A comparison of parent and adolescent reports describing the health-related quality of life of adolescents treated for cancer

Differences in health-related quality of life in children with chronic kidney disease as reported by children and parent proxies

BACKGROUND

Correlation between reports of children and parent for health-related quality of life (HRQOL) is not well studied. This study aims to assess the degree of agreement between child self- and parent proxy-rated HRQOL and to identify factors associated with discordance at baseline and during follow-up in Taiwanese children with chronic kidney disease (CKD).

METHODS

This study includes pediatric patients aged 5-18 years with confirmed CKD. Participants completed the generic version of the Pediatric Quality of Life Inventory (PedsQL) at baseline and every 6 months during follow-up. Child-parent agreement on HRQOL reports was assessed using intraclass correlation coefficient (ICC). Multivariate regression models were used to determine factors associated with child-parent discordance.

RESULTS

Of the 112 child-parent dyads included in the analysis, 97 dyads with 640 patient visits were assessed in 4.5 years. Children reported higher total scores on the physical and psychosocial domains as compared to their parent proxies. ICC was low (< 0.5) for the psychosocial domain and moderate for the physical health domain at initial assessment and slightly increased for the physical health (0.62) and for school functioning (0.51) during follow-up. Development of mineral bone disorder/anemia (β, 11.75 [3.77-19.72]) and proteinuria (β, 8.48 [1.15-15.81]) in the follow-up were associated with increased discordance in school functioning, and fathers with chronic disease were associated with increased discordance in social functioning (β, 4.21 [0.68-7.74]).

CONCLUSIONS

Parent proxy consistently estimated lower PedsQL score compared to self-reports of children. Child self-rated psychosocial health domains should be evaluated whenever possible to better elucidate treatment outcome over time. A higher resolution version of the Graphical abstract is available as Supplementary information.

Lack of Concordance in Symptomatic Adverse Event Reporting by Children, Clinicians, and Caregivers: Implications for Cancer Clinical Trials

PURPOSE

To examine concordance in symptomatic adverse event (AE) grading using the Common Terminology Criteria for Adverse Events (CTCAE 4.0) for clinicians and its patient-reported outcome (PRO) versions for children (Ped-PRO-CTCAE) and caregivers (Ped-PRO-CTCAE [Caregiver]).

METHODS

Children age 7-18 years with a first cancer diagnosis, their clinicians, and caregivers completed CTCAE-based measures before starting a treatment course (T1) and after the treatment (T2). Grades (0-3) were assigned by each reporter for 15 core AEs spanning physical and mental health. Mean grades were compared between reporters using two-sample t-tests; agreement was estimated using weighted kappa (κ) statistics. Multivariable mixed regression models were used to evaluate associations of clinical factors with AE reporting concordance. Significance was set at α = .05 (two-sided).

RESULTS

There were 438 child-clinician-caregiver triads with complete data at either T1 or T2. For children, the mean age was 13 years (standard deviation = 3.4), 53.7% were male, 32.6% non-White, and 56.4% had leukemia/lymphoma. At T1, clinician mean AE grades were significantly lower (ie, better) than children for all AEs and remained significantly lower at T2 except for constipation, nausea, anorexia, neuropathy, and anxiety. Caregiver mean AE grades were similar to children at T1 and significantly higher (ie, worse) at T2 for nausea, vomiting, anorexia, pain, fatigue, anxiety, and depression. Agreement for child-clinician grading was poor-to-fair at T1 (κ range, 0.08-0.34) and T2 (0.11-0.35), and for child-caregiver, was fair-to-good at T1 (0.34-0.65) and T2 (0.24-0.60). No factors were consistently associated with reporter concordance across AEs.

CONCLUSION

Compared with children, symptomatic AEs were consistently under-reported by clinicians with low agreement and over-reported by caregivers with low-moderate agreement. Direct reporting by children using Ped-PRO-CTCAE or similar measures should be routinely incorporated for toxicity assessment in clinical trials.

Development and Evaluation of the Quality of Life Scale for Children With Visual Impairments in China

BACKGROUND

Visual impairments related to non-correctable vision loss, including blindness and low vision, have been consistently shown to lower a person's health-related quality of life. This study assessed the reliability, validity, and discrimination of the Quality of Life Scale for Children with Visual Impairments (QOLS-CVI) in China.

METHODS

The Pediatric Quality of Life Inventory™ 4.0 and World Health Organization Quality of Life-Disability Scale for physical disability were selected to define conceptual frameworks and item libraries based on relevant existing studies. According to two rounds of expert consultations and group discussions, some items were modified, and the draft scale was developed. Two item selection processes based on classical test theory and item response theory were used to conduct a preliminary survey and a formal survey in special schools in Shanxi and Hebei Provinces. Finally, the reliability and validity of the quality of life scale for visually impaired children in China were verified.

RESULTS

The final QOLS-CVI consisted of 38 items, 10 subdomains, and 6 domains. Reliability was verified by Cronbach's alpha coefficient, split-half reliability, and test-retest reliability (Cronbach's alpha for the full scale, 0.841; split-half reliability, 0.629; and test-retest reliability, 0.888). The validity results showed that the multidimensional scale met expectations: exploratory factor analysis and confirmatory factor analysis indicated good fitting models for children with visual impairments.

CONCLUSIONS

The QOLS-CVI was determined to be reliable and valid and to have strong feasibility and effectiveness. This scale can be used as an evaluation tool to study the QOL and social-participation ability of children with visual impairments.

Considerations to Support Use of Patient-Reported Outcomes Measurement Information System Pediatric Measures in Ambulatory Clinics

OBJECTIVE

To identify challenges to the use of Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric measures in the ambulatory pediatric setting and possible solutions to these challenges.

STUDY DESIGN

Eighteen semistructured telephone interviews of health system leaders, measurement implementers, and ambulatory pediatric clinicians were conducted. Five coders used applied thematic analysis to iteratively identify and refine themes in interview data.

RESULTS

Most interviewees had roles in leadership or the implementation of patient-centered outcomes; 39% were clinicians. Some had experience using PROMIS clinically (44%) and 6% were considering this use. Analyses yielded 6 themes: (1) selection of PROMIS measures, (2) method of administration, (3) use of PROMIS Parent Proxy measures, (4) privacy and confidentiality of PROMIS responses, (5) interpretation of PROMIS scores, and (6) using PROMIS scores clinically. Within the themes, interviewees illuminated specific unique considerations for using PROMIS with children, including care transitions and privacy.

CONCLUSIONS

Real-world challenges continue to hamper PROMIS use. Ongoing efforts to disseminate information about the integration of PROMIS measures in clinical care is critical to impacting the health of children.

Child perceptions questionnaire: translation, cultural adaptation and initial validation in a Greek adolescent population with malocclusion

PURPOSE

Several studies have shown that orthodontic anomalies may affect young people's Oral Health-Related Quality of Life (OHRQoL). The purpose the present study was to translate in the Greek language, culturally adapt and initially validate the CPQ_11-14 ISF-16 for a Greek adolescent population with malocclusion.

METHODS

Following relevant methodological recommendations, after translation, the comprehensiveness of the Greek version of CPQ_11-14 ISF-16 (CPQ_11-14 ISF-16-GR) was verified in a pilot study of 20 Greek adolescents. The main study was undertaken in a sample of 200 adolescents that presented for an initial consultation at the Postgraduate Orthodontic Clinic. Cronbach's alpha was used to test internal consistency/reliability and Spearman's rho for criterion validity with the Oral Health Impact Profile (OHIP-14). Forty individuals completed the same questionnaires again after 3 weeks. Test-retest reliability was assessed using Intraclass Correlation Coefficient. Statistical tests were undertaken using SPSS (v. 24, IBM Corp., NY, USA).

