1
|
Heitzer AM, MacArthur E, Tamboli M, Wilson A, Hankins JS, Hoyt CR. Awareness, access, and communication: provider perspectives on early intervention services for children with sickle cell disease. Front Pediatr 2024; 12:1366522. [PMID: 38590772 PMCID: PMC11000123 DOI: 10.3389/fped.2024.1366522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 03/13/2024] [Indexed: 04/10/2024] Open
Abstract
Purpose This study aimed to identify determinants influencing the utilization of early intervention services among young children with sickle cell disease (SCD) based on perspectives from medical and early intervention providers. Design and methods Early intervention and medical providers from the catchment area surrounding St. Jude Children's Research Hospital and Washington University were recruited (20 total providers). Interviews were completed over the phone and audio recorded. All interviews were transcribed verbatim, coded, and analyzed using inductive thematic analysis. Results Three overarching themes were identified from both groups: Awareness (e.g., lack of awareness about the EI system and SCD), Access (e.g., difficulties accessing services), and Communication (e.g., limited communication between medical and early intervention providers, and between providers and families). Although these three themes were shared by medical and early intervention providers, the differing perspectives of each produced subthemes unique to the two professional fields. Conclusions Early intervention services can limit the neurodevelopmental deficits experienced by young children with SCD; however, most children with SCD do not receive these services. The perspectives of early intervention and medical providers highlight several potential solutions to increase early intervention utilization among young children with SCD.
Collapse
Affiliation(s)
- Andrew M. Heitzer
- Department of Psychology and Biobehavioral Sciences, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Erin MacArthur
- Department of Psychology and Biobehavioral Sciences, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Mollie Tamboli
- Department of Psychology and Biobehavioral Sciences, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Ashley Wilson
- Program in Occupational Therapy, Washington University in St. Louis, St. Louis, MO, United States
| | - Jane S. Hankins
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, United States
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Catherine R. Hoyt
- Program in Occupational Therapy, Departments of Neurology and Pediatrics, Washington University in St. Louis, St. Louis, MO, United States
| |
Collapse
|
2
|
Heitzer AM, Longoria J, Porter JS, MacArthur E, Potter B, Ding J, Gossett J, Kang G, Hankins JS. Internalizing Symptoms in Adolescents With Sickle Cell Disease. J Pediatr Psychol 2023; 48:91-103. [PMID: 35980301 PMCID: PMC10120839 DOI: 10.1093/jpepsy/jsac068] [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: 04/08/2022] [Revised: 07/26/2022] [Accepted: 08/01/2022] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE Sickle cell disease (SCD) is a genetic blood disorder that may affect patients' mood and behavior. However, measuring the prevalence of internalizing symptoms (anxiety and depression) in patients with SCD has been elusive. We assessed internalizing symptoms in adolescents with SCD to evaluate prevalence and to test whether neurocognitive performance and frequency of pain-related episodes were associated with internalizing concerns. METHODS One hundred eighty-five patients (57% HbSS/HbSß0-thalassemia, 43% HbSC/HbSß+-thalassemia), ages 12-18 years, received a neuropsychological evaluation as a part of a larger cohort study. Internalizing symptoms were measured using the Behavior Assessment System for Children, Second or Third Edition. Scores on the depression and anxiety scales were compared to normative values using Wilcoxon signed rank test. Spearman correlations examined associations between neurocognitive performances and internalizing symptoms. Robust multivariable regression models measured associations between internalizing symptoms and age, sex, sickle genotype, total hemoglobin, fetal hemoglobin, socioeconomic status, and frequency of pain episodes. RESULTS Parent- and self-reported ratings of internalizing symptoms were not elevated compared to normative expectations. Overall, 1.8% and 6.3% of the sample displayed clinically elevated symptoms of anxiety and depression based on self-report, respectively. There were no associations between internalizing symptoms and neurocognitive performance (all p > .05). In multivariable analyses, the frequency of pain episodes was positively associated with self-reported anxiety (p = .006) and parent-reported depressive symptoms (p = .017). CONCLUSIONS Adolescents with SCD do not report elevated internalizing symptoms compared to normative expectations. Further research is needed to examine the trajectory of internalizing symptoms and the bidirectional relationship between pain and psychosocial functioning in SCD.
