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Tutelman PR, MacKenzie NE, Chambers CT, Coffman S, Cornelissen L, Cormier B, Higgins KS, Phinney J, Blankenburg M, Walker S. Quantitative sensory testing for assessment of somatosensory function in children and adolescents: a scoping review. Pain Rep 2024; 9:e1151. [PMID: 38586595 PMCID: PMC10994437 DOI: 10.1097/pr9.0000000000001151] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 01/14/2024] [Accepted: 02/02/2024] [Indexed: 04/09/2024] Open
Abstract
Quantitative sensory testing (QST) refers to a group of noninvasive psychophysical tests that examine responses to a range of calibrated mechanical and thermal stimuli. Quantitative sensory testing has been used extensively in adult pain research and has more recently been applied to pediatric pain research. The aims of this scoping review were to map the current state of the field, to identify gaps in the literature, and to inform directions for future research. Comprehensive searches were run in 5 databases. Titles, abstracts, and full texts were screened by 2 reviewers. Data related to the study aims were extracted and analyzed descriptively. A total of 16,894 unique studies were identified, of which 505 were screened for eligibility. After a full-text review, 301 studies were retained for analysis. Date of publication ranged from 1966 to 2023. However, the majority of studies (61%) were published within the last decade. Studies included participants across the developmental trajectory (ie, early childhood to adolescence) and most often included a combination of school-age children and adolescents (49%). Approximately 23% of studies were conducted in healthy samples. Most studies (71%) used only one QST modality. Only 14% of studies reported using a standardized QST protocol. Quantitative sensory testing in pediatric populations is an emerging and rapidly growing area of pain research. Future work is needed using comprehensive, standardized QST protocols to harness the full potential that this procedure can offer to our understanding of pediatric pain.
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Affiliation(s)
- Perri R. Tutelman
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Canada
- Centre for Pediatric Pain Research, IWK Health, Halifax, Canada
| | - Nicole E. MacKenzie
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Canada
- Centre for Pediatric Pain Research, IWK Health, Halifax, Canada
| | - Christine T. Chambers
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Canada
- Centre for Pediatric Pain Research, IWK Health, Halifax, Canada
- Department of Pediatrics, Dalhousie University, Halifax, Canada
| | - Siobhan Coffman
- Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital, Boston, USA
| | - Laura Cornelissen
- Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital, Boston, USA
- Department of Anaesthesia, Harvard Medical School, Boston, USA. Cornelissen is now with the Alzheimer's Disease and Brain Health, Eisai Inc, Nutley, NJ, USA
| | | | - Kristen S. Higgins
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Canada
- Centre for Pediatric Pain Research, IWK Health, Halifax, Canada
| | - Jackie Phinney
- Dalhousie Medicine New Brunswick, Dalhousie University, Saint John, Canada
| | - Markus Blankenburg
- Pediatric Neurology, Psychosomatics and Pain Therapy, Children's Pain Center Baden-Württemberg, Klinikum Stuttgart, Germany
| | - Suellen Walker
- Department of Paediatric Anaesthesia, Great Ormond St Hospital NHS Foundation Trust, London, United Kingdom
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Tutelman PR, Chambers CT, Parker JA, Eisen SJ, Noel M. Preliminary development of a measure of parental behavioral responses to everyday pains in young children: the PREP. Pain Rep 2024; 9:e1154. [PMID: 38586593 PMCID: PMC10994502 DOI: 10.1097/pr9.0000000000001154] [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] [Received: 07/10/2023] [Revised: 01/25/2024] [Accepted: 02/20/2024] [Indexed: 04/09/2024] Open
Abstract
Introduction Everyday pains are experienced frequently by young children. Parent responses shape how young children learn about and experience pain. However, research on everyday pains in toddlers and preschoolers is scarce, and no self-report measures of parent responses to their child's pain exist for this age group. Objectives The objective of this study was to develop a preliminary self-report measure of parent behavioral responses to everyday pains in the toddler and preschool years (the PREP) and examine its relationship with child age, sex, and parent and child distress. Methods Items for the PREP were based on a behavioural checklist used in a past observational study of caregiver responses to toddler's everyday pains. Parents (N = 290; 93% mothers) of healthy children (47.9% boys) between 18 and 60 months (Mage = 34.98 months, SD = 11.88 months) completed an online survey of 46 initial PREP items, demographic characteristics, and their child's typical distress following everyday pains. An exploratory factor analysis was performed on the PREP items that describe observable actions parents may take in response to their young child's everyday pains. Results The final solution included 10 items across 3 factors: Distract, Physical Soothe, and Extra Attention and explained 60% of the model variance. All PREP subscales were related to child distress; only Physical Soothe and Extra Attention were related to parent distress. Conclusion This study was a preliminary step in the development and testing of a new self-report measure of parental responses to everyday pains during early childhood.
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Affiliation(s)
- Perri R. Tutelman
- Department of Psychology & Neuroscience, Dalhousie University, Halifax, NS, Canada
- Centre for Pediatric Pain Research, IWK Health, Halifax, NS, Canada
- Departments of Oncology and
- Psychology, University of Calgary, Calgary, AB, Canada
| | - Christine T. Chambers
- Department of Psychology & Neuroscience, Dalhousie University, Halifax, NS, Canada
- Centre for Pediatric Pain Research, IWK Health, Halifax, NS, Canada
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Jennifer A. Parker
- Department of Psychology & Neuroscience, Dalhousie University, Halifax, NS, Canada
- Centre for Pediatric Pain Research, IWK Health, Halifax, NS, Canada
| | - Samantha J. Eisen
- Department of Psychology & Neuroscience, Dalhousie University, Halifax, NS, Canada
- Centre for Pediatric Pain Research, IWK Health, Halifax, NS, Canada
| | - Melanie Noel
- Psychology, University of Calgary, Calgary, AB, Canada
- Children's Hospital Research Institute, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Owerko Centre, Calgary, AB, Canada
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Tutelman PR, Moran C, Beattie SM, Khu M, Howlett M, Scheidl J, Boychuk A, Silveira K, Henning JW, Schulte FSM. Acceptability, feasibility and preliminary effects of an online group psychotherapy intervention for adolescents and young adults with cancer. Psychooncology 2024; 33:e6335. [PMID: 38526517 DOI: 10.1002/pon.6335] [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] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/23/2024] [Accepted: 03/14/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Adolescents and young adults (AYAs; ages 15-29 years) diagnosed with cancer are increasingly recognized as an oncology population with distinct psychosocial needs. However, few specialized psychosocial interventions for AYAs currently exist. This study reports on the development of a novel group-based psychotherapy intervention to address the psychosocial needs of AYAs. The objective was to evaluate the acceptability, feasibility, and preliminary effects of the intervention. METHODS The manualized group psychotherapy program is delivered virtually over an 8-week period by registered psychologists. Four groups (n = 5-11 AYAs per group) with a total of N = 33 participants (Mage = 20.97 years, SD = 3.68, range = 15-29 years, 76% women) were conducted. Recruitment and retention data assessed intervention feasibility. Patient-reported psychosocial outcomes were measured at baseline and immediately following the intervention to assess preliminary effects. Acceptability was assessed following the intervention using a self-report measure of participant satisfaction. RESULTS Overall, the completion rate of the intervention was 85% (n = 28). All participants "strongly agreed" (88%) or "agreed" (13%) that they were satisfied with the group. Meeting, sharing experiences, and expressing feelings with other AYAs were identified as the most helpful aspects. Participants reported significant improvements in emotional (p < 0.05) and functional (p < 0.01) quality of life from baseline to immediately post-intervention with medium effect sizes (d = 0.58-0.70). CONCLUSIONS Findings suggest that the intervention is feasible, acceptable, and shows promise for improving psychosocial outcomes for AYAs. Further research will refine the intervention and establish efficacy in a randomized trial.
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Affiliation(s)
- Perri R Tutelman
- Department of Psychosocial and Rehabilitation Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Chelsea Moran
- Department of Psychosocial and Rehabilitation Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada
- Substance Use and Concurrent Disorders Program, The Royal Ottawa Mental Health Centre, Ottawa, Ontario, Canada
| | - Sara M Beattie
- Department of Psychosocial and Rehabilitation Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Melanie Khu
- Hematology, Oncology, Transplant Program, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Melissa Howlett
- Hematology, Oncology, Transplant Program, Alberta Children's Hospital, Calgary, Alberta, Canada
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jessica Scheidl
- Department of Psychosocial and Rehabilitation Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - April Boychuk
- Department of Psychosocial and Rehabilitation Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Kristen Silveira
- Department of Psychosocial and Rehabilitation Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Jan-Willem Henning
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
- Department of Medical Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Fiona S M Schulte
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
- Hematology, Oncology, Transplant Program, Alberta Children's Hospital, Calgary, Alberta, Canada
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Moss SJ, Stelfox M, McArthur E, Sriskandarajah C, Ahmed SB, Birnie K, Halperin DM, Halperin SA, Harley M, Hu J, Kamstra JN, Leppan L, Nickel A, Racine N, Russell K, Smith S, Solis M, Tutelman PR, Stelfox HT, Fiest KM, Parsons Leigh J. Social factors associated with self-reported changes in mental health symptoms among youth in the COVID-19 pandemic: a cross-sectional survey. BMC Public Health 2024; 24:631. [PMID: 38413913 PMCID: PMC10900679 DOI: 10.1186/s12889-024-18087-8] [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] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/13/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Children and youth experienced marked impacts on day-to-day life in the COVID-19 pandemic that were associated with poorer familial and friend relationships, and greater mental health challenges. Few studies provide self-report data on mental health symptoms from children and youth themselves. We sought to examine the associations between social factors and child and youth self-reported symptoms of worsened mood, anxiety, and irritability during the COVID-19 pandemic. METHODS A nationally representative cross-sectional survey was administered online to collect self-report data across 10 Canadian provinces among children (11-14 years) and youth (15-18 years), April-May 2022. Age-appropriate questions were based on The Partnership for Maternal, Newborn & Child Health and the World Health Organization of the United Nations H6 + Technical Working Group on Adolescent Health and Well-Being consensus framework and the Coronavirus Health and Impact Survey. Associations between a priori defined social factors (e.g., relationship quality) and respondent self-reported mental health were evaluated using ordinal logistic regression models adjusted for age, sex, and geographic location. RESULTS We analyzed data from 483 (51.7%) children (11-14 years; 227, 47.0% girls) and 450 (48.3%) youth (15-18 years; 204, 45.3% girls). The parents of most children and youth had resided in Canada for over 20 years (678, 72.7%). Over one-quarter of children and youth self-identified as Black, Indigenous, or a Person of Color (134, 27.7%; 134, 29.8%, respectively). Over one-third of children and youth self-reported symptoms of worsened mood (149, 30.9%; 125, 27.8%, respectively), anxiety (181, 37.5%; 167, 37.1%, respectively), or irritability (160, 33.1%; 160, 35.6%, respectively) during, compared to pre-pandemic. In descending order of odds ratios (OR), for children and youth, worsened familial relationships (during compared to pre-pandemic) was associated with the self-reported symptoms of worsened mood (child: OR 4.22, 95%CI 2.51-6.88; youth: OR 6.65 95%CI 3.98-11.23), anxiety (child: OR 4.24, 95%CI2.69-6.75; youth: OR 5.28, 95%CI 3.17-8.86), and irritability (child: OR 2.83, 95%CI 1.76-4.56; youth: OR 6.46, 95%CI 3.88-10.90). CONCLUSIONS Self-reported data from a nationally representative sample of children and youth suggest strong associations between social factors and mental health during the COVID-19 pandemic. Interventions targeting child and youth familial relationships may positively impact child and youth mental health.