RESULTS

The CPQ_11-14 ISF-16-GR presented high internal consistency (Cronbach's alpha = 0.848 > 0.70) and very satisfactory Discrimination Index (DI = 0.47 > 0.30). Moreover, the CPQ_11-14ISF-16 showed excellent criterion validity with OHIP-14 (rho = 0.719, p < 0.001). Test-retest reliability was at high levels as well (ICC = 0.719, p < 0.001).

CONCLUSION

The CPQ_11-14 ISF-16-GR exhibits satisfactory psychometric properties to continue the investigation of OHRQoL in Greek adolescents with malocclusion. Further testing of is required in a variety of environments to increase generalizability and investigate the particular characteristics of CPQ application in malocclusion cases.

Assessment and validation of a screening questionnaire for the diagnosis of pediatric bladder and bowel dysfunction

INTRODUCTION

Pediatric bladder and bowel dysfunction (BBD) is a common problem in children. However, the current ability to diagnosis and quantify pediatric BBD is limited as only a few validated instruments exist. In addition, the current questionnaires are limited by their lack of psychometric processing and methods of validation. To address these issues, the authors developed a new questionnaire to objectively diagnose pediatric BBD symptoms. This study aimed to evaluate the performance of this newly devised objective instrument in diagnosing and quantifying the symptomatology of BBD in children.

MATERIALS AND METHODS

An 18-item, 5-point questionnaire was developed using both a literature review and expert opinions. The total questionnaire score could range from 0 to 72. Questions were subgrouped into six symptom categories: (1) nocturnal enuresis, (2) lower urinary tract symptoms, (3) urinary holding, (4) infrequent urination, (5) bowel symptoms, and (6) daytime urinary incontinence. The questionnaire also assessed the degree of bother associated with the symptoms. Patients were divided into cases and controls, and these two groups were compared.

DISCUSSION/RESULTS

A total of 1265 new patients (758 cases and 507 controls) completed the new BBD questionnaire. The mean age of the whole study cohort was 9.5 years (range, 3-19 years). The total mean questionnaire score was significantly higher at 23 (3-58) in the cases, compared with 8 (0-35) in the controls (p < 0.001) (Summary Figure). Reliability analysis of the 18-item instrument showed a Cronbach's alpha reliability coefficient of 0.80 for the scale.

CONCLUSIONS

This new instrument provides a valid and reliable method for diagnosis of pediatric BBD and classification of patients into subcategories of BBD based on their specific symptoms.

Difference and relation between adolescents' and their parents or caregivers' reported oral health-related quality of life related to orthodontic treatment: a prospective cohort study

BACKGROUND

Parents/caregivers play an important role in deciding whether their children will undergo orthodontic treatment or not. Their perceptions also have an influence on other choices involving orthodontic treatment. The purpose of this study was to investigate the difference and correlation between the ratings given by children and their parents or caregivers on their oral health-related quality of life (OHRQoL) before, during and after orthodontic treatment.

METHODS

In this ongoing observational prospective cohort study, 498 children aged 11 to 16 years-old and one of their parents/caregivers completed questionnaires before (T0), 1 year after start (T1) and 1 month after the end of orthodontic treatment (T2). OHRQoL was scored by using the Child Perception Questionnaire (CPQ11-14) and the Parental-Caregiver Perception questionnaire (P-CPQ). The self-perception of oral aesthetics was evaluated with the Oral Aesthetic Subjective Impact Scale (OASIS) in addition to the aesthetic component (AC) of the Index of Orthodontic Treatment Need (IOTN). Spearman correlations, Mann-Whitney U-tests and linear models were used to analyze the longitudinal data.

RESULTS

At T0, the ratings of parents/caregivers were significantly lower for the total CPQ as well as for the subdomains of oral symptoms, functional limitations and emotional well-being. Parents/caregivers also scored significantly lower at T2 for the total CPQ and the subdomain of oral symptoms. The relations between the scores of children and their parents/caregivers were significant at all three time points, as were the changes in scores, but all of them were at most moderate in size. Parents/caregivers scored significantly lower for OASIS than their children at all time points and only at baseline a significant, weak correlation was found.

CONCLUSION

The reports of parents/caregivers should be seen as important complementary information in OHRQoL research.

TRIAL REGISTRATION

This study was approved by the Medical Ethical Commitee of the University Hospitals Leuven and the Katholieke Universiteit Leuven (ML5739), Leuven, Belgium, on the 12th of May of 2009, with the registration number S51642. All procedures performed are in accordance with the ethical standards of the institutional and/or national research committees and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Child and adolescent self-report symptom measurement in pediatric oncology research: a systematic literature review

OBJECTIVE

Previous work in pediatric oncology has found that clinicians and parents tend to under-report the frequency and severity of treatment-related symptoms compared to child self-report. As such, there is a need to identify high-quality self-report instruments to be used in pediatric oncology research studies. This study's objective was to conduct a systematic literature review of existing English language instruments used to measure self-reported symptoms in children and adolescents undergoing cancer treatment.

METHODS

A comprehensive literature search was conducted in MEDLINE/PubMed, EMBASE, CINAHL, and PsycINFO to identify relevant articles published through November 10, 2016. Using pre-specified inclusion/exclusion criteria, six trained reviewers carefully screened abstracts and full-text articles for eligibility.

RESULTS

There were 7738 non-duplicate articles identified in the literature search. Forty articles met our eligibility criteria, and within these articles, there were 38 self-report English symptom instruments. Most studies evaluated only cross-sectional psychometric properties, such as reliability or validity. Ten studies assessed an instrument's responsiveness or ability to detect changes in symptoms over time. Eight instruments met our criteria for use in future longitudinal pediatric oncology studies.

CONCLUSIONS

This systematic review aids pediatric oncology researchers in identifying and selecting appropriate symptom measures with strong psychometric evidence for their studies. Enhancing the child's voice in pediatric oncology research studies allows us to better understand the impact of cancer and its treatment on the lives of children.

Systematic review of the health-related quality of life issues facing adolescents and young adults with cancer

PURPOSE

For adolescents and young adults (AYAs), the impact of a cancer diagnosis and subsequent treatment is likely to be distinct from other age groups given the unique and complex psychosocial challenges of this developmental phase. In this review of the literature, we report the health-related quality of life (HRQoL) issues experienced by AYAs diagnosed with cancer and undergoing treatment.

METHODS

MEDLINE, EMBASE, CINAHL, PsychINFO and the Cochrane Library Databases were searched for publications reporting HRQoL of AYAs. Issues generated from interviews with AYAs or from responses to patient reported outcome measures (PROMs) were extracted.

RESULTS

166 papers were reviewed in full and comprised 72 papers covering 69 primary studies, 49 measurement development or evaluation papers and 45 reviews. Of the 69 studies reviewed, 11 (16%) used interviews to elicit AYAs' descriptions of HRQoL issues. The majority of the PROMs used in the studies represent adaptations of paediatric or adult measures. HRQoL issues were organised into the following categories: physical, cognitive, restricted activities, relationships with others, fertility, emotions, body image and spirituality/outlook on life.

CONCLUSION

The HRQoL issues presented within this review are likely to be informative to health care professionals and AYAs. The extensive list of issues suggests that the impact of a cancer diagnosis and treatment during adolescence and young adulthood is widespread and reflects the complexities of this developmental phase.