Collapse
Affiliation(s)
- Andrew M Heitzer
- Department of Psychology, St. Jude Children's Research Hospital, USA
| | - Jennifer Longoria
- Department of Psychology, St. Jude Children's Research Hospital, USA
| | - Jerlym S Porter
- Department of Psychology, St. Jude Children's Research Hospital, USA
| | - Erin MacArthur
- Department of Psychology, St. Jude Children's Research Hospital, USA
| | - Brian Potter
- Department of Psychology, St. Jude Children's Research Hospital, USA
| | - Juan Ding
- Department of Biostatistics, St. Jude Children's Research Hospital, USA
| | - Jeffrey Gossett
- Department of Biostatistics, St. Jude Children's Research Hospital, USA
| | - Guolian Kang
- Department of Biostatistics, St. Jude Children's Research Hospital, USA
| | - Jane S Hankins
- Department of Hematology, St. Jude Children's Research Hospital, USA
| |
Collapse
|
3
|
Sil S, Manikowski A, Schneider M, Cohen LL, Dampier C. Identifying Chronic Pain Subgroups in Pediatric Sickle Cell Disease: A Cluster-Analytic Approach. Clin J Pain 2022; 38:601-611. [PMID: 35997659 PMCID: PMC9481686 DOI: 10.1097/ajp.0000000000001065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 08/11/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Youth with sickle cell disease (SCD) and chronic pain, defined in this study as pain on most days for 3 months, experience variability in daily pain and physical and psychosocial functioning. This study aimed to (1) empirically derive chronic pain subgroups based on pain characteristics among youth with chronic SCD pain; and (2) investigate derived subgroups for differences in sociodemographics, clinical characteristics, and psychosocial and functional outcomes. MATERIALS AND METHODS Youth with chronic SCD pain (n=62, Mage =13.9, SD=2.5, 10 to 18 y; 58% female, 60% HbSS) completed a battery of questionnaires. Clinical characteristics (eg, medications, treatments) and health care utilization were abstracted from electronic medical records. Hierarchical cluster analysis informed the number of clusters at the patient level. k-means cluster analysis used multidimensional pain assessment to identify and assign patients to clusters. RESULTS Cluster 1 (n=35; Moderate Frequency, Moderate Pain) demonstrated significantly lower worst pain intensity, number of pain days per month, number of body sites affected by pain, and pain quality ratings. Cluster 2 (n=27; Almost Daily, High Pain) reported high ratings of worst pain intensity, almost daily to daily pain, greater number of body sites affected by pain, and higher ratings of pain quality (all P 's <0.05). There were no differences between subgroups by sociodemographics, clinical characteristics, or health care utilization. The Almost Daily, High Pain subgroup reported significantly higher pain interference, depressive symptoms, and pain catastrophizing than the Moderate Frequency, Moderate Pain subgroup. DISCUSSION Identifying chronic SCD pain subgroups may inform tailored assessment and intervention to mitigate poor pain and functional outcomes.