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Affiliation(s)
| | - Maia Stelfox
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | | | | | - Sofia B Ahmed
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Kathryn Birnie
- Departments of Anesthesiology, Perioperative, and Pain Medicine, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Donna M Halperin
- Rankin School of Nursing, St. Francis Xavier University, Antigonish, NS, Canada
| | - Scott A Halperin
- Canadian Center for Vaccinology, Departments of Pediatrics and Microbiology & Immunology, Dalhousie University, Halifax, NS, Canada
| | | | - Jia Hu
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Josh Ng Kamstra
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Laura Leppan
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Angie Nickel
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Nicole Racine
- Faculty of Social Sciences, University of Ottawa, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | | | - Stacie Smith
- Young Canadian Roundtable On Health, Toronto, ON, Canada
| | - May Solis
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Perri R Tutelman
- Department of Oncology, University of Calgary, Calgary, AB, Canada
| | - Henry T Stelfox
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Kirsten M Fiest
- Department of Critical Care Medicine and O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
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Heathcote LC, Webster SN, Loecher N, Spunt SL, Simon P, Pradhan P, Coutts-Bain D, Sharpe L, Tutelman PR, Simons LE. The bodily threat monitoring scale: Development and preliminary validation in adult and childhood cancer survivors. Psychooncology 2023; 32:1885-1894. [PMID: 37916988 DOI: 10.1002/pon.6236] [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] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/15/2023] [Accepted: 10/18/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE Bodily threat monitoring is a core clinical feature of Fear of cancer recurrence (FCR) and is targeted in psycho-oncology treatments, yet no comprehensive self-report measure exists. The aim of this study was the theory-informed development and initial validation of the Bodily Threat Monitoring Scale (BTMS). METHODS Adult survivors of breast and gynaecological cancers (Study 1: N = 306, age = 37-81 years) and childhood cancer survivors (Study 2: N = 126, age = 10-25 years) completed the BTMS, designed to assess how individuals monitor for and interpret uncertain symptoms as indicating that something is wrong with their body. Participants completed measures to assess construct and criterion validity of the BTMS, and childhood cancer survivors (Study 2) completed the BTMS again 2 weeks later to assess test-retest reliability. RESULTS The 19-item BTMS demonstrated excellent internal consistency across adult and childhood cancer samples (α = 0.90-0.96). Factor analyses indicated two subscales capturing 1. Monitoring of bodily sensations and 2. Threatening interpretations of bodily sensations. Two-week stability estimates were acceptable. For construct validity, the BTMS correlated with body vigilance and anxiety sensitivity. The BTMS also demonstrated criterion validity, yielding significant associations with FCR, intolerance of uncertainty, help-seeking behaviours, and quality of life. The BTMS was associated with FCR while controlling for body vigilance and anxiety sensitivity, indicating a unique contribution of this theory-informed measure. CONCLUSIONS The BTMS shows evidence of sound psychometric properties and could be used to elucidate the role of bodily threat monitoring in the maintenance and management of FCR.
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Affiliation(s)
- Lauren C Heathcote
- Health Psychology Section, Department of Psychology, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Sarah N Webster
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Nele Loecher
- Department of Psychology and Behavioral Sciences, St Jude's Children's Research Hospital, Memphis, Tennessee, USA
| | - Sheri L Spunt
- Department of Pediatric Oncology, Stanford University School of Medicine, Stanford, California, USA
| | - Pamela Simon
- Department of Pediatric Oncology, Stanford University School of Medicine, Stanford, California, USA
| | - Poorva Pradhan
- The School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Daelin Coutts-Bain
- The School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Louise Sharpe
- The School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Perri R Tutelman
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Laura E Simons
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
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Moss SJ, Racine N, Ahmed S, Birnie K, Cherak MS, Curran JA, Halperin D, Halperin SA, Harley M, Hu J, Leppan L, Nickel A, Russell K, Solis M, Smith S, Soo A, Stelfox M, Tutelman PR, Stelfox HT, Fiest KM, Parsons Leigh J. Codesigning a user-centred digital psychoeducational tool for youth mental well-being with families in Canada: study protocol for a sequential exploratory mixed methods study. BMJ Open 2023; 13:e072533. [PMID: 37369410 PMCID: PMC10410808 DOI: 10.1136/bmjopen-2023-072533] [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] [Received: 02/07/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
INTRODUCTION On 11 March 2020, WHO declared the novel coronavirus (COVID-19) disease a global pandemic. Governments globally implemented physical distancing measures and closure of public institutions that resulted in varying implications to youth mental well-being (eg, social isolation, reduced extracurricular activities). These impacts may have detrimental short-term and long-term effects on youth mental well-being; care for youth with mental health disorders was already overstretched, underfunded and fragmented before the pandemic and youth are not often considered in mental health initiatives. There is a pressing need to partner with youth and families to target and improve youth mental well-being prior to the onset of a mental health disorder, as well as to conduct research on youth mental well-being needs related to pandemic recovery. Here we present a protocol for partnering with youth and families to codesign a user-centred digital tool for youth mental well-being. METHODS AND ANALYSIS We will conduct a national research study to develop a catalogue of recommendations specific to supporting youth mental well-being, and a digital tool to support youth mental well-being through three phases of work: (1) expert consultation on data related to supporting youth mental well-being existing within our Pandemic Preparedness Research Program; (2) codesign of an innovative digital tool for youth mental well-being; and (3) assessment of the tool's usability and acceptability. ETHICS AND DISSEMINATION This study has been approved by the Dalhousie Research Ethics Board (2023-6538) and the Conjoint Health Research Ethics Board (23-0039). This study will complement ongoing foundational research in youth conducted by our team that involves partnering with youth and families to understand the unique implications of the pandemic on this population.
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Affiliation(s)
| | - Nicole Racine
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Sofia Ahmed
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kathryn Birnie
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Michal S Cherak
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Janet A Curran
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Donna Halperin
- School of Nursing, St Francis Xavier University, Antigonish, Nova Scotia, Canada
| | - Scott A Halperin
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Micaela Harley
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jia Hu
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Laura Leppan
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Angie Nickel
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kristine Russell
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - May Solis
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Stacie Smith
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Andrea Soo
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Maia Stelfox
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Perri R Tutelman
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Kirsten M Fiest
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Leigh JP, Moss SJ, Sriskandarajah C, McArthur E, Ahmed SB, Birnie K, Halperin D, Halperin S, Harley M, Hu J, Ng Kamstra J, Leppan L, Nickel A, Racine N, Russell K, Smith S, Solis M, Stelfox M, Tutelman PR, Stelfox HT, Fiest KM. A muti-informant national survey on the impact of COVID-19 on mental health symptoms of parent-child dyads in Canada. Sci Rep 2023; 13:7972. [PMID: 37198202 DOI: 10.1038/s41598-023-34544-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 05/03/2023] [Indexed: 05/19/2023] Open
Abstract
The COVID-19 pandemic negatively impacted the mental health of children, youth, and their families which must be addressed and prevented in future public health crises. Our objective was to measure how self-reported mental health symptoms of children/youth and their parents evolved during COVID-19 and to identify associated factors for children/youth and their parents including sources accessed for information on mental health. We conducted a nationally representative, multi-informant cross-sectional survey administered online to collect data from April to May 2022 across 10 Canadian provinces among dyads of children (11-14 years) or youth (15-18 years) and a parent (> 18 years). Self-report questions on mental health were based on The Partnership for Maternal, Newborn & Child Health and the World Health Organization of the United Nations H6+ Technical Working Group on Adolescent Health and Well-Being consensus framework and the Coronavirus Health and Impact Survey. McNemar's test and the test of homogeneity of stratum effects were used to assess differences between children-parent and youth-parent dyads, and interaction by stratification factors, respectively. Among 933 dyads (N = 1866), 349 (37.4%) parents were aged 35-44 years and 485 (52.0%) parents were women; 227 (47.0%) children and 204 (45.3%) youth were girls; 174 (18.6%) dyads had resided in Canada < 10 years. Anxiety and irritability were reported most frequently among child (44, 9.1%; 37, 7.7%) and parent (82, 17.0%; 67, 13.9%) dyads, as well as among youth (44, 9.8%; 35, 7.8%) and parent (68, 15.1%; 49, 10.9%) dyads; children and youth were significantly less likely to report worsened anxiety (p < 0.001, p = 0.006, respectively) or inattention (p < 0.001, p = 0.028, respectively) compared to parents. Dyads who reported financial or housing instability or identified as living with a disability more frequently reported worsened mental health. Children (96, 57.1%), youth (113, 62.5%), and their parents (253, 62.5%; 239, 62.6%, respectively) most frequently accessed the internet for mental health information. This cross-national survey contextualizes pandemic-related changes to self-reported mental health symptoms of children, youth, and families.
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Affiliation(s)
| | | | | | | | - Sofia B Ahmed
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Kathryn Birnie
- Department of Anesthesiology, Perioperative, and Pain Medicine, Calgary, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Donna Halperin
- Rankin School of Nursing, St. Francis Xavier University, Antigonish, NS, Canada
| | - Scott Halperin
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | | | - Jia Hu
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Josh Ng Kamstra
- Department of Surgery, University of Hawaii John A Burns School of Medicine, Honolulu, HI, Canada
| | - Laura Leppan
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Angie Nickel
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Nicole Racine
- Faculty of Social Sciences, University of Ottawa, Ottawa, ON, Canada
| | | | - Stacie Smith
- Young Canadian Roundtable On Health, Toronto, ON, Canada
| | - May Solis
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Maia Stelfox
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | | | - Henry T Stelfox
- Department of Critical Care Medicine, Calgary, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Canada
| | - Kirsten M Fiest
- Department of Critical Care Medicine, Calgary, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Canada
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Brandelli YN, Tutelman PR, Chambers CT, Parker JA, Stinson JN, Huber AM, Stirling Cameron E, Wilson JP. "Every Little Furrow of Her Brow Makes Me Want To Stop": An Interpretative Phenomenologic Analysis of Mothers' Experiences With Juvenile Idiopathic Arthritis Treatments. Arthritis Care Res (Hoboken) 2022; 74:1761-1769. [PMID: 34151534 DOI: 10.1002/acr.24735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 04/29/2021] [Accepted: 06/17/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Children with juvenile idiopathic arthritis (JIA) are faced with a complex medical journey requiring consistent adherence to treatments to achieve disease management. Parents are intimately involved in JIA treatments; however, little is known about their experiences in this role. This is relevant as many treatments necessitate procedural pain (e.g., self-injections) or side effects (e.g., nausea), which may impact a parents' ability to follow treatment plans. The objective of this study was to explore the lived experiences of parents who identified challenges with their child's JIA treatments. METHODS Parents of children with JIA who identified challenges with their child's treatments were invited to take part in semistructured interviews. Data were analyzed using interpretative phenomenological analysis. RESULTS Ten mothers of children with JIA (60% female with a mean age of 11.83 years [range 4-16 years]) participated. Four superordinate themes were present in mothers' experiences: 1) treatments altered mothers' roles within the family, increasing their caregiver burden and advocacy; 2) treatments positively and negatively impacted their relationships (e.g., increased support from others, decreased time with others); 3) treatments elicited various emotional responses (e.g., frustration, grief), which affected their well-being; and 4) treatments were at times a source of internal conflict, affecting mothers' actions and adherence. CONCLUSION Mothers' experiences with their child's JIA treatments affects them in various ways that can subsequently impact treatment adherence. Results highlight the value of supporting parents through these complex treatment regimens and incorporating their experiences in treatment decisions to help promote optimal outcomes for children with JIA and their families.
