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Ehrenberg S, Stransky OM, Wright CE, Jain R, Kazmerski TM. Partner perspectives on women's sexual and reproductive healthcare in cystic fibrosis. J Cyst Fibros 2022; 22:217-222. [PMID: 35970694 DOI: 10.1016/j.jcf.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/30/2022] [Accepted: 08/07/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Women with cystic fibrosis (CF) face many sexual and reproductive health (SRH) concerns. Studies suggest that educating and involving partners in SRH care can improve outcomes. This study investigated partners' perceptions of and preferences for women's SRH care in CF. METHODS We surveyed partners of women with CF from ten United States (U.S.) CF centers regarding their attitudes and preferences related to CF SRH care. Items assessed experiences with SRH care, sexual relationships, family planning, pregnancy, fertility, and parenthood. We used descriptive statistics to assess results related to the timing, content, setting and delivery of CF SRH care. RESULTS A total of 94 partners completed the survey (94% male; average age 36±1 years; 70% married; 36% parents). Among those who/whose partners experienced a pregnancy, 48% received preconception counseling and 29% fertility testing/treatment. One-third of all respondents (32%) worried their children would have CF and 86% would undergo CF genetic testing if their CF partner became pregnant. One-third (34%) indicated that they did not have any SRH conversations with their partner's CF team, while 70% would like to have such discussions. The topics that respondents would most like to discuss were pregnancy (50%), fertility (43%), sexual functioning (36%), sexual activity (31%) and parenthood (29%). CONCLUSIONS Partners report gaps in SRH care and counseling despite the majority wanting to discuss SRH concerns with their partner's CF team. CF partners serve as key supports for women with CF and results can be used to design patient-centered interventions to optimize CF SRH care.
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Affiliation(s)
- Sarah Ehrenberg
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Olivia M Stransky
- Center for Innovative Research on Gender Health Equity (CONVERGE), University of Pittsburgh, Pittsburgh, PA, United States
| | - Catherine E Wright
- Center for Innovative Research on Gender Health Equity (CONVERGE), University of Pittsburgh, Pittsburgh, PA, United States
| | - Raksha Jain
- University of Texas Southwestern, Dallas, TX, United States
| | - Traci M Kazmerski
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Center for Innovative Research on Gender Health Equity (CONVERGE), University of Pittsburgh, Pittsburgh, PA, United States.
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2
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Bray LA, Campbell CM, Brown J, Ladores S. Paths to Motherhood for Women with Cystic Fibrosis. MCN Am J Matern Child Nurs 2022; 47:147-153. [PMID: 35475925 DOI: 10.1097/nmc.0000000000000812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Cystic fibrosis (CF) is no longer a disease limited to childhood. With medical advancements, many of those with CF live into adulthood and have similar life goals as their non-CF peers. Most women with CF want to become mothers. However, available options and the related decision-making process is not well understood. The purpose of this study was to explore the decision-making framework of women with CF to better understand the factors they consider when deciding on a path to motherhood. STUDY DESIGN AND METHODS Qualitative interviews were performed using a grounded theory approach. Inclusion criteria were women with CF who became mothers through biological pregnancy, adoption, or gestational surrogacy. Results: Twenty-five mothers with CF were interviewed. A distinct decision-making process was identified through which women started with a desire for motherhood, assessed several factors, then eventually took the path they felt was right for them and their family. CLINICAL IMPLICATIONS Our findings provide women with CF a framework that other women with CF have used to assist in making decisions about their reproductive options. Conversations about family planning should occur early and regularly between women with CF and their health care providers. The decision-making process to achieve motherhood for women with a chronic illness, such as CF, includes consideration of unique factors that should be included in clinical conversations.
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Clarke AR, Stransky OM, Bernard M, Hughan KS, Ladores S, Sawicki GS, Stalvey MS, Kazmerski TM. Men's sexual and reproductive health in cystic fibrosis in the era of highly effective modulator therapies–A qualitative study. J Cyst Fibros 2022; 21:657-661. [DOI: 10.1016/j.jcf.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/31/2021] [Accepted: 02/05/2022] [Indexed: 11/15/2022]
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Stransky OM, Pam M, Ladores SL, Birru Talabi M, Borrero S, Godfrey EM, Roe AH, Sawicki GS, Zuckerwise LC, Mody S, Mentch L, Deal A, O’Leary R, Taylor-Cousar JL, Jain R, Kazmerski TM. Engaging Stakeholders in the Development of a Reproductive Goals Decision AID for Women with Cystic Fibrosis. J Patient Exp 2022; 9:23743735221077527. [PMID: 35128042 PMCID: PMC8814976 DOI: 10.1177/23743735221077527] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objective: More people with cystic fibrosis (pwCF) are reaching adulthood and considering their reproductive futures. Unfortunately, many pwCF report gaps in their reproductive healthcare. We describe measures of stakeholder engagement in developing a reproductive goals decision aid for women with CF called MyVoice:CF. Methods: Stakeholders reviewed the content, design, and usability of the tool, which was informed by prior research related to CF family planning experiences and preferences as well as a conceptual understanding of reproductive decision making. We evaluated stakeholder engagement via process measures and outcomes of stakeholder involvement. We collected data via recorded stakeholder recommendations and surveys. Results: Fourteen stakeholders participated and the majority described their role on the project as "collaborator", "advisor", or "expert." Most felt their expectations for the project were met or exceeded, that they had contributed significantly, and that they received sufficient and frequent information about the process. All stakeholders provided recommen-dations and clarified aims for a CF-specific family planning tool, including its content and focus on facilitating shared decision making. Discussion: Utilizing meaningful stakeholder contributions, we developed MyVoice:CF, a novel web-based decision aid to help women with CF engage in shared decision-making regarding their reproductive goals. Practical Value: Our findings from working with stakeholders for MyVoice:CF indicate that disease-specific reproductive health resources can and should be designed with input from individuals in the relevant communities.