Collapse
Affiliation(s)
- Soumitri Sil
- Emory University School of Medicine, Department of Pediatrics
- Children’s Healthcare of Atlanta, Aflac Cancer and Blood Disorders Center
| | - Alison Manikowski
- Children’s Healthcare of Atlanta, Aflac Cancer and Blood Disorders Center
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences
| | - Mallory Schneider
- Children’s Healthcare of Atlanta, Aflac Cancer and Blood Disorders Center
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences
| | - Lindsey L. Cohen
- Children’s Healthcare of Atlanta, Aflac Cancer and Blood Disorders Center
- Georgia State University, Department of Psychology
| | - Carlton Dampier
- Emory University School of Medicine, Department of Pediatrics
- Children’s Healthcare of Atlanta, Aflac Cancer and Blood Disorders Center
| |
Collapse
|
4
|
Moody KL. Healthcare utilization and the quality of life of children and adolescents with sickle cell disease. Pediatr Blood Cancer 2022; 69:e29685. [PMID: 35373909 DOI: 10.1002/pbc.29685] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 03/03/2022] [Accepted: 03/09/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND/OBJECTIVE Youth diagnosed with sickle cell disease (SCD) are at increased risk of poor health-related quality of life (HRQOL) due to the complexities associated with this disease. The literature notes that predictors such as pain and poor mental health are associated with increased healthcare access; however, the connection between healthcare use and their overall well-being has been understudied. This study investigates whether healthcare utilization predicts the HRQOL in youth with SCD. DESIGN/METHODS Patients completed the Pediatric Quality of Life (PedsQL) 3.0 SCD module, whereas the researcher conducted a retrospective chart review to gather patient characteristics such as emergency room (ER) and hospitalization occurrences over the past 12 months. RESULTS The study consisted of 150 pediatric patients with SCD, ages 8-17 years old, and their parents. Patients with ≥ 4 ER visits and hospitalizations reported worse HRQOL scores than their respective counterparts. Additionally, a higher frequency of ER visits (P = 0.05) and hospitalizations (P = 0.005) predicted lower HRQOL scores. Age (P = 0.04) also emerged as a significant predictor for both regression models, as increased healthcare access among older patients with SCD was associated with poorer HRQOL. CONCLUSION This study found that as youth with SCD require ER treatment and/or hospital admission, they are at increased risk for lower HRQOL, specifically as they get older. Findings suggest that attention should be paid to patients who require more frequent healthcare intervention. Improvement in outpatient care of pediatric patients with SCD may help to mitigate ER and inpatient use.
Collapse
Affiliation(s)
- Kendall L Moody
- School of Social Work, Howard University, Washington, District of Columbia
| |
Collapse
|
5
|
Johnson YL, Woodward K, Dampier C, Cohen L, Sil S. Biopsychosocial Factors Associated with Parenting Stress in Pediatric Sickle Cell Disease. J Clin Psychol Med Settings 2022; 29:365-374. [PMID: 34994921 PMCID: PMC9187584 DOI: 10.1007/s10880-021-09837-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2021] [Indexed: 01/11/2023]
Abstract
Caregivers of children with sickle cell disease (SCD) experience significant physical and emotional hardship with their child's disease management. Little is known about the potential contributors to parenting stress in pediatric SCD. The present study aimed to identify child and caregiver biopsychosocial factors associated with disease-related parenting stress in pediatric SCD. Participants included 74 caregiver-youth dyads. Parenting stress was associated with increased child pain frequency, more missed school days, and increased healthcare utilization, and inversely correlated with caregiver mental health and social-emotional functioning. Parenting stress also partially explained the relationship between child pain frequency and healthcare utilization after controlling for parent depression and anxiety. Parenting stress may play a unique and critical role in pediatric SCD and underscore the impact parenting stress may have on youth in medical and academic settings. Further research is warranted to determine risk factors and appropriate interventions for parenting stress to improve comprehensive patient care.
Collapse
Affiliation(s)
- Yelena L Johnson
- Children's Healthcare of Atlanta, Aflac Cancer and Blood Disorders Center, Atlanta, GA, 30322, USA
- Department of Psychiatry and Behavioral Science, Emory University School of Medicine, Atlanta, GA, USA
| | - Kerri Woodward
- Children's Healthcare of Atlanta, Aflac Cancer and Blood Disorders Center, Atlanta, GA, 30322, USA
- Department of Psychiatry and Behavioral Science, Emory University School of Medicine, Atlanta, GA, USA
| | - Carlton Dampier
- Children's Healthcare of Atlanta, Aflac Cancer and Blood Disorders Center, Atlanta, GA, 30322, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Lindsey Cohen
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | - Soumitri Sil
- Children's Healthcare of Atlanta, Aflac Cancer and Blood Disorders Center, Atlanta, GA, 30322, USA.