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Affiliation(s)
- Yvonne N Brandelli
- Dalhousie University and IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Perri R Tutelman
- Dalhousie University and IWK Health Centre, Halifax, Nova Scotia, Canada
| | | | | | - Jennifer N Stinson
- University of Toronto and Hospital for Sick Children, Toronto, Ontario, Canada
| | - Adam M Huber
- Dalhousie University and IWK Health Centre, Halifax, Nova Scotia, Canada
| | | | - Jennifer P Wilson
- Cassie & Friends: A Society for Children With Juvenile Arthritis and Other Rheumatic Diseases, Vancouver, British Columbia, Canada
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9
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Vader K, Tutelman PR, Linkiewich D, Paré C, Wagenaar-Tison A, Birnie KA, Chambers CT, Eubanks K, Ghasemlou N, Gunderson J, Hudspith M, Lane T, Miller J, Richards DP. The state of patient engagement among pain research trainees in Canada: Results of a national web-based survey. Can J Pain 2022; 6:185-194. [DOI: 10.1080/24740527.2022.2115879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Affiliation(s)
- Kyle Vader
- School of Rehabilitation Therapy, Queen’s University, Kingston, Ontario, Canada
| | - Perri R. Tutelman
- Department of Psychology & Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Delane Linkiewich
- Chronic Pain Network, McMaster University, Hamilton, Ontario, Canada
- Department of Psychology, University of Guelph, Guelph, Ontario, Canada
| | - Catherine Paré
- Department of Psychology, McGill University, Montréal, Québec, Canada
| | - Alice Wagenaar-Tison
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Kathryn A. Birnie
- Department of Psychology & Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
- Chronic Pain Network, McMaster University, Hamilton, Ontario, Canada
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Christine T. Chambers
- Department of Psychology & Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kathleen Eubanks
- Chronic Pain Network, McMaster University, Hamilton, Ontario, Canada
| | - Nader Ghasemlou
- Chronic Pain Network, McMaster University, Hamilton, Ontario, Canada
- Departments of Anesthesiology & Perioperative Medicine and Biomedical & Molecular Sciences, Queen’s University, Kingston, Ontario, Canada
| | - Janet Gunderson
- Chronic Pain Network, McMaster University, Hamilton, Ontario, Canada
| | - Maria Hudspith
- Chronic Pain Network, McMaster University, Hamilton, Ontario, Canada
- Pain BC, Vancouver, British Columbia, Canada
| | - Therese Lane
- Chronic Pain Network, McMaster University, Hamilton, Ontario, Canada
| | - Jordan Miller
- School of Rehabilitation Therapy, Queen’s University, Kingston, Ontario, Canada
| | - Dawn P. Richards
- Chronic Pain Network, McMaster University, Hamilton, Ontario, Canada
- Five02 Labs Inc, Toronto, Ontario, Canada
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10
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Heathcote LC, Cunningham SJ, Webster SN, Tanna V, Mattke E, Loecher N, Spunt SL, Simon P, Dahl G, Walentynowicz M, Murnane E, Tutelman PR, Schapira L, Simons LE, Mueller C. Smartphone-based Ecological Momentary Assessment to study "scanxiety" among Adolescent and Young Adult survivors of childhood cancer: A feasibility study. Psychooncology 2022; 31:1322-1330. [PMID: 35411626 PMCID: PMC9545782 DOI: 10.1002/pon.5935] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/21/2022] [Accepted: 03/24/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Scan-related anxiety ("scanxiety") refers to the fear, stress, and anxiety in anticipation of tests and scans in follow-up cancer care. This study assessed the feasibility of Ecological Momentary Assessment (EMA) for real-world, real-time capture of scanxiety using patients' personal smartphone. METHODS Adolescent and Young Adult survivors of childhood cancer were prompted to complete EMA surveys on a smartphone app three times per day for 11 days (33 surveys total) around their routine surveillance scans. Participants provided structured feedback on the EMA protocol. RESULTS Thirty out of 46 contacted survivors (65%) enrolled, exceeding the preregistered feasibility cutoff of 55%. The survey completion rate (83%) greatly exceeded the preregistered feasibility cutoff of 65%. Participants generally found the smartphone app easy and enjoyable to use and reported low levels of distress from answering surveys. Participants reported significantly more daily fear of cancer recurrence (FCR) and negative affect in the days before compared to the days after surveillance scans, aligning with the expected trajectory of scanxiety. Participants who reported greater FCR and scanxiety using comprehensive measures at baseline also reported significantly more daily FCR around their surveillance scans, indicating validity of EMA items. Bodily threat monitoring was prospectively and concurrently associated with daily FCR, thus warranting further investigation as a risk factor for scanxiety. CONCLUSIONS Findings indicate the feasibility, acceptability, and validity of EMA as a research tool to capture the dynamics and potential risk factors for scanxiety.
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Affiliation(s)
- Lauren C. Heathcote
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College LondonLondonUK
| | - Sarah J. Cunningham
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of MedicineStanfordCaliforniaUSA
| | - Sarah N. Webster
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of MedicineStanfordCaliforniaUSA
| | - Vivek Tanna
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of MedicineStanfordCaliforniaUSA
| | - Elia Mattke
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of MedicineStanfordCaliforniaUSA
| | - Nele Loecher
- Department of Mental Health Law and PolicyUniversity of South FloridaTampaFloridaUSA
| | - Sheri L. Spunt
- Stanford Cancer Institute, Stanford University School of MedicineStanfordCaliforniaUSA
| | - Pamela Simon
- Lucile Packard Children's Hospital at StanfordPalo AltoCaliforniaUSA
| | - Gary Dahl
- Stanford Cancer Institute, Stanford University School of MedicineStanfordCaliforniaUSA
| | - Marta Walentynowicz
- Centre for the Psychology of Learning and Experimental Psychopathology, KU LeuvenLeuvenBelgium
- Psychological Science Research InstituteUniversité Catholique de LouvainLouvain‐la‐NeuveBelgium
| | | | | | - Lidia Schapira
- Stanford Cancer Institute, Stanford University School of MedicineStanfordCaliforniaUSA
| | - Laura E. Simons
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of MedicineStanfordCaliforniaUSA
| | - Claudia Mueller
- Department of Pediatrics, Stanford University School of MedicineStanfordCaliforniaUSA
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11
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Moss SJ, Lorenzetti DL, FitzGerald EA, Smith S, Harley M, Tutelman PR, Birnie K, Mizen SJ, Anglin MC, Stelfox HT, Fiest KM, Parsons Leigh J. Strategies to mitigate the impact of the COVID-19 pandemic on child and youth well-being: a scoping review protocol. BMJ Open 2022; 12:e062413. [PMID: 35879014 PMCID: PMC9327437 DOI: 10.1136/bmjopen-2022-062413] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Children and youth are often more vulnerable than adults to emotional impacts of trauma. Wide-ranging negative effects (eg, social isolation, lack of physical activity) of the COVID-19 pandemic on children and youth are well established. This scoping review will identify, describe and categorise strategies taken to mitigate potentially deleterious impacts of the COVID-19 pandemic on children, youth and their families. METHODS AND ANALYSIS We will conduct a scoping review following the Arksey-O'Malley five-stage scoping review method and the Scoping Review Methods Manual by the Joanna Briggs Institute. Well-being will be operationalised according to pre-established domains (health and nutrition, connectedness, safety and support, learning and competence, and agency and resilience). Articles in all languages for this review will be identified in CINAHL, Cochrane CENTRAL Register of Controlled Trials, EMBASE, ERIC, Education Research Complete, MEDLINE and APA PsycINFO. The search strategy will be restricted to articles published on or after 1 December 2019. We will include primary empirical and non-empirical methodologies, excluding protocols, reports, opinions and editorials, to identify new data for a broad range of strategies to mitigate potentially deleterious impacts of the COVID-19 pandemic on child and youth well-being. Two reviewers will calibrate screening criteria and the data abstraction form and will independently screen records and abstract data. Data synthesis will be performed according to the convergent integrated approach described by the Joanna Briggs Institute. ETHICS AND DISSEMINATION Ethical approval is not applicable as this review will be conducted on published data. Findings of this study will be disseminated at national and international conferences and will inform our pan-Canadian multidisciplinary team of researchers, public, health professionals and knowledge users to codesign and pilot test a digital psychoeducational health tool-an interactive, web-based tool to help Canadian youth and their families address poor mental well-being resulting from and persisting beyond the COVID-19 pandemic.
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Affiliation(s)
| | - Diane L Lorenzetti
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | | | - Stacie Smith
- Young Canadians Roundtable on Health, Toronto, Ontario, Canada
| | | | - Perri R Tutelman
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Kathryn Birnie
- Departments of Anesthesiology, Perioperative and Pain Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Sara J Mizen
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Melanie C Anglin
- Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Henry T Stelfox
- Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Kirsten M Fiest
- Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Jeanna Parsons Leigh
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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12
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Tutelman PR, Chambers CT, Noel M, Heathcote LC, Fernandez CV, Flanders A, MacLeod J, Sherry SB, Simard S, Stern M, Stewart SH, Urquhart R. Pain and Fear of Cancer Recurrence in Survivors of Childhood Cancer. Clin J Pain 2022; 38:484-491. [PMID: 35686578 DOI: 10.1097/ajp.0000000000001049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 05/03/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Theoretical models suggest that anxiety, pain intensity, and pain catastrophizing are implicated in a cycle that leads to heightened fear of cancer recurrence (FCR). However, these relationships have not been empirically examined. The objective of this study was to examine the relationships between anxiety symptoms, pain intensity, pain catastrophizing, and FCR in childhood cancer survivors and their parents and to examine whether pain catastrophizing predicts increased FCR beyond anxiety symptoms and pain intensity. METHODS The participants were 54 survivors of various childhood cancers (Mage=13.1 y, range=8.4 to 17.9 y, 50% female) and their parents (94% mothers). Children reported on their pain intensity in the past 7 days. Children and parents separately completed measures of anxiety symptoms, pain catastrophizing, and FCR. RESULTS Higher anxiety symptoms were associated with increased pain intensity, pain catastrophizing, and FCR in childhood cancer survivors. Higher anxiety symptoms and pain catastrophizing, but not child pain intensity, were associated with FCR in parents. Hierarchical linear regression models revealed that pain catastrophizing explained unique variance in both parent (ΔR2=0.11, P<0.01) and child (ΔR2=0.07, P<0.05) FCR over and above the effects of their own anxiety symptoms and child pain. DISCUSSION The results of this study provides novel data on the association between pain and FCR and suggests that a catastrophic style of thinking about pain is more closely related to heightened FCR than one's anxiety symptoms or the sensory pain experience in both childhood cancer survivors and their parents. Pain catastrophizing may be a novel intervention target for survivors and parents struggling with fears of recurrence.