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Affiliation(s)
- Olivia M. Stransky
- Center for Women's Health Research and Innovation, 230 McKee Place, Pittsburgh, PA 15213, USA
| | - Molly Pam
- Cystic Fibrosis Reproductive and Sexual Health Collaborative, Seattle, WA, USA
| | - Sigrid L. Ladores
- University of Alabama at Birmingham, School of Nursing, 1701 University Blvd, THT 422, Birmingham, AL 35294, USA
| | - Mehret Birru Talabi
- Center for Women's Health Research and Innovation, 230 McKee Place, Pittsburgh, PA 15213, USA
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Sonya Borrero
- Center for Women's Health Research and Innovation, 230 McKee Place, Pittsburgh, PA 15213, USA
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive (151C), Pittsburgh, PA 15240, USA
| | - Emily M. Godfrey
- Department of Family Medicine, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Andrea H. Roe
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | | | - Lisa C. Zuckerwise
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, 1161 21 Avenue South, B-1100 Medical Center North, Nashville, TN 37232, USA
| | - Sheila Mody
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Diego
| | - Laura Mentch
- Cystic Fibrosis Reproductive and Sexual Health Collaborative, Seattle, WA, USA
| | - Ashley Deal
- School of Design, Carnegie Mellon University, 5130 Margaret Morrison St, Pittsburgh, PA 15213, USA
| | - Raelynn O’Leary
- School of Design, Carnegie Mellon University, 5130 Margaret Morrison St, Pittsburgh, PA 15213, USA
| | - Jennifer L. Taylor-Cousar
- Divisions of Pulmonary, Critical Care and Sleep Medicine and Pediatric Pulmonary Medicine, National Jewish Health, 1400 Jackson Street, Denver, Colorado 80206, USA
| | - Raksha Jain
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, USA
| | - Traci M. Kazmerski
- Center for Women's Health Research and Innovation, 230 McKee Place, Pittsburgh, PA 15213, USA
- Department of Pediatrics, UPMC Children’s Hospital of Pittsburgh, University Center, 120 Lytton Ave., Mezzanine Floor Suite M060, Pittsburgh, PA, 15213, USA
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West NE, Kazmerski TM, Taylor-Cousar JL, Tangpricha V, Pearson K, Aitken ML, Jain R. Optimizing sexual and reproductive health across the lifespan in people with cystic fibrosis. Pediatr Pulmonol 2022; 57 Suppl 1:S89-S100. [PMID: 34570960 PMCID: PMC9291766 DOI: 10.1002/ppul.25703] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/14/2021] [Accepted: 09/23/2021] [Indexed: 11/19/2022]
Abstract
With improved therapies, people with cystic fibrosis are living longer and healthier lives and increasingly have questions surrounding their sexual and reproductive health. This article will summarize the important issues of which providers should be aware during the lifespan of people with cystic fibrosis, including puberty, adulthood, and menopause. A wide range of sexual and reproductive health topics are addressed such as puberty, transgender and gender nonbinary identities, contraception, sexually transmitted infections, hypogonadism, sexual functioning, cyclical hemoptysis, and urinary incontinence. We discuss gaps in knowledge and current evidence as well as management strategies to optimize care. Our goal is to support providers to enable them to give comprehensive care throughout the lifespan of people with cystic fibrosis.
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Affiliation(s)
- Natalie E West
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Traci M Kazmerski
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Center for Women's Health Research and Innovation (CWHRI), University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Vin Tangpricha
- Department of Medicine, Division of Endocrinology, Metabolism & Lipids, Emory University, Atlanta, Georgia, USA
| | - Kelsie Pearson
- Cystic Fibrosis Foundation Therapeutics Development Network, Seattle Children's Hospital, Seattle, Washington, USA
| | - Moira L Aitken
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Raksha Jain
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Clarke AR, Stransky OM, Bernard M, Hughan KS, Ladores S, Sawicki GS, Stalvey M, Kazmerski TM. Exploring provider attitudes and perspectives related to men's health in cystic fibrosis. J Cyst Fibros 2022; 21:652-656. [PMID: 34998704 DOI: 10.1016/j.jcf.2021.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 12/06/2021] [Accepted: 12/22/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND New modulator therapies have markedly improved the health of people with cystic fibrosis (CF), allowing an increased focus on quality-of-life improvements for men with CF, including those related to sexual and reproductive health (SRH). This study explored CF providers' attitudes and experiences with addressing men's health in CF. METHODS We interviewed geographically diverse adult and pediatric United States (U.S.) CF program directors via semi-structured telephone interviews exploring their perspectives and practices related to men's SRH in CF. Two coders analyzed transcribed interviews and created a codebook to identify key themes. RESULTS We interviewed 20 providers and identified the following themes: 1) Men's SRH is important to address within CF care, but there is no standardization around this aspect of care; 2) There is no consensus about the recommendation or utilization of semen analysis to assess men's infertility; 3) There are many barriers to men's SRH care provision in CF centers, including the low priority of SRH concerns and provider discomfort and lack of expertise in SRH; 4) Providers desire clear evidence-based guidelines and patient resources related to men's SRH in CF; and 5) Providers believe future research should focus on testosterone and the impact of modulators on men's SRH. CONCLUSIONS CF center directors acknowledge the importance of addressing SRH with men with CF, but there is a lack of standardization and research in this aspect of care. Existing barriers to optimal SRH care and identified facilitators in this study can serve as targets for interventions in the CF care model.
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Affiliation(s)
- Alison R Clarke
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
| | - Olivia M Stransky
- Center for Women's Health Research and Innovation, Pittsburgh, PA, United States.
| | - Miriam Bernard
- Center for Women's Health Research and Innovation, Pittsburgh, PA, United States.
| | - Kara S Hughan
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
| | - Sigrid Ladores
- School of Nursing, The University of Alabama at Birmingham, Birmingham, AL, United States.
| | | | - Michael Stalvey
- Department of Pediatrics, The University of Alabama at Birmingham, Birmingham, AL, United States.
| | - Traci M Kazmerski
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Center for Women's Health Research and Innovation, Pittsburgh, PA, United States.
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Roe AH, Merjaneh L, Oxman R, Hughan KS. Gynecologic health care for females with cystic fibrosis. J Clin Transl Endocrinol 2021; 26:100277. [PMID: 34849351 PMCID: PMC8607192 DOI: 10.1016/j.jcte.2021.100277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/03/2021] [Accepted: 11/12/2021] [Indexed: 11/19/2022] Open
Abstract
Females with CF may have cyclic lung symptoms, yeast infections, and urinary incontinence. Contraception is safe, but comorbidities should be considered in method selection. Females with CF have reduced fertility, though the etiology is unknown. Females with CF underutilize basic preventive gynecologic services.
As females with cystic fibrosis (CF) increasingly reach their reproductive years, gynecologic issues have become an important area of clinical care and research. First, females with CF may have disease-specific gynecologic problems, including cyclic pulmonary symptoms, vaginal yeast infections, and urinary incontinence. Next, contraceptive methods are thought to be overall safe and effective, however further research is needed to confirm this and to understand the lower rates of uptake among females with CF compared to the general population. Further, females with CF have reduced fertility, although the etiology of this is unknown and under investigation. While assisted reproductive technologies may help achieve pregnancy, decision-making around parenthood remains complex. Finally, while patients and providers agree on the importance of sexual and reproductive health care, females with CF underutilize basic preventive services such as cervical cancer screening, and better approaches are needed to bridge the gap with gynecology. In this review, we discuss the current state of gynecologic care for females with CF, as well as clinical and research opportunities for improvement.
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Affiliation(s)
- Andrea H. Roe
- Division of Family Planning, Department of Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, United States
- Corresponding author.
| | - Lina Merjaneh
- Division of Endocrinology, Department of Pediatrics, University of Washington, Seattle, WA 98115, United States
| | - Rachael Oxman
- Division of Endocrinology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, United States
| | - Kara S. Hughan
- Division of Pediatric Endocriology and Metabolism, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, United States
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Abstract
Women with cystic fibrosis (CF) face several unaddressed concerns related to their health. These areas of concern include explanations and guidance on a sex disparity in outcomes, timing of puberty, effects of contraception, prevalence of infertility and impact of pregnancy, and prevention of urinary incontinence and osteoporosis. These understudied topics leave women with numerous unanswered questions about how to manage sexual and reproductive health in the setting of CF. Because people with CF are living longer and healthier lives, there is an increasing awareness of these important aspects of care and multiple ongoing studies to address these understudied topics.