Experiences of posttraumatic growth in siblings of children with cancer

As survival rates continue to improve for children diagnosed with cancer, strides in achieving better psychosocial outcomes for both children with cancer and their families have been accentuated. The current study aimed to explore the experiences of siblings of children diagnosed with cancer and attempted to overcome some of the limitations described in previous research. Primarily, the study considered the theoretical framework of posttraumatic growth (PTG) in the project design and analysis. Semi-structured interviews were completed with six siblings. Thematic analysis was employed to identify themes within the data set as a whole. The data revealed that siblings experienced a range of difficult emotions throughout the cancer trajectory as well as experiencing remarkable changes in their lives. This included both positive and negative changes. These changes included increased empathy and resilience, improved family relationships, disrupted routine, increased responsibility and perceived changes in the ill child. Siblings described factors which they found helpful and unhelpful in adjusting to these changes. The report ends with a discussion of the themes and their clinical and theoretical implications. The report also highlights the research limitations and areas for future investigation.

[How do Affected Children and Adolescents Experience their Short Stature, and what is the Point of View of their Parents?]

How do Affected Children and Adolescents Experience their Short Stature, and what is the Point of View of their Parents? Despite a large number of publications on the psychosocial situation of short statured children and their parents only a few qualitative studies focus on the perspective of the affected families. Within the European QoLISSY study ("Quality of Life in Short Stature Youth") an instrument to assess the health related quality of life of short statured children was developed. The aim of this project was to examine the self-perceived quality of life of the children themselves in comparison to their parents' perspective. During the development of the QoLISSY instrument, focus groups were conducted as a first step of this study. A total of 23 short statured children and 31 parents participated and discussed their experiences in separate groups with trained moderators. The discussions were analyzed qualitatively und results were used to generate a first list of items for the questionnaire to be developed. While parents focused on socio-emotional problems, children talked much more about their growth hormone treatment and problems in their social environment. In comparison to other studies children rated their quality of life worse than their parents. Not only medical treatment but also a psychological and socio-emotional intervention seems to be indicated.

Quality of Life in Children With Advanced Cancer: A Report From the PediQUEST Study

CONTEXT

Modifiable factors of health-related quality of life (HRQOL) are poorly described among children with advanced cancer. Symptom distress may be an important factor for intervention.

OBJECTIVES

We aimed to describe patient-reported HRQOL and its relationship to symptom distress.

METHODS

Prospective, longitudinal data from the multicenter Pediatric Quality of Life and Symptoms Technology study included primarily patient-reported symptom distress and HRQOL, measured at most weekly with the Memorial Symptoms Assessment Scale and Pediatric Quality of Life inventory, respectively. Associations were evaluated using linear mixed-effects models adjusting for sex, age, cancer type, intervention arm, treatment intensity, and time since disease progression.

RESULTS

Of 104 enrolled patients, 49% were female, 89% were white, and median age was 12.6 years. Nine hundred and twenty surveys were completed over nine months of follow-up (84% by patients). The median total Pediatric Quality of Life score was 74 (interquartile range 63-87) and was "poor/fair" (e.g., <70) 38% of the time. "Poor/fair" categories were highest in physical (53%) and school (48%) compared to emotional (24%) and social (16%) subscores. Thirteen of 24 symptoms were independently associated with reductions in overall or domain-specific HRQOL. Patients commonly reported distress from two or more symptoms, corresponding to larger HRQOL score reductions. Neither cancer type, time since progression, treatment intensity, sex, nor age was associated with HRQOL scores in multivariable models. Among 25 children completing surveys during the last 12 weeks of life, 11 distressing symptoms were associated with reductions in HRQOL.

CONCLUSION

Symptom distress is strongly associated with HRQOL. Future research should determine whether alleviating distressing symptoms improves HRQOL in children with advanced cancer.

[Formula: see text]Executive functioning and health-related quality of life in pediatric sickle cell disease

Research consistently indicates that children with sickle cell disease (SCD) face multiple risk factors for neurocognitive impairment. Despite this, no empirical research to date has examined the impact of neurocognitive functioning on quality of life for this pediatric group. Thus, the current study aims to examine the relationship between executive functioning and quality of life in a sample of children with SCD and further explore psychosocial and family/caregiver resources as moderators of this relationship. A total of 45 children with SCD aged 8 to 16 years and their caregivers completed measures of quality of life, behavioral ratings of executive functioning, and psychosocial functioning. Hierarchical linear regression models were utilized to determine the impact of executive functioning on quality of life and further test the interaction effects of proposed moderating variables. Controlling for age, pain, and socioeconomic status (SES), executive functioning was found to significantly predict child- and parent-reported quality of life among youth with SCD. Psychosocial resources of the primary caregiver or family was not found to moderate the relationship between executive functioning and quality of life. These results provide the first empirical evidence that lower executive skills negatively predict quality of life for children with SCD, supporting clinical and research efforts which aim to establish efficacious interventions that target cognitive decrements within this pediatric population.

Symptom assessment in pediatric oncology: how should concordance between children's and parents' reports be evaluated?

BACKGROUND

Clinical evaluations in pediatric oncology are often triadic, involving children or adolescents, parents, and clinicians. However, few studies have evaluated the concordance between children's and parents' reports of symptom occurrence.

OBJECTIVES

The purposes of this study were to evaluate the concordance between children's and parents' symptom reports during the week of chemotherapy administration using 5 statistical approaches and determine which factors are associated with higher levels of dyadic concordance.

METHODS

Independent assessments of symptom occurrence were obtained from children and adolescents with cancer (n = 107) and their parents using the Memorial Symptom Assessment Scale 10-18. Concordance was assessed using (1) percentage of overall agreement, (2) Cohen κ coefficients, (3) McNemar tests, (4) positive percentage agreement, and (5) negative percentage agreement.

RESULTS

For each dyad, an average of 20 of the 31 symptom reports were concordant. Using children's reports as the "gold standard," parents rarely underestimated the children's symptoms. However, compared with children's reports, parents overestimated 7 symptoms. Advantages and disadvantages of each of the statistical approaches used to evaluate concordance are described in this article.

CONCLUSIONS

A variety of statistical approaches are needed to obtain a thorough evaluation of the concordance between symptom reports. Discordance was most common for symptoms that children refuted, particularly psychosocial symptoms.

IMPLICATIONS FOR PRACTICE

Clinicians need to interview children and adolescents along with their parents about the occurrence of symptoms and evaluate discrepant reports. Effective approaches are needed to improve communication between children and parents to improve symptom assessment and management.

Psychosocial difficulties in adolescent and young adult survivors of childhood cancer

BACKGROUND

With a large number of children surviving cancer worldwide, numerous investigations have assessed psychological and social adjustment among childhood cancer survivors. According to these studies, it is unclear whether childhood cancer survivors successfully adjust to daily life after being discharged from hospital, especially for adolescent and young adult survivors who have unique needs and concerns. The primary aim of this study was to identify the factors underlying psychosocial difficulties faced by adolescent and young adult survivors in their day-to-day lives after being discharged from hospital.

METHODS

Semi-structured interviews were conducted. Twenty-five childhood cancer survivors were recruited from two regional cancer institutions in Japan. Content analysis was applied to the responses.

RESULTS

Nineteen attributes were extracted and classified into four categories as follows: physical difficulties, interpersonal difficulties, behavioral difficulties, and uncertainty about the future. The attributes indicated by >50% of the participants were "I am worried about not feeling well," "I have difficulty continuing treatment in daily life," "I have difficulty moving my body," "I have to be absent from school or work because of illness," and "I am left behind academically."

CONCLUSIONS

This study identified important factors of psychosocial day-to-day difficulties. Clinically, these results suggest that it is important to watch for these signs and to provide early support to survivors so that their daily life and development are not hindered by the treatment and its side-effects, and to offer long-term support focusing on individual patient characteristics such as sex, age, and cancer history.

