How to assess quality of life in child and adolescent psychiatry

Safety of Patient-Controlled Analgesia After Surgery in Children And Adolescents: Concerns And Potential Solutions

Patient-controlled analgesia (PCA) is common practice for acute postoperative pain management. Postoperative PCA use decreases pain intensity and improves patient satisfaction when compared to non-PCA routes of medication administration. Although PCA has several advantages regarding efficacy and safety, adverse events remain a concern. Programming errors and protocols, patient monitoring, and PCA by proxy or with continuous infusion are recurring silent dangers of PCA use in children and adolescents. Innovative considerations need to be emphasized for future improvement of PCA devices for elective surgical patients. With technology within the healthcare setting advancing at a fast pace, smart pump technology is something to look forward to.

Impact of quality of life (QoL) on glycemic control (HbA1c) among adolescents and emerging adults with long-duration type 1 diabetes: A prospective cohort-study

OBJECTIVE

To evaluate the impact of self-reported chronic-generic and condition-specific quality of life (QoL) on glycemic control among adolescents and emerging adults with long-duration type 1 diabetes (T1D) in a longitudinal design.

METHODS

The database used was a nationwide cohort study of patients with ≥10 years T1D duration at baseline in Germany. The baseline questionnaire survey was conducted in 2009-2010, the follow-up survey in 2012-2013; additional clinical data of routine care procedures were linked. QoL was assessed by the DISABKIDS chronic generic module (DCGM-12) and diabetes module (DM) with treatment and impact scales. Regression analyses were conducted for the outcome hemoglobin A1c (HbA1c) at follow up with baseline DISABKIDS scores as predictors and sociodemographic and health-related covariates.

RESULTS

At baseline, the included 560 patients had a mean age of 15.9 (SD 2.3) years, a diabetes duration of 13.0 (2.0) years, and an HbA1c of 67 (14.2) mmol/mol. Mean follow-up time was 3.0 (0.6) years. Univariate analyses indicated associations between baseline QoL scores and HbA1c at follow-up (β[DCGM-12] = -0.174 (SE 0.038), β[DM treatment] = -0.100 (0.022), β[DM impact] = -0.177 (0.030), p < .001). The associations remained significant after adjustment for sociodemographic and illness-related factors, but dissolved (p > .60) when additionally adjusting for baseline HbA1c. In patients with poor baseline HbA1c (>75 mmol/mol), significant associations were observed between DCGM-12 and DM impact scores and follow-up HbA1c (β[DCGM-12] = -0.144 (0.062), p = .021; β[DM impact] = -0.139 (0.048), p = .004).

CONCLUSIONS

QoL was inversely associated with HbA1c after 3 years in the course of T1D only in patients poorly controlled at baseline.

Development and validation of a Quality of Life Scale for elementary school students

Emotional well-being affects the school performance of elementary school children. Quality of life (QoL) measurements are indicative of emotional well-being; however, the development of assessment tools suitable for measuring the QoL of elementary school children has received little attention and, therefore, the creation of reliable assessment tools for measuring QoL among this population is required. Method: We employed qualitative and quantitative research methods to develop and validate a QoL scale for elementary school children in Taiwan. We used cluster random sampling to recruit 711 fifth and sixth grade students, aged 10-12 years, from 14 elementary schools. Results: The scale comprised six factors (School function, Family function, Environmental life, Vitality for life, Learning ability, and Peer relationships) that explained 44% of the variance. The developed 21-item elementary school QoL (ESQoL) instrument had high internal consistency and satisfactory reliability and validity. Conclusions: The ESQoL instrument can facilitate the evaluation of factors associated with students' emotional well-being. Additional studies using the ESQoL instrument are required to assess its applicability for evaluating relationships between QoL and school performance and other areas of student life.

Patient- and person-reports on healthcare: preferences, outcomes, experiences, and satisfaction - an essay

With the shift towards patient-centered healthcare, patient- and person-reports of health-related factors, including outcomes, are seen as important determinants for evaluating and improving healthcare. However, a comprehensive, systematic categorization of patient- and person-reports is currently lacking in the literature. This study aims at developing a new classification system with well-defined constructs for patients' and persons' self-reports on health and healthcare. A literature research and evaluation by the Reported Health Outcomes (RHO) Group were used to develop this classification system. The new classification system includes patient- and person-reported preferences, outcomes, experiences, and satisfaction related to healthcare and health outcomes. Moreover, the most constitutive methods to measure these four categories - preferences, outcomes, experiences, and satisfaction - have been described in this article. Even though the value of patients' and persons' perspectives on healthcare is increasingly being recognized, its measurement and implementation presents a lasting challenge to researchers, clinicians, patients, and the general population.

Patient-reported outcomes measure for children born preterm: validation of the SOLE VLBWI Questionnaire, a new quality of life self-assessment tool

AIM

This study was conducted to develop and validate a new self-report questionnaire for measuring quality of life (QoL), at school age, in children with a very low birthweight (VLBW).

METHOD

Through a focus group approach, children were involved directly in defining the questionnaire items, which were presented as illustrations rather than written questions. This preliminary validation of the questionnaire was conducted in 152 participants with VLBW (aged 7-11y) randomly selected from the five participating Italian centres. The questionnaire was completed by children and parents separately; data on children's demographic and medical history, and intellectual, adaptive, and behavioural functioning were collected using standardized scales. All the children also completed the Paediatric Quality of Life Inventory (PedsQL), another Italian-language measure of QoL in children.