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Abstract
PURPOSE OF REVIEW With improving life expectancy and quality of life, sexual and reproductive health (SRH) has become an increasingly important aspect of patient-centered cystic fibrosis care. This review aims to describe advances in cystic fibrosis-related SRH and highlight optimal practices. RECENT FINDINGS Recent publications suggest that people with cystic fibrosis follow a similar trajectory of sexual development and activity as their noncystic fibrosis peers, although contraception use is lower. Although fertility is reduced in patients with cystic fibrosis, improved survival and assisted reproductive technologies have led to an increasing pursuit and incidence of pregnancy. Cystic fibrosis transmembrane regulator modulators that correct the underlying cystic fibrosis defect might improve fertility and thus far appear safe in pregnancy, though data are limited.Despite medical knowledge of SRH in cystic fibrosis, patients continue to report they lack sufficient education about these aspects of their healthcare, and cystic fibrosis multidisciplinary teams are ill prepared to counsel their patients. SUMMARY Understanding of the effects of cystic fibrosis on SRH continues to improve, although many questions remain regarding optimal care from the choice of contraception to the safety of cystic fibrosis-specific medications in pregnancy. Further development of cystic fibrosis-informed interdisciplinary specialist networks and a wider framework of practice would both enhance health outcomes and better support patients.
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10
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Men's health in the modern era of cystic fibrosis. J Cyst Fibros 2020; 20:e121-e123. [PMID: 33376059 DOI: 10.1016/j.jcf.2020.12.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/17/2020] [Accepted: 12/17/2020] [Indexed: 11/22/2022]
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Hughan KS, Daley T, Rayas MS, Kelly A, Roe A. Female reproductive health in cystic fibrosis. J Cyst Fibros 2020; 18 Suppl 2:S95-S104. [PMID: 31679735 DOI: 10.1016/j.jcf.2019.08.024] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/21/2019] [Accepted: 08/22/2019] [Indexed: 02/06/2023]
Abstract
Women with cystic fibrosis (CF) are living longer and healthier lives, and opportunities for childbearing are increasingly promising. However, this population can also face sexual and reproductive health concerns, including menstrual irregularities, unplanned pregnancies, infertility and pregnancy complications. Additionally, more women are entering menopause and are at risk for the consequences of estrogen deficiency. The exact mechanisms involved in female reproductive health conditions in CF are not clearly understood, but are thought to include cystic fibrosis transmembrane regulator (CFTR)-mediated abnormalities, changes in female sex hormones, and other CF health-related factors. In the era of CFTR modulator therapy, new data are necessary to understand the impact of CFTR modulation on contraceptive effectiveness, fertility, and pregnancy outcomes to help guide future clinical care. This article reviews the current scientific knowledge of major reproductive health issues for women with CF.
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Affiliation(s)
- Kara S Hughan
- Division of Pediatric Endocrinology and Diabetes, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, 4401 Penn Avenue, Pittsburgh, PA, USA.
| | - Tanicia Daley
- Division of Pediatric Endocrinology and Metabolism, Emory Children's Pediatric Institute, Emory University School of Medicine, 1400 Tullie Road, Atlanta, GA, USA
| | - Maria Socorro Rayas
- Division of Pediatric Endocrinology and Diabetes, University of Texas Health San Antonio, 7703 Floyd Curl, San Antonio, TX, USA
| | - Andrea Kelly
- Division of Pediatric Endocrinology and Diabetes, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 2716 South Street, Philadelphia, PA, USA
| | - Andrea Roe
- Division of Family Planning, Department of Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania, 1000 Courtyard, 3400 Spruce Street, Philadelphia, PA, USA
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Leech MM, Stransky OM, Talabi MB, Borrero S, Roe AH, Kazmerski TM. Exploring the reproductive decision support needs and preferences of women with cystic fibrosis . Contraception 2020; 103:32-37. [PMID: 33068614 DOI: 10.1016/j.contraception.2020.10.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 09/29/2020] [Accepted: 10/02/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES As women with cystic fibrosis (CF) live longer, healthier lives, they increasingly face decisions related to their reproductive health. This qualitative study explores their unique decision support needs and preferences to aid in the development of a CF-specific reproductive goals decision aid. STUDY DESIGN Womenwith CF age 18-44 years participated in individual, semi-structured, telephone-based interviews, and women with CF age 18 years and older participated in semi-structured focus group discussions (FGDs). Both explored experiences and attitudes surrounding parenthood, pregnancy, contraception, and preferences for reproductive health care provision.FGDs also explored the use, content, and format of a reproductive goals decision aid for women with CF. We transcribed interviews and FGDs and conducted content and thematic analyses using an inductive approach. RESULTS Twenty women (age range 20-42 years) participated in interviews and 18 women (age range 26-63 years) participated in three FGDs. Major themes identified included: 1) CF complicates pregnancy and parenting decisions; 2) Women make contraceptive decisions within the context of their CF; 3) Women with CF prefer to receive reproductive health counseling from their CF team; 4) Women with CF desire defragmented, coordinated reproductive health care; and 5) A disease-specific reproductive goals decision aid would encourage relevant parenting, pregnancy, and contraceptive discussions. CONCLUSION Women with CF have unique reproductive health care needs and often face uncertainty and disjointed care when making reproductive health and contraceptive decisions. IMPLICATIONS This study underscores the central role of the CF team and illustrates opportunities to better support women with CF in their decisions surrounding sexual and reproductive health, including through a patient-centered, disease-specific, reproductive goals decision aid.
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Affiliation(s)
- Mary M Leech
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Olivia M Stransky
- Center for Women's Health Research and Innovation, Pittsburgh, PA, USA
| | - Mehret Birru Talabi
- Center for Women's Health Research and Innovation, Pittsburgh, PA, USA; UPMC, Pittsburgh, PA, USA
| | - Sonya Borrero
- Center for Women's Health Research and Innovation, Pittsburgh, PA, USA; UPMC, Pittsburgh, PA, USA; Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Andrea H Roe
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Traci M Kazmerski
- Center for Women's Health Research and Innovation, Pittsburgh, PA, USA; Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
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Earle S, Blackburn M. Young adults with life-limiting or life-threatening conditions: sexuality and relationships support. BMJ Support Palliat Care 2020; 11:163-169. [PMID: 32241956 DOI: 10.1136/bmjspcare-2019-002070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 02/03/2020] [Accepted: 03/09/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVE The research project addressed the need to support young adults with issues relating to sexuality and relationships though the development of guidance and standards for practice. METHODS An action research project underpinned by an interpretivist qualitative framework. Participants were recruited to the project via three hospices in the UK. Data from four focus groups were analysed thematically using a process of constant comparison. RESULTS Sixteen young adults with life-limiting or life-threatening conditions aged 21-33 years participated in the study. Three significant themes were identified: sexuality and the transition to adulthood, recognising the significance of sex and relationships, and realising sexual rights. CONCLUSION Sexuality and relationships play an important role in the transition to adulthood for people with life-limiting or life-threatening conditions living in the UK. While young adults with these conditions may have considerable support needs, it is important to balance this with the freedom to exercise choice and to make independent decisions. Sex negativity can have an adverse impact on the experiences of young adults and creates barriers. Improved ongoing access to sex education and the provision of enabling environments that afford privacy and safety are important to support young adults with sexuality and relationships.
