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Hwang K, Sivaratnam S, Azeredo R, Hashemi E, Jibb LA. Exploring the use of social media and online methods to engage persons with lived experience and healthcare professionals in creating research agendas: Lessons from a pediatric cancer research priority-setting partnership. PLOS Digit Health 2024; 3:e0000181. [PMID: 38190369 PMCID: PMC10773937 DOI: 10.1371/journal.pdig.0000181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 12/06/2023] [Indexed: 01/10/2024]
Abstract
Social media is increasingly used to engage persons with lived experience and healthcare professionals in research, however, there remains sparse guidance on how to effectively use social media to engage these groups in research agenda-setting. Here we report our process and experience utilizing a social media campaign to engage Canadians within the pediatric cancer community in a research priority-setting exercise. Following the James Lind Alliance method, we launched a priority-setting partnership (PSP) to develop a child with cancer-, survivor-, family member-, and healthcare professional-based Canadian pediatric cancer research agenda. Social media-based strategies were implemented to recruit participants for two PSP surveys, including preparatory activities, developing a website, launching graphics and advertisements, and engaging internal and external networks. Descriptive statistics of our data and analytics provided by the platforms are used presently to report our process. The framework we implemented involved preparing for social media use, identifying a target audience, developing campaign content, conducting the campaign, refining the campaign as needed, and evaluating its success. Our process resulted in a substantial social media-based reach, good survey completion rates, and a successfully developed pediatric cancer community-specified research agenda. Social media may represent a useful approach to engage persons with lived experience and healthcare professionals in research agenda development. Based on our experience, we present strategies to increase social media campaign engagement that may be useful to those seeking to conduct health research priority-setting exercises.
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Affiliation(s)
| | - Surabhi Sivaratnam
- Hospital for Sick Children, Toronto, Canada
- University of Toronto, Toronto, Canada
| | | | | | - Lindsay A. Jibb
- Hospital for Sick Children, Toronto, Canada
- University of Toronto, Toronto, Canada
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Jibb LA, Sivaratnam S, Hashemi E, Chu CH, Nathan PC, Chartrand J, Alberts NM, Masama T, Pease HG, Torres LB, Cortes HG, Zworth M, Kuczynski S, Fortier MA. Parent and clinician perceptions and recommendations on a pediatric cancer pain management app: A qualitative co-design study. PLOS Digit Health 2023; 2:e0000169. [PMID: 38019890 PMCID: PMC10686487 DOI: 10.1371/journal.pdig.0000169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 10/14/2023] [Indexed: 12/01/2023]
Abstract
Pain is one of the most prevalent and burdensome pediatric cancer symptoms for young children and their families. A significant proportion of pain episodes are experienced in environments where management options are limited, including at home. Digital innovations such as apps may have positive impacts on pain outcomes for young children in these environments. Our overall aim is to co-design such an app and the objective of this study was to explore the perceptions of children's parents about app utility, needed system features, and challenges. We recruited parents of young children with cancer and multidisciplinary pediatric oncology clinicians from two pediatric cancer care centers to participate in audio-recorded, semi-structured, co-design interviews. We conducted interviews structured around technology acceptance and family caregiving theories until data saturation was reached. Audio-recordings were then transcribed, coded, and analyzed using thematic analysis. Forty-two participants took part in the process. Participants endorsed the concept of an app as a useful, safe, and convenient way to engage caregivers in managing their young child's pain. Overall, the app was valued as a means to provide real-time, multimodal informational and procedural pain support to parents, while also reducing the emotional burden of pain care. Recommendations for intervention design included accessibility-focused features, comprehensive symptom tracking, and embedded scientific- and clinically-sound symptom assessments and management advice. Predicted challenges to app use included the workload burden it may place on parents and clinicians. The insights gathered will inform the design principles of our future childhood cancer pain digital research.
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Affiliation(s)
- Lindsay A. Jibb
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Canada
| | - Surabhi Sivaratnam
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Elham Hashemi
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Canada
| | - Charlene H. Chu
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Paul C. Nathan
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Canada
| | - Julie Chartrand
- Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
- Research Institute, Children’s Hospital of Eastern Ontario, Ottawa, Canada
| | | | - Tatenda Masama
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Canada
| | - Hannah G. Pease
- Sue and Bill Gross School of Nursing, University of California Irvine, Irvine, California, United States of America
| | - Lessley B. Torres
- Sue and Bill Gross School of Nursing, University of California Irvine, Irvine, California, United States of America
- Department of Pediatric Psychology, Children’s Hospital of Orange County, Orange, California, United States of America
- UCI Center on Stress and Health, University of California Irvine, Irvine, California, United States of America
| | - Haydee G. Cortes
- Sue and Bill Gross School of Nursing, University of California Irvine, Irvine, California, United States of America
- Department of Pediatric Psychology, Children’s Hospital of Orange County, Orange, California, United States of America
- UCI Center on Stress and Health, University of California Irvine, Irvine, California, United States of America
| | - Mallory Zworth
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Canada
| | - Susan Kuczynski
- Ontario Parents Advocating for Children with Cancer, Toronto, Canada
| | - Michelle A. Fortier
- Sue and Bill Gross School of Nursing, University of California Irvine, Irvine, California, United States of America
- Department of Pediatric Psychology, Children’s Hospital of Orange County, Orange, California, United States of America
- UCI Center on Stress and Health, University of California Irvine, Irvine, California, United States of America
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Kilfoy A, Panesar P, Hashemi E, Masama T, Pereira M, Liu W, Alexander S, Korenblum C, Jibb LA. "It just made me feel better": qualitative examination of the implementation of a novel virtual psychosocial support program for adolescents with cancer. Support Care Cancer 2023; 31:610. [PMID: 37792141 DOI: 10.1007/s00520-023-08054-1] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/18/2023] [Indexed: 10/05/2023]
Abstract
PURPOSE Adolescents with cancer routinely report feelings of isolation and exclusion, including from medical decision-making. To address this problem and support adolescents, we designed and implemented the novel, virtual, weekly Teens4Teens peer support group and patient education program. We examined the views of participating adolescents, program guest speakers, and program moderators as they pertained to the need for the program, its feasibility, acceptability, and perceived impact. METHODS We recruited all available adolescents, moderators, and guest speakers who participated in Teens4Teens to take part in audio-recorded, semi-structured interviews. Interviews were transcribed, coded, and analyzed using thematic analysis. RESULTS We conducted 21 interviews across participant groups. We identified four broad themes: pathways into the Teen4Teens program, Teens4Teens implementation capacity, perspectives of the positive impact of Teens4Teens, and suggestions to improve Teens4Teens. These themes described a perceived need for adolescent-centered psychosocial programming in pediatric cancer care, provided lessons on how best to build and apply such a program, and highlighted the value of the program for both adolescents' and clinicians' acceptability, feasibility, and perceived utility. CONCLUSION Adolescents, guest speakers, and moderators valued Teens4Teens and made suggestions to improve capacity to routinely implement the program. Adolescent-tailored psychosocial programming, such as Teens4Teens, is positioned to be integrated into clinical care with relative ease and may serve to improve the cancer care experience of adolescents and their families. This study has potential to provide researchers and clinicians with valuable information about the content, design, and delivery of virtual peer support programming for adolescents with cancer.