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
| |
Collapse
|
6
|
Arends AM, Perez A, Wilder C, Jacob SA. Evaluation of Individualized Pain Plans for Children With Sickle Cell Disease Admitted for Vaso-occlusive Crisis at Riley Hospital for Children. J Pediatr Pharmacol Ther 2022; 27:312-315. [PMID: 35558343 PMCID: PMC9088439 DOI: 10.5863/1551-6776-27.4.312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 10/22/2021] [Indexed: 09/17/2023]
Abstract
OBJECTIVE Vaso-occlusive crisis (VOC) is the most common problem reported by patients with sickle cell disease (SCD). The objective of this study was to evaluate the impact of individualized pain plans in pediatric patients with SCD admitted for VOC. METHODS This was a pre- and post-study of patients with SCD admitted to Riley Hospital for Children for VOC from July 1, 2019, through July 1, 2020. The primary outcome was length of inpatient stay for VOC. Secondary outcomes included final pain score, days on scheduled opioids, days on breakthrough opioids, and average morphine milligram equivalents (MME) used per day. RESULTS Nine patients were included. The mean age was 16 years (range, 10-20 years). Key clinical findings were decreases in median [IQR] for final pain scores (7 [4.5-9] vs 6 [2.5-8], p = 0.396) and number of days of breakthrough opioid use (5 [3-8] vs 4 [2.5-5.5], p = 0.233). Following implementation of an individualized pain plan, there was an increase in median average MME per day (65.94 [53.1-97.7] vs 82.85 [41-114.3], p = 0.844). Median length of stay and days on scheduled opioids remained the same. CONCLUSIONS This study demonstrated that use of individualized pain plans in a small population of patients with SCD might result in decreased pain scores and decreased days on breakthrough opioids.
Collapse
Affiliation(s)
- Alexandria M. Arends
- Riley Hospital for Children at Indiana University Health (AMA, SAJ), Indianapolis, IN
| | | | | | - Seethal A. Jacob
- Riley Hospital for Children at Indiana University Health (AMA, SAJ), Indianapolis, IN
- Center for Pediatric and Adolescent Comparative Effectiveness Research (SAJ), Indiana University, Indianapolis, IN
| |
Collapse
|
7
|
Stokoe M, Zwicker HM, Forbes C, Abu-Saris NEH, Fay-McClymont TB, Désiré N, Guilcher GM, Singh G, Leaker M, Yeates KO, Russel KB, Cho S, Carrels T, Rahamatullah I, Henry B, Dunnewold N, Schulte F. Health related quality of life in children with sickle cell disease: A systematic review and meta-analysis. Blood Rev 2022; 56:100982. [DOI: 10.1016/j.blre.2022.100982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 04/27/2022] [Accepted: 05/16/2022] [Indexed: 11/02/2022]
|
8
|
The association between sleep disturbances and neurocognitive function in pediatric sickle cell disease. Sleep Med 2022; 97:27-35. [DOI: 10.1016/j.sleep.2022.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 05/17/2022] [Accepted: 05/20/2022] [Indexed: 11/17/2022]
|
9
|
Claahsen - van der Grinten HL, Speiser PW, Ahmed SF, Arlt W, Auchus RJ, Falhammar H, Flück CE, Guasti L, Huebner A, Kortmann BBM, Krone N, Merke DP, Miller WL, Nordenström A, Reisch N, Sandberg DE, Stikkelbroeck NMML, Touraine P, Utari A, Wudy SA, White PC. Congenital Adrenal Hyperplasia-Current Insights in Pathophysiology, Diagnostics, and Management. Endocr Rev 2022; 43:91-159. [PMID: 33961029 PMCID: PMC8755999 DOI: 10.1210/endrev/bnab016] [Citation(s) in RCA: 132] [Impact Index Per Article: 66.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Indexed: 11/19/2022]
Abstract
Congenital adrenal hyperplasia (CAH) is a group of autosomal recessive disorders affecting cortisol biosynthesis. Reduced activity of an enzyme required for cortisol production leads to chronic overstimulation of the adrenal cortex and accumulation of precursors proximal to the blocked enzymatic step. The most common form of CAH is caused by steroid 21-hydroxylase deficiency due to mutations in CYP21A2. Since the last publication summarizing CAH in Endocrine Reviews in 2000, there have been numerous new developments. These include more detailed understanding of steroidogenic pathways, refinements in neonatal screening, improved diagnostic measurements utilizing chromatography and mass spectrometry coupled with steroid profiling, and improved genotyping methods. Clinical trials of alternative medications and modes of delivery have been recently completed or are under way. Genetic and cell-based treatments are being explored. A large body of data concerning long-term outcomes in patients affected by CAH, including psychosexual well-being, has been enhanced by the establishment of disease registries. This review provides the reader with current insights in CAH with special attention to these new developments.