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Affiliation(s)
- Perri R Tutelman
- Departments of Psychology and Neuroscience
- Centre for Pediatric Pain Research
| | - Christine T Chambers
- Departments of Psychology and Neuroscience
- Pediatrics
- Centre for Pediatric Pain Research
| | - Melanie Noel
- Department of Psychology
- Alberta Children's Hospital Research Institute, University of Calgary
- Hotchkiss Brain Institute, Calgary, AB
| | - Lauren C Heathcote
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Conrad V Fernandez
- Pediatrics
- Bioethics
- Division of Pediatric Hematology-Oncology, IWK Health Centre
| | | | | | | | - Sébastien Simard
- Département des sciences de la santé & Centre Intersectoriel en Santé Durable (CISD), Université du Québec à Chicoutimi (UQAC), Saguenay, QC
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13
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Tutelman PR, Chambers CT, Cornelissen L, Fernandez CV, Flanders A, MacLeod J, Sherry SB, Stewart SH, Urquhart R, de Gagne S, Guilcher GM, Hashmi J, Heathcote LC, Noel M, Schulte FS, Stinson JN, Stern M. Long-term alterations in somatosensory functioning in survivors of childhood cancer. Pain 2022; 163:1193-1205. [PMID: 34855647 PMCID: PMC9100454 DOI: 10.1097/j.pain.0000000000002486] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 09/06/2021] [Accepted: 09/09/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Cancer and its treatment can have lasting consequences on somatosensation, including pain, which is often underrecognized and undertreated. Research characterizing the impact of cancer on pain and sensory processing in survivors of childhood cancer is scarce. This study aimed to quantify generalized differences in pain and sensory processing in survivors of childhood cancer compared with reference data using a standardized thermal and mechanical quantitative sensory testing (QST) protocol. The association between demographic, clinical (eg, leukemia vs other cancers and treatment exposures), and psychosocial (eg, anxiety and pain catastrophizing) variables and sensitivity to pain and sensory stimuli were also evaluated. Participants were 56 survivors of various types of childhood cancer (52% male, Mage = 13.5 years, SD = 3.2, range = 8-17 years). On average, children were 7 years (SD = 4.1, range = 1.2-16.5) post treatment. Almost all participants (86%) had at least 1 abnormal QST parameter compared with age- and sex-matched reference data; however, few participants self-reported the presence of sensory abnormalities. Generally, participants exhibited reduced sensitivity across the QST parameters examined (Ps < 0.05, ds = 0.40-3.45). A significant minority (45%) also exhibited pain sensitization (P <0.001, d = 0.42). Several risk factors for changes in sensory processing were identified, including current age, history of leukemia, certain treatment exposures (eg, vincristine cumulative dose, major surgery, and bone marrow or stem cell transplant), time off treatment, and higher anxiety and pain catastrophizing scores. Overall, this study demonstrated that somatosensory changes are prevalent in survivors of childhood cancer years after the completion of treatment. Future research is needed to understand long-term implications of altered somatosensation in this complex population.
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Affiliation(s)
- Perri R. Tutelman
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS, Canada
| | - Christine T. Chambers
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS, Canada
| | - Laura Cornelissen
- Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital, Boston, MA, United States
- Department of Anaesthesia, Harvard Medical School, Boston, MA, United States
| | - Conrad V. Fernandez
- Division of Pediatric Hematology‐Oncology, IWK Health Centre, Halifax, NS, Canada
- Departments of Pediatrics and Bioethics, Dalhousie University, Halifax, NS, Canada
| | - Annette Flanders
- Division of Pediatric Hematology‐Oncology, IWK Health Centre, Halifax, NS, Canada
| | | | - Simon B. Sherry
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Sherry H. Stewart
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Robin Urquhart
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | | | - Gregory M.T. Guilcher
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Haematology, Oncology & Transplant Program, Alberta Children's Hospital, Calgary, AB, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Javeria Hashmi
- Department of Anesthesia, Pain Management, and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada
| | - Lauren C. Heathcote
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University Medical School, Stanford, CA, United States
| | - Melanie Noel
- Department of Psychology, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, Calgary, AB, Canada
| | - Fiona S.M. Schulte
- Haematology, Oncology & Transplant Program, Alberta Children's Hospital, Calgary, AB, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Jennifer N. Stinson
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
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14
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Tutelman PR, Dawson SJ, Schwenck GC, Rosen NO. A Longitudinal Examination of Common Dyadic Coping and Sexual Distress in New Parent Couples during the Transition to Parenthood. Fam Process 2022; 61:278-293. [PMID: 33928639 DOI: 10.1111/famp.12661] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
New parents experience significant disruption to their sexual relationships such as lower desire and sexual frequency relative to prepregnancy. Little is known about the sexual distress new parents feel related to these changes, how sexual distress evolves over time, or how coping with stress relates to this distress. New parent couples who engage in more adaptive, joint coping with mutual stressors-common dyadic coping (CDC)-may be better able to manage distress related to their sexuality and thus, experience less sexual distress at 3-months postpartum and experience more marked improvement over time. In 99 first-time parent couples, we examined the link between CDC measured at 3-months postpartum and trajectories of sexual distress across 3-, 6-, and 12-months postpartum. Analyses used dyadic latent growth curve modeling informed by the actor-partner interdependence model. Mothers' sexual distress at 3-months postpartum was clinically elevated and higher than their partner's. Mothers' sexual distress declined significantly over time, whereas partners' sexual distress remained low and stable. An individual's higher perceptions of CDC was significantly associated with their own (but not their partner's) lower sexual distress at 3-months postpartum. No significant associations were found between CDC and change in sexual distress over time. How new parents jointly cope with stressors early in the postpartum period may lessen the distress they have about their sexuality at a time when most couples have just resumed sexual activity. Results identify CDC as a possible novel target for interventions aimed at helping couples manage sexual distress during the transition to parenthood.
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Affiliation(s)
- Perri R Tutelman
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Samantha J Dawson
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
- Department of Psychology, The University of British Columbia, Vancouver, BC, Canada
| | - Gracielle C Schwenck
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Natalie O Rosen
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
- Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, NS, Canada
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15
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Kenney AE, Tutelman PR, Fisher RS, Lipak KG, Barrera M, Gilmer MJ, Fairclough D, Akard TF, Compas BE, Davies B, Hogan NS, Vannatta K, Gerhardt CA. Impact of End-of-Life Circumstances on the Adjustment of Bereaved Siblings of Children Who Died from Cancer. J Clin Psychol Med Settings 2022; 29:230-238. [PMID: 34173900 PMCID: PMC8710186 DOI: 10.1007/s10880-021-09797-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 06/11/2021] [Indexed: 10/21/2022]
Abstract
The aim of this study was to examine the impact of end-of-life (EoL) circumstances on grief and internalizing symptoms among bereaved siblings. Bereaved families (N = 88) were recruited from three sites 3-12 months (M = 11.57, SD = 3.48) after their child's death from cancer. One sibling per family aged 8-17 years (M = 12.41, SD = 2.64) was randomly selected to participate. Families completed measures of siblings' grief and internalizing symptoms, as well as a structured interview about circumstances surrounding the death. Mother and sibling reports of EoL circumstances were generally concordant, except there was a discrepancy between mothers and children about whether or not children expected their sibling's death (t(75) = 1.52, p = .018). Mother reports of sibling internalizing symptoms were above the normative mean (t(83) = 4.44, p ≤ .001 (M = 56.01 ± 12.48), with 39% (n = 33) in the borderline/clinical range. Sibling opportunity to say goodbye was associated with greater grief-related growth (t(79) = - 1.95, p = .05). Presence at the death and wishing they had done something differently were both associated with greater grief (t(80) = - 2.08, p = .04 and t(80) = - 2.24, p = .028, respectively) and grief-related growth (t(80) = - 2.01, p = .048 and t(80) = - 2.31, p = .024, respectively). However, findings were primarily unique to sibling report, with few mother-reported effects. The adjustment of bereaved siblings may be affected by certain modifiable circumstances surrounding the death of their brother or sister. A proportion of bereaved siblings had elevated internalizing symptoms irrespective of circumstances at EoL. Further work is needed to understand predictors of adjustment among bereaved siblings to provide better support and optimize their outcomes.