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Affiliation(s)
- A Kilfoy
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College St, Toronto, ON, M5T 1P8, Canada
- Division of Hematology and Oncology, Hospital for Sick Children, 170 Elizabeth St, Toronto, ON, M5G 1E8, Canada
- Child Health Evaluative Sciences, Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G 0A4, Canada
| | - P Panesar
- Faculty of Health Sciences, McMaster University, 1280 Main Street West, ON, Hamilton, L8S 4L8, Canada
| | - E Hashemi
- Child Health Evaluative Sciences, Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G 0A4, Canada
| | - T Masama
- Division of Hematology and Oncology, Hospital for Sick Children, 170 Elizabeth St, Toronto, ON, M5G 1E8, Canada
| | - M Pereira
- Child Health Evaluative Sciences, Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G 0A4, Canada
| | - W Liu
- Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
| | - S Alexander
- Division of Hematology and Oncology, Hospital for Sick Children, 170 Elizabeth St, Toronto, ON, M5G 1E8, Canada
- Temerty Faculty of Medicine, University of Toronto, 1 King's College Cir, ON, Toronto, M5S 1A8, Canada
| | - C Korenblum
- Department of Supportive Care, University Health Network, Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON, M6G 2C4, Canada
- Temerty Faculty of Medicine, University of Toronto, 1 King's College Cir, ON, Toronto, M5S 1A8, Canada
- Division of Adolescent Medicine, Hospital for Sick Children, 170 Elizabeth St, Toronto, ON, M5G 1E8, Canada
| | - L A Jibb
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College St, Toronto, ON, M5T 1P8, Canada.
- Division of Hematology and Oncology, Hospital for Sick Children, 170 Elizabeth St, Toronto, ON, M5G 1E8, Canada.
- Child Health Evaluative Sciences, Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G 0A4, Canada.
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Chu CH, Jibb LA, MacInnes N, Beekhoo ZD. A New Age of Health Promotion: The Use of Digital Infographics in Nursing Education. Nurs Educ Perspect 2023:00024776-990000000-00137. [PMID: 37253190 DOI: 10.1097/01.nep.0000000000001142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
ABSTRACT The COVID-19 pandemic has shifted how nursing education and information are delivered, with many classes being moved to an online platform. This opened opportunities to find creative ways to engage students. As a result, an entirely online infographic assignment for final-year baccalaureate nursing students was created. The focus of this assignment was to engage students to identify important health issues, consider multilevel solutions, and communicate information to relevant stakeholders using visual storytelling for maximum impact.
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Affiliation(s)
- Charlene H Chu
- About the Authors Charlene H. Chu, PhD, RN, is assistant professor tenure stream, Lawrence S. Bloomberg Faculty of Nursing, is cross-appointed at the Institute for Life Course and Aging and Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada. She is also an affiliate scientist, KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada. Lindsay A. Jibb, PhD, RN, is assistant professor tenure stream, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, and scientist, Hospital for Sick Children, Toronto, Ontario, Canada. Neal MacInnes, MA, BA, is academic information and communication technology supervisor, and Zoraida D. Beekhoo, MA, RN, is associate professor teaching stream, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto. For more information, contact Dr. Chu at
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Jibb LA, Nanos SM, Alexander S, Malfitano C, Rydall A, Gupta S, Schimmer AD, Zimmermann C, Hales S, Nissim R, Marmar C, Schultebraucks K, Mah K, Rodin G. Traumatic stress symptoms in family caregivers of patients with acute leukaemia: protocol for a multisite mixed methods, longitudinal, observational study. BMJ Open 2022; 12:e065422. [PMID: 36332954 PMCID: PMC9639100 DOI: 10.1136/bmjopen-2022-065422] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION The diagnosis, progression or recurrence of cancer is often highly traumatic for family caregivers (FCs), but systematic assessments of distress and approaches for its prevention and treatment are lacking. Acute leukaemia (AL) is a life-threatening cancer of the blood, which most often presents acutely, requires intensive treatment and is associated with severe physical symptoms. Consequently, traumatic stress may be common in the FCs of patients with AL. We aim to determine the prevalence, severity, longitudinal course and predictors of traumatic stress symptoms in FCs of patients with AL in the first year after diagnosis, and to understand their lived experience of traumatic stress and perceived support needs. METHODS AND ANALYSIS This two-site longitudinal, observational, mixed methods study will recruit 223 adult FCs of paediatric or adult patients newly diagnosed with AL from two tertiary care centres. Quantitative data will be collected from self-report questionnaires at enrolment, and 1, 3, 6, 9 and 12 months after admission to hospital for initial treatment. Quantitative data will be analysed using descriptive and machine learning approaches and a multilevel modelling (MLM) approach will be used to confirm machine learning findings. Semi-structured qualitative interviews will be conducted at 3, 6 and 12 months and analysed using a grounded theory approach. ETHICS AND DISSEMINATION This study is funded by the Canadian Institutes of Health Research (CIHR number PJT 173255) and has received ethical approval from the Ontario Cancer Research Ethics Board (CTO Project ID: 2104). The data generated have the potential to inform the development of targeted psychosocial interventions for traumatic stress, which is a public health priority for high-risk populations such as FCs of patients with haematological malignancies. An integrated and end-of-study knowledge translation strategy that involves FCs and other stakeholders will be used to interpret and disseminate study results.
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Affiliation(s)
- Lindsay A Jibb
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Stephanie M Nanos
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Sarah Alexander
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Carmine Malfitano
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Anne Rydall
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Sumit Gupta
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Aaron D Schimmer
- Department of Medical Oncology/Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Sarah Hales
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Rinat Nissim
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Charles Marmar
- Department of Psychiatry, New York University, New York, New York, USA
| | - Katharina Schultebraucks
- Department of Emergency Medicine, Columbia University Irving Medical Center, New York, New York, USA
- Department of Psychiatry, Columbia University, New York, New York, USA
| | - Kenneth Mah
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Jibb LA, Ameringer S, Macpherson CF, Sivaratnam S. The Symptom Experience in Pediatric Cancer: Current Conceptualizations and Future Directions. Curr Oncol Rep 2022; 24:443-450. [PMID: 35150393 DOI: 10.1007/s11912-022-01222-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW We aimed to review the recent research on the childhood cancer symptom experience pertaining to socioeconomic factors, biology and genetics, growth and development, family psychosocial dynamics, and social and treating environments to begin to formulate recommendations for a personalized approach to symptom management. RECENT FINDINGS Cancer symptoms are common and distressing in children and negatively impact child and family quality of life. Many interacting factors influence children's cancer symptoms experiences, including the assessment and management of such symptoms. This paper highlights several gaps in the research related to the cancer symptom experience including routine symptom assessment, the impact of socioeconomic, biological, and genetic factors on symptoms, and the establishment of effective symptom management partnerships with families. Based on our findings, we provide recommendations related to that research which is ready to be implemented into clinical practice and areas for needed future efforts.