Collapse
Affiliation(s)
| | - Phyllis W Speiser
- Cohen Children’s Medical Center of NY, Feinstein Institute, Northwell Health, Zucker School of Medicine, New Hyde Park, NY 11040, USA
| | - S Faisal Ahmed
- Developmental Endocrinology Research Group, School of Medicine Dentistry & Nursing, University of Glasgow, Glasgow, UK
| | - Wiebke Arlt
- Institute of Metabolism and Systems Research (IMSR), College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Richard J Auchus
- Division of Metabolism, Endocrinology, and Diabetes, Departments of Internal Medicine and Pharmacology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Henrik Falhammar
- Department of Molecular Medicine and Surgery, Karolinska Intitutet, Stockholm, Sweden
- Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden
| | - Christa E Flück
- Pediatric Endocrinology, Diabetology and Metabolism, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Leonardo Guasti
- Centre for Endocrinology, William Harvey Research Institute, Bart’s and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Angela Huebner
- Division of Paediatric Endocrinology and Diabetology, Department of Paediatrics, Universitätsklinikum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Barbara B M Kortmann
- Radboud University Medical Centre, Amalia Childrens Hospital, Department of Pediatric Urology, Nijmegen, The Netherlands
| | - Nils Krone
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
- Department of Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Deborah P Merke
- National Institutes of Health Clinical Center and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD 20892, USA
| | - Walter L Miller
- Department of Pediatrics, Center for Reproductive Sciences, and Institute for Human Genetics, University of California, San Francisco, CA 94143, USA
| | - Anna Nordenström
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
- Pediatric Endocrinology, Karolinska University Hospital, Stockholm, Sweden
| | - Nicole Reisch
- Medizinische Klinik IV, Klinikum der Universität München, Munich, Germany
| | - David E Sandberg
- Department of Pediatrics, Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI 48109, USA
| | | | - Philippe Touraine
- Department of Endocrinology and Reproductive Medicine, Center for Rare Endocrine Diseases of Growth and Development, Center for Rare Gynecological Diseases, Hôpital Pitié Salpêtrière, Sorbonne University Medicine, Paris, France
| | - Agustini Utari
- Division of Pediatric Endocrinology, Department of Pediatrics, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - Stefan A Wudy
- Steroid Research & Mass Spectrometry Unit, Laboratory of Translational Hormone Analytics, Division of Paediatric Endocrinology & Diabetology, Justus Liebig University, Giessen, Germany
| | - Perrin C White
- Division of Pediatric Endocrinology, UT Southwestern Medical Center, Dallas TX 75390, USA
| |
Collapse
|
10
|
Hassan M, Mones H, Al Hussein Ahmed B. Health-related quality of life of adolescents with sickle cell disease on hydroxyurea: A case-control study. JOURNAL OF APPLIED HEMATOLOGY 2022. [DOI: 10.4103/joah.joah_7_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