Emotion regulation, internalizing symptoms and somatic complaints in pediatric survivors of acute lymphoblastic leukemia

OBJECTIVES

This study aimed to examine whether respiratory sinus arrhythmia (RSA)-a physiological index of children's emotion regulation-moderates the relation between cancer diagnosis and internalizing problems in children.

METHODS

Participants were twenty-two 7-12-year survivors of acute lymphoblastic leukemia and 20 age-matched controls. RSA was calculated from cardiac interbeat interval using spectral time-series analysis. t-Scores on the Child Behavior Checklist Anxious/Depressed, Withdrawn/Depressed, and Somatic Complaints subscales were computed.

RESULTS

Respiratory sinus arrhythmia moderated the relation between diagnostic status and both child somatic complaints and withdrawn/depressed symptoms. The positive association between diagnostic status and somatic complaints was significant for children with low RSA but not significant for children with high RSA. This association was also significant for withdrawn/depressed symptoms. Low RSA was associated with more somatic complaints and withdrawn/depressed symptoms for children with cancer but not for control participants.

CONCLUSIONS

Children who have poor emotion regulation abilities may be more vulnerable to the range of stressors associated with the diagnosis, treatment, and survivorship of cancer. Behavioral interventions targeting emotion regulation skills may reduce internalizing symptoms in this population.

Translation and linguistic validation of the Pediatric Patient-Reported Outcomes Measurement Information System measures into simplified Chinese using cognitive interviewing methodology

BACKGROUND

The Pediatric Patient-Reported Outcomes Measurement Information System (PROMIS) measures were developed using modern measurement theory and tested in a variety of settings to assess the quality of life, function, and symptoms of children and adolescents experiencing a chronic illness and its treatment. Developed in English, this set of measures had not been translated into Chinese.

OBJECTIVE

The objective of this study was to develop the Chinese version of the Pediatric PROMIS measures (C-Ped-PROMIS), specifically 8 short forms, and to pretest the translated measures in children and adolescents through cognitive interviewing methodology.

METHODS

The C-Ped-PROMIS was developed following the standard Functional Assessment of Chronic Illness Therapy Translation Methodology. Bilingual teams from the United States and China reviewed the translation to develop a provisional version, which was then pretested with cognitive interview by probing 10 native Chinese-speaking children aged 8 to 17 years in China.

RESULTS

The translation was finalized by the bilingual teams. Most items, response options, and instructions were well understood by the children, and some revisions were made to address patient's comments during the cognitive interview.

CONCLUSIONS

The results indicated that the C-Ped-PROMIS items were semantically and conceptually equivalent to the original. Children aged 8 to 17 years in China were able to comprehend these measures and express their experience and feelings about illness or their life.

IMPLICATIONS FOR PRACTICE

The C-Ped-PROMIS is available for psychometric validation. Future work will be directed at translating the rest of the item banks, calibrating them and creating a Chinese final version of the short forms.

The Effect of Sertraline on the Quality of Life for Children and Adolescents with Anxiety Disorder

INTRODUCTION

In this study, we aimed to determine the changes in quality of life of children/adolescents with anxiety disorders during six months of sertraline treatment, to investigate parent-child/adolescent concordance in perception of quality of life and to examine the effect of treatment on children/adolescents.

METHODS

In this study, 30 patients with anxiety disorders according to criteria specified in Diagnostic and Statistical Manual of Mental Disorders, 4^th. Edition (DSM-IV) were assigned to sertraline treatment. The patients were evaluated using the Pediatric Quality of Life Inventory (PedsQL), State-Trait Anxiety Inventory for Children, Clinical Global Impression Scale (CGI) and the Children's Global Assessment Scale (CGAS) at 0th, 2^nd and 6^th months.

RESULTS

PedsQL total scores increased significantly with the treatment in children and adolescents (p<.001), however, no differences were observed in parent proxy report (p=.326). The mean CGAS score was 59.85±7.73 at the beginning of treatment and 73.70±7.01 at the end of treatment (p<.001). The average CGI score decreased from 4.68±.96 to 2.27±.84.

CONCLUSION

It was observed that perception of quality of life in children and adolescents with anxiety disorders increased with the treatment.

Health-related quality of life in children with sickle cell disease using the child health questionnaire

INTRODUCTION

This study sought to determine if changes in parent-reported health-related quality of life (HRQOL) in children with sickle cell disease (SCD-SS) occurred after participation in a nutritional supplementation study and to compare HRQOL responses with normative scores from non-White children.

METHOD

Parents of children with SCD-SS between the ages of 5 and 13 years completed the Child Health Questionnaire (CHQ-PF50) at baseline and at 12 months.

RESULTS

For the 47 children (8.6 ± 2.4 yrs, 43% female), baseline Child Health Questionnaire scale scores were significantly lower than normative scale scores for parental emotional impact, general health, and overall physical health, but they were higher for mental health. After the nutritional supplementation study, overall physical health and parental emotional impact improved to normative levels. Furthermore, physical role functioning significantly improved.

DISCUSSION

Participation in a nutritional study had a positive impact on parent-reported HRQOL physical scores in children with SCD-SS. More research is necessary to develop care providers' awareness and adequate HRQOL interventions for this population.

Association of the family environment with behavioural and cognitive outcomes in children with chromosome 22q11.2 deletion syndrome

BACKGROUND

Children with 22q11.2 deletion syndrome (22q11DS) are at risk for social-behavioural and neurocognitive sequelae throughout development. The current study examined the impact of family environmental characteristics on social-behavioural and cognitive outcomes in this paediatric population.

METHOD

Guardians of children with 22q11DS were recruited through two medical genetics clinics. Consenting guardians were asked to complete several questionnaires regarding their child's social, emotional and behavioural functioning, as well as family social environment and parenting styles. Children with 22q11DS were asked to undergo a cognitive assessment, including IQ and achievement testing, and measures of attention, executive function and memory.

RESULTS

Modest associations were found between aspects of the family social environment and parenting styles with social-behavioural and cognitive/academic outcomes. Regression models indicated that physical punishment, socioeconomic status, parental control and family organisation significantly predicted social-behavioural and cognitive outcomes in children with 22q11DS.

CONCLUSION

Characteristics of the family social environment and parenting approaches appear to be associated with functional outcomes of children with 22q11DS. Understanding the impact of environmental variables on developmental outcomes can be useful in determining more effective targets for intervention. This will be important in order to improve the quality of life of individuals affected by 22q11DS.

Considering quality of life for children with cancer: a systematic review of patient-reported outcome measures and the development of a conceptual model

OBJECTIVES

An appraisal of pediatric cancer-specific quality-of-life (QOL) instruments revealed a lack of clarity about what constitutes QOL in this population. This study addresses this concern by identifying the concepts that underpin the construct of QOL as determined by a content analysis of all patient-reported outcome (PRO) instruments used in childhood cancer research.

METHODS

A systematic review was performed of key databases (i.e., MEDLINE, CINAHL, PsychINFO) to identify studies of QOL in children with cancer. A content analysis process was used to code and categorize all items from generic and cancer-specified PRO instruments. Our objective was to provide clarification regarding the conceptual underpinnings of these instruments, as well as to help inform the development of theory and contribute to building a conceptual framework of QOL for children with cancer.

RESULTS

A total of 6,013 English language articles were screened, identifying 148 studies. Ten generic and ten cancer-specific PRO instruments provided 957 items. Content analysis led to the identification of four major domains of QOL (physical, psychological, social, and general health), with 11 subdomains covering 98 different concepts. While all instruments reflected items relating to the broader domains of QOL, there was substantial heterogeneity in terms of the content and variability in the distribution of items.

