Health perceptions and medical care opinions of inner-city adults with sickle cell disease or asthma compared with those of their siblings

Lessons Learned from Building a Pediatric-to-Adult Sickle Cell Transition Program

OBJECTIVE

More effective transitions and transfers of young people with sickle cell disease (SCD) into the adult healthcare setting is a focus of both primary care and specialty care medical organizations. Effective transition and transfer requires six core elements: establishing a policy, tracking progress, administering transition readiness assessments, planning for adult care, transferring to adult care, and integrating into an adult practice. We developed a program using these six core elements. The objective of our report was to assess the development and implementation of this program.

METHODS

We used the six core elements to develop and implement a program at Virginia Commonwealth University for children and adolescents with SCD to transition to adult health care.

RESULTS

We assessed individuals' differences by age and grade, their independent living skills, their feelings about moving to adult care; tallied and analyzed several assessment scales; and assessed transfer success and patient retention.

CONCLUSIONS

The principles and lessons we learned in developing and implementing this program over 5 years, accompanied by caring, flexible, and dedicated care team members, often can overcome even severe barriers to care transitions.

Survey of Physician Perspective towards Management of Pain for Chronic Conditions in the Emergency Department

Sickle cell disease (SCD) pain is often acute-on-chronic, likening it to other chronic acute-on-chronic pain conditions. Pain treatment of SCD was already reported as inadequate prior to the current opioid epidemic, but attitudes underlying treatment were understudied. Understanding these attitudes prior to the current epidemic would be revealing. Therefore in 1997, before the current opioid epidemic, we surveyed physicians' attitudes toward pain management and treatment preferences for acute pain exacerbations in the Emergency Department in SCD versus those of chronic pancreatitis and chronic low back pain, two other acute-on-chronic pain diseases. Thirty-nine residency trainees were surveyed in a level one triage hospital. Resident estimates of the rate of opioid addiction in SCD were higher than estimates in both chronic pancreatitis and chronic low back pain. Most residents relied on their personal clinical experience rather than external sources of data or knowledge as the most important driver when they managed chronic pain. This survey research shows that, predating the current opioid epidemic, there was both a backdrop of opioid-phobia and a bias against treating SCD pain compared to other chronic pain conditions among our sample. Repeating this survey research among current training physicians, along with surveys of other attitudes, would provide useful comparisons.

Adult sickle cell quality-of-life measurement information system (ASCQ-Me): conceptual model based on review of the literature and formative research

OBJECTIVES

Research-derived evidence about the impact of sickle cell disease (SCD) on the lives of affected adults is lacking. We conducted formative research to provide the basis for a comprehensive description of how SCD affects the lives of adults, with the goal of developing a SCD-specific quality-of-life measurement system.

METHODS

We conducted a comprehensive literature review of patient-reported outcomes, followed by a series of focus groups and structured individual interviews with adults with SCD (n=122) and their health care providers (n=15).

RESULTS

We reviewed 473 abstracts and included 86 articles in the final review. The literature revealed broad categories of the impact of SCD and its treatment on the lives of adults-pain; emotional distress; social-role functioning; overall quality-of-life; and quality of care. We classified 1213 incidents from the focus groups and interviews into a taxonomy (16 domains) that met the criterion for saturation and was demonstrated to be reliable for the classification of incidents. The final conceptual model was built upon the taxonomy.

DISCUSSION

Our conceptual model was similar to previous models with the effects of pain predominating, interwoven with emotional distress, quality of care, and stigmatization. We found a broad range of emotions reflected, including positive effects of SCD. Items for the quality-of-life measure were derived from the taxonomy and the conceptual model may be of use in generating hypotheses for clinical research and improving understanding for clinicians of the lived experience of adults with SCD.

Treating pain in sickle cell disease with opioids: clinical advances, ethical pitfalls

This article explores the ethical principles of prescribing in Sickle Cell Disease. The first two sections of the article provide detailed scientific justification for the last section of the manuscript, which explores and discusses the ethical principles.

Frequently asked questions by hospitalists managing pain in adults with sickle cell disease

Pain is the predominant medical presentation to hospitalists for patients with sickle cell disease (SCD). Dramatic treatment gains of SCD in childhood have resulted in more adults now requiring hospitalization than children. This has created new challenges to improve the quality of hospital care for SCD. The evidence base for pain management in SCD is lacking. We therefore offer some evidence and our informed opinion to answer frequently asked questions (FAQs) about pain management by hospitalists caring for adults with SCD. The most common questions center around defining a crisis; selecting and managing opioids; distinguishing between opioid tolerance, physical dependence, and addiction or misuse; determining appropriateness of discharge; and avoiding lengthy or recurrent hospitalizations.

Parental attitudes toward research participation in pediatric sickle cell disease

BACKGROUND

Socio-cultural attitudes and perceptions are commonly cited barriers to the recruitment of African-Americans for medical research, yet no studies have examined the factors influencing research participation among individuals with sickle cell disease (SCD) or caregivers of children with SCD.