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Affiliation(s)
- Lindsay A Jibb
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, M5T 1P8, Toronto, Canada. .,Child Health Evaluative Sciences, Hospital for Sick Children, 686 Bay Street, Toronto, M5G 0A4, Canada.
| | | | | | - Surabhi Sivaratnam
- Child Health Evaluative Sciences, Hospital for Sick Children, 686 Bay Street, Toronto, M5G 0A4, Canada.,Michael G. DeGroote School of Medicine, McMaster University, 1280 Main Street West, Hamilton, L8S 4K1, Canada
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Hundert AS, Birnie KA, Abla O, Positano K, Cassiani C, Lloyd S, Tiessen PH, Lalloo C, Jibb LA, Stinson J. A Pilot Randomized Controlled Trial of Virtual Reality Distraction to Reduce Procedural Pain During Subcutaneous Port Access in Children and Adolescents With Cancer. Clin J Pain 2021; 38:189-196. [PMID: 34974512 PMCID: PMC8823907 DOI: 10.1097/ajp.0000000000001017] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 10/04/2021] [Accepted: 11/02/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We aimed to determine the feasibility of virtual reality (VR) distraction for children with cancer undergoing subcutaneous port (SCP) access. We also aimed to estimate preliminary treatment effects of VR compared with an active distraction control (iPad). MATERIALS AND METHODS A single-site pilot randomized controlled trial comparing VR to iPad distraction was conducted. Eligible children and adolescents were aged 8 to 18 years undergoing treatment for cancer with upcoming SCP needle insertions. Intervention acceptability was evaluated by child, parent, and nurse self-report. Preliminary effectiveness outcomes included child-reported pain intensity, distress, and fear. Preliminary effectiveness was determined using logistic regression models with outcomes compared between groups using preprocedure scores as covariates. RESULTS Twenty participants (mean age 12 y) were randomized to each group. The most common diagnosis was acute lymphocytic leukemia (n=23, 58%). Most eligible children and adolescents (62%) participated, and 1 withdrew after randomization to the iPad group. Nurses, parents, and children reported the interventions in both groups to be acceptable, with the VR participants reporting significantly higher immersion in the distraction environment (P=0.0318). Although not statistically significant, more VR group participants indicated no pain (65% vs. 45%) and no distress (80% vs. 47%) during the procedure compared with the iPad group. Fear was similar across groups, with ~60% of the sample indicating no fear. DISCUSSION VR was feasible and acceptable to implement as an intervention during SCP access. Preliminary effectiveness results indicate that VR may reduce distress and distress compared with iPad distraction. These data will inform design of a future full-scale randomized controlled trial.
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Affiliation(s)
| | - Kathryn A. Birnie
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Calgary, Alberta Children’s Hospital Research Institute, Calgary, AB, Canada
| | - Oussama Abla
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children
- Department of Paediatrics
| | - Karyn Positano
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children
| | | | | | | | - Chitra Lalloo
- Child Health Evaluative Sciences
- Institute of Health Policy, Management & Evaluation
| | - Lindsay A. Jibb
- Child Health Evaluative Sciences
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Jennifer Stinson
- Child Health Evaluative Sciences
- Institute of Health Policy, Management & Evaluation
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
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Jibb LA, Chartrand J, Masama T, Johnston DL. Home-Based Pediatric Cancer Care: Perspectives and Improvement Suggestions From Children, Family Caregivers, and Clinicians. JCO Oncol Pract 2021; 17:e827-e839. [PMID: 33914620 DOI: 10.1200/op.20.00958] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Although the hospital remains the dominant site for delivering most pediatric cancer care, home-based care is increasingly provided. To effectively deliver comprehensive, relevant, and acceptable care in children's homes, the voices of these key informants must be considered. We examined the views of children with cancer, their family caregivers, and clinicians on home-based cancer care to identify necessary strategies to improve the delivery of care. METHODS Children with cancer, their family caregivers, and multiprofessional clinicians who provide care at a tertiary pediatric care center or in the community participated in audio-recorded, semistructured interviews in French and English. Interviews were conducted until data saturation in each participant group was achieved. Interviews were transcribed, coded, and analyzed using thematic analysis. RESULTS Thirteen children, 20 family caregivers, and 22 clinicians participated. Home-based care was endorsed as a means to improve child health-, family social- and financial-, and system-level outcomes. The success of a home-based model is built on care that addresses child and family informational, treatment and care, material, and psychosocial needs. Mechanisms to improve care include enhanced homecare agency-hospital-family communication, training for homecare nurses in pediatric cancer care, virtual solutions, and an expanded breadth of services provided in-home. Child-, family-, and system-related factors affect the delivery of optimal home-based care. CONCLUSION Children, families, and clinicians value a model of pediatric cancer care that incorporates home-based services. The insights of these key informants should be reflected in the principles that become the basis of home-based cancer care best practices.
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Affiliation(s)
- Lindsay A Jibb
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.,Hospital for Sick Children, Toronto, Ontario, Canada
| | - Julie Chartrand
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Tatenda Masama
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Donna L Johnston
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Jibb LA, Khan JS, Seth P, Lalloo C, Mulrooney L, Nicholson K, Nowak DA, Kaur H, Chee-A-Tow A, Foster J, Stinson JN. Electronic Data Capture Versus Conventional Data Collection Methods in Clinical Pain Studies: Systematic Review and Meta-Analysis. J Med Internet Res 2020; 22:e16480. [PMID: 32348259 PMCID: PMC7351264 DOI: 10.2196/16480] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/21/2020] [Accepted: 03/22/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The most commonly used means to assess pain is by patient self-reported questionnaires. These questionnaires have traditionally been completed using paper-and-pencil, telephone, or in-person methods, which may limit the validity of the collected data. Electronic data capture methods represent a potential way to validly, reliably, and feasibly collect pain-related data from patients in both clinical and research settings. OBJECTIVE The aim of this study was to conduct a systematic review and meta-analysis to compare electronic and conventional pain-related data collection methods with respect to pain score equivalence, data completeness, ease of use, efficiency, and acceptability between methods. METHODS We searched the Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica Database (EMBASE), and Cochrane Central Register of Controlled Trials (CENTRAL) from database inception until November 2019. We included all peer-reviewed studies that compared electronic (any modality) and conventional (paper-, telephone-, or in-person-based) data capture methods for patient-reported pain data on one of the following outcomes: pain score equivalence, data completeness, ease of use, efficiency, and acceptability. We used random effects models to combine score equivalence data across studies that reported correlations or measures of agreement between electronic and conventional pain assessment methods. RESULTS A total of 53 unique studies were included in this systematic review, of which 21 were included in the meta-analysis. Overall, the pain scores reported electronically were congruent with those reported using conventional modalities, with the majority of studies (36/44, 82%) that reported on pain scores demonstrating this relationship. The weighted summary correlation coefficient of pain score equivalence from our meta-analysis was 0.92 (95% CI 0.88-0.95). Studies on data completeness, patient- or provider-reported ease of use, and efficiency generally indicated that electronic data capture methods were equivalent or superior to conventional methods. Most (19/23, 83%) studies that directly surveyed patients reported that the electronic format was the preferred data collection method. CONCLUSIONS Electronic pain-related data capture methods are comparable with conventional methods in terms of score equivalence, data completeness, ease, efficiency, and acceptability and, if the appropriate psychometric evaluations are in place, are a feasible means to collect pain data in clinical and research settings.