CONCLUSIONS

This systematic review and the proposed model represent a useful starting point in the critical appraisal of the conceptual underpinnings of PRO instruments used in pediatric oncology and contribute to the need to place such tools under a critical, yet reflective and analytical lens.

Impaired parent-reported health-related quality of life of underweight and obese children at elementary school entry

PURPOSE

Examine the health-related quality of life of 5-6-year-old underweight, overweight and obese children.

METHODS

Our cross-sectional study included 3,227 parent-child dyads from the "Be active, eat right" study. Parents completed questionnaires regarding child and parental characteristics. Health-related quality of life of the child was measured using the Child Health Questionnaire Parent Form 28. Children were classified normal weight, overweight, obese, severely obese, and underweight according to the international age and gender BMI cutoff points. Bootstrap analyses were performed for general linear models corrected for potential confounding variables.

RESULTS

Severely obese children (β, -2.60; 95% CI, -4.80 to -0.57, p < 0.01) and underweight children (β, -1.11; 95% CI, -1.85 to -0.39, p < 0.01) had lower parent-reported scores on the physical summary scale. On the physical functioning profile scale parents of overweight and severely obese children also reported statistically significant lower scores (p < 0.05 and p < 0.01, respectively).There were no significant differences regarding the psychosocial summary scale scores between the different weight categories.

CONCLUSION

Underweight and overweight children experience impaired health-related quality of life on the physical functioning domain. Physicians, teachers and parents should be aware of the possible negative impact on health-related quality of life in underweight and overweight 5-6-year-old children.

Percepção da fluorose dentária e avaliação da concordância entre pais e filhos: validação de um instrumento

Objetivou-se validar o Child's and Parent's Questionnaire about Teeth Appearance, avaliando as preocupações relacionadas à fluorose em 213 pares de pais/crianças (12 anos) de duas regiões brasileiras. A confiabilidade foi avaliada pelo alfa de Cronbach e pelo coeficiente de correlação intraclasse; e a validade de constructo e de critério, pela correlação de Spearman. Para comparar as duas regiões e avaliar a concordância pais/filhos, foi utilizado o teste t de Student. A consistência interna foi aceitável, e a confiabilidade teste-reteste, moderada a excelente. Houve correlação significativa entre percepção da fluorose moderada e severa e os dados clínicos e entre percepção da fluorose e preocupações dos indivíduos. Embora os pais de Rafael Arruda, Ceará, Brasil, tenham tido maior percepção da fluorose, o incômodo e a preocupação com a aparência foram maiores em Piracicaba, São Paulo. Os pais se mostraram mais incomodados, preocupados e insatisfeitos com a aparência dentária das crianças do que elas mesmas. Essa versão é válida e confiável para avaliar a percepção da estética dentária em crianças e em seus pais.

Health-Related Quality of Life in Children with Developmental Coordination Disorder and Their Parents

This study measured health-related quality of life (HRQOL) in children with developmental coordination disorder (DCD) and their parents. A convenience sample of 369 children with DCD (144 girls; mean age: 11.2 ± 3.66 years) and 360 children with typical development (146 girls; mean age: 11.4 ± 4.09 years) was enrolled. The Bruininks—Oseretsky Test of Motor Proficiency-Second Edition was used to classify the DCD group into five levels of motor abilities. The HRQOL of the children was assessed with the Child Health Questionnaire-Parent Form 50, and the HRQOL of the parents was assessed with the 12-Item Short Form Health Survey (SF-12), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). Although the two groups had comparable physical health, the DCD group had significantly lower HRQOL in all psychosocial domains. The degree to which HRQOL is reduced is related to motor proficiency. Compared to parents of typically developing children, parents of children with DCD had significantly lower HRQOL ( p < .05 for both SF-12 and BAI). HRQOL of the parents was unassociated with the motor proficiency of the children. DCD significantly affects multiple HRQOL domains in both the child with DCD and the parents.

The family impacts of proton radiation therapy for children with brain tumors

Children with brain tumors experience significant alterations to their health and well-being due to the tumors themselves and oncologic treatment. Caring for children with brain tumors can have significant impacts on families, especially during and shortly after treatment. In this study of the impacts on families caring for children undergoing proton radiation therapy for brain tumors, the authors found that families experienced a broad array of negative impacts. Families reported feeling like they were living on a roller coaster, feeling that others treated them differently, and having to give up things as a family. In the multivariable linear regression model, older age of the child and higher reported child health-related quality of life were associated with less family impact. The presence of concurrent chemotherapy was associated with increased family impact. This is the first study to specifically evaluate the families of children being treated with proton radiation therapy. The findings in this study are consistent with the findings in other studies of children treated with standard therapy that show that families experience a variety of stressors and negative impacts while their children are receiving treatment. Health care providers should be aware of the potential impacts on families of children with brain tumors and their treatment to provide robust services to meet the health, psychological, and social needs of such children and their families.

Health-related quality of life in pediatric cancer survivors: a multifactorial assessment including parental factors

AIM

We aimed to evaluate the health-related quality of life (HRQOL) and the effect of associated factors such as cancer type, treatment strategies, sex, age, and parental factors like education and psychopathology in pediatric cancer survivors and make a comparison with healthy children.

PATIENTS AND METHODS

"Pediatric Quality of Life Inventory (PedsQL) 4.0 TM, Generic Core Scale" for children and parents, and "Brief Symptom Inventory" for parents were used. Three hundred and two survivors without major mental or motor deficit and 272 healthy controls of 8 to 18 years of age were enrolled to study.

RESULTS

Comparison of scores according to child self-report between survivor and control groups revealed lower points in physical and school subscale of survivor group (P<0.01 and P<0.001, respectively). Female survivors had reported significantly worse HRQOL in physical and emotional subscales of PedsQL than male survivors (P<0.001). Female survivors of ≥16 years of age had reported worse scores in school subscale than females of younger age groups and male survivors of same age group. Parents of control group reported better results in school subscales (P<0.001) and social functioning subscales (P<0.05) than parents of survivor group. Brief Symptom Inventory score had significant effect on child self-report and parent proxy-report of physical functioning (P<0.001), emotional functioning (P<0.001), social functioning (P<0.001), and school subscales (P<0.001) of PedsQL. Significantly better scores of physical functioning subscale in the survivors whose parents are university graduate than the survivors whose parents are primary school graduate were detected (P<0.001). The survivors with central nervous system tumors had reported lower scores in the social, emotional, physical, and school functioning subscales of PedsQL than patients with non-Hodgkin and Hodgkin lymphoma (P<0.001). Child self-report school subscale scores were lower in survivors treated with radiotherapy in combination or as sole therapy than survivors in whom radiotherapy was not given (P<0.001).

CONCLUSIONS

Our study has provided evidence about less-studied determinants of HRQOL like parental factors such as psychopathology or educational level in childhood cancer survivors. Future research can build on this evidence to obtain additional factors other than well-known medical and treatment-related factors.

Family Structure and Adolescent Physical Health, Behavior, and Emotional Well-Being

This study uses data from the Child Development Supplement of the Panel Study of Income Dynamics to examine family structure's associations with adolescent physical health, behavior, and emotional well-being. Findings suggest that adolescents in most other family types tend to have poorer outcomes than those in two-biological-parent families. Adolescents living with their biological father but not their mother have similar outcomes to those living with their single, biological mother. Although transitioning to a single-parent family is adversely associated with multiple outcomes, few associations are found for other types of transitions, and there are few differences in adolescent outcomes by parental marital status. Estimates from models utilizing adolescent- and caregiver-reported outcome measures, though similar with regard to behavior problems, differ considerably with regard to physical health and emotional well-being such that those using adolescent reports suggest a stronger relation between family structure and adolescent well-being than those using caregiver reports.