RESULTS

Our questionnaire was readily accepted and understood, and quick to complete. The Cronbach's alpha value showed it to be a reliable instrument. The child-compiled version correlated well with the PedsQL, whereas no correlations emerged with the other scales used, IQ, or degree of impairment. Conversely, these variables correlated significantly with the parent-compiled version. Children's and parents' answers were divergent on practically all the items.

INTERPRETATION

The results confirm the validity of the new instrument and highlight a poor overlap between parents' and children's perspectives.

Health-related quality of life in teenagers with a parent with cancer

PURPOSE

Health-related quality of life (HRQoL) in teenagers exposed to parental cancer has shown divergent results as an outcome measure. In this study we wanted to: 1) compare the HRQoL of teenagers exposed to parental cancer (CASES) with normative European HRQoL data (NORMs) measured close to parental diagnosis and treatment; 2) study changes in the HRQoL of CASES from baseline to follow-up; 3) explore sex differences in the HRQoL of CASES; and 4) explore eventual confounders of HRQoL of CASES at baseline.

METHODS

Forty-five families with one parent diagnosed with primary invasive cancer were included, these families had 69 teenagers. At the follow-up, 26 families with 29 teenagers complied. Both parents and teenagers filled in electronic questionnaires over the Internet. HRQoL in teenagers was self-rated by the KIDSCREEN-27 at baseline and follow-up, and the responses were compared to a European normative sample (NORMs).

RESULTS

1) The teenagers scored significantly lower on the Physical well-being dimension compared to the NORMs at baseline, while no significant differences were observed concerning the four other HRQoL dimensions. 2) Some significant improvements were observed on HRQoL dimensions from baseline to follow-up. 3) CASES girls showed a trend towards lower HRQoL scores compared to boys. 4) Parental cancer-related characteristics and family function were not related to teenagers' HRQoL, but so were teenagers' self-esteem.

CONCLUSIONS

At group level, living with a parent who receives curative treatment for a recently diagnosed cancer affects teenagers' HRQoL to certain extent. Self-esteem is a confounder to teenagers' HRQoL in our sample.

Child maltreatment and quality of life: a study of adolescents in residential care

BACKGROUND

Childhood maltreatment is an important risk factor for mental and physical health problems. Adolescents living in residential youth care (RYC) have experienced a high rate of childhood maltreatment and are a high-risk group for psychiatric disorders. Quality of life (QoL) is a subjective, multidimensional concept that goes beyond medical diagnoses. There is a lack of research regarding the associations between childhood maltreatment and QoL. In the present study, we compare self-reported QoL between adolescents in RYC in Norway with and without maltreatment histories, and adolescents from the general population. We also study the impact of number of types of adversities on QoL.

METHODS

Adolescents aged 12-23 years living in RYC in Norway were invited to participate in the study; 400 participated, yielding a response rate of 67 %. Maltreatment histories were assessed through interviews with trained research assistants, and completed by 335 adolescents. Previous exposure to maltreatment was reported by 237 adolescents. The Questionnaire for Measuring Health-Related Quality of Life in Children and Adolescents (KINDL-R) was used. Nonexposed peers in RYC (n = 98) and a sample of adolescents from the general population (n = 1017) were used for comparison. General linear model analyses (ANCOVA) were conducted with five KINDL-R life domains as dependent variables. Linear regression was used to study the effect of number of types of adversities.

RESULTS

Exposed adolescents in RYC reported poorer QoL than peers in control groups. Compared with nonexposed peers in RYC, the 95 % confidence intervals for mean score differences on the KINDL-R subdomains (0-100 scale) were 1.9-11.4 (Physical Well-being), 2.2-11.1 (Emotional Well-being), -0.7-10.0 (Self-esteem), and 1.8-10.9 (Friends). Compared with the general population sample, the 95 % confidence intervals for mean score differences were 9.7-17.6 (Physical Well-being), 7.9-15.3 (Emotional Well-being), 3.6-12.5 (Self-esteem), and 5.3-12.8 (Friends). Number of types of adversities was associated with a poorer QoL score on all subdomains (Physical- and Emotional Well-being, Self-esteem, Friends, and School).

CONCLUSIONS

Childhood maltreatment was associated with a poorer QoL score. We suggest the use of QoL and maltreatment measures for all children and adolescents in RYC.

Quality of life in children: A critical examination of concepts, approaches, issues, and future directions

The quality of children's life is important both as an investment in the future of our society and because children constitute an important group of themselves and deserve to experience well-being presently. Quality of life (QOL) has been conceptualized and studied in children for several decades, but with disparate approaches that have rarely been discussed jointly with application to children in general. Here we describe and critically examine the three main approaches to children's QOL: health-related QOL (HRQOL), social indicators, and subjective well-being (SWB). Although this is not a review of instruments per se, we illustrate these approaches by describing their most prominent measures. Issues and opportunities in research on children's QOL are then discussed related to conceptual clarity, content specification, range of experience, subjective and objective perspectives, development in childhood, reporting source, and malleability of QOL. Finally, directions for advancing children's QOL are considered. We highlight the benefits of focusing on social indicators and SWB, rather than HRQOL, when representing this concept for children in general, the need for applying more sophisticated research strategies, and using QOL as a universal indicator of success whenever we intend to advance the well-being of children through intervention, programs, and policy.