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Affiliation(s)
- Lindsay A Jibb
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, ON, Canada
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - James S Khan
- Department of Anesthesia, Mount Sinai Hospital, Toronto, ON, Canada
- Department of Anesthesia, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Puneet Seth
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Chitra Lalloo
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Lauren Mulrooney
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Kathryn Nicholson
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Dominik A Nowak
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Harneel Kaur
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | - Joel Foster
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Jennifer N Stinson
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, ON, Canada
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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Loeffen EAH, Mulder RL, Font-Gonzalez A, Leroy PLJM, Dick BD, Taddio A, Ljungman G, Jibb LA, Tutelman PR, Liossi C, Twycross A, Positano K, Knops RR, Wijnen M, van de Wetering MD, Kremer LCM, Dupuis LL, Campbell F, Tissing WJE. Reducing pain and distress related to needle procedures in children with cancer: A clinical practice guideline. Eur J Cancer 2020; 131:53-67. [PMID: 32302949 DOI: 10.1016/j.ejca.2020.02.039] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 02/13/2020] [Accepted: 02/17/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Children with cancer often undergo long treatment trajectories involving repeated needle procedures that potentially cause pain and distress. As part of a comprehensive effort to develop clinical practice guidelines (CPGs) to address pain prevention and management in children with cancer, we aimed to provide recommendations on the pharmacological and psychological management of procedure-related pain and distress. METHODS Of the international inter-disciplinary CPG development panel (44 individuals), two working groups including 13 healthcare professionals focused on procedural pain and distress. Grading of Recommendations Assessment, Development and Evaluation methodology was used, including the use of systematic literature reviews to inform recommendations and the use of evidence to decision frameworks. At an in-person meeting in February 2018, the guideline panel discussed these frameworks and formulated recommendations which were then discussed with a patient-parent panel consisting of 4 survivors and 5 parents. RESULTS The systematic reviews led to the inclusion of 48 randomised controlled trials (total number of participants = 2271). Quality of evidence supporting the recommendations ranged from very low to moderate. Strong recommendations were made for the use of topical anesthetics in all needle procedures, for offering deep sedation (DS)/general anesthesia (GA) to all children undergoing lumbar puncture, for the use of DS/ GA in major procedures in children of all ages, for the use of hypnosis in all needle procedures and for the use of active distraction in all needle procedures. CONCLUSION In this CPG, an evidence-based approach to manage procedure-related pain and distress in children with cancer is presented. As children with cancer often undergo repeated needle procedures during treatment, prevention and alleviation of procedure-related pain and distress is of the utmost importance to increase quality of life in these children and their families.
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Affiliation(s)
- Erik A H Loeffen
- University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Department of Pediatric Oncology/Hematology, Groningen, the Netherlands.
| | - Renée L Mulder
- Department of Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Anna Font-Gonzalez
- Department of Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Piet L J M Leroy
- Department of Pediatrics, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Bruce D Dick
- Departments of Anesthesiology and Pain Medicine, Psychiatry &Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Anna Taddio
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada; Department of Pharmacy and Research Institute, The Hospital for Sick Children, Toronto, Canada
| | - Gustaf Ljungman
- Department of Women's and Children's Health, Pediatric Oncology, Uppsala University, Uppsala, Sweden
| | - Lindsay A Jibb
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Perri R Tutelman
- Centre for Pediatric Pain Research, IWK Health Centre Halifax, NS, Canada
| | - Christina Liossi
- Pediatric Psychology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Alison Twycross
- School of Health and Social Care, London South Bank University, London, United Kingdom
| | | | - Rutger R Knops
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Marc Wijnen
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | | | - Leontien C M Kremer
- Department of Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - L Lee Dupuis
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada; Department of Pharmacy and Research Institute, The Hospital for Sick Children, Toronto, Canada
| | - Fiona Campbell
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Wim J E Tissing
- University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Department of Pediatric Oncology/Hematology, Groningen, the Netherlands; Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
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11
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Khan JS, Jibb LA, Busse JW, Gilron I, Choi S, Paul JE, McGillion M, Mackey S, Buckley DN, Lee SF, Devereaux PJ. Electronic Versus Traditional Data Collection: A Multicenter Randomized Controlled Perioperative Pain Trial. Can J Pain 2019; 3:16-25. [PMID: 35005415 PMCID: PMC8730625 DOI: 10.1080/24740527.2019.1587584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background: Electronic data collection is increasingly available as a means to collect pain-related clinical trial data; however, effectiveness and costs relative to traditional data collection are uncertain. Aims: The aim of this study was to evaluate data quality, protocol adherence, satisfaction, and resource requirements of electronic data collection (i.e., Internet-based electronic submission) compared to traditional data collection methods (i.e., paper-based diaries and telephone interviews) in a perioperative factorial randomized controlled trial. Methods: This study was an open-label two-arm parallel randomized controlled trial. Women (18-75 years) undergoing breast cancer surgery were allocated to either electronic or traditional data collection and completed pain-related questionnaires at baseline, postoperative period, and 3-month follow-up (NCT02240199). Results: We acquired outcome data at all time points from 78 randomized patients, 38 in the electronic group and 40 in the traditional group. The number of data queries (e.g., erroneously entered data) per patient was higher in the electronic data group (4.92 [SD = 4.67] vs. 1.88 [SD = 1.51]; P < 0.001). No between-group differences were observed for compliance with medications, data completeness, loss to follow-up, or patient or research assistant satisfaction. More research assistant time per patient was spent collecting data in the traditional group (42.6 min [SD = 12.8] vs. 9.92 min [SD = 7.6]; P < 0.001); however, costs per patient were higher in the electronic group ($176.85 [SD = 2.90] vs. $16.33 [SD = 4.90]; P < 0.001). Conclusion: Electronic data collection is feasible for perioperative pain clinical trials. Additional trials, including different surgical populations, are needed to confirm our findings and optimize use of electronic data capture methods.