'He Never Liked Sport Anyway' - Mother's Views of Young People Coping With a Bone Tumour in the Lower Limb

Purpose: Treatment for a bone tumour can compromise quality of life (QOL), especially for young patients. We used qualitative methods to assess mothers' views of patients' experiences and their coping strategies at approximately 6 months after diagnosis (T1: n=12) and 12–18 months later (T2: n=11).

Subjects: Mothers of young people (aged 6–22 years) who were undergoing treatment for either osteosarcoma or Ewing's sarcoma in the lower limb took part.

Methods: A semi-structured interview was devised to assess participation in sport, social life, schooling and general mobility. Interviews were transcribed and analysed using content analysis.

Results: Mothers reported a number of situations in which QOL was compromised, and these remained relatively constant over time (mean=4.25 at T1 and 4.27 at T2). However, strategies to manage these difficulties changed from Problem (constructive attempts to deal with challenges) to Emotion (managing the situation through use of emotions) focused coping from T1 to T2.

Discussion: Although the sample size is small, our results suggest that patients adopt a variety of coping strategies to deal with the physical and social restrictions associated with disease and treatment. The findings suggest that young people continue to experience many stresses up to 18 months after diagnosis. The shift from Problem to Emotion focussed coping over time may suggest a degree of acceptance of practical problems.

Identifying determinants of quality of life of children with cancer and childhood cancer survivors: a systematic review

PURPOSE

This paper describes a systematic review conducted to identify factors that have been investigated as explanations of variability in the quality of life of children with cancer and childhood cancer survivors. Our purpose was to build an evidence base that could be used to guide and direct future research.

METHODS

MEDLINE, CINAHL, EMBASE, PsycINFO, Cancerlit, and Sociological Abstracts were searched from the inception of each database to June 15, 2009 using the following search terms: "quality of life," "health-related quality of life," "quality adjusted life years," "health status," "functional status," "well-being," or "patient-reported outcome." Sample characteristics and information about the relationship between a quality of life domain or total scale score and at least one factor (e.g., child gender or age, coping skills, family income) were extracted from eligible studies.

RESULTS

Nine cancer-specific and nine generic QOL questionnaires were used in 58 publications described 239 factors (50 unique factors). The large number of cancer, treatment, child, and family variables considered indicates that extensive research activity has occurred. However, most of the variables identified were examined in only a few studies and most represent medical and treatment variables with less research attention paid to child and family variables.

CONCLUSIONS

Our study has compiled evidence about determinants of QOL for children with cancer and childhood cancer survivors from the existing literature. Future research can build on this evidence base to expand the range of factors studied as most research to date has focused on medical and treatment factors.

Participation in daily activities and quality of life in survivors of retinoblastoma

PURPOSE

To assess the participation and health-related quality of life (HRQOL) of survivors of childhood retinoblastoma (RB).

PATIENTS AND METHODS

Parents of 46 survivors of childhood RB between the ages of 2-18 were administered questionnaires relating to their children's participation (CFFS) and HRQOL (CHQ and PedsQL) and children were administered the PedsQL. Results of the HRQOL were compared to population-based norms.

RESULTS

The overall QOL of survivors of RB was similar to that of age norms. However, parents' rating of their children's general and emotional health was lower than that of age norms, and survivors reported lower QOL related to school. Survivors of bilateral RB participated less in daily activities and had lower emotional QOL compared to those with unilateral RB, and parents of children who had an eye enucleated reported that their children had lower self-esteem. The level of participation was related to the perceived QOL.

CONCLUSION

Our results indicate that children who are survivors of RB have an overall QOL that is similar to their age-peers. However, subgroups of survivors appear to have unique difficulties that require continued follow-up and intervention. Focus should be placed on their participation in daily activities both in the community and at school.

Concordance of quality of life assessments following pediatric hematopoietic stem cell transplantation

PURPOSE

To examine the concordance between pediatric patient's self-report and parent-report regarding a patient's quality of life (QoL) prior to and following hematopoietic stem cell transplantation (HSCT) and to identify potential medical and demographic covariates of concordance.

PATIENTS AND METHODS

Utilizing the PedsQL 4.0, the longitudinal QoL data were obtained from 68 pediatric HSCT patient-parent dyads prior to and up to two years post-transplantation.

RESULTS

Reliability based upon Intraclass Correlation Coefficients (ICC) indicates a parabolic pattern of concordance being significantly poorer in the acute phase of treatment 3 months post-HSCT, followed by a return to pre-transplant levels at subsequent assessments and a substantial rise at one- and two-year follow-up assessments (Baseline ICC = 0.42; 3 months = 0.11; 6 months = 0.54). Paired t-tests further indicate that concordance was highest for observable domains of functioning (Physical and School) with greater inter-rater discrepancies on the subjective domains (Emotional and Social) of QoL at baseline and 6 months post-transplantation.

CONCLUSION

Children typically rated their QoL as higher than parents at all time points and in virtually all domains; however, both perspectives are vital in providing a more accurate depiction of a patient's treatment experience. Dyads speaking the same language exhibited higher levels of QoL agreement than those that did not, while concordance among female-patient-dyads was more disparate than male-patient-dyads. Such findings highlight the importance of implementing psychosocial assessments and possible interventions for patients and parents proactively during the HSCT to effectively address the impact of the treatment and recovery experiences.

An Evaluation of Health-Related Quality of Life (HRQoL) in a group of 4-7 year-old children with cleft lip and palate

BACKGROUND AND OBJECTIVE

Cleft lip and palate (CLP) is the most common congenital craniofacial abnormality. The interventions' intensity and psychosocial burden of the cleft may have a lasting impact on the child. The aim of this study was to assess the psychosocial functioning of 4 to 7-year-old children with non-syndromic CLP.

MATERIAL AND METHODS

Health-Related Quality of Life (HRQoL) was assessed using the revised German KINDL HRQoL questionnaire, a five-point, 24-Likert-item questionnaire covering six domains (physical well-being, emotional well-being, self-esteem, family life, friends and school). The total score is the sum of all item scores. In addition, a chronic generic module consisting of six items, and a specific parent module consisting of 22 items have been added to the core KINDL questionnaire. Higher scores indicate better HRQoL. All the parents of 4 to 7-year-old children with non-syndromic CLP treated at the interdisciplinary CLP center at Cologne University Hospital were invited to participate in the study.

RESULTS

A total of 74 families were contacted, 61 of whom agreed to study participation (82% response). The 61 children (32 boys and 29 girls) had a mean age of 5.39 years. The mean values for the total scale were slightly lower for children with CLP, but when compared, CLP and non-CLP children revealed no statistically significant difference in HRQoL levels.

CONCLUSION

This study demonstrated that 4 to 7-year-old children with CLP do not appear to experience major psychosocial problems when compared with their non-CLP peers.

Assessing quality of life: mother-child agreement in depressed and non-depressed Hungarian

PURPOSE

An important question in child psychiatry is the agreement between parents and children. We studied mother-child concordance about the quality of life of children (QoL). We hypothesized that mothers of depressed children rate lower QoL than children for themselves while mothers of non-depressed children rate better QoL; that inter-informant agreement is higher in the non-depressed sample; and finally that agreement increases with age of the child.

METHODS

QoL of depressed children (N = 248, mean age 11.45 years, SD 2.02) were compared to that of non-depressed children (N = 1695, mean age 10.34 years, SD 2.19). QoL was examined by a 7 item questionnaire (ILK).

RESULTS

Mothers of depressed children rated lower QoL than their children while mothers of nondepressed children rated higher QoL than their children. Agreement was low in both samples but higher in the controls. Inter-informant agreement was only influenced by depression.