11
|
Hood AM, Kölbel M, Stotesbury H, Kawadler J, Slee A, Inusa B, Pelidis M, Howard J, Chakravorty S, Height S, Awogbade M, Kirkham FJ, Liossi C. Biopsychosocial Predictors of Quality of Life in Paediatric Patients With Sickle Cell Disease. Front Psychol 2021; 12:681137. [PMID: 34594262 PMCID: PMC8476744 DOI: 10.3389/fpsyg.2021.681137] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 08/18/2021] [Indexed: 11/13/2022] Open
Abstract
Sickle cell disease (SCD) refers to a group of inherited blood disorders with considerable morbidity that causes severe pain, reduces life expectancy, and requires significant self-management. Acute painful episodes are the hallmark of SCD, but persistent daily pain is also highly prevalent in this population. Characterising the impact and experience of SCD-related morbidity (i.e., sleep disruption, frequent emergency department visits, cognitive dysfunction) on health-related quality of life (HRQOL) requires multiple assessment methods to best capture the underlying mechanisms. To gain a greater understanding of the effect of common symptom categories on HRQOL and to determine potential pain coping targets, the present study investigated whether demographic, socioeconomic, sleepiness, pain burden, frequency of emergency department (ED) visits, and cognition predicted HRQOL in a paediatric sample of patients with SCD. Our study was a secondary analysis of baseline assessment data of children with SCD aged 8-15 years (n = 30) in the Prevention of Morbidity in Sickle Cell Anaemia Phase 2b (POMSb2) randomised controlled clinical trial of auto-adjusting continuous positive airways pressure. Patients completed cognitive testing (IQ, Processing Speed Index, Delis-Kaplan Executive Function Scale (DKEFS) Tower, Conner's Continuous Performance Test), sleepiness (Epworth Sleepiness Scale), and HRQOL (PedsQL Sickle Cell Module) at baseline. Patients reported pain burden (Sickle Cell Pain Burden Inventory-Youth) each month over 8 visits. Caregivers provided demographic information and reported their child's executive function (Behavioural Rating Inventory of Executive Function) at baseline. Data from our analysis demonstrated that demographic factors (i.e., age, gender, level of neighbourhood deprivation) and treatment variables (i.e., hydroxyurea use) did not independently predict HRQOL, and laboratory values (i.e., haemoglobin, haematocrit, mean oxygen saturation) were not significantly correlated with HRQOL (ps > 0.05). However, sleepiness, pain burden, ED visits, and executive dysfunction independently predicted HRQOL (R 2 = 0.66) with large effects (η2 = 0.16 to 0.32). These findings identify specific, measurable symptom categories that may serve as targets to improve HRQOL that are responsive to change. This knowledge will be useful for multimodal interventions for paediatric patients with SCD that include sleep management, pain coping strategies, and executive function training.