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Affiliation(s)
- Ansley E. Kenney
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
| | | | - Rachel S. Fisher
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
| | - Keagan G. Lipak
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
| | - Maru Barrera
- The Hospital for Sick Children, Toronto, ON, Canada,University of Toronto, Toronto, ON, Canada
| | - Mary Jo Gilmer
- Vanderbilt University School of Nursing, Nashville, TN, USA
| | | | | | - Bruce E. Compas
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
| | | | - Nancy S. Hogan
- Professor Emerita, Loyola University Chicago, Chicago, IL, USA
| | - Kathryn Vannatta
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA,Department of Pediatrics, The Ohio State University, Columbus, OH, USA
| | - Cynthia A. Gerhardt
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA,Department of Pediatrics, The Ohio State University, Columbus, OH, USA
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16
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Tutelman PR, Chambers CT, Heathcote LC, Fernandez CV, Flanders A, Patton M, Schulte FSM, Guilcher GMT, Simard S, MacLeod J, Stern M. Measuring Fear of Cancer Recurrence in Survivors of Childhood Cancer: Development and Preliminary Validation of the FCRI-Child and FCRI-Parent Versions. Psychooncology 2022; 31:911-919. [PMID: 35018689 DOI: 10.1002/pon.5879] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Fear of cancer recurrence (FCR) is a common and distressing psychosocial concern for adult cancer survivors. Data on this construct in child survivors is limited and there are no validated measures for this population. This study aimed to adapt the Fear of Cancer Recurrence Inventory-Short Form (FCRI-SF) for survivors of childhood cancer aged 8-18 years (FCRI-C) and their parents (FCRI-P) to self-report on their own FCR and to examine the initial psychometric properties. METHODS The FCRI-SF was adapted through expert panel input and cognitive interviews with child survivors <18 years. The factor structure, internal consistency and construct and criterion validity of the FCRI-C and FCRI-P were examined in 124 survivors of childhood cancer (43% female; Mage =14.58 years, SD=2.90) and 106 parents (90% mothers). RESULTS All FCRI-SF items were retained for the FCRI-C with simplified language. The internal consistencies of the FCRI-C (α= .88) and FCRI-P (α= .83) were good. Exploratory factor analyses yielded one-factor structures for both measures. Higher scores on the FCRI-C and FCRI-P were associated with greater intolerance of uncertainty and pain catastrophizing. Higher child FCR was also related to more hypervigilance to bodily symptoms. Parents with higher FCR reported contacting their child's doctors and nurses and scheduling medical appointments for their child more frequently. Children reported significantly lower FCR compared to parents. CONCLUSIONS The FCRI-C and FCRI-P demonstrated strong reliability and preliminary validity. This study offers preliminary data to support the use of the FCRI-C and FCRI-P to measure FCR in survivors of childhood cancer aged 8-18 years and their parents. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Perri R Tutelman
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Christine T Chambers
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Nova Scotia, Canada
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Lauren C Heathcote
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University Medical School, Stanford, California, USA
| | - Conrad V Fernandez
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
- Division of Pediatric Hematology-Oncology, IWK Health Centre, Halifax, Nova Scotia, Canada
- Department of Bioethics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Annette Flanders
- Division of Pediatric Hematology-Oncology, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Michaela Patton
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Fiona S M Schulte
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Haematology, Oncology and Transplant Program, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Gregory M T Guilcher
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Haematology, Oncology and Transplant Program, Alberta Children's Hospital, Calgary, Alberta, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sébastien Simard
- Department of Health Sciences, Centre intersectoriel en santé durable (CIUSD), Université du Québec à Chicoutimi (UQAC), Saguenay, Québec, Canada
| | | | - Maya Stern
- Patient Partner, Toronto, Ontario, Canada
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17
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Bamgboje-Ayodele A, Smith A'B, Short CE, Fardell JE, Shaw J, Beatty L, Higgins K, Tutelman PR, Chambers CT, Girgis A. Barriers and facilitators to the availability of efficacious self-directed digital health tools for adults living with cancer and their caregivers: A systematic literature review and author survey study. Patient Educ Couns 2021; 104:2480-2489. [PMID: 33741232 DOI: 10.1016/j.pec.2021.03.012] [Citation(s) in RCA: 5] [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: 11/18/2020] [Revised: 02/15/2021] [Accepted: 03/08/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE This study aimed to examine barriers and facilitators to the dissemination of efficacious self-directed digital health tools for adults affected by cancer, and quantify funding used to develop and evaluate these digital health tools. METHODS We conducted: (1) a systematic literature review to identify efficacious self-directed digital health tools for adults affected by cancer, published between 2009 and 2019 and (2) an author survey to identify barriers and facilitators to dissemination of those tools, grant funding and the user centredness of their design (UCD) process. RESULTS Of 1314 screened articles, 29 articles describing 26 tools met the inclusion criteria. From 26 surveys sent, 12 were completed, 6 of which described disseminated tools. Whilst researchers' motivation and infrastructure support facilitate tool dissemination, limited funds, lack of infrastructure and limited research timelines are the most common barriers. A median of AUD$250,000 was spent on tools not disseminated to end-users. CONCLUSION Although incorporating UCD processes in the development of digital health tools is important, it is imperative to integrate implementation processes into the planning stages of tool development to ensure dissemination. PRACTICE IMPLICATIONS Researchers, academic institutions, funding agencies and government and non-government organisations all have roles to play to support long-term implementation.
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Affiliation(s)
- Adeola Bamgboje-Ayodele
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, Australia.
| | - Allan 'Ben' Smith
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Camille E Short
- Melbourne School of Psychological Sciences and Melbourne School of Health Sciences (jointly appointed), The University of Melbourne, Australia
| | - Joanna E Fardell
- School of Women's and Children's Health, UNSW Medicine, University of New South Wales; Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Australia
| | - Joanne Shaw
- Psycho-Oncology Co-operative Research Group (PoCoG), School of Psychology, Faculty of Science, The University of Sydney, Sydney, Australia
| | - Lisa Beatty
- Flinders Health & Medical Research Institute, College of Medicine & Public Health, Flinders University, Australia
| | - Kristen Higgins
- Department of Psychology and Neuroscience, Dalhousie University and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS, Canada
| | - Perri R Tutelman
- Department of Psychology and Neuroscience, Dalhousie University and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS, Canada
| | - Christine T Chambers
- Department of Psychology and Neuroscience, Dalhousie University and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS, Canada
| | - Afaf Girgis
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
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18
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MacKenzie NE, Tutelman PR, Chambers CT, Parker JA, MacDonald NE, McMurtry CM, Pluye P, Granikov V, Taddio A, Barwick M, Birnie KA, Boerner KE. Factors associated with parents' experiences using a knowledge translation tool for vaccination pain management: a qualitative study. BMC Health Serv Res 2021; 21:355. [PMID: 33863339 PMCID: PMC8052692 DOI: 10.1186/s12913-021-06326-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Received: 09/16/2020] [Accepted: 03/28/2021] [Indexed: 12/18/2022] Open
Abstract
Background Vaccination is a common painful procedure for children. Parents’ concern regarding vaccination pain is a significant driver of vaccine hesitancy. Despite the wealth of evidence-based practices available for managing vaccination pain, parents lack knowledge of, and access to, these strategies. Knowledge translation (KT) tools can communicate evidence-based information to parents, however little is known about what factors influence parents’ use of these tools. A two-page, electronic KT tool on psychological, physical, and pharmacological vaccination pain management strategies for children, was shared with parents as part of a larger mixed methods study, using explanatory sequential design, exploring factors related to uptake of this KT tool. The aim of this qualitative study was to understand what influenced parents’ perceptions of the relevance of the KT tool, as well as their decision as to whether to use the tool. Methods A qualitative descriptive design was used. A total of 20 parents of children aged 0–17 years (n = 19 mothers) reviewed the KT tool ahead of their child’s upcoming vaccination and participated in a semi-structured interview at follow-up. Interviews were recorded, transcribed verbatim, and analyzed with reflexive thematic analysis using an inductive approach. Results The analysis generated three interrelated themes which described factors related to parents’ use of the KT tool: (1) Relevance to parents’ needs and circumstances surrounding their child’s vaccination; (2) Alignment with parents’ personal values around, and experiences with, vaccination pain management (e.g., the importance of managing pain); and (3) Support from the clinical environment for implementing evidence-based strategies (e.g., physical clinical environment and quality of interactions with the health care provider). Conclusions Several factors were identified as central to parents’ use of the KT tool, including the information itself and the clinical environment. When the tool was perceived as relevant, aligned with parents’ values, and was supported by health care providers, parents were more inclined to use the KT tool to manage their children’s vaccination pain. Future research could explore other factors related to promoting engagement and uptake when creating parent-directed KT tools for a range of health-related contexts. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06326-2.
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Affiliation(s)
- Nicole E MacKenzie
- Dalhousie University, Department of Psychology and Neuroscience, Halifax, Nova Scotia, Canada.,IWK Health Centre, Centre for Pediatric Pain Research, Halifax, Nova Scotia, Canada
| | - Perri R Tutelman
- Dalhousie University, Department of Psychology and Neuroscience, Halifax, Nova Scotia, Canada.,IWK Health Centre, Centre for Pediatric Pain Research, Halifax, Nova Scotia, Canada
| | - Christine T Chambers
- Dalhousie University, Department of Psychology and Neuroscience, Halifax, Nova Scotia, Canada. .,IWK Health Centre, Centre for Pediatric Pain Research, Halifax, Nova Scotia, Canada. .,Dalhousie University, Department of Pediatrics, Halifax, Nova Scotia, Canada.
| | - Jennifer A Parker
- IWK Health Centre, Centre for Pediatric Pain Research, Halifax, Nova Scotia, Canada
| | - Noni E MacDonald
- Dalhousie University, Department of Pediatrics, Halifax, Nova Scotia, Canada
| | - C Meghan McMurtry
- University of Guelph, Department of Psychology, Guelph, Ontario, Canada and Pediatric Chronic Pain Program, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Pierre Pluye
- McGill University, Department of Family Medicine, Montreal, Quebec, Canada
| | - Vera Granikov
- McGill University, Department of Family Medicine, Montreal, Quebec, Canada
| | - Anna Taddio
- University of Toronto, Leslie Dan Faculty of Pharmacy, Toronto, Ontario, Canada.,Child Health Evaluative Sciences Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Melanie Barwick
- Child Health Evaluative Sciences Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.,8University of Toronto, Department of Psychiatry, Faculty of Medicine and University of Toronto, Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Kathryn A Birnie
- Dalhousie University, Department of Psychology and Neuroscience, Halifax, Nova Scotia, Canada.,University of Calgary, Department of Anesthesiology, Perioperative and Pain Medicine, Calgary, Alberta, Canada
| | - Katelynn E Boerner
- BC Children's Hospital & University of British Columbia, Department of Psychiatry, Vancouver, British Columbia, Canada
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Tutelman PR, Lipak KG, Adewumi A, Fults MZ, Humphrey LM, Gerhardt CA. Concerns of Parents With Children Receiving Home-Based Pediatric Palliative Care. J Pain Symptom Manage 2021; 61:705-712. [PMID: 32931905 DOI: 10.1016/j.jpainsymman.2020.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 07/27/2020] [Revised: 09/03/2020] [Accepted: 09/04/2020] [Indexed: 01/03/2023]
Abstract
CONTEXT Caring for a child who will die from a life-limiting illness is one of the most difficult experiences a parent may face. Pediatric palliative care (PPC) has grown as a specialty service to address the unique needs of children and families with serious illness. However, gaps remain between the needs of families in PPC and the support received. OBJECTIVES The objective of this study was to explore the concerns of parents who have a child in home-based PPC. METHODS Semistructured interviews were conducted with 25 mothers and 10 fathers from 25 families shortly after their child's referral to home-based PPC. Children (57% male, Mage = 10.5 years, SD = 3.95, range = 4-18 years) had a range of diagnoses. Data were analyzed using inductive content analysis. RESULTS Parents' concerns clustered into four main themes: 1) ensuring that their child's remaining days were spent living well physically, emotionally, and socially; 2) uncertainty regarding their child's diagnosis, prognosis, and treatments; 3) their child's death (e.g., the process of dying and when it will occur); and 4) the family, including the impact of the child's illness and death on siblings and wanting to cherish as much time together with family as possible. CONCLUSION Parents of children receiving home-based PPC expressed concerns across a range of domains, both about their seriously ill child and the broader family. These results highlight salient worries among parents of children in PPC and point to critical areas for intervention for seriously ill children and the broader family.