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Affiliation(s)
- James S. Khan
- Department of Anesthesia, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada,CONTACT James S. Khan Department of Anesthesia, University of Toronto, 12th Floor, 123 Edward Street, Toronto, ONM5G 1E2, Canada
| | - Lindsay A. Jibb
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada,Evidence-to-Practice Program, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Jason W. Busse
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada,Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada,The Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University, Hamilton, Ontario, Canada
| | - Ian Gilron
- Department of Anesthesiology & Perioperative Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Stephen Choi
- Department of Anesthesia, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada,Department of Anesthesia, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - James E. Paul
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Michael McGillion
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada,School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Sean Mackey
- Division of Pain Medicine, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Palo Alto, CA, USA
| | - D. Norman Buckley
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada,Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada
| | - Shun Fu Lee
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - P. J. Devereaux
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada,Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada,Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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12
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Jibb LA, Stacey D, Carley M, Davis A, Graham ID, Green E, Jolicoeur L, Kuziemsky C, Ludwig C, Truant T. Research priorities for the pan-Canadian Oncology Symptom Triage and Remote Support practice guides: a modified nominal group consensus. ACTA ACUST UNITED AC 2019; 26:173-182. [PMID: 31285662 DOI: 10.3747/co.26.4247] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction The pan-Canadian Oncology Symptom Triage and Remote Support (costars) team is studying how to improve the quality and consistency of cancer symptom management. Methods A 1-day invitational meeting was held 24 October 2017 in Ottawa, Ontario, to review the current evidence from costars projects and to establish research priorities for a future largescale implementation study. The meeting included 36 participants who were clinicians from adult oncology, pediatric oncology, and homecare; policymakers from national, provincial, and regional organizations; researchers; and a patient. Half the day involved summarizing evidence from four costars studies and experiences with implementing the costars symptom practice guides. The second half of the day used a modified nominal group technique to generate research questions within small groups, presentation of research questions to all participants, and two rounds of voting to reach consensus on research priorities. Results Participants proposed 4 research categories:■ User-centred augmentation to enhance usability (for example, designing a mobile costars solution)■ Outcome measurement (for example, determining key competencies for clinicians)■ Regular renewal of costars to keep pace with evolving evidence (for example, updates for novel therapies)■ Integration into clinical practice (for example, meaningful engagement of patients and caregivers in study design). Conclusions Across categories, the top 3 priorities were effect on health services use, competency development, and a mobile costars solution. Future research will address identified priorities, reflecting the needs and perspectives of diverse stakeholders. Stakeholder collaboration will continue to guide our approach to operationalizing this priority research agenda.
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Affiliation(s)
- L A Jibb
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON
| | - D Stacey
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON.,Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON
| | - M Carley
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON
| | - A Davis
- Washington State University College of Nursing, Vancouver, WA, U.S.A
| | - I D Graham
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON.,Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON.,Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON
| | - E Green
- The Ottawa Hospital, Cancer Program, Ottawa, ON
| | - L Jolicoeur
- The Ottawa Hospital, Cancer Program, Ottawa, ON
| | - C Kuziemsky
- Telfer School of Management, University of Ottawa, Ottawa, ON
| | | | - T Truant
- BC Cancer, Education and Innovation, Vancouver, BC
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13
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Jibb LA, Birnie KA, Nathan PC, Beran TN, Hum V, Victor JC, Stinson JN. Using the MEDiPORT humanoid robot to reduce procedural pain and distress in children with cancer: A pilot randomized controlled trial. Pediatr Blood Cancer 2018; 65:e27242. [PMID: 29893482 DOI: 10.1002/pbc.27242] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 04/09/2018] [Accepted: 04/11/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Subcutaneous port needle insertions are painful and distressing for children with cancer. The interactive MEDiPORT robot has been programmed to implement psychological strategies to decrease pain and distress during this procedure. This study assessed the feasibility of a future MEDiPORT trial. The secondary aim was to determine the preliminary effectiveness of MEDiPORT in reducing child pain and distress during subcutaneous port accesses. METHODS This 5-month pilot randomized controlled trial used a web-based service to randomize 4- to 9-year-olds with cancer to the MEDiPORT cognitive-behavioral arm (robot using evidence-based cognitive-behavioral interventions) or active distraction arm (robot dancing and singing) while a nurse conducted a needle insertion. We assessed accrual and retention; technical difficulties; outcome measure completion by children, parents, and nurses; time taken to complete the study and clinical procedure; and child-, parent-, and nurse-rated acceptability. Descriptive analyses, with exploratory inferential testing of child pain and distress data, were used to address study aims. RESULTS Forty children were randomized across study arms. Most (85%) eligible children participated and no children withdrew. Technical difficulties were more common in the cognitive-behavioral arm. Completion times for the study and needle insertion were acceptable and >96% of outcome measure items were completed. Overall, MEDiPORT and the study were acceptable to participants. There was no difference in pain between arms, but distress during the procedure was less pronounced in the active distraction arm. CONCLUSION The MEDiPORT study appears feasible to implement as an adequately-powered effectiveness-assessing trial following modifications to the intervention and study protocol. ClinicalTrials.gov NCT02611739.
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Affiliation(s)
- Lindsay A Jibb
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.,Evidence-to-Practice Program, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Kathryn A Birnie
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Paul C Nathan
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Division of Hematology/Oncology, Department of Pediatrics, Hospital for Sick Children, Toronto, Canada
| | - Tanya N Beran
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Vanessa Hum
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Canada
| | - J Charles Victor
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Jennifer N Stinson
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.,Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, Canada
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14
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Jibb LA, Stevens BJ, Nathan PC, Seto E, Cafazzo JA, Johnston DL, Hum V, Stinson JN. Perceptions of Adolescents With Cancer Related to a Pain Management App and Its Evaluation: Qualitative Study Nested Within a Multicenter Pilot Feasibility Study. JMIR Mhealth Uhealth 2018; 6:e80. [PMID: 29625951 PMCID: PMC5910537 DOI: 10.2196/mhealth.9319] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 01/08/2018] [Accepted: 01/26/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Pain in adolescents with cancer is common and negatively impacts health-related quality of life. The Pain Squad+ smartphone app, capable of providing adolescents with real-time pain management support, was developed to enhance pain management using a phased approach (ie, systematic review, consensus conference and vetting, iterative usability testing cycles). A 28-day Pain Squad+ pilot was conducted with 40 adolescents with cancer to evaluate the feasibility of implementing the app in a future clinical trial and to obtain estimates of treatment effect. OBJECTIVE The objective of our nested qualitative study was to elucidate the perceptions of adolescents with cancer to determine the acceptability and perceived helpfulness of Pain Squad+, suggestions for app improvement, and satisfaction with the pilot study protocol. METHODS Post pilot study participation, telephone-based, semistructured, and audio-recorded exit interviews were conducted with 20 adolescents with cancer (12-18 years). All interviews were transcribed and independently coded by 2 study team members. Content analysis was conducted to identify data categories and overarching themes. RESULTS Five major themes comprising multiple categories and codes emerged. These themes focused on the acceptability of the intervention, acceptability of the study, the perceived active ingredients of the intervention, the suitability of the intervention to adolescents' lives, and recommendations for intervention improvement. CONCLUSIONS Overall, Pain Squad+ and the pilot study protocol were acceptable to adolescents with cancer. Suggestions for intervention and study improvements will be incorporated into the design of a future randomized clinical trial (RCT) aimed at assessing the effectiveness of Pain Squad+ on adolescents with cancer health outcomes.