Collapse
Affiliation(s)
- Anna M Hood
- Developmental Neurosciences Unit and Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Melanie Kölbel
- Developmental Neurosciences Unit and Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Hanne Stotesbury
- Developmental Neurosciences Unit and Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Jamie Kawadler
- Developmental Neurosciences Unit and Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - April Slee
- Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Baba Inusa
- Department of Paediatric Haematology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - Maria Pelidis
- Department of Paediatric Haematology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - Jo Howard
- Department of Haematological Medicine, King's College London, London, United Kingdom.,Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Subarna Chakravorty
- Paediatric Haematology, King's College Hospital NHS Trust, London, United Kingdom
| | - Sue Height
- Paediatric Haematology, King's College Hospital NHS Trust, London, United Kingdom
| | - Moji Awogbade
- Department of Haematological Medicine, King's College Hospital NHS Trust, London, United Kingdom
| | - Fenella J Kirkham
- Developmental Neurosciences Unit and Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, United Kingdom.,Department of Clinical Haematology, University College London Hospitals NHS Foundation Trust, London, United Kingdom.,Department of Child Health, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.,Clinical and Experimental Sciences, University of Southampton, Southampton, United Kingdom
| | - Christina Liossi
- Department of Psychology, University of Southampton, Southampton, United Kingdom.,Paediatric Psychology, Great Ormond Hospital for Children NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
12
|
Marchese V, Rock K, Harpold A, Salazar A, Williams M, Shipper AG. Physical Impairment and Function in Children and Adolescents With Sickle Cell Disease: A Systematic Review. Arch Phys Med Rehabil 2021; 103:1144-1167.e2. [PMID: 34592159 DOI: 10.1016/j.apmr.2021.08.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/17/2021] [Accepted: 08/30/2021] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To examine physical impairments and physical function in children and adolescents with sickle cell disease (SCD). DATA SOURCES PubMed, Embase (embase.com), Cumulative Index to Nursing and Allied Health (EBSCO), Cochrane Central Register of Controlled Trials (Wiley), and Dissertations and Theses (ProQuest) were searched from January 1, 1990, to September 25, 2020. References retrieved were required to include a term for SCD and a term for physical impairments or physical function. Results were limited to articles with children and adolescents and in the English language. STUDY SELECTION A total of 3054 nonduplicate articles were independently screened by 2 reviewers, resulting in 240 articles for full-text review. The full-text review, performed by 2 independent reviewers, resulted in 67 articles. DATA EXTRACTION Data were extracted from each full text to a custom Excel document by a single reviewer and were verified by a secondary reviewer. DATA SYNTHESIS The studies identified in this systematic review offer evidence that children and adolescents with SCD demonstrate physical impairments and physical function limitations compared with control participants as noted by varying percentages in deficits up to 19%-58% in muscle and bone composition and/or symptoms, muscle strength, cardiopulmonary function, motor performance, physical activity, and physical function domains of quality of life questionnaires. CONCLUSIONS Children and adolescents with SCD present with physical impairments and physical function limitations. Scientists and clinicians should consider developing collaborative standards to define and objectively measure physical impairment and function in this population to comprehensively examine the underlying factors that contribute to physical impairments and function.
Collapse
Affiliation(s)
- Victoria Marchese
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD.
| | - Kelly Rock
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD
| | - Andria Harpold
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD
| | - Abigail Salazar
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD
| | - Mary Williams
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD
| | - Andrea G Shipper
- Health Sciences and Human Services Library, University of Maryland, Baltimore, Baltimore, MD
| |
Collapse
|
13
|
Wright LA, Cohen LL, Gise J, Shih S, Sil S, Carter S. Pain and QOL in Pediatric Sickle Cell Disease: Buffering by Resilience Processes. J Pediatr Psychol 2021; 46:1015-1024. [PMID: 34131745 DOI: 10.1093/jpepsy/jsab034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 03/07/2021] [Accepted: 03/11/2021] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE Sickle cell disease (SCD) is a group of inherited blood disorders. The central feature of this chronic condition is pain. Several identified risk factors exacerbate the impact of pain on quality of life (QOL) in SCD; however, there are relatively fewer investigations of strengths-based resilience variables that might buffer the influence of pain on living with SCD. The purpose of this study was to examine strength-based resilience processes in youth with SCD and their parents. Grounded in an ecological resilience-risk model, we evaluated whether adolescent and parent protective factors (pain acceptance, mindfulness, and psychological flexibility) moderated the relation between adolescent-reported pain burden and QOL. METHODS Ninety-three 12- to 18-year-old adolescents with SCD and their parents participated. Adolescents completed assessments of pain characteristics, pain acceptance, mindfulness, and QOL. Parents completed instruments measuring demographic and disease variables and parent psychological flexibility. RESULTS Pain variables were associated with protective factors in predicted directions. Adolescent acceptance and mindfulness were positively correlated with QOL. Parent psychological flexibility and adolescent QOL were not related. After controlling for demographic, pain, and disease variables, moderation analyses indicated that adolescent pain acceptance buffered the relation between SCD pain burden and QOL. Moderation analyses were not significant for adolescent mindfulness or parent psychological flexibility. CONCLUSIONS Results suggest that strengths-based factors may play an important role for adolescents' QOL within the context of SCD pain. Interventions that enhance teenagers' ability to accept pain might be particularly useful to improve QOL in adolescents living with SCD pain.