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Affiliation(s)
- Perri R Tutelman
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Keagan G Lipak
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Aminat Adewumi
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Marci Z Fults
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Lisa M Humphrey
- Division of Palliative Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA; Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | - Cynthia A Gerhardt
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA; Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
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20
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MacKenzie NE, Tutelman PR, Chambers CT, Parker JA, MacDonald NE, McMurtry CM, Pluye P, Granikov V, Taddio A, Barwick M, Birnie KA, Boerner KE. Understanding parents' use of a knowledge translation tool to manage children's vaccination pain. Pain Rep 2021; 6:e907. [PMID: 33728388 PMCID: PMC7954376 DOI: 10.1097/pr9.0000000000000907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/05/2020] [Revised: 01/12/2021] [Accepted: 01/24/2021] [Indexed: 01/12/2023] Open
Abstract
Supplemental Digital Content is Available in the Text. The relevance of KT tools, and parents' confidence in using them, was related to uptake of vaccination pain management strategies for children. Introduction: Although several evidence-based strategies for managing children's vaccination pain exist, many parents report being unaware of them. Knowledge translation (KT) tools present evidence-based information in plain language. Objectives: This two-phase study assessed parents/caregivers' uptake of evidence-based pain management strategies via a KT tool and considered factors related to parents' planned, actual, and future use of these strategies. Methods: In phase 1, parents were exposed to an online KT tool on physical, psychological, and pharmacological vaccination pain management strategies, and their impressions were assessed by questionnaires including the Information Assessment Method for Parents. In phase 2, after vaccination, parents completed a follow-up survey on their uptake and experiences using the information. Results: A total of 312 participants reported their plans for KT tool use. Parents who found the KT tool relevant were more likely to plan to use it at their child's upcoming vaccination. A total of 128 parents (93% mothers) completed both surveys. Nearly all parents who planned to use the information did so during their child's subsequent vaccination (90%). When the KT tool was relevant to their needs, parents were more likely to use the information during their child's vaccination. Parents who felt confident using the tool were significantly more likely to report plans for future tool use. Discussion: This study demonstrates the effectiveness of a KT tool that was relevant to parents' needs and built confidence to increase parent-reported uptake of evidence-based strategies. Proper pain management could positively impact parents' uptake of vaccinations for children.
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Affiliation(s)
- Nicole E MacKenzie
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada.,Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS, Canada
| | - Perri R Tutelman
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada.,Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS, Canada
| | - Christine T Chambers
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada.,Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS, Canada.,Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Jennifer A Parker
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS, Canada
| | - Noni E MacDonald
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - C Meghan McMurtry
- Department of Psychology, University of Guelph, Guelph, Ontario, Canada, and Pediatric Chronic Pain Program, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Pierre Pluye
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Vera Granikov
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Anna Taddio
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Melanie Barwick
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Department of Psychiatry, Faculty of Medicine, University of Toronto, and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Kathryn A Birnie
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Calgary, Calgary, AB, Canada
| | - Katelynn E Boerner
- Department of Psychiatry, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
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21
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Tutelman PR, Langley CL, Chambers CT, Parker JA, Finley GA, Chapman D, Jones GT, Macfarlane GJ, Marianayagam J. Epidemiology of chronic pain in children and adolescents: a protocol for a systematic review update. BMJ Open 2021; 11:e043675. [PMID: 33593785 PMCID: PMC7888311 DOI: 10.1136/bmjopen-2020-043675] [Citation(s) in RCA: 3] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 12/28/2020] [Accepted: 01/18/2021] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Chronic pain, defined as persistent or recurring pain or pain lasting longer than 3 months, is a common childhood problem and can profoundly impact children's physical, psychological and social functioning. The last comprehensive systematic review estimating the prevalence of chronic pain in children and adolescents was published in 2011. Since then, the literature on paediatric chronic pain has grown substantially. This manuscript outlines a protocol for an updated systematic review to provide updated estimates of the prevalence of various forms of chronic pain in children and adolescence. The review will also examine the relationship between sociodemographic and psychosocial factors related to chronic pain prevalence. METHODS AND ANALYSIS This review will follow Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We will search EMBASE, PubMed, CINAHL and PsycINFO for observational studies published in English between 2009 and 2020 reporting population-based estimates of chronic non-disease-related pain prevalence in children or adolescents (age ≤19 years). Two independent reviewers will screen the titles and abstracts retrieved from the search based on predefined eligibility criteria. The full texts of relevant studies will then be assessed by two reviewers. Studies meeting inclusion criteria will be categorised according to the type of pain investigated: headache only, abdominal pain only, back pain only, musculoskeletal pain, combined pain, general pain and other pain. Data will be extracted using customised forms and studies will be assessed for risk of bias using a 10-item tool developed by Hoy et al (2012). A narrative synthesis will summarise the prevalence estimates of paediatric chronic pain and associated sociodemographic and psychosocial correlates. Meta-analyses and meta-regressions will be performed if the data permit. ETHICS AND DISSEMINATION Ethical approval is not required. Findings will be disseminated through publication in an academic journal, presentations at conferences and in various media. PROSPERO REGISTRATION NUMBER CRD42020198690.
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Affiliation(s)
- Perri R Tutelman
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Charlotte L Langley
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Christine T Chambers
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Nova Scotia, Canada
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jennifer A Parker
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - G Allen Finley
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Nova Scotia, Canada
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Darlene Chapman
- Library Services, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Gareth T Jones
- Epidemiology Group and Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Gary J Macfarlane
- Epidemiology Group and Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Justina Marianayagam
- Patient Partner, Thunder Bay, Ontario, Canada
- Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
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22
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Tutelman PR, Heathcote LC. Fear of cancer recurrence in childhood cancer survivors: A developmental perspective from infancy to young adulthood. Psychooncology 2020; 29:1959-1967. [PMID: 33068463 DOI: 10.1002/pon.5576] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 06/24/2020] [Revised: 10/08/2020] [Accepted: 10/09/2020] [Indexed: 12/13/2022]
Abstract
AIMS Fear of cancer recurrence (FCR) is among the most prevalent and distressing concerns reported by cancer survivors. While younger age is the most consistent predictor of elevated FCR, research to date has focused almost exclusively on adult cancer survivors. This is despite the fact that children with cancer are more likely to survive compared to adults, and will become regular, lifelong users of the medical system to mitigate the effects of toxic treatment. The early experience of cancer yields unique challenges and circumstances that may impact children's capacity for and experience of FCR across the developmental trajectory. The aim of this paper is to present a developmental perspective of FCR from infancy to young adulthood. METHODS Drawing on the developmental science literature and recent theoretical advancements in FCR, we outline cognitive and social factors that may influence children's capacity for and experience of FCR across the developmental trajectory. RESULTS First, distinct developmental groups that fall under the classification of "childhood cancer survivor," and that all require attention, are summarized. Using the structure of these groupings, we centrally provide a developmental perspective of FCR that offers a useful starting point for research in pediatric populations. Key research gaps, including the need for validated assessment tools to measure FCR in child and adolescent survivors, are highlighted. CONCLUSIONS Consideration of the unique context of childhood is needed to guide the identification of childhood cancer survivors at risk for FCR as well as the development of effective FCR interventions for this population.
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Affiliation(s)
- Perri R Tutelman
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada.,Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Lauren C Heathcote
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, California, USA
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23
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Heathcote LC, Loecher N, Simon P, Spunt SL, Jordan A, Tutelman PR, Cunningham S, Schapira L, Simons LE. Symptom appraisal in uncertainty: a theory-driven thematic analysis with survivors of childhood cancer. Psychol Health 2020; 36:1182-1199. [DOI: 10.1080/08870446.2020.1836180] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Lauren C. Heathcote
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Nele Loecher
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Pamela Simon
- Department of Pediatric Hematology-Oncology, Lucile Packard Children’s Hospital Stanford, Palo Alto, CA, USA
| | - Sheri L. Spunt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Abbie Jordan
- Department of Psychology & Centre for Pain Research, University of Bath, Bath, UK
| | - Perri R. Tutelman
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sarah Cunningham
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Lidia Schapira
- Department of Medical Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Laura E. Simons
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Abstract
Much of what we know about the meaning and experience of pain has been facilitated through qualitative research. However, qualitative inquiry continues to be underrepresented in the pain literature relative to quantitative approaches. In this Commentary and Introduction to the Special Issue on Qualitative Research and Pain, we present a collection of high-quality, cutting-edge qualitative studies in pain that highlight theoretical and methodological advancements in the field. The articles included in this Special Issue feature a range of designs (e.g., grounded theory, phenomenology, qualitative description), methods of data collection (e.g., interviews, object elicitation, photovoice), and populations (e.g., immigrant women, individuals with heart disease). Throughout this Commentary we also address three common controversies regarding the quality of qualitative research and the stance we took on them for the Issue. These primarily deal with the procedure-related issues of sample size, generalizability, and saturation. We discuss how a more substantive-centered approach to evaluation—that is, an approach that considers the methodological and theoretical significance of the work—is crucial for advancing qualitative research in pain.
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Affiliation(s)
- Perri R. Tutelman
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Fiona Webster
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
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25
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Heathcote LC, Loecher N, Spunt SL, Simon P, Tutelman PR, Wakefield CE, Ach E, Schapira L. Do qualitative interviews cause distress in adolescents and young adults asked to discuss fears of cancer recurrence? Psychooncology 2020; 30:123-126. [PMID: 32909342 DOI: 10.1002/pon.5544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/12/2020] [Accepted: 08/31/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Lauren C Heathcote
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Nele Loecher
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Sheri L Spunt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Pamela Simon
- Lucile Packard Children's Hospital Stanford, Palo Alto, California, USA
| | - Perri R Tutelman
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Claire E Wakefield
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Emily Ach
- Department of Psychiatry, Stanford University School of Medicine, Stanford, California, USA
| | - Lidia Schapira
- Department of Medical Oncology, Stanford University School of Medicine, Stanford, California, USA
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26
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Tutelman PR, Webster F. Qualitative Research and Pain: Current Controversies and Future Directions. Can J Pain 2020. [DOI: 10.1080/24740527.2020.1814131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Perri R. Tutelman
- Department of Psychology and Neuroscience, Dalhousie University
- Centre for Pediatric Pain Research, IWK Health Centre
| | - Fiona Webster
- Arthur Labatt Family School of Nursing, Western University
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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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Dol J, Tutelman PR, Chambers CT, Barwick M, Drake EK, Parker JA, Parker R, Benchimol EI, George RB, Witteman HO. Health Researchers' Use of Social Media: Scoping Review. J Med Internet Res 2019; 21:e13687. [PMID: 31719028 PMCID: PMC6881779 DOI: 10.2196/13687] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [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: 02/12/2019] [Revised: 05/16/2019] [Accepted: 06/29/2019] [Indexed: 11/13/2022] Open
Abstract
Background Health researchers are increasingly using social media in a professional capacity, and the applications of social media for health researchers are vast. However, there is currently no published evidence synthesis of the ways in which health researchers use social media professionally, and uncertainty remains as to how best to harness its potential. Objective This scoping review aimed to explore how social media is used by health researchers professionally, as reported in the literature. Methods The scoping review methodology guided by Arksey and O’Malley and Levac et al was used. Comprehensive searches based on the concepts of health research and social media were conducted in MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC, and Web of Science databases, with no limitations applied. Articles were screened at the title and abstract level and at full text by two reviewers. One reviewer extracted data that were analyzed descriptively to map the available evidence. Results A total of 8359 articles were screened at the title and abstract level, of which 719 were also assessed at full text for eligibility. The 414 articles identified for inclusion were published in 278 different journals. Studies originated from 31 different countries, with the most prevalent being the United States (52.7% [218/414]). The health discipline of the first authors varied, with medicine (33.3% [138/414]) being the most common. A third of the articles covered health generally, with 61 health-specific topics. Papers used a range of social media platforms (mean 1.33 [SD 0.7]). A quarter of the articles screened reported on social media use for participant recruitment (25.1% [104/414]), followed by practical ways to use social media (15.5% [64/414]), and use of social media for content analysis research (13.3% [55/414]). Articles were categorized as celebratory (ie, opportunities for engagement, 72.2% [299/414]), contingent (ie, opportunities and possible limitations, 22.7% [94/414]) and concerned (ie, potentially harmful, 5.1% [21/414]). Conclusions Health researchers are increasingly publishing on their use of social media for a range of professional purposes. Although most of the sentiment around the use of social media in health research was celebratory, the uses of social media varied widely. Future research is needed to support health researchers to optimize their social media use.