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Affiliation(s)
- Lindsay A Jibb
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.,Evidence-to-Practice Program, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Bonnie J Stevens
- Child Health Evaluative Sciences Program, Hospital for Sick Children, Toronto, ON, Canada.,Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Paul C Nathan
- Child Health Evaluative Sciences Program, Hospital for Sick Children, Toronto, ON, Canada.,Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Emily Seto
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,eHealth Innovation, University Health Network, Toronto, ON, Canada
| | - Joseph A Cafazzo
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,eHealth Innovation, University Health Network, Toronto, ON, Canada
| | - Donna L Johnston
- Evidence-to-Practice Program, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Vanessa Hum
- Think Research Corporation, Toronto, ON, Canada
| | - Jennifer N Stinson
- Child Health Evaluative Sciences Program, Hospital for Sick Children, Toronto, ON, Canada.,Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.,Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, ON, Canada
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15
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Jibb LA, Stevens BJ, Nathan PC, Seto E, Cafazzo JA, Johnston DL, Hum V, Stinson JN. Implementation and preliminary effectiveness of a real-time pain management smartphone app for adolescents with cancer: A multicenter pilot clinical study. Pediatr Blood Cancer 2017; 64. [PMID: 28423223 DOI: 10.1002/pbc.26554] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Revised: 02/15/2017] [Accepted: 02/20/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Pain in adolescents with cancer (12-18 years) is common and negatively impacts health-related quality of life (HRQL). The Pain Squad+ smartphone app, which provides adolescents with real-time pain self-management support, was developed to address this issue. This study evaluated the implementation of the app to inform a future randomized controlled trial (RCT) and obtain treatment effect estimates for pain intensity, pain interference, HRQL, and self-efficacy. PROCEDURE A one-group baseline/poststudy design with 40 adolescents recruited from two pediatric tertiary care centers was used. Baseline questionnaires were completed and adolescents used the app at least twice daily for 28 days, receiving algorithm-informed self-management advice depending on their reported pain. A nurse received alerts in response to sustained pain and contacted adolescents to assist in pain care. Poststudy questionnaires were completed. Descriptive analyses, with exploratory inferential testing conducted on health outcome data, were used to address study aims. RESULTS Most (40/52; 77%) eligible adolescents participated. Two participants withdrew participation. Intervention fidelity was impacted by technical difficulties (occurring for 15% of participants) and a prolonged time for nurse contact in the event of sustained pain. Adherence to pain reporting was 68.8 ± 38.1%. Outcome measure completion rates were high and the intervention was acceptable to participants. Trends in improvements in pain intensity, pain interference, and HRQL were significant, with effect sizes of 0.23-0.67. CONCLUSIONS Implementation of Pain Squad+ is feasible and the app appears to improve pain-related outcomes for adolescents with cancer. A multicenter RCT will be undertaken to examine app effectiveness.
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Affiliation(s)
| | - Bonnie J Stevens
- Hospital for Sick Children, Toronto, Canada.,University of Toronto, Toronto, Canada
| | - Paul C Nathan
- Hospital for Sick Children, Toronto, Canada.,University of Toronto, Toronto, Canada
| | - Emily Seto
- University of Toronto, Toronto, Canada.,University Health Network, Toronto, Canada
| | - Joseph A Cafazzo
- University of Toronto, Toronto, Canada.,University Health Network, Toronto, Canada
| | - Donna L Johnston
- University of Ottawa, Ottawa, Canada.,Children's Hospital of Eastern Ontario, Ottawa, Canada
| | | | - Jennifer N Stinson
- Hospital for Sick Children, Toronto, Canada.,University of Toronto, Toronto, Canada
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16
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Jibb LA, Cafazzo JA, Nathan PC, Seto E, Stevens BJ, Nguyen C, Stinson JN. Development of a mHealth Real-Time Pain Self-Management App for Adolescents With Cancer: An Iterative Usability Testing Study [Formula: see text]. J Pediatr Oncol Nurs 2017; 34:283-294. [PMID: 28376666 DOI: 10.1177/1043454217697022] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE A user-centered design approach was used to refine the mHealth Pain Squad+ real-time pain self-management app for adolescents with cancer for its usability (defined as being easy to use, easy to understand, efficient to complete, and acceptable). METHOD Three iterative usability testing cycles involving adolescent observation and interview were used to achieve this objective. During each cycle, adolescents used the app while "thinking aloud" about issues encountered. Observed difficulties and errors were recorded and a semistructured interview about the experience was conducted. Using a qualitative conventional content analysis approach, themes related to app usability were identified. RESULTS Participants required an average of 4.3 minutes to complete the pain assessment component of Pain Squad+. Overall, the app was acceptable. Problematic issues related to software malfunction, interface design flaws, and confusing text. Software revisions were made to address each issue. CONCLUSION The multifaceted usability approach used provided insight into how a real-time app can be made acceptable to adolescents with cancer and succeeded in developing a Pain Squad+ app that is fit for future effectiveness testing.
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Affiliation(s)
- Lindsay A Jibb
- 1 Hospital for Sick Children, Toronto, Ontario, Canada.,2 University of Toronto, Toronto, Ontario, Canada
| | - Joseph A Cafazzo
- 2 University of Toronto, Toronto, Ontario, Canada.,3 University Health Network, Toronto, Ontario, Canada
| | - Paul C Nathan
- 1 Hospital for Sick Children, Toronto, Ontario, Canada.,2 University of Toronto, Toronto, Ontario, Canada
| | - Emily Seto
- 2 University of Toronto, Toronto, Ontario, Canada.,3 University Health Network, Toronto, Ontario, Canada
| | - Bonnie J Stevens
- 1 Hospital for Sick Children, Toronto, Ontario, Canada.,2 University of Toronto, Toronto, Ontario, Canada
| | | | - Jennifer N Stinson
- 1 Hospital for Sick Children, Toronto, Ontario, Canada.,2 University of Toronto, Toronto, Ontario, Canada
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Stinson JN, Jibb LA, Greenberg M, Barrera M, Luca S, White ME, Gupta A. A Qualitative Study of the Impact of Cancer on Romantic Relationships, Sexual Relationships, and Fertility: Perspectives of Canadian Adolescents and Parents During and After Treatment. J Adolesc Young Adult Oncol 2016; 4:84-90. [PMID: 26812556 DOI: 10.1089/jayao.2014.0036] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
PURPOSE We sought to gain insight into perspectives around core domains of adolescent development--romantic relationships, sexual relationships, and fertility--from the vantage point of Canadian adolescents and parents during and after cancer treatment. METHODS Twenty adolescents (12-17 years old at interview) and 20 parents (who may or may not have had an adolescent interviewed) participated in this study. Using a semistructured guide, adolescents and parents were interviewed separately. All interviews were audio-recorded and transcribed. Transcribed interview data were independently coded according to the study objectives by two trained analysts. Codes were organized into categories that reflected emerging themes. Discrepancies in coding were resolved through discussion with the lead investigator. RESULTS Qualitative analysis revealed main themes for adolescents and parents related to: (1) romantic relationships (opinions on the importance of dating in the context of cancer, expectations that cancer will impact future relationships, dating as a source of moral support, and limited opportunities to engage with partners); (2) sexual relationships (thoughts related to the impact of cancer on future sexual relationships); (3) fertility (initiating treatment as a primary concern and fear of infertility and perceived consequences); and (4) recommendations for care (access to knowledge and support through adolescent-friendly and accessible means). CONCLUSION Findings from this study highlight cancer-specific relationship and fertility issues faced by adolescents and provide important direction to the development of interventions that may ultimately improve the psychosocial health of adolescents during and after cancer treatment.