Collapse
Affiliation(s)
- Laura A Wright
- Department of Neuropsychology, Children's Healthcare of Atlanta
| | | | - Jensi Gise
- Department of Psychology, Georgia State University
| | - Sharon Shih
- Department of Psychology, Georgia State University
| | - Soumitri Sil
- Department of Neuropsychology, Children's Healthcare of Atlanta.,Department of Pediatrics, Emory University School of Medicine
| | | |
Collapse
|
14
|
Asnani MR, Francis D, Knight-Madden J, Chang-Lopez S, King L, Walker S. Integrating a problem-solving intervention with routine care to improve psychosocial functioning among mothers of children with sickle cell disease: A randomized controlled trial. PLoS One 2021; 16:e0252513. [PMID: 34106974 PMCID: PMC8189456 DOI: 10.1371/journal.pone.0252513] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/16/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To assess the feasibility of a problem-solving skills training intervention in improving psychological outcomes in mothers of infants with sickle cell disease (SCD). DESIGN AND METHODS This parallel randomized controlled trial recruited 64 babies with SCD, 6 to 12 months of age, and their mothers. Baseline measurements assessed mothers' coping and problem-solving skills, depression, and parental stress before random assignment to intervention or control groups (n = 32 each). Problem-solving skills intervention was delivered through 6 monthly sessions, when babies attended for routine penicillin prophylaxis. All measurements were repeated for both groups at the end of the intervention period. Intention to treat analysis used repeated measures mixed models with the restricted estimation maximum likelihood approach. RESULTS The problem-solving intervention had no significant effect on mothers' problem-solving skills (adjusted treatment effect: -1.69 points (95% CI:-5.62 to 2.25)), coping behaviours (adjusted treatment effect: 0.65 points (95% CI:- -7.13 to 8.41)) or depressive symptoms (adjusted treatment effect: -0.41 (95% CI: -6.00 to 5.19)). It reduced mothers' level of difficulty in managing stressful events by 9.5 points (95% CI (-16.86 to -2.16); effect size: 0.21 SD). In the subgroup of mothers at risk of depression (n = 31 at baseline), the intervention reduced depression scores with treatment effect of 10.4 points (95%CI: -18.83 to -1.88; effect size: 0.67 SD). CONCLUSION This problem-solving skills intervention study suggests feasibility and possible efficacy in improving some maternal outcomes. Further refinement and culturally appropriate adaptations of the intervention could lead to stronger effects.
Collapse
Affiliation(s)
- Monika R. Asnani
- Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
- * E-mail:
| | - Damian Francis
- School of Health and Human Performance, Georgia College, Milledgeville, Georgia, United States of America
| | - Jennifer Knight-Madden
- Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Susan Chang-Lopez
- Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Lesley King
- Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Susan Walker
- Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| |
Collapse
|
15
|
Sil S, Woodward KE, Johnson YL, Dampier C, Cohen LL. Parental Psychosocial Distress in Pediatric Sickle Cell Disease and Chronic Pain. J Pediatr Psychol 2021; 46:557-569. [PMID: 33484135 PMCID: PMC8502425 DOI: 10.1093/jpepsy/jsaa130] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/20/2020] [Accepted: 12/19/2020] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Pediatric sickle cell disease (SCD) management can result in considerable caregiver distress. Parents of youth with chronic SCD pain may face the additional challenge of managing children's chronic pain and chronic illness. This study examined associations between parent psychological distress and child functioning and the moderating role of chronic pain among youth with SCD. METHODS Youth presenting to pediatric outpatient comprehensive SