Homocystinuria patient and caregiver survey: experiences of diagnosis and patient satisfaction

Background

The main genetic causes of homocystinuria are cystathionine beta-synthase (CBS) deficiency and the remethylation defects. Many patients present in childhood but milder forms may present later in life. Some countries have newborn screening programs for the homocystinurias but these do not detect all patients.

Results

HCU Network Australia is one of the very few support groups for patients with homocystinurias. Here we report the results of its survey of 143 patients and caregivers from 22 countries, evaluating current diagnostic pathways and management for the homocystinurias. Most (110) of the responses related to patients with CBS deficiency. The diagnosis was made by newborn screening in 20% of patients and in 50% of the others within 1 year of the initial symptom but in 12.5% it took over 15 years. The delay was attributed mainly to ignorance of the disease. Physicians need to learn to measure homocysteine concentrations in children with neurodevelopmental problems, and in patients with heterogeneous symptoms such as thromboembolism, dislocation of the optic lens, haemolytic uraemic syndrome, and psychiatric disease. Even when the diagnosis is made, the way it is communicated is sometimes poor. Early-onset CBS deficiency usually requires a low-protein diet with amino acid supplements. More than a third of the participants reported problems with the availability or cost of treatment. Only half of the patients always took their amino acid mixture. In contrast, good adherence to the protein restriction was reported in 98% but 80% said it was hard, time-consuming and caused unhappiness.

Conclusions

There is often a long delay in diagnosing the homocystinurias unless this is achieved by newborn screening; this survey also highlights problems with the availability and cost of treatment and the palatability of protein substitutes.

Importance of and Satisfaction with Information about Their Disease in Cancer Patients

To learn more about information needs and satisfaction with provided information among cancer patients and whether dissatisfaction with information has any association with how therapy decisions are made. An online survey was conducted during March 2015 and January 2016 by the German non-profit patient organization "Das Lebenshaus e.V." among their members with rare solid tumors. A total of 338 records was analyzed. The majority found information on their disease important and was satisfied with the provided information. The participants were less satisfied with the information concerning management of side effects than with other aspects of information (p < .001). Support groups, lectures, and the oncologist were rated as the most helpful sources of information followed by a second opinion and media. Participants who were dissatisfied with the information more often made the decision on the treatment alone by themselves (p < .001). Our results show a high satisfaction with disease-related information among our study participants. Improvements could be made by offering more information on the management of side effects and by giving more information about support groups, reliable websites, and other helpful media.

Situational analysis to inform development of primary care and community-based mental health services for severe mental disorders in Nepal

Background

Nepal is representative of Low and Middle Income Countries (LMIC) with limited availability of mental health services in rural areas, in which the majority of the population resides.

Methods

This formative qualitative study explores resources, challenges, and potential barriers to the development and implementation of evidence-based Comprehensive Community-based Mental Health Services (CCMHS) in accordance with the mental health Gap Action Programme (mhGAP) for persons with severe mental health disorders and epilepsy. Focus Group Discussions (FGDs, n = 9) and Key-Informant Interviews (KIIs, n = 26) were conducted in a rural district in western Nepal. Qualitative data were coded using the Framework Analysis Method employing QSR NVIVO software.

Results

Health workers, general community members, and persons living with mental illness typically attributed mental illness to witchcraft, curses, and punishment for sinful acts. Persons with mental illness are often physically bound or locked in structures near their homes. Mental health services in medical settings are not available. Traditional healers are often the first treatment of choice. Primary care workers are limited both by lack of knowledge about mental illness and the inability to prescribe psychotropic medication. Health workers supported upgrading their existing knowledge and skills through mhGAP resources. Health workers lacked familiarity with basic computing and mobile technology, but they supported the introduction of mobile technology for delivering effective mental health services. Persons with mental illness and their family members supported the development of patient support groups for collective organization and advocacy. Stakeholders also supported development of focal community resource persons to aid in mental health service delivery and education.

Conclusion

Health workers, persons living with mental illness and their families, and other stakeholders identified current gaps and barriers related to mental health services. However, respondents were generally supportive in developing community-based care in rural Nepal.

Does source of patient recruitment affect the impact of communication on trust?

OBJECTIVES

To investigate how comparable outcomes of medical communication research are when using different patient accrual methods by comparing cancer patients organization members with outpatient clinic patients.

METHODS

In an experimental video-vignettes study, the impact of oncologist communication on trust was tested. Background characteristics (socio-demographics, trait anxiety, health locus of control and attachment style), reported trust, and the impact of communication on trust were compared between the two groups.

RESULTS

Cancer patient organization members (n=196) were younger and higher educated than clinical patients (n=148). Members felt more personal control over their health (p<.01) but were also more anxious (p<.05). They reported lower trust in general health care (p<.05), in their own oncologist (p<.001) and in the oncologist in the videos (p<.05). The impact of oncologist communication on trust was similar for both groups.

CONCLUSIONS

Despite considerable differences in trust levels, both groups appear equally affected by oncologist communication. Thus, although including cancer patient organization members may impact the generalizability of some findings, using these participants to investigate communication appears justified.

PRACTICE IMPLICATIONS

Cancer patient organization members may regard their oncologist more critically. Research including both members and patients recruited through hospital clinics could take group membership into account as a possible confounder. Nonetheless, communicating competence, honesty and caring may benefit the relation with these patients similarly as with other patients.