CONCLUSIONS

Our results show that mothers relate more serious negative effects to childhood depression than their children and rate less problems for their non-depressed children compared to self-reports. Mother-child agreement is negatively influenced by depression which further stresses the importance of obtaining reports from the child and at least one parent in order to understand the subjective experiences caused by the illness.

The complexity of symptoms and problems experienced in children with cancer: a review of the literature

To adequately help children with cancer, care providers need to understand the complexity of symptoms and problems associated with the illness that children are experiencing, which can enable them to better tailor patient care individually to each child. In this integrative literature review, we identified the types of symptoms and problems that children with cancer can experience during treatment and rehabilitation; the terms/expressions they use to describe their symptoms and problems; how children's symptoms and problems vary during the course of their illness; and how they vary and co-vary with age, gender or race. Of the 1175 titles identified, 110 articles met the inclusion criteria and were included in the review. Seventy-eight were research-based. A total of 219 distinct symptoms or problems were identified in the literature either as the main problem or a symptom of the main problem. There is significant evidence that children and adolescents experience numerous and complex symptoms, and problems during and after treatment for cancer. Children use many different expressions to talk about their symptom experiences. However, few articles looked at how children's symptoms and problems varied during the course of their illness or the variations in symptom severity and degree of bother, or examined the relationship between children's symptom experience and age, gender, or race. Most instruments that were used to measure symptoms were interviewer-administered questionnaires, often adaptations from adult versions, and in younger children, symptoms were often obtained from adult informants. The insights gained from this review can be helpful to researchers and clinicians who wish to better understand how symptoms and problems are experienced from the children's own perspective. However, more research is needed: to better understand differences in symptom experiences among different age groups; to identify differences among children from distinct cultural, ethnic, or socio-economic backgrounds; to clarify how symptoms and problems interfere with daily life; and to refine assessment methods that allow even younger children to communicate their symptom experiences in an age-adjusted manner.

The impact of childhood conditions and concurrent morbidities on child health and well-being

BACKGROUND

Understanding the impact of illnesses and morbidities experienced by children and adolescents is essential to clinical and population health programme decision making and intervention research. This study sought to: (1) examine the population prevalence of physical and mental health conditions for children and quantify their impact on multiple dimensions of children's health and well-being; and (2) examine the cumulative effect of concurrent conditions.

METHODS

We conducted a cross-sectional school-based epidemiological study of 5414 children and adolescents aged 5-18 years, and examined parental reports of child health and well-being using the parent-report Child Health Questionnaire (CHQ) PF50 13 scales are scored on a 0-100 pt scale with clinically meaningful differences of five points and the presence of childhood conditions (illnesses and health problems).

RESULTS

Asthma, dental, vision and allergies are the most commonly identified health problems for children and adolescents, followed by attention- and behaviour-related problems (asthma 17.9-23.2%, dental 11.9-22.7%, vision 7.2-14.7%, chronic allergies 8.8-13.9%, attention problems 5.1-13.8% and behaviour problems 5.7-12.0%). As the number of concurrent health problems increase, overall health and well-being decreases substantively with mean differences in CHQ scale scores of 14 points (-7.69 to -21.51) for physical health conditions, and 28 points (-5.15 to -33.81) for mental health conditions.

CONCLUSIONS

Children's health and well-being decreases linearly with increasing presence and frequency of health problems. Having three or more conditions concurrently significantly burdens children's health and well-being, particularly for family-related CHQ domains, with a greater burden experienced for mental health conditions than physical health conditions.

Physical function assessment tools in pediatric rheumatology

Pediatric rheumatic diseases with predominant musculoskeletal involvement such as juvenile idiopathic arthritis (JIA) and juvenile dermatomyositis(JDM) can cause considerable physical functional impairment and significantly affect the children's quality of life (QOL). Physical function, QOL, health-related QOL (HRQOL) and health status are personal constructs used as outcomes to estimate the impact of these diseases and often used as proxies for each other. The chronic, fluctuating nature of these diseases differs within and between patients, and complicates the measurement of these outcomes. In children, their growing needs and expectations, limited use of age-specific questionnaires, and the use of proxy respondents further influences this evaluation. This article will briefly review the different constructs inclusive of and related to physical function, and the scales used for measuring them. An understanding of these instruments will enable assessment of functional outcome in clinical studies of children with rheumatic diseases, measure the impact of the disease and treatments on their lives, and guide us in formulating appropriate interventions.

Parent-child agreement across child health-related quality of life instruments: a review of the literature

AIM

To systematically review the literature published since 1999 on paediatric health-related quality of life (HRQL) in relation to parent-child agreement.

METHODS

Literature searches used to identify studies which evaluated parent-child agreement for child HRQL measures.

RESULTS

Nineteen studies were identified, including four HRQL instruments. The Pediatric Quality of Life Inventory (PedsQL) was most commonly used. Differences in parent-child agreement were noted between domains for different measures. The impact of child and parent characteristics were not consistently considered; however parents of children in a nonclinical sample tended to report higher child HRQL scores than children themselves, while parents of children with health conditions tended to underestimate child HRQL.

CONCLUSION

Despite increasing numbers of studies considering children's HRQL, information about variables contributing to parent-child agreement levels remains limited. Authors need to consistently provide evidence for reliability and validity of measures, and design studies to systematically investigate variables that impact on levels of parent-child agreement.

Oral health-related quality of life in children: part III. Is there agreement between parents in rating their children's oral health-related quality of life? A systematic review

OBJECTIVE

One issue that receives a great deal of attention is the comparison between measurement of children's oral health-related quality of life (OHRQoL) reports with those of their parents. However, the extent to which parents understand the effects of ill-health on their children's lives remains unanswered. The purpose of this systematic review was to identify the literature on the nature, extent and the pattern of agreement/disagreement between parent and child reports about child OHRQoL and assess the association between them.

MATERIALS AND METHODS

The literature was searched using MEDLINE, ISI, Lilacs and Scielo, from January 1985 to March 2007. The selected studies used well-validated instruments and provided children's and parent's perceptions of child OHRQoL.

RESULTS

A total of 87 articles were retrieved and five were selected for the review, which showed that children and parents do not necessarily share similar views about child OHRQoL. Some parents may have limited knowledge about their children's OHRQoL, particularly the impact on social and emotional well-being.

CONCLUSIONS

Valid and reliable information can be obtained from parents and children using appropriate questionnaire techniques. Although the parents' reports may be incomplete due to lack of knowledge about certain experiences, they still provide useful information.

Economic evaluation and health-related quality of life

Health-related quality of life (HRQL) is concerned with the opportunities that a person's health status affords, the constraints that it places upon the person and the value that a person places on his or her health status. The rationale for measuring HRQL falls into three categories: discrimination, evaluation, and prediction. Measures have to meet generally accepted psychometric criteria such as acceptability, reliability/reproducibility, responsiveness, validity, interpretability, and usefulness. HRQL instruments have been designed for self-administration or administration by interviews and some have been adapted to multiple cultural/linguistic needs. For adolescents and young adults with cancer several instruments are available. Overall HRQL is compromised, to varying degrees, in such survivors by comparison with peers in the general population; and the burden of morbidity is greatest after brain and bone tumors. As there is a burden of treatment-related morbidity and as the number of survivors within the health care system is growing, the economic dimension of care and cure has to be taken into consideration. Economic evaluation affords a comparison of the costs and consequences (effects) of relevant therapeutic alternatives. The future research activities with respect to HRQL have to consider these new dimensions of care.

