1
|
Stabouli S, Sommer A, Kraft S, Schweer K, Bethe D, Bertholet-Thomas A, Batte S, Ariceta G, Brengmann S, Bacchetta J, Emma F, Levtchenko E, Topaloglu R, Willem L, Haffner D, Oh J. Addressing the psychosocial aspects of transition to adult care in patients with cystinosis. Pediatr Nephrol 2024:10.1007/s00467-024-06345-1. [PMID: 38517536 DOI: 10.1007/s00467-024-06345-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/23/2024] [Accepted: 02/23/2024] [Indexed: 03/24/2024]
Abstract
Cystinosis is a rare autosomal-recessive lysosomal storage disease that progressively affects multiple organs beginning with the kidneys. Patients require lifelong multidisciplinary care for the management of kidney disease and progressive extra-renal manifestations, and thus, they are especially fragile and vulnerable during transition from pediatric to adult care. Previous documents have provided guidance to help the medical transition of these highly burdened patients. Patients and their families often experience great psychological distress and face significant social challenges; for these reasons, they often need help from psychologists, social workers, and other psychosocial professionals. Due to the rarity of the disease, most psychosocial professionals have no expertise in this disorder and require advice. To this end, a steering committee (SC) composed of six experts, including pediatric nephrologists, psychologists, and social workers with experience in the care for patients with cystinosis, have identified and addressed seven key questions related to psychosocial challenges of the disease and the burden of treatment. Ten additional international experts (the extended faculty, EF) were invited to answer these questions. Since robust evidence is lacking, as in many rare diseases, conclusions were based on collective agreement between members of the SC and the EF, and the consolidated answers were summarized into expert opinion statements. The present document contains information on the concerns and psychosocial burden of patients with cystinosis and of their caregivers, and provides practical advice for timely and appropriate support to facilitate the transition to adult care.
Collapse
Affiliation(s)
- Stella Stabouli
- 1st Department of Pediatrics, Aristotle University Thessaloniki, Hippokratio Hospital, 49 Konstantinoupoleos Str, 54642, Thessaloniki, Greece.
| | - Anna Sommer
- Department of Pediatric Nephrology, University Hamburg-Eppendorf, Hamburg, Germany
| | - Stefanie Kraft
- Department of Pediatric Nephrology, University Hamburg-Eppendorf, Hamburg, Germany
| | - Katharina Schweer
- Department of Pediatric Nephrology, University Hamburg-Eppendorf, Hamburg, Germany
| | - Dirk Bethe
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, University Hospital, Heidelberg, Germany
| | - Aurelia Bertholet-Thomas
- Pediatric Nephrology, Rheumatology and Dermatology Unit, Reference Center for Rare Renal Diseases, Hospices Civils de Lyon & INSERM1033 Research Unit, Hospital Femme Mere Enfant, Lyon 1 University, Lyon, France
| | - Suzanne Batte
- Children's Renal & Urology Unit, Queens Medical Centre, Nottingham, UK
| | - Gema Ariceta
- Department of Pediatric Nephrology, Hospital Vall d´Hebron, University Autonomous of Barcelona, Barcelona, Spain
| | - Sandra Brengmann
- Department of Pediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Justine Bacchetta
- Pediatric Nephrology, Rheumatology and Dermatology Unit, Reference Center for Rare Renal Diseases, Hospices Civils de Lyon & INSERM1033 Research Unit, Hospital Femme Mere Enfant, Lyon 1 University, Lyon, France
| | - Francesco Emma
- Division of Nephrology, Bambino Gesù Children's Hospital - IRCCS, Rome, Italy
| | - Elena Levtchenko
- Department of Pediatric Nephrology, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Rezan Topaloglu
- Department of Pediatric Nephrology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Lore Willem
- Department of Child Nephrology and Organ Transplantation, Leuven University Hospital, Louvain, Belgium
| | - Dieter Haffner
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Jun Oh
- Department of Pediatric Nephrology, University Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
2
|
Abstract
It is well recognised that chronic illness in children can have a significant effect upon siblings, but their viewpoints need to be sought if we are to change our practice. We conducted semi-structured interviews at home with 15 siblings (8 males) aged 8-12 years whose brother/sister were on chronic dialysis or had received or were waiting for a renal transplant. The interviews were analysed using a grounded theory approach. The children also completed the Spence Children's Anxiety Scale (SCAS), which revealed no statistically significant evidence that they were exhibiting chronic clinical anxiety. Qualitative data indicated that siblings had a variety of concerns concerning their own health and that of their siblings and worried about the effects on family routine and separation from parents. The siblings felt more protective towards their chronically ill sibling and felt that they themselves needed to be more grown up. The study has implications for our clinical practice in that our psychosocial assessment of families needs to include an assessment of sibling needs and siblings should be involved when preparing patients for chronic renal failure treatment. The importance of maintaining family routines should be emphasised, as well as trying to involve siblings in unit activities.
Collapse
Affiliation(s)
- Suzanne Batte
- Children and Young People's Kidney Unit, City Hospital, Hucknall Road, Nottingham NG5 1PB, UK
| | | | | |
Collapse
|