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Affiliation(s)
- Justine Dol
- Dalhousie University, Faculty of Health, Halifax, NS, Canada.,IWK Health Centre, Centre for Pediatric Pain Research, Halifax, NS, Canada
| | - Perri R Tutelman
- IWK Health Centre, Centre for Pediatric Pain Research, Halifax, NS, Canada.,Dalhousie University, Department of Psychology and Neuroscience, Halifax, NS, Canada
| | - Christine T Chambers
- IWK Health Centre, Centre for Pediatric Pain Research, Halifax, NS, Canada.,Dalhousie University, Department of Psychology and Neuroscience, Halifax, NS, Canada.,Dalhousie University, Department of Pediatrics, Halifax, NS, Canada
| | - Melanie Barwick
- The Hospital for Sick Children, SickKids Research Institute, Child Health Evaluative Sciences, Toronto, ON, Canada.,University of Toronto, Faculty of Medicine, Toronto, ON, Canada.,University of Toronto, Dalla Lana School of Public Health, Toronto, ON, Canada
| | - Emily K Drake
- Dalhousie University, Faculty of Health, Halifax, NS, Canada
| | - Jennifer A Parker
- IWK Health Centre, Centre for Pediatric Pain Research, Halifax, NS, Canada
| | - Robin Parker
- Dalhousie University, WK Kellogg Health Sciences Library, Halifax, NS, Canada
| | - Eric I Benchimol
- University of Ottawa, Faculty of Medicine, Department of Pediatrics, Ottawa, ON, Canada.,University of Ottawa, Faculty of Medicine, School of Epidemiology and Public Health, Ottawa, ON, Canada
| | - Ronald B George
- University of California San Francisco, Department of Anesthesia and Perioperative Care, San Francisco, CA, United States
| | - Holly O Witteman
- Laval University, Faculty of Medicine, Department of Family and Emergency Medicine, Quebec, QC, Canada.,Laval University, Faculty of Medicine, Office of Education and Professional Development, Quebec, QC, Canada.,CHU de Québec-Université Laval, Quebec, QC, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Brandelli YN, Chambers CT, Tutelman PR, Stinson JN, Huber AM, Wilson JP. Parent Pain Cognitions and Treatment Adherence in Juvenile Idiopathic Arthritis. J Pediatr Psychol 2019; 44:1111-1119. [PMID: 31509198 PMCID: PMC6761964 DOI: 10.1093/jpepsy/jsz067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 03/01/2019] [Revised: 07/30/2019] [Accepted: 07/31/2019] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE Given the high levels of pain and low rates of treatment adherence in children with juvenile idiopathic arthritis (JIA) and their families, this study sought to examine the relationship between parent pain cognitions (i.e., pain catastrophizing, fear of pain) and treatment adherence, and how barriers to treatment (e.g., forgetting treatments, children resisting injections) may be implicated in this relationship. METHODS Parents of children under 18 years of age who have been diagnosed with JIA were recruited to complete an online survey. In total, 221 parents (93% mothers) of children aged 2-17 years (M = 11.10, SD = 4.25) took part, completing questions regarding their pain cognitions, perceived barriers to treatment, and their child's arthritis treatment adherence ability. RESULTS Hierarchical regressions demonstrated that both pain cognitions (i.e., pain catastrophizing and fear of pain) were related to a decrease in parent-reported treatment adherence, however, pain catastrophizing was no longer significant when fear of pain was added to the model. The presence of treatment barriers partially mediated the relationship between fear of pain and treatment adherence, above and beyond the alternate model proposed. CONCLUSION These results suggest that parent pain catastrophizing and fears of pain are related to a greater difficulty following treatment plans, possibly in part because of barriers parents experience that preclude adherence. Given these findings, the identification and management of parent pain cognitions is critical to improving treatment adherence and outcomes for children with JIA and their families.
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Affiliation(s)
- Yvonne N Brandelli
- Department of Psychology and Neuroscience, Dalhousie University
- Centre for Pediatric Pain Research, IWK Health Centre
| | - Christine T Chambers
- Department of Psychology and Neuroscience, Dalhousie University
- Centre for Pediatric Pain Research, IWK Health Centre
- Department of Pediatrics, Dalhousie University
| | - Perri R Tutelman
- Department of Psychology and Neuroscience, Dalhousie University
- Centre for Pediatric Pain Research, IWK Health Centre
| | - Jennifer N Stinson
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto
- Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children
| | - Adam M Huber
- Department of Pediatrics, Dalhousie University
- Division of Pediatric Rheumatology, IWK Health Centre
| | - Jennifer P Wilson
- Cassie and Friends: A Society for Children with Juvenile Arthritis and Other Rheumatic Diseases
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Tutelman PR, Chambers CT, Urquhart R, Fernandez CV, Heathcote LC, Noel M, Flanders A, Guilcher GMT, Schulte F, Stinson JN, MacLeod J, Stern M. When "a headache is not just a headache": A qualitative examination of parent and child experiences of pain after childhood cancer. Psychooncology 2019; 28:1901-1909. [PMID: 31276614 DOI: 10.1002/pon.5170] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [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: 02/28/2019] [Revised: 06/26/2019] [Accepted: 06/30/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Today, more than 80% of children diagnosed with cancer are expected to survive. Despite the high prevalence of pain associated with the diagnosis and treatment of childhood cancer, there is a limited understanding of how having cancer shapes children's experience and meaning of pain after treatment has ended. This study addresses this gap by exploring childhood cancer survivors' (CCS') experiences of pain from their perspective and the perspective of their parents. METHODS Twenty semi-structured interviews were completed with CCS (50% female; mean age = 13.20 y, range = 8-17 y) and their parents (90% mothers). Data were analyzed using interpretive phenomenological analysis. RESULTS Analyses revealed three superordinate themes present in the data: (a) pain is a changed experience after childhood cancer; (b) new or ambiguous pains may be interpreted by CCS and parents as a threat of disease recurrence, late effects, or a secondary cancer; and (c) pain interpretation occurs within the broader context of how CCS and parents appraise their cancer experience. Parents generally appraised their child's cancer and pain as more threatening and were influential in guiding their child's interpretations. CONCLUSIONS The cancer experience played an important role in shaping CCS' and their parents' experience and interpretation of pain in survivorship. This study provides novel data to inform the development and refinement of new and existing conceptual models of pain and symptom perception after cancer. The results also point to key areas for future investigation and clinical intervention to address the issue of pain in cancer survivorship.
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Affiliation(s)
- Perri R Tutelman
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada.,Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Christine T Chambers
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Nova Scotia, Canada.,Departments of Pediatrics and Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Robin Urquhart
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Conrad V Fernandez
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada.,Division of Pediatric Hematology-Oncology, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Lauren C Heathcote
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University Medical School, Stanford, California, USA
| | - Melanie Noel
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Annette Flanders
- Division of Pediatric Hematology-Oncology, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Gregory M T Guilcher
- Departments of Paediatrics and Oncology, University of Calgary, Calgary, Alberta, Canada.,Haematology, Oncology and Transplant Program, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Fiona Schulte
- Haematology, Oncology and Transplant Program, Alberta Children's Hospital, Calgary, Alberta, Canada.,Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer N Stinson
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.,Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | | | - Maya Stern
- Patient Partner, Toronto, Ontario, Canada
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Tutelman PR, Drake EK, Urquhart R. "It Could Have Been Me": An Interpretive Phenomenological Analysis of Health Care Providers' Experiences Caring for Adolescents and Young Adults with Terminal Cancer. J Adolesc Young Adult Oncol 2019; 8:587-592. [PMID: 31259657 DOI: 10.1089/jayao.2019.0015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 01/07/2023] Open
Abstract
Purpose: Adolescents and young adults (AYAs) with terminal cancer are a marginalized population with unique medical and psychosocial needs. AYAs commonly report challenges with their health care experiences, however, little is known about the experiences of the health care providers (HCPs) who deliver this specialized care. The purpose of the current study was to understand HCPs' experiences caring for AYAs with terminal cancer. Methods: Nine HCPs (four nurses and five physicians) took part in in-depth semistructured interviews. Participants were eligible if they were a nurse or physician in Atlantic Canada; cared for at least one AYA patient with terminal cancer in the past 3 years; and were able to speak and understand English. Data were analyzed using interpretive phenomenological analysis. Results: Analyses revealed four superordinate themes present in the data: (1) many unknowns and uncertainties associated with providing care for AYAs compounded by minimal or no training specifically concerning this population; (2) an intense emotional experience compared with caring for patients with terminal cancer of other ages; (3) personal identification with patients and their families; and (4) attempts to make sense of the circumstance thwarted by feelings of injustice and unfairness. Conclusions: HCPs experienced unique emotional and logistical challenges when caring for AYAs with terminal cancer, which can influence the care they provide. HCPs' experiences highlight the need for training to support clinicians in caring for AYAs with terminal cancer to optimize their own well-being and delivery of health care services to this population.