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Affiliation(s)
- Jennifer N Stinson
- 1 Department of Child Health Evaluative Sciences, Hospital for Sick Children , Toronto, Ontario, Canada .,2 Department of Anesthesia and Pain Medicine, Hospital for Sick Children , Toronto, Ontario, Canada .,3 Lawrence S. Bloomberg Faculty of Nursing, University of Toronto , Toronto, Ontario, Canada
| | - Lindsay A Jibb
- 3 Lawrence S. Bloomberg Faculty of Nursing, University of Toronto , Toronto, Ontario, Canada .,4 Division of Hematology/Oncology, Hospital for Sick Children , Toronto, Ontario, Canada .,5 Pediatric Oncology Group of Ontario , Toronto, Ontario, Canada
| | - Mark Greenberg
- 4 Division of Hematology/Oncology, Hospital for Sick Children , Toronto, Ontario, Canada .,5 Pediatric Oncology Group of Ontario , Toronto, Ontario, Canada .,6 Faculty of Medicine, University of Toronto , Toronto, Ontario, Canada
| | - Maru Barrera
- 1 Department of Child Health Evaluative Sciences, Hospital for Sick Children , Toronto, Ontario, Canada .,4 Division of Hematology/Oncology, Hospital for Sick Children , Toronto, Ontario, Canada .,6 Faculty of Medicine, University of Toronto , Toronto, Ontario, Canada
| | - Stephanie Luca
- 1 Department of Child Health Evaluative Sciences, Hospital for Sick Children , Toronto, Ontario, Canada
| | | | - Abha Gupta
- 4 Division of Hematology/Oncology, Hospital for Sick Children , Toronto, Ontario, Canada .,6 Faculty of Medicine, University of Toronto , Toronto, Ontario, Canada .,8 Adolescent and Young Adult Program, Princess Margaret Cancer Centre , Toronto, Ontario, Canada
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18
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Jibb LA, Stevens BJ, Nathan PC, Seto E, Cafazzo JA, Stinson JN. A smartphone-based pain management app for adolescents with cancer: establishing system requirements and a pain care algorithm based on literature review, interviews, and consensus. JMIR Res Protoc 2014; 3:e15. [PMID: 24646454 PMCID: PMC3978558 DOI: 10.2196/resprot.3041] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 02/04/2014] [Accepted: 02/21/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pain that occurs both within and outside of the hospital setting is a common and distressing problem for adolescents with cancer. The use of smartphone technology may facilitate rapid, in-the-moment pain support for this population. To ensure the best possible pain management advice is given, evidence-based and expert-vetted care algorithms and system design features, which are designed using user-centered methods, are required. OBJECTIVE To develop the decision algorithm and system requirements that will inform the pain management advice provided by a real-time smartphone-based pain management app for adolescents with cancer. METHODS A systematic approach to algorithm development and system design was utilized. Initially, a comprehensive literature review was undertaken to understand the current body of knowledge pertaining to pediatric cancer pain management. A user-centered approach to development was used as the results of the review were disseminated to 15 international experts (clinicians, scientists, and a consumer) in pediatric pain, pediatric oncology and mHealth design, who participated in a 2-day consensus conference. This conference used nominal group technique to develop consensus on important pain inputs, pain management advice, and system design requirements. Using data generated at the conference, a prototype algorithm was developed. Iterative qualitative testing was conducted with adolescents with cancer, as well as pediatric oncology and pain health care providers to vet and refine the developed algorithm and system requirements for the real-time smartphone app. RESULTS The systematic literature review established the current state of research related to nonpharmacological pediatric cancer pain management. The 2-day consensus conference established which clinically important pain inputs by adolescents would require action (pain management advice) from the app, the appropriate advice the app should provide to adolescents in pain, and the functional requirements of the app. These results were used to build a detailed prototype algorithm capable of providing adolescents with pain management support based on their individual pain. Analysis of qualitative interviews with 9 multidisciplinary health care professionals and 10 adolescents resulted in 4 themes that helped to adapt the algorithm and requirements to the needs of adolescents. Specifically, themes were overall endorsement of the system, the need for a clinical expert, the need to individualize the system, and changes to the algorithm to improve potential clinical effectiveness. CONCLUSIONS This study used a phased and user-centered approach to develop a pain management algorithm for adolescents with cancer and the system requirements of an associated app. The smartphone software is currently being created and subsequent work will focus on the usability, feasibility, and effectiveness testing of the app for adolescents with cancer pain.
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Stinson JN, Jibb LA, Nguyen C, Nathan PC, Maloney AM, Dupuis LL, Gerstle JT, Alman B, Hopyan S, Strahlendorf C, Portwine C, Johnston DL, Orr M. Development and testing of a multidimensional iPhone pain assessment application for adolescents with cancer. J Med Internet Res 2013; 15:e51. [PMID: 23475457 PMCID: PMC3636147 DOI: 10.2196/jmir.2350] [Citation(s) in RCA: 206] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 11/26/2012] [Accepted: 02/13/2013] [Indexed: 11/24/2022] Open
Abstract
Background Pain is one of the most common and distressing symptoms reported by adolescents with cancer. Despite advancements in pain assessment and management research, pain due to cancer and/or its treatments continues to be poorly managed. Our research group has developed a native iPhone application (app) called Pain Squad to tackle the problem of poorly managed pain in the adolescent with cancer group. The app functions as an electronic pain diary and is unique in its ability to collect data on pain intensity, duration, location, and the impact pain has on an adolescent’s life (ie, relationships, school work, sleep, mood). It also evaluates medications and other physical and psychological pain management strategies used. Users are prompted twice daily at configurable times to complete 20 questions characterizing their pain and the app transmits results to a database for aggregate reporting through a Web interface. Each diary entry represents a pain case filed by an adolescent with cancer and a reward system (ie, moving up through law-enforcement team ranks, built-in videotaped acknowledgements from fictitious officers) encourages consistent use of the diary. Objective Our objective was to design, develop, and test the usability, feasibility, compliance, and satisfaction of a game-based smartphone pain assessment tool for adolescents with cancer. Methods We used both low- and high-fidelity qualitative usability testing with qualitative semi-structured, audio-taped interviews and iterative cycles to design and refine the iPhone based Pain Squad app. Qualitative thematic analysis of interviews using constant comparative methodology captured emergent themes related to app usability. Content validity was assessed using question importance-rating surveys completed by participants. Compliance and satisfaction data were collected following a 2-week feasibility trial where users were alarmed to record their pain twice daily on the app. Results Thematic analysis of usability interviews showed the app to be appealing overall to adolescents. Analyses of both low- and high-fidelity testing resulted in minor revisions to the app to refine the theme and improve its usability. Adolescents resoundingly endorsed the game-based nature of the app and its virtual reward system. The importance of app pain diary questions was established by content validity analysis. Compliance with the app, assessed during feasibility testing, was high (mean 81%, SD 22%) and adolescents from this phase of the study found the app likeable, easy to use, and not bothersome to complete. Conclusions A multifaceted usability approach demonstrated how the Pain Squad app could be made more appealing to children and adolescents with cancer. The game-based nature and built-in reward system of the app was appealing to adolescents and may have resulted in the high compliance rates and satisfaction ratings observed during clinical feasibility testing.
