwick, Coventry, UK; University Hospital Coventry and Warwickshire, Coventry, UK
| | - Melina Kunar
- Department of Psychology, University of Warwick, Coventry, UK
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