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Affiliation(s)
- Sarah Earle
- Faculty of Wellbeing, Education and Language Studies, The Open University, Milton Keynes, UK
| | - Madeleine Blackburn
- Faculty of Wellbeing, Education and Language Studies, The Open University, Milton Keynes, UK
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Rousset-Jablonski C, Reynaud Q, Perceval M, Nove-Josserand R, Durupt S, Ray-Coquard I, Golfier F, Durieu I. Improvement in contraceptive coverage and gynecological care of adult women with cystic fibrosis following the implementation of an on-site gynecological consultation. Contraception 2020; 101:183-188. [DOI: 10.1016/j.contraception.2019.10.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 10/27/2019] [Accepted: 10/30/2019] [Indexed: 12/18/2022]
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15
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Sexual and Reproductive Health in Cystic Fibrosis. Respir Med 2020. [DOI: 10.1007/978-3-030-42382-7_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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16
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Female Sexual Dysfunction as a Warning Sign of Chronic Disease Development. CURRENT SEXUAL HEALTH REPORTS 2019. [DOI: 10.1007/s11930-019-00229-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Bourke SJ, Anderson A, Briggs J, Doe S, Echevarria C, Choudhary M, McEleny K, Stewart J. Current status of fertility and family formation in men with cystic fibrosis. HUM FERTIL 2019; 24:298-303. [DOI: 10.1080/14647273.2019.1656824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Stephen J. Bourke
- Royal Victoria Infirmary, Adult Cystic Fibrosis Centre, Newcastle upon Tyne, UK
| | - Alan Anderson
- Royal Victoria Infirmary, Adult Cystic Fibrosis Centre, Newcastle upon Tyne, UK
| | - Jonathan Briggs
- Royal Victoria Infirmary, Adult Cystic Fibrosis Centre, Newcastle upon Tyne, UK
| | - Simon Doe
- Royal Victoria Infirmary, Adult Cystic Fibrosis Centre, Newcastle upon Tyne, UK
| | - Carlos Echevarria
- Royal Victoria Infirmary, Adult Cystic Fibrosis Centre, Newcastle upon Tyne, UK
| | - Meenakshi Choudhary
- Newcastle Fertility Centre at Life, International Centre for Life, Newcastle upon Tyne, UK
| | - Kevin McEleny
- Newcastle Fertility Centre at Life, International Centre for Life, Newcastle upon Tyne, UK
| | - Jane Stewart
- Newcastle Fertility Centre at Life, International Centre for Life, Newcastle upon Tyne, UK
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Kazmerski TM, Miller E, Sawicki GS, Thomas P, Prushinskaya O, Nelson E, Hill K, Miller A, Jean Emans S. Developing Sexual and Reproductive Health Educational Resources for Young Women with Cystic Fibrosis: A Structured Approach to Stakeholder Engagement. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2019; 12:267-276. [PMID: 30361885 DOI: 10.1007/s40271-018-0342-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE Stakeholder engagement, specifically integration of patient and family perspectives about what matters, is increasingly recognized as a critical component of patient-centered healthcare delivery. This study describes a structured approach to and evaluation of stakeholder engagement in the development of novel sexual and reproductive health (SRH) educational resources for adolescent and young adult (AYA) women with cystic fibrosis (CF). METHODS Key stakeholders participated in a systematic series of steps to iteratively develop and adapt patient educational resources. Process measures (stakeholder recruitment, composition, co-learning, and transparency) and proximal outcomes of stakeholder involvement (impact on the development process and satisfaction) were measured via recorded stakeholder recommendations and a stakeholder survey. RESULTS Seventeen stakeholders participated in seven group and two patient-only conference calls. The majority of stakeholders understood their roles, had their expectations met or exceeded, and were satisfied with the frequency and quality of engagement in the project. All stakeholders in attendance provided multiple concrete recommen-dations during the development process. Stakeholders explored the motivations of AYA women with CF related to SRH and agreed that the ideal resource should be online. After reviewing the design of existing resources, stakeholders decided by consensus to partner with a pre-existing young women's health website and created 11 CF-specific SRH guides. CONCLUSIONS This study illuminates a path for a formal process of stakeholder engagement and evaluation in educational resource development centered on the SRH care needs of AYA women with CF. Similar systematic, planned processes could be extended to other populations and aspects of healthcare.
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Affiliation(s)
- Traci M Kazmerski
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University Center, 120 Lytton Ave, Mezzanine Floor Suite M060, Pittsburgh, PA, 15213, USA. .,Center for Women's Health Research and Innovation (CWHRI), University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University Center, 120 Lytton Ave, Mezzanine Floor Suite M060, Pittsburgh, PA, 15213, USA.,Center for Women's Health Research and Innovation (CWHRI), University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Gregory S Sawicki
- Division of Respiratory Diseases, Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Phaedra Thomas
- Division of Adolescent/Young Adult Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Olga Prushinskaya
- Division of Respiratory Diseases, Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Eliza Nelson
- Division of Respiratory Diseases, Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Kelsey Hill
- Division of Respiratory Diseases, Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Anna Miller
- Division of Adolescent/Young Adult Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - S Jean Emans
- Division of Adolescent/Young Adult Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
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Sexual and Reproductive Health of Young Women With Cystic Fibrosis: A Concept Mapping Study. Acad Pediatr 2019; 19:307-314. [PMID: 30176294 DOI: 10.1016/j.acap.2018.08.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 08/21/2018] [Accepted: 08/25/2018] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Adolescent and young adult (AYA) women with pediatric-onset chronic diseases, such as cystic fibrosis (CF), face disease-specific sexual and reproductive health (SRH) concerns. Using concept mapping (CM), this study aimed to identify the SRH topics and outcomes valued by AYA women with CF and their parents. METHODS Women with CF who were 13 to 30years of age and parents of 13- to 30-year-old daughters with CF participated in an online CM study. Participants individually brainstormed, rated, and sorted SRH topics important for AYA women with CF. Using multidimensional scaling, hierarchical cluster analyses, and t tests to assess rating differences, multidisciplinary stakeholders interpreted results during in-person meetings. RESULTS Twenty-four participants (13 AYAs and 11 parents) generated 109 statements around SRH in CF; 88% completed rating and sorting. Sixteen stakeholders named 6 main clusters of concepts: fertility and pregnancy, deciding to have children, birth control, navigating life, sex, and gynecologic concerns. Participants rated birth control as highest in importance for adolescent women (mean = 3.9 ± 0.1 on a 5-point scale) and fertility and pregnancy as highest for young adult women (mean = 4.2 ± 0.04). Parents provided higher importance ratings for all clusters than patient participants. Stakeholders identified patient-centered outcomes for each cluster and focused on how to improve SRH knowledge, decision making, and patient-provider communication in the subspecialty setting. CONCLUSIONS Eliciting patient-centered outcomes using CM can inform improvements in the care of AYAs with pediatric-onset chronic diseases. The SRH topics and patient-centered outcomes identified in this study should inform enhancements to comprehensive clinical care delivery for these populations.