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Abstract
Juvenile idiopathic arthritis (JIA) is a common chronic childhood illness. Pain is the most common and distressing symptom of JIA. Pain has been found to negatively impact all aspects of functioning, including physical, social, emotional and role functions. Children with arthritis continue to experience clinically significant pain despite adequate doses of disease-modifying antirheumatic drugs and anti-inflammatory agents. The present article reviews the prevalence and nature of pain in JIA, the biopsychosocial factors that contribute to the pain experience, current approaches to assessing pain in this population, and ways of managing both acute and persistent pain using pharmacological, physical and psychological therapies. Finally, new approaches to delivering disease self-management treatment for youth with JIA using the Internet will be outlined.
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Stinson JN, Connelly M, Jibb LA, Schanberg LE, Walco G, Spiegel LR, Tse SML, Chalom EC, Chira P, Rapoff M. Developing a standardized approach to the assessment of pain in children and youth presenting to pediatric rheumatology providers: a Delphi survey and consensus conference process followed by feasibility testing. Pediatr Rheumatol Online J 2012; 10:7. [PMID: 22490427 PMCID: PMC3366881 DOI: 10.1186/1546-0096-10-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Accepted: 04/10/2012] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Pain in children with rheumatic conditions such as arthritis is common. However, there is currently no standardized method for the assessment of this pain in children presenting to pediatric rheumatologists. A more consistent and comprehensive approach is needed to effectively assess, treat and monitor pain outcomes in the pediatric rheumatology population. The objectives of this study were to: (a) develop consensus regarding a standardized pain assessment tool for use in pediatric rheumatology practice and (b) test the feasibility of three mediums (paper, laptop, and handheld-based applications) for administration. METHODS In Phase 1, a 2-stage Delphi technique (pediatric rheumatologists and allied professionals) and consensus meeting (pediatric pain and rheumatology experts) were used to develop the self- and proxy-report pain measures. In Phase 2, 24 children aged 4-7 years (and their parents), and 77 youth, aged 8-18 years, with pain, were recruited during routine rheumatology clinic appointments and completed the pain measure using each medium (order randomly assigned). The participant's rheumatologist received a summary report prior to clinical assessment. Satisfaction surveys were completed by all participants. Descriptive statistics were used to describe the participant characteristics using means and standard deviations (for continuous variables) and frequencies and proportions (for categorical variables) RESULTS Completing the measure using the handheld device took significantly longer for youth (M = 5.90 minutes) and parents (M = 7.00 minutes) compared to paper (M = 3.08 and 2.28 minutes respectively p = 0.001) and computer (M = 3.40 and 4.00 minutes respectively; p < 0.001). There was no difference in the number of missed responses between mediums for children or parents. For youth, the number of missed responses varied across mediums (p = 0.047) with the greatest number of missed responses occurring with the handheld device. Most children preferred the computer (65%, p = 0.008) and youth reported no preference between mediums (p = 0.307). Most physicians (60%) would recommend the computer summary over the paper questionnaire to a colleague. CONCLUSIONS It is clinically feasible to implement a newly developed consensus-driven pain measure in pediatric rheumatology clinics using electronic or paper administration. Computer-based administration was most efficient for most users, but the medium employed in practice may depend on child age and economic and administrative factors.
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Affiliation(s)
- Jennifer N Stinson
- University of Toronto Lawrence S, Bloomberg Faculty of Nursing, 155 College Street, Toronto ON M5T 1P8, Canada.
| | - Mark Connelly
- Children's Mercy Hospitals and Clinics, Pain Management Program, 2401 Gillham Road, Kansas City MO 64108, USA
| | - Lindsay A Jibb
- University of Toronto Lawrence S. Bloomberg Faculty of Nursing, 155 College Street, Toronto ON M5T 1P8, Canada
| | - Laura E Schanberg
- Duke Medical Center, Department of Pediatrics, DUMC 3212, Durham NC 27710, USA
| | - Gary Walco
- Seattle Children's Hospital, Department of Anesthesia and Pain Medicine, 4800 Sand Point, Way NE Seattle WA 98105, USA
| | - Lynn R Spiegel
- University of Toronto, Department of Pediatrics, 1 King's College Circle, Toronto ON M5S 1A8, Canada,The Hospital for Sick Children, Department of Pediatrics, 555 University Avenue, Toronto ON M5G 1X8, Canada
| | - Shirley ML Tse
- University of Toronto, Department of Pediatrics, 1 King's College Circle, Toronto ON M5S 1A8, Canada,The Hospital for Sick Children, Department of Pediatrics, 555 University Avenue, Toronto ON M5G 1X8, Canada
| | - Elizabeth C Chalom
- Saint Barnabas Medical Center, Department of Pediatrics, 94 Old Shore Hills Road, Livingston NJ 07039, USA
| | - Peter Chira
- Indiana University School of Medicine, Department of Pediatrics, 705 Riley Hospital Drive, Indianapolis IN 46202, USA
| | - Michael Rapoff
- University of Kansas Medical Center, Department of Pediatrics, 3901 Rainbow Boulevard, Kansas City KS 66160, USA
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Jibb LA, Richards JG. AMP-activated protein kinase activity during metabolic rate depression in the hypoxic goldfish, Carassius auratus. ACTA ACUST UNITED AC 2008; 211:3111-22. [PMID: 18805810 DOI: 10.1242/jeb.019117] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Cell survival during hypoxia exposure requires a metabolic reorganization to decrease ATP demands to match the reduced capacity for ATP production. We investigated whether AMP-activated protein kinase (AMPK) activity responds to 12 h exposure to severe hypoxia ( approximately 0.3 mg O2 l(-1)) in the anoxia-tolerant goldfish (Carassius auratus). Hypoxia exposure in goldfish was characterized by a strong activation of creatine phosphate hydrolysis and glycolysis in liver and muscle. AMPK activity increased by approximately 5.5-fold in goldfish liver within 0.5 h hypoxia exposure and this increase in activity was temporally associated with an 11-fold increase in [AMP(free)]/[ATP]. No changes in total AMPK protein amount were observed, suggesting that the changes in AMPK activity are due to post-translational phosphorylation of the protein. Hypoxia exposure had no effect on the expression of two identified AMPK alpha-subunit isoforms and caused an approximately 50% decrease in the mRNA levels of AMPK beta-subunit isoform. Changes in AMPK activity in the liver were associated with an increase in percentage phosphorylation of a well-characterized target of AMPK, eukaryotic elongation factor-2 (eEF2), and decreases in protein synthesis rates measured in liver cell-free extracts. No activation of AMPK was observed in muscle, brain, heart or gill during the 12 h hypoxia exposure suggesting a tissue-specific regulation of AMPK possibly related to a lack of change in cellular [AMP(free)]/[ATP] as observed in muscle.
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Affiliation(s)
- Lindsay A Jibb
- Department of Zoology, The University of British Columbia, 6270 University Boulevard, Vancouver, BC, Canada V6T 1Z4
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