Development of a parent version of the Manchester-Minneapolis quality of life survey for use by parents and carers of UK children: MMQL-UK (PF)

Background

Although it is now widely endorsed that children should as far as possible rate their own health related quality of life (HRQL), there are situations where proxy information on child HRQL may be useful, especially where a child is too ill or young to provide their own HRQL assessment. There is limited availability of generic HRQL scales that have a parallel child and parent version and that are reliable, valid, brief, comprehensible and suitable for use in UK populations. The aims of this study were therefore to develop and validate a parent version of the anglicised Manchester-Minneapolis Quality of Life child form (MMQL-UK (CF)) and to determine the level of association between the child and parent versions of this form.

Methods

This study was undertaken concurrently with the anglicisation and validation of the MMQL, a measure of HRQL developed for use with children in North America. At that time, no parent version existed, so the MMQL form for children (MMQL-UK (CF)) was used as the basis for the development of the MMQL-UK parent form (PF). The sample included a control group of healthy children and their parents and five exemplar groups; children diagnosed with asthma, diabetes or inflammatory bowel disease and their parents, children in remission from cancer and their parents and children in public care and their carers. Consistency of the MMQL-UK (PF) components were assessed by calculating Cronbach's alpha. Validation of the parent questionnaire was undertaken by comparing MMQL-UK (PF) component scores with comparable components on the proxy PedsQL™ quality of life scales, comparing MMQL-UK (PF) component scores between parents of healthy and chronic disease children and by comparison of component scores from children and their parents or carers. Reproducibility and responsiveness were assessed by retesting parents by follow-up questionnaires.

Results

A total of 874 children (completing MMQL-UK (CF)) and 572 parents or carers (completing MMQL-UK (PF)) took part in the study. The internal consistency of all the MMQL-UK (PF) components exceeding the accepted criterion of 0.70 and the construct validity was good with moderate correlations being evident between comparable components of the MMQL-UK (PF) and the proxy PedsQL™. Discriminant validity was demonstrated with significant differences being identified between parents of healthy children and those with chronic conditions. Intra-class correlations exceeded 0.65 for all MMQL-UK (PF) components demonstrating good reproducibility. Weak to moderate levels of responsiveness were demonstrated for all but social functioning. The MMQL-UK (PF) showed moderate parent-child correlation with the MMQL-UK (CF) for all components. The best correlations were seen for those components measuring the same construct (Pearson's r ranged from 0.31 to 0.61, p < 0.01 for equivalent components).

Conclusion

The MMQL-UK (PF) showed moderate to good correlations with the MMQL-UK (CF) component scores. The MMQL-UK (PF) will be of use when comparing child and parent/carer perception of the impact of a child's condition on their HRQL or where the child is too ill or young to provide their own report.

Quality of life in children with systemic lupus erythematosus: a review

Systemic lupus erythematosus (SLE) in children is a chronic multisystem disease with wide ranging effects on their quality of life (QOL). While SLE's impact on different arenas of life and well-being has been extensively examined in the adult population, its effect on children has not received adequate attention. This review discusses the multidimensional aspect of QOL, the biopsychosocial implications of SLE, factors complicating QOL measurement in the affected population, and the different generic and disease-specific scales used for measuring QOL and related constructs. Until now, there have not been any pediatric SLE-specific health-related QOL (HRQOL) scales. A section is devoted to a novel instrument developed specifically for measuring QOL in pediatric lupus called the Simple Measure of the Impact of Lupus Erythematosus in Youngsters (SMILEY). SMILEY is a brief, easily understood, valid, reliable and internally consistent pediatric SLE-specific QOL scale and will be a useful adjunct to clinical trials and outcomes research.

Determinants of child-parent agreement in quality-of-life reports: a European study of children with cerebral palsy

OBJECTIVES

The differences between child self-reports and parent proxy reports of quality of life in a large population of children with cerebral palsy were studied. We examined whether child characteristics, severity of impairment, socioeconomic factors, and parental stress were associated with parent proxy reports being respectively higher or lower than child self-reports of quality of life.

METHODS

This study was conducted in 2004-2005 and assessed child quality of life (using the Kidscreen questionnaire, 10 domains, each scored 0-100) through self-reports and parent proxy reports of 500 children aged 8 to 12 years who had cerebral palsy and were living in 7 countries in Europe.

RESULTS

The mean child-reported scores of quality of life were significantly higher than the parent proxy reports in 8 domains, significantly lower for the finances domain, and similar for the emotions domain. The average frequency of disagreement (child-parent difference greater than half an SD of child scores) over all domains was 64%, with parents rating their child's quality of life lower than the children themselves in 29% to 57% of child-parent pairs. We found that high levels of stress in parenting negatively influenced parents' perception of their child's quality of life, whereas the main factor explaining parents' ratings of children's quality of life higher than the children themselves is self-reported severe child pain.

CONCLUSIONS

This study shows that the factors associated with disagreement are different according to the direction of disagreement. In particular, parental well-being and child pain should be taken into account in the interpretation of parent proxy reports, especially when no child self-report of quality of life is available. In the latter cases, it may be advisable to obtain additional proxy reports (from caregivers, teachers, or clinicians) to obtain complementary information on the child's quality of life.

Incontinence Symptom Index-Pediatric: Development and Initial Validation of a Urinary Incontinence Instrument for the Older Pediatric Population

PURPOSE

Although urinary incontinence is common in children, no validated pediatric instruments exist for measuring urinary incontinence symptoms and bother. We developed and validated a patient reported pediatric survey for urinary incontinence measurement.

MATERIALS AND METHODS

The Incontinence Symptom Index-Pediatric is an 11-item instrument comprising 2 domains, that is 1) impairment and 2) symptom severity, including subdomains for stress urinary incontinence, urge urinary incontinence, insensate urinary incontinence, nocturnal urinary incontinence and pad use. The survey was self-administered twice, 2 weeks apart, to boys and girls ages 11 to 17 years. Children completed the survey independently. Cases consisted of patients presenting to pediatric urology clinic with the chief complaint of urinary incontinence. Controls consisted of healthy children presenting for evaluation up at a general pediatric practice. Formal validation analysis was performed.

RESULTS

A total of 19 subjects per arm completed at least 1 survey. Internal consistency was good with a Cronbach's alpha of 0.84 for the complete instrument. Item-scale correlations were greater than 0.60 for all except 1 item. Test-retest reliability was also good (r = 0.97, p <0.0001). Discriminative validity was good with a total severity scale score of 9.3 in wet children and 0.7 in controls (p <0.0001). Impairment scale scores differed by 2.2 points (p <0.0001). Mean scores differed significantly between subscales for all domains except pad use. The most dramatic difference was in the urge urinary incontinence domain, which differed by a mean of 3.6 points (p = 0.0002).

CONCLUSIONS

This pilot study provides initial validation of a survey instrument for urinary incontinence in children and adolescents. This instrument can be used in children ages 11 to 17 years to objectively and reproducibly measure patient reported urinary incontinence.

Socio-economic differentials in the health-related quality of life of Australian children: results of a national study

OBJECTIVE

To examine differences in health-related quality of life (HRQL) of children living in different socio-economic contexts in Australia.

METHODS

Parental reports describing the HRQL and socio-economic status of a random national sample of 3,597 school-age children were obtained using the Child Health Questionnaire (CHQ) and a standardised socio-economic interview. Response rate was 70%.

RESULTS

Children in families of higher income, whose parents had more years of schooling and were employed and children who lived in two-parent, original families had significantly higher HRQL across a range of domains assessed by the CHQ.

CONCLUSION

Children from lower socio-economic backgrounds in Australia have a significantly more negative experience of health and wellness. Such differences may well increase unless deliberate political attention is given to addressing the widening differences in relative wealth in Australia.