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20
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Kazmerski TM, Nelson EB, Newman LR, Haviland MJ, Luff D, Leichtner AM, Hayes MM, Miller E, Emans SJ, Sawicki GS. Interprofessional provider educational needs and preferences regarding the provision of sexual and reproductive health care in cystic fibrosis. J Cyst Fibros 2019; 18:671-676. [PMID: 30795973 DOI: 10.1016/j.jcf.2019.01.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/25/2019] [Accepted: 01/28/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Sexual and reproductive health (SRH) is an important disease-specific concern for adolescent and young adult (AYA) women that is not consistently addressed in cystic fibrosis (CF) centers. This study identifies educational needs and preferences of interprofessional CF providers regarding SRH in AYA women with CF. METHODS Interprofessional CF providers participated in an anonymous survey regarding general and CF-specific SRH knowledge and skills, factors for optimizing SRH care, and preferred approaches for SRH training. We calculated descriptive statistics for all respondents and stratified by provider type. RESULTS A total of 523 providers completed the survey (39% physicians/advanced practice providers, 19% nurses, 20% social workers, and 22% other disciplines). Half reported comfort responding to female AYA SRH concerns; however, only one-third were comfortable asking appropriate questions and confident taking a sexual history. Only 29% were comfortable with their current CF-specific SRH knowledge. Respondents' preferred SRH topics for further training included: pregnancy/parenthood planning, sexual functioning, urinary incontinence, intimate partner violence, and taking a sexual history. Nearly two-thirds felt having connection to women's health specialists familiar with CF would facilitate SRH care. Approximately one-third desired SRH educational materials for providers to view at point-of-care or through online case-based learning; <10% were interested in role playing SRH skills. CONCLUSION Many interprofessional CF providers lack comfort and skills in addressing SRH with AYA women with CF. Provider training needs and approaches identified in this study can be used to develop tailored educational interventions to improve comprehensive CF care.
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Affiliation(s)
- Traci M Kazmerski
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America; Center for Women's Health Research and Innovation (CWHRI), University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America.
| | - Eliza B Nelson
- Division of Respiratory Diseases, Department of Pediatrics, Boston Children's Hospital, Boston, MA, United States of America
| | - Lori R Newman
- Department of Medical Education, Boston Children's Hospital, Boston, MA, United States of America
| | - Miriam J Haviland
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States of America
| | - Donna Luff
- Department of Medical Education, Boston Children's Hospital, Boston, MA, United States of America
| | - Alan M Leichtner
- Department of Medical Education, Boston Children's Hospital, Boston, MA, United States of America
| | - Margaret M Hayes
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
| | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America; Center for Women's Health Research and Innovation (CWHRI), University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - S Jean Emans
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA, United States of America
| | - Gregory S Sawicki
- Division of Respiratory Diseases, Department of Pediatrics, Boston Children's Hospital, Boston, MA, United States of America
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21
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Wilson C, Duckers J, Speight L, Lau D, Ketchell RI, Edwards A. Assessment of Sexual Reproductive Health Knowledge Amongst Patients with Cystic Fibrosis. SEXUALITY AND DISABILITY 2019. [DOI: 10.1007/s11195-019-09558-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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22
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Norris E, Phillips S, Butler C, James K. Sex and Relationships Education for Individuals with Cystic Fibrosis: A Service-Based Approach. SEXUALITY AND DISABILITY 2018; 36:363-376. [PMID: 30524155 PMCID: PMC6244530 DOI: 10.1007/s11195-018-9535-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Increasing life expectancy within cystic fibrosis (CF) raises challenges around previously neglected topics such as sexual and reproductive health (SRH). The study aimed to gather retrospective experiences of service provision around SRH to consider the role of the CF service, age of information provision and unmet needs highlighting possible improvements to provision. A mixed-methods retrospective survey-based design was employed. An Adult CF team participated in a consultation session generating survey questions around SRH. A 20-item online survey was constructed and disseminated to adult CF patients. Unmet needs were found in SRH provision in pediatric and adult CF services, with further information required by patients on topics including parenthood and fertility. Results support previous research findings highlighting the need for standardized provision around SRH. Age of SRH provision suggested individual differences in need within the pediatric service. Further research could explore format and specific age of SRH information provision.
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Affiliation(s)
- Emily Norris
- Department of Psychology, University of Bath, Claverton Down, Bath, Somerset BA2 7AY UK
| | - Samantha Phillips
- Bristol Adult CF Centre, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Bristol, BS2 8HW UK
| | - Catherine Butler
- Department of Psychology, University of Bath, Claverton Down, Bath, Somerset BA2 7AY UK
| | - Kirsty James
- Bristol Adult CF Centre, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Bristol, BS2 8HW UK
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23
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Kazmerski TM, Hill K, Prushinskaya O, Nelson E, Greenberg J, Pitts SA, Borrero S, Miller E, Sawicki GS. Perspectives of adolescent girls with cystic fibrosis and parents on disease-specific sexual and reproductive health education. Pediatr Pulmonol 2018; 53:1027-1034. [PMID: 29696829 DOI: 10.1002/ppul.24015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 03/30/2018] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Adolescent girls with cystic fibrosis (CF) face significant disease-specific sexual and reproductive health (SRH) concerns that are not typically addressed in routine clinical care. Additionally, there is a paucity of developmentally appropriate CF-specific SRH educational resources for this population. The goal of this study was to explore patient and parent attitudes toward SRH educational resources for adolescent girls with CF. METHODS Adolescent girls ages 13-18 years with CF and parents of daughters ages 10-18 years with CF completed individual, semi-structured interviews regarding their experiences and preferences around CF-specific SRH education and care. To facilitate discussion, participants provided feedback on the format and design of existing SRH educational resources. Qualitative analysis was conducted using a thematic analysis approach. RESULTS We interviewed 26 participants (14 parents and 12 patients). The majority reported they had never discussed SRH in the CF care setting. All participants preferred a comprehensive, online patient educational resource complemented by real patient stories and interactive components. Participants noted that such resources should create a sense of normalcy and community around CF and female SRH. Most desired more frequent communication around SRH between adolescent girls with CF and their healthcare providers as a way to promote SRH knowledge, decision making, and health outcomes. DISCUSSION Adolescent girls with CF and their parents desire an online patient educational resource that normalizes SRH and enhances patient-provider communication around these topics. Creation of developmentally appropriate resources would facilitate improved health outcomes around this aspect of comprehensive care in CF.
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Affiliation(s)
- Traci M Kazmerski
- Division of Respiratory Diseases, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts.,Institute for Healthcare Improvement, Cambridge, Massachusetts
| | - Kelsey Hill
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University Medical Center, New York, New York
| | - Olga Prushinskaya
- Division of Respiratory Diseases, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Eliza Nelson
- Division of Respiratory Diseases, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Jonathan Greenberg
- Division of Respiratory Diseases, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Sarah Ab Pitts
- Division of Adolescent Medicine, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Sonya Borrero
- Department of Medicine, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania.,VA Pittsburgh Center for Health Equity Research and Promotion, Pittsburgh, Pennsylvania.,Center for Women's Health Research and Innovation (CWHRI), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Elizabeth Miller
- Center for Women's Health Research and Innovation (CWHRI), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - Gregory S Sawicki
- Division of Respiratory Diseases, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts
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Ladores S, Bray LA, Brown J. "If We Would Have Known": A Couple's Regret Over a Missed Opportunity to Have a Biological Child After Lung Transplantation. J Patient Exp 2018; 5:320-322. [PMID: 30574555 PMCID: PMC6295801 DOI: 10.1177/2374373518778861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Cystic fibrosis (CF) is a genetic, chronic disease that results in thickened secretions in the respiratory, gastrointestinal, and reproductive tracts. Over 95% of males with CF have congenital bilateral absence of the vas deferens causing infertility. This is a case study of a 29-year-old male who underwent a lung transplant after 8 months of oxygen dependency secondary to poor lung function. Approximately 1 year posttransplant, he and his wife decided that they wanted to start a family and consulted a fertility specialist who advised them to utilize donor sperm due to the teratogenic effects of posttransplant medications. Taken by surprise with this news, they expressed regret about the missed opportunity for pretransplant sperm aspiration and cryopreservation to conceive a biological child. He reported, “If we would have known, we would have made sure I [banked] my own [sperm].” This case study highlights a critical gap in CF comprehensive clinical care.
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Affiliation(s)
- Sigrid Ladores
- School of Nursing, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Leigh Ann Bray
- School of Nursing, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Janet Brown
- School of Nursing, The University of Alabama at Birmingham, Birmingham, AL, USA
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25
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Suivi et prise en charge gynécologique chez les femmes atteintes de mucoviscidose. Rev Mal Respir 2018; 35:592-603. [DOI: 10.1016/j.rmr.2017.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 08/03/2017] [Indexed: 11/18/2022]
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Farber JG, Prieur MG, Roach C, Shay R, Walter M, Borowitz D, Dellon EP. Difficult conversations: Discussing prognosis with children with cystic fibrosis. Pediatr Pulmonol 2018; 53. [PMID: 29528566 PMCID: PMC5904004 DOI: 10.1002/ppul.23975] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
UNLABELLED Background Despite the chronic, progressive, and life-threatening nature of cystic fibrosis (CF), there are no guidelines for when and how to communicate prognosis to children with CF. METHODS Semi-structured interviews with young adults with CF, parents of young adults with CF, and multidisciplinary CF health care providers assessed recall of and practices for communicating about prognosis. Recommendations for improvements were also solicited. RESULTS Young adults with CF recalled learning that life expectancy is limited by CF between the ages of 8 and 16 years, and that CF is a progressive disease between the ages of 7 and 19 years. They reported that the information often came from CF physicians or from online resources. Patients and parents reported earlier knowledge of prognosis than providers assumed. While learning about prognosis caused sadness and stress for some patients and families, others denied negative feelings. Interestingly, most patients reported that disclosure of prognosis had minimal impact on their adherence and treatment goals. Patients and parents reported wanting physicians to be involved in conversations about prognosis. However, providers noted several barriers to discussing prognosis, including their own reluctance, time limitations, and uncertainty about appropriate timing and content of communication. CONCLUSIONS Communication about prognosis is important but also difficult for providers, patients, and families. Appropriately timed conversations, using tools to facilitate communication, could ensure patients receive timely, accurate information.
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Affiliation(s)
- Julia Gray Farber
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Mary G Prieur
- Departments of Psychiatry and Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Christine Roach
- Department of Pediatrics, Jacobs School of Medicine, University at Buffalo of State University of New York, Buffalo, New York
| | - Rosemary Shay
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Michelle Walter
- Department of Geriatrics and Palliative Medicine, Jacobs School of Medicine, University at Buffalo of State University of New York, Buffalo, New York
| | - Drucy Borowitz
- Department of Pediatrics, Jacobs School of Medicine, University at Buffalo of State University of New York, Buffalo, New York.,Cystic Fibrosis Foundation, Bethesda, Maryland
| | - Elisabeth P Dellon
- Division of Pulmonology, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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Kazmerski TM, Gmelin T, Slocum B, Borrero S, Miller E. Attitudes and Decision Making Related to Pregnancy Among Young Women with Cystic Fibrosis. Matern Child Health J 2018; 21:818-824. [PMID: 27531009 DOI: 10.1007/s10995-016-2181-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Introduction The number of female patients with CF able to consider pregnancy has increased with improved therapies. This study explored attitudes and decision making regarding pregnancy among young women with CF. Methods Twenty-two women with CF ages 18-30 years completed semi-structured, in-person interviews exploring experiences with preconception counseling and reproductive care in the CF setting. Interviews were audio-recorded, transcribed, and coded using a thematic analysis approach. Results Participants indicated CF is a major factor in pregnancy decision making. Although women acknowledged that CF influences attitudes toward pregnancy, many expressed confusion about how CF can affect fertility/pregnancy. Many perceived disapproval from CF providers regarding pregnancy and were dissatisfied with reproductive care in the CF setting. Discussion Young female patients with CF reported poor understanding of the effect of CF on fertility and pregnancy and limited preconception counseling in CF care. Improvements in female sexual and reproductive health care in CF are warranted.
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Affiliation(s)
- Traci M Kazmerski
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, University of Pittsburgh, 4401 Penn Ave. AOB 3rd Floor Suite 3300, Pittsburgh, PA, 15224, USA.
| | - Theresa Gmelin
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, University of Pittsburgh, 4401 Penn Ave. AOB 3rd Floor Suite 3300, Pittsburgh, PA, 15224, USA
| | - Breonna Slocum
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Sonya Borrero
- Department of Medicine, University of Pittsburgh and VA Pittsburgh Center for Health Equity Research and Promotion, Pittsburgh, PA, USA
| | - Elizabeth Miller
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, University of Pittsburgh, 4401 Penn Ave. AOB 3rd Floor Suite 3300, Pittsburgh, PA, 15224, USA
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High proportion of abnormal pap smear tests and cervical dysplasia in women with cystic fibrosis. Eur J Obstet Gynecol Reprod Biol 2018; 221:40-45. [DOI: 10.1016/j.ejogrb.2017.12.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 11/16/2017] [Accepted: 12/05/2017] [Indexed: 02/06/2023]
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Kazmerski TM, Sawicki GS, Miller E, Jones KA, Abebe KZ, Tuchman LK, Ladores S, Rubenstein RC, Sagel SD, Weiner DJ, Pilewski JM, Orenstein DM, Borrero S. Sexual and reproductive health care utilization and preferences reported by young women with cystic fibrosis. J Cyst Fibros 2018; 17:64-70. [DOI: 10.1016/j.jcf.2017.08.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 08/12/2017] [Accepted: 08/13/2017] [Indexed: 01/06/2023]
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30
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Provider Attitudes and Practices toward Sexual and Reproductive Health Care for Young Women with Cystic Fibrosis. J Pediatr Adolesc Gynecol 2017; 30:546-552. [PMID: 28163120 DOI: 10.1016/j.jpag.2017.01.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 12/12/2016] [Accepted: 01/03/2017] [Indexed: 11/22/2022]
Abstract
STUDY OBJECTIVE To investigate the attitudes and practices of cystic fibrosis (CF) providers toward sexual and reproductive health (SRH) care in young women with CF. DESIGN, SETTING, PARTICIPANTS, AND INTERVENTIONS Adult and pediatric US CF providers were sent an online survey exploring their attitudes toward SRH importance, SRH care practices, and barriers/facilitators to SRH care in adolescent and/or young adult women. Descriptive statistics and logistic regression were used to analyze results. MAIN OUTCOME MEASURES Attitudes toward the importance of SRH care in patients with CF and self-report of practice patterns of SRH discussion. RESULTS Respondents (n = 196) were 57% pediatric (111/196) and 24% adult physicians (48/196) and 19% nurse practitioners (NPs)/physician assistants (PAs) (37/196). Ninety-four percent of respondents believed SRH was important for female patients with CF (184/196). More than 75% believed SRH care should be standardized within the CF care model (147/196) and 41% believed the CF team should have the primary role in SRH discussion and care (80/196). For many CF-specific SRH topics, discrepancies emerged between how important respondents believed these were to address and how often they reported discussing these topics in practice. Significant differences in SRH attitudes and practices were present between adult and pediatric physicians. The most significant barriers to SRH care identified were lack of time (70%, 137/196) and the presence of family in clinic room (54%, 106/196). Potential facilitators included training materials for providers (68%, 133/196) and written (71%, 139/196) or online (76%, 149/196) educational resources for patients. CONCLUSION CF providers perceive SRH topics as important to discuss, but identify barriers to routine discussion in current practice. Providers endorsed provider training and patient educational resources as means to improve SRH delivery.
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Sexual and reproductive health behaviors and experiences reported by young women with cystic fibrosis. J Cyst Fibros 2017; 17:57-63. [PMID: 28774749 DOI: 10.1016/j.jcf.2017.07.017] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 06/29/2017] [Accepted: 07/21/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND The prevalence of general and disease-specific sexual and reproductive health (SRH) concerns is unknown in the United States (U.S.) female CF population. This study aimed to describe and compare the SRH experiences and behaviors of young women with CF with the general U.S. POPULATION METHODS Young women with CF ages 15-24years from five geographically diverse U.S. CF centers participated in a survey investigating SRH. Results were summarized and compared to the U.S. National Survey of Family Growth (NSFG) using logistic regression adjusting for confounders. FINDINGS A total of 188 young women with CF (mean age 19.7±2.7years) completed the survey; data were compared to 1997 NSFG respondents (mean age 19.6±0.10years). Fifty-four percent of women with CF reported having had vaginal sex with a male partner compared to 66% of U.S. women (p=0.55). Women with CF were less likely to have ever used contraception (55% vs. 74%, p=0.0001) or have been tested for sexually transmitted infections in the past year (19% vs. 34%, p=0.001) compared to the general population. Two percent of women with CF reported having ever been pregnant compared to 24% of U.S. women (p<0.0001). One-third of young women with CF reported perceived pubertal delay, 16% urinary incontinence, 16% sexual dysfunction, and 49% yeast infections. INTERPRETATION Young women with CF face significant SRH concerns and appear to be experiencing gaps in SRH care provision. Opportunities exist for intervention development around this aspect of comprehensive CF care. FUNDING CF Foundation (KAZMER15A0); U.S. National Institutes of Health (UL1TR000005).
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32
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Frayman KB, Kazmerski TM, Sawyer SM. A systematic review of the prevalence and impact of urinary incontinence in cystic fibrosis. Respirology 2017; 23:46-54. [DOI: 10.1111/resp.13125] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 05/04/2017] [Accepted: 06/04/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Katherine B. Frayman
- Department of Respiratory and Sleep Medicine; Royal Children's Hospital; Parkville VIC Australia
- Department of Paediatrics; The University of Melbourne; Parkville VIC Australia
- Murdoch Childrens Research Institute; Parkville VIC Australia
| | - Traci M. Kazmerski
- Division of Pulmonary and Respiratory Diseases, Department of Medicine; Boston Children's Hospital; Boston MA USA
- Institute for Healthcare Improvement; Cambridge MA USA
| | - Susan M. Sawyer
- Department of Paediatrics; The University of Melbourne; Parkville VIC Australia
- Murdoch Childrens Research Institute; Parkville VIC Australia
- Royal Children's Hospital Centre for Adolescent Health; Parkville VIC Australia
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Aguiar KCA, Marson FAL, Gomez CCS, Pereira MC, Paschoal IA, Ribeiro AF, Ribeiro JD. Physical performance, quality of life and sexual satisfaction evaluation in adults with cystic fibrosis: An unexplored correlation. REVISTA PORTUGUESA DE PNEUMOLOGIA 2017; 23:179-192. [PMID: 28438512 DOI: 10.1016/j.rppnen.2017.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 02/23/2017] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Quality of life (QOL), sexual satisfaction (SS) and physical performance have been assessed in the management of numerous chronic diseases. METHODS In this study, the following tests and surveys were applied: (i) QOL questionnaire [Cystic Fibrosis Questionnaire (CFQ)]; (ii) SS questionnaire (SSQ) [female sexual quotient (FSQ) and male sexual quotient (MSQ)]; (iii) 6-minute walk test (6MWT). Spearman's correlation was used for comparison between the data; the Mann-Whitney test was applied to analyze the difference between genders. A total of 52 adult patients with CF were included in this study. RESULTS There was a positive correlation between CFQ domains and SSQ questions. The CFQ showed a positive correlation with peripheral oxygen saturation of hemoglobin (SpO2) and the distance walked in the 6MWT, and a negative correlation with the Borg scale. The SSQ showed positive correlation with the distance walked and a negative correlation with the Borg scale. For some markers evaluated in the 6MWT, there was sometimes association with the evaluated domains and questions. Male patients showed better scores in the emotional CFQ domain, better performance in SSQ and physical performance. CONCLUSIONS There was a correlation between CFQ, SSQ and 6MWT in CF. Finally; we believe that QOL surveys should assess the domain "sexuality" as well as physical performance tests.
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Affiliation(s)
- K C A Aguiar
- Department of Pediatrics, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - F A L Marson
- Department of Pediatrics, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil; Department of Medical Genetics, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil.
| | - C C S Gomez
- Department of Pediatrics, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - M C Pereira
- Department of Medical Clinic, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - I A Paschoal
- Department of Medical Clinic, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - A F Ribeiro
- Department of Pediatrics, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - J D Ribeiro
- Department of Pediatrics, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
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Kazmerski TM, Borrero S, Tuchman LK, Weiner DJ, Pilewski JM, Orenstein DM, Miller E. Provider and Patient Attitudes Regarding Sexual Health in Young Women With Cystic Fibrosis. Pediatrics 2016; 137:peds.2015-4452. [PMID: 27244858 DOI: 10.1542/peds.2015-4452] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/03/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To explore the attitudes, preferences, and experiences of patients with cystic fibrosis (CF) and CF providers toward sexual and reproductive health (SRH) care for young women with CF. METHODS Young women with CF aged 18 to 30 years from a US CF care center and pediatric and adult CF program directors from a national sample participated in qualitative interviews investigating their experiences regarding SRH care and their attitudes and preferences toward SRH care provision in the CF setting. Interviews were audio-recorded, transcribed, and coded by using a thematic analysis approach. RESULTS Twenty-two patient participants and 16 CF program directors were interviewed. Themes shared by both groups included the importance of SRH discussion in the CF care setting, patient and provider discomfort as a barrier to SRH care, and the need for SRH educational resources and provider training to improve SRH care. Providers highlighted the lack of standardization around SRH care in the current CF care model. Patients desired SRH educational resources coupled with early SRH discussions initiated by their CF provider. CONCLUSIONS Both CF providers and patients agree that the CF provider has a fundamental role in providing CF-specific SRH care. Educational resources coupled with individualized SRH discussions may facilitate improved SRH care for young women with CF. Investigation into the implementation of SRH education and services into pediatric-onset chronic disease care models is needed.