PROCEDURE

We distributed a 32-item, self-administered survey to parents or legal guardians of children with SCD over a 6-month period. We used Pearson's chi-square to determine factors associated with a favorable attitude toward research participation and logistic regression to determine independent associations.

RESULTS

We collected 151 surveys in this pilot study. In general, 86% of respondents believed more research needed to be done for SCD and 57% would allow their child to participate in a medical research study, corresponding to a favorable attitude. Respondent belief that more research needed to be done for SCD (OR 23.4, 95% CI 4.5-121.9, P = 0.001), perception of greater severity of their own child's SCD (OR 2.7, 95% CI 1.0-7.1, P = 0.041) and prior exposure to research (OR 3.2, 95% CI 1.0-10.3, P = 0.043) were significantly associated with a favorable attitude, although only the first two remained independent associations in our regression model. Attitude toward research participation was not affected by respondent country of birth.

CONCLUSIONS

Parents of children with SCD who allow participation in medical research are likely to believe that more research is needed in SCD and that their child's SCD is moderate to severe. Developing effective tools, based on identified knowledge gaps related to clinical research, may improve research participation in this population.

Hospital self-discharge among adults with sickle-cell disease (SCD): associations with trust and interpersonal experiences with care

BACKGROUND

Patient self-discharge from hospitals has been associated with a number of negative clinical outcomes. Research suggests that low patient trust and poor quality interpersonal experiences with care may be associated with hospital self-discharge. Although adults with sickle-cell disease (SCD) often report poorer quality healthcare experiences, research examining hospital self-discharge and its associations with both patient trust and quality of healthcare experiences is lacking for this patient population.

OBJECTIVE

To examine the association of interpersonal experiences with care and trust in the medical profession with hospital self-discharge history among patients with SCD.

DESIGN

Cross-sectional study.

SETTING

A large, urban academic medical center.

PATIENTS

Adults (age 18+ years) with SCD seeking outpatient or inpatient care.

MEASUREMENTS

We compared patient characteristics, patient perceptions of the quality of interpersonal experiences with care, and levels of trust between patients with and without a history of hospital self-discharge.

RESULTS

Adjusted analyses indicated that having a history of hospital self-discharge was associated with more negative interpersonal experiences and lower levels of trust.

CONCLUSIONS

Hospital self-discharge may be an important indicator of the quality of care received by adults with SCD. Further research is needed to better understand this phenomenon so that effective interventions can be designed to prevent its occurrence.

Sickle cell disease in the United States: looking back and forward at 100 years of progress in management and survival

The past 100 years since James Herrick's first description of sickle cell disease in the United States have been characterized by the gradual development of management strategies. We review the progress in sickle cell disease management in the United States over the past 100 years, with emphasis on the diverse forces surrounding advances in disease management. Mortality and survival data are presented chronologically, with an attempt to highlight improvements in survival associated with specific advancements for pediatric and adult care. Finally, the future course for sickle cell disease management is explored, given the continued work in advancing the field.

The pain experience of patients with sickle cell anemia

Sickle cell anemia is a genetic disorder that affects 1 in 600 black infants in the United States. The painful crisis is one of its most characteristic manifestations and consists of pain in the extremities, back, abdomen, or chest. It may occur in 4 phases and may be precipitated by a variety of factors. The frequency, location, duration, severity, and character of pain differ both within and among patients. The pain may be localized, involve several areas, be diffuse, or be migratory. The intensity of pain varies from mild to excruciating and is perceived to be more intense by those who have experienced other forms of pain such as postoperative pain. Patients with sickle cell anemia who experience frequent painful crises exhibit problems with self-concept and low self-esteem, anxiety, depression, dissatisfaction with body image, poor school performance, social isolation, decreased participation in normal activities of daily living, and poor peer and family relationships. The periodic and unpredictable episodes can be incapacitating and may affect the way children see and feel about themselves, the way they relate to other people, the goals they set for themselves, and the way they approach a range of activities and situations. Research is very limited, and most of the available literature is based on personal observations, opinions, and anecdotal reports. The purpose of this report is to describe the phases of a painful episode as well as to examine the predisposing factors to, defining characteristics of, and patient outcomes associated with a painful crisis from sickle cell anemia.

Psychosocial determinants of health care utilization in sickle cell disease patients

This article reviews the literature on psychosocial factors associated with sickle cell disease and health care utilization. The Health Belief Model is proposed as a framework that may help guide our understanding about how these variables influence health care utilization. Since the existing literature on psychosocial variables and health care utilization among sickle cell disease patients is scant, studies from related behavioral medicine research will be presented as a basis for future research. This review suggests that identifying modifiable psychosocial variables associated with utilization could aid in the development of interventions aimed at reducing utilization and thereby reducing health care costs.