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Affiliation(s)
- Perri R Tutelman
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Canada.,Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Canada
| | - Emily K Drake
- Faculty of Health, Dalhousie University, Halifax, Canada.,Cancer Outcomes Research Program, Nova Scotia Health Authority, Halifax, Canada
| | - Robin Urquhart
- Faculty of Health, Dalhousie University, Halifax, Canada.,Cancer Outcomes Research Program, Nova Scotia Health Authority, Halifax, Canada.,Department of Surgery, Dalhousie University, Halifax, Canada
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Tutelman PR, Chambers CT, Stinson JN, Parker JA, Barwick M, Witteman HO, Jibb L, Stinson HC, Fernandez CV, Nathan PC, Campbell F, Irwin K. The Implementation Effectiveness of a Freely Available Pediatric Cancer Pain Assessment App: A Pilot Implementation Study. JMIR Cancer 2018; 4:e10280. [PMID: 30578200 PMCID: PMC6320418 DOI: 10.2196/10280] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 03/01/2018] [Revised: 09/20/2018] [Accepted: 10/26/2018] [Indexed: 12/31/2022] Open
Abstract
Background Pain Squad is an evidence-based, freely available iOS app designed to assess pain in children with cancer. Once research-based technologies such as Pain Squad are validated, it is important to evaluate their performance in natural settings to optimize their real-world clinical use. Objective The objective of this study was to evaluate the implementation effectiveness of Pain Squad in a natural setting. Methods Parents of 149 children with cancer (aged 8-18 years) were contacted to invite their child to participate. Participating children downloaded Pain Squad on their own iOS devices from the Apple App Store and reported their pain using the app twice daily for 1 week. Participants then emailed their pain reports from the app to the research team and completed an online survey on their experiences. Key implementation outcomes included acceptability, appropriateness, cost, feasibility, fidelity, penetration, and sustainability. Results Of the 149 parents contacted, 16 of their children agreed to participate. More than a third (6/16, 37.5%) of participating children returned their pain reports to the research team. Adherence to the pain assessments was 62.1% (mean 8.7/14 assessments). The 6 children who returned reports rated the app as highly feasible to download and use and rated their overall experience as acceptable. They also reported that they would be willing to sustain their Pain Squad use over several weeks and that they would recommend it to other children with cancer, which suggests that it may have potential for penetration. Conclusions While Pain Squad was well received by the small number of children who completed the study, user uptake, engagement, and adherence were significant barriers to the implementation of Pain Squad in a natural setting. Implementation studies such as this highlight important challenges and opportunities for promoting the use and uptake of evidence-based technologies by the intended end-users.
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Affiliation(s)
- Perri R Tutelman
- Dalhousie University, Halifax, NS, Canada.,IWK Health Centre, Halifax, NS, Canada
| | - Christine T Chambers
- Dalhousie University, Halifax, NS, Canada.,IWK Health Centre, Halifax, NS, Canada
| | - Jennifer N Stinson
- University of Toronto, Toronto, ON, Canada.,The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Melanie Barwick
- University of Toronto, Toronto, ON, Canada.,The Hospital for Sick Children, Toronto, ON, Canada
| | - Holly O Witteman
- Laval University, Quebec, QC, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | | | - Conrad V Fernandez
- Dalhousie University, Halifax, NS, Canada.,IWK Health Centre, Halifax, NS, Canada
| | - Paul C Nathan
- University of Toronto, Toronto, ON, Canada.,The Hospital for Sick Children, Toronto, ON, Canada
| | - Fiona Campbell
- University of Toronto, Toronto, ON, Canada.,The Hospital for Sick Children, Toronto, ON, Canada
| | - Karen Irwin
- Cancer Knowledge Network, Milton, ON, Canada
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Higgins KS, Tutelman PR, Chambers CT, Witteman HO, Barwick M, Corkum P, Grant D, Stinson JN, Lalloo C, Robins S, Orji R, Jordan I. Availability of researcher-led eHealth tools for pain assessment and management: barriers, facilitators, costs, and design. Pain Rep 2018; 3:e686. [PMID: 30324177 PMCID: PMC6172815 DOI: 10.1097/pr9.0000000000000686] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 08/07/2018] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Numerous eHealth tools for pain assessment and management have been developed and evaluated with promising results regarding psychometric properties, efficacy, and effectiveness. Although considerable resources are spent on developing and evaluating these tools with the aim of increasing access to care, current evidence suggests they are not made available to end users, reducing their impact and creating potential research waste. METHODS This study consisted of 2 components: (1) a systematic review of eHealth tools for pediatric pain assessment and/or management published in the past 10 years, and (2) an online survey, completed by the authors of identified tools, of tool availability, perceived barriers or facilitators to availability, grant funding used, and a validated measure of user-centeredness of the design process (UCD-11). RESULTS Ninety articles (0.86% of citations screened) describing 53 tools met inclusion criteria. Twenty-six survey responses were completed (49.06%), 13 of which (50.00%) described available tools. Commonly endorsed facilitators of tool availability included researchers' beliefs in tool benefits to the target population and research community; barriers included lack of infrastructure and time. The average cost of each unavailable tool was $314,425.31 USD ($3,144,253.06 USD total, n = 10). Authors of available tools were more likely to have followed user-centered design principles and reported higher total funding. CONCLUSION Systemic changes to academic and funding structures could better support eHealth tool availability and may reduce potential for research waste. User-centered design and implementation science methods could improve the availability of eHealth tools and should be further explored in future studies.
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Affiliation(s)
- Kristen S. Higgins
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Canada
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Canada
| | - Perri R. Tutelman
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Canada
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Canada
| | - Christine T. Chambers
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Canada
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Canada
- Department of Pediatrics, Dalhousie University, Halifax, Canada
| | - Holly O. Witteman
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Québec City, Canada
- CHU de Québec, Québec City, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Melanie Barwick
- Child Health Evaluative Sciences Research Institute, The Hospital for Sick Children, Toronto, Canada
- Department of Psychiatry and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Penny Corkum
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Canada
- Department of Psychiatry, Dalhousie University, Halifax, Canada
- Colchester East Hands ADHD Clinic, Colchester East Hants Health Authority, Truro, Canada
| | - Doris Grant
- Industry Liaison and Innovation, Dalhousie University, Halifax, Canada
| | - Jennifer N. Stinson
- Child Health Evaluative Sciences Research Institute, The Hospital for Sick Children, Toronto, Canada
- Chronic Pain Program, The Hospital for Sick Children, Toronto, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Chitra Lalloo
- Child Health Evaluative Sciences Research Institute, The Hospital for Sick Children, Toronto, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Sue Robins
- Patient Advocate and Partner, Bird Communications, Vancouver, Canada
| | - Rita Orji
- Faculty of Computer Science, Dalhousie University, Halifax, Canada
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Tutelman PR, Dol J, Tougas ME, Chambers CT. Navigating your social media presence: Opportunities and challenges. Clinical Practice in Pediatric Psychology 2018. [DOI: 10.1037/cpp0000228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Noel M, Chambers CT, Parker JA, Aubrey K, Tutelman PR, Morrongiello B, Moore C, McGrath PJ, Yanchar NL, Von Baeyer CL. Boo-boos as the building blocks of pain expression: An observational examination of parental responses to everyday pain in toddlers. Canadian Journal of Pain 2018; 2:74-86. [PMID: 35005368 PMCID: PMC8730579 DOI: 10.1080/24740527.2018.1442677] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Everyday pain experiences (minor bumps/scrapes) are common in early childhood and create frequent opportunities for socialization of pain behaviors. Nevertheless, everyday pain during the formative toddler period has been largely overlooked. Aims The aim of the current study was to describe the frequency and nature of toddlers’ everyday pain experiences, child and parent responses, and the relationship between child characteristics (age, sex, temperament) and responses. Methods Fifty-two children aged 12–32 months and their parents were observed at an indoor play facility. Using an observational checklist, trained observers recorded children’s everyday pain incidents and associated child and parent responses. Results Overall, 101 pain incidents were observed, the majority of which evoked low levels of pain and distress, which resolved after 1 min. Pain incidents occurred at a rate of 1.02 incidents/child/hour, with 81% of children experiencing at least one incident, which is higher than previous research with preschoolers and daycare staff. Common parent responses included a range of verbal (reassurance) and nonverbal (staying closer, hugging/kissing child) behaviors. Boys were more likely to not exhibit any protective behaviors. Parents were more likely to pick up older toddlers. Conclusions Future research should examine the link between self-reported and observed parent responses to child pain in everyday and clinical contexts.
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Affiliation(s)
- Melanie Noel
- Department of Psychology, The University of Calgary and Alberta Children’s Hospital Research Institute , Calgary, AB, Canada
| | - Christine T. Chambers
- Department of Psychology and Neuroscience , Dalhousie University, Halifax, NS, Canada
- Centre for Pediatric Pain Research, IWK Health Centre ; Halifax, NS, Canada
- Department of Pediatrics, Dalhousie University ; IWK Health Centre, Halifax, NS, Canada
| | - Jennifer A. Parker
- Centre for Pediatric Pain Research, IWK Health Centre ; Halifax, NS, Canada
| | - Kate Aubrey
- Department of Psychology and Neuroscience , Dalhousie University, Halifax, NS, Canada
- Centre for Pediatric Pain Research, IWK Health Centre ; Halifax, NS, Canada
| | - Perri R. Tutelman
- Department of Psychology and Neuroscience , Dalhousie University, Halifax, NS, Canada
- Centre for Pediatric Pain Research, IWK Health Centre ; Halifax, NS, Canada
| | | | - Chris Moore
- Department of Psychology and Neuroscience , Dalhousie University, Halifax, NS, Canada
| | - Patrick J. McGrath
- Departments of Psychiatry and Community Health and Epidemiology, Dalhousie University , Halifax, NS, Canada
- Faculty of Medicine, Centre for Research in Family Health, IWK Health Centre , Halifax, NS, Canada
| | | | - Carl L. Von Baeyer
- Departments of Clinical Health Psychology and Pediatrics and Child Health, University of Manitoba , Winnipeg, MB, Canada
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Tutelman PR, Ohayon J, Terry J, Sherlock ME. Diagnostic yield of allergy testing in Pediatric Eosinophilic Esophagitis: a 10 year experience at a tertiary care centre. Allergy Asthma Clin Immunol 2014. [PMCID: PMC4126049 DOI: 10.1186/1710-1492-10-s1-a28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Tutelman PR, Aubert G, Milner RA, Dalal BI, Schultz KR, Deyell RJ. Paroxysmal nocturnal haemoglobinuria phenotype cells and leucocyte subset telomere length in childhood acquired aplastic anaemia. Br J Haematol 2013; 164:717-21. [DOI: 10.1111/bjh.12656] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 10/02/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Perri R. Tutelman
- Division of Pediatric Hematology/Oncology/Bone Marrow Transplantation; British Columbia Children's Hospital; University of British Columbia; Vancouver BC Canada
| | - Geraldine Aubert
- Terry Fox Laboratory; British Columbia Cancer Agency; Vancouver BC Canada
| | - Ruth A. Milner
- Child and Family Research Institute; University of British Columbia; Vancouver BC Canada
| | - Bakul I. Dalal
- Division of Laboratory Hematology; Department of Pathology and Laboratory Medicine; Vancouver General Hospital; Vancouver BC Canada
| | - Kirk R. Schultz
- Division of Pediatric Hematology/Oncology/Bone Marrow Transplantation; British Columbia Children's Hospital; University of British Columbia; Vancouver BC Canada
- Child and Family Research Institute; University of British Columbia; Vancouver BC Canada
| | - Rebecca J. Deyell
- Division of Pediatric Hematology/Oncology/Bone Marrow Transplantation; British Columbia Children's Hospital; University of British Columbia; Vancouver BC Canada
- Child and Family Research Institute; University of British Columbia; Vancouver BC Canada
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