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Affiliation(s)
- Traci M Kazmerski
- Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Center for Women's Health Research and Innovation (CWHRI), University of Pittsburgh School of Medicine, and
| | - Sonya Borrero
- Center for Women's Health Research and Innovation (CWHRI), University of Pittsburgh School of Medicine, and Department of Medicine, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania; VA Pittsburgh Center for Health Equity Research and Promotion, Pittsburgh, Pennsylvania; and
| | - Lisa K Tuchman
- Division of Adolescent and Young Adult Medicine, Children's National Health System, Washington, District of Columbia
| | - Daniel J Weiner
- Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC
| | - Joseph M Pilewski
- Department of Medicine, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Elizabeth Miller
- Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Center for Women's Health Research and Innovation (CWHRI), University of Pittsburgh School of Medicine, and
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Kazmerski TM, Tuchman LK, Borrero S, Weiner D, Pilewski JM, Orenstein DM, Miller E. Cystic fibrosis program directors' attitudes toward sexual and reproductive health in young women with CF. Pediatr Pulmonol 2016; 51:22-7. [PMID: 26551521 DOI: 10.1002/ppul.23321] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 08/20/2015] [Accepted: 09/14/2015] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Advancements in therapy have led to dramatic increases in the life expectancy of patients with cystic fibrosis (CF). As survival improves, young women with CF will have expectations for their sexual and reproductive health (SRH) futures similar to their counterparts without CF. As they face unique CF-specific SRH concerns, they may rely on CF care providers for disease-specific SRH care provision. The purpose of this study was to investigate the attitudes of CF providers toward female SRH and perceived barriers in the current CF care model. MATERIALS AND METHODS U.S. CF program directors (n = 16) participated in qualitative interviews investigating attitudes and barriers to female CF SRH care. Interviews were audio-recorded, transcribed, and coded using a thematic analysis approach. RESULTS Participants (nine pediatric, five adult, and two combined) all agreed CF providers have a fundamental role in CF female SRH care. Most respondents named lack of time and patient and provider discomfort as significant barriers to effective SRH communication. Other reported barriers included: lack of training in SRH, family members in the room, low priority of SRH in setting of other CF issues, and lack of adequate rapport with patients. DISCUSSION This is the first study to assess the attitudes and experiences of CF care providers toward SRH discussion and care among female CF patients. Despite their perceived fundamental role in CF female SRH care, CF providers face significant barriers. Investment in provider training is needed to better address the complex SRH needs of young female patients.
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Affiliation(s)
- Traci M Kazmerski
- Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Lisa K Tuchman
- Division of Adolescent and Young Adult Medicine, Children's National Health System, Washington, DC
| | - Sonya Borrero
- Department of Medicine, University of Pittsburgh and VA Pittsburgh Center for Health Equity Research and Promotion, Pittsburgh, Pennsylvania
| | - Daniel Weiner
- Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Joseph M Pilewski
- Department of Medicine, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - David M Orenstein
- Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Elizabeth Miller
- Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Cystic Fibrosis Transitions of Care: Lessons Learned and Future Directions for Cystic Fibrosis. Clin Chest Med 2015; 37:119-26. [PMID: 26857773 DOI: 10.1016/j.ccm.2015.11.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Advances in cystic fibrosis (CF) care transformed the condition from one considered lethal by age 7 into a chronic illness (median lifespan, >40 years). With the growing numbers of adults with CF voicing their preference for care in age appropriate settings, the CF community met the challenge by developing an adult-focused care system modeled on the highly successful pediatric CF centers. Adult CF programs ensure lifelong CF specialty care. Preparation for transfer occurs in a process of "transition." This article reviews progress in transition-related care and provides recommendations for research and clinical practice to improve the transition process.
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AKRE C, LIGHT A, SHERMAN L, POLVINEN J, RICH M. What young people with spina bifida want to know about sex and are not being told. Child Care Health Dev 2015; 41:963-9. [PMID: 26331351 PMCID: PMC4715573 DOI: 10.1111/cch.12282] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 06/30/2015] [Accepted: 07/15/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The aim of this paper was to examine sexual knowledge, concerns and needs of youth with spina bifida (SB) to inform the medical community on ways to better support their sexual health. METHODS As part of the Video Intervention/Prevention Assessment (VIA) - transitions, a prospective cohort study, 309 h of video data were collected from 14 participants (13-28 years old) with SB. Participants were loaned a video camcorder for 8-12 weeks to shoot visual narratives about any aspects of their lives. V/A visual narratives were analysed with grounded theory using NVivo. RESULTS Out of 14 participants, 11 (six women) addressed issues surrounding romantic relationships and sexuality in their video clips. Analysis revealed shared concerns, questions and challenges regarding sexuality gathered under four main themes: romantic relationships, sexuality, fertility and parenthood, and need for more talk on sexuality. CONCLUSIONS Youth with SB reported difficulties in finding answers to questions regarding their sexuality, romantic relationships and fertility. This study revealed a need for help from the medical community to inform and empower youth with SB in the area of sexual health. Through sexual and reproductive health education with patients and parents starting at an early age, medical providers can further encourage healthy emotional and physical development in adolescents transitioning into adulthood.
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Affiliation(s)
- Christina AKRE
- Center on Media and Child Health, Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Harvard Medical School, Harvard School of Public Health, 300 Longwood Avenue, Boston, Massachusetts 02215, USA, phone: +1 (617) 355-4127, fax: +1 (617) 730-0004
| | - Alexis LIGHT
- Washington Hospital Center Department of Obstetrics and Gynecology, Washington, DC, USA
| | - Laura SHERMAN
- Wheelock College, Boston, Massachusetts, Boston, Massachusetts, USA
| | - Julie POLVINEN
- Center on Media and Child Health, Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Harvard Medical School, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Michael RICH
- Center on Media and Child Health, Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Harvard Medical School, Harvard School of Public Health, Boston, Massachusetts, USA
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Rousset Jablonski C, Reynaud Q, Perceval M, Nove-Josserand R, Durupt S, Lega J, Durieu I. Contraceptive practices and cervical screening in women with cystic fibrosis. Hum Reprod 2015; 30:2547-51. [DOI: 10.1093/humrep/dev217] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 08/11/2015] [Indexed: 01/10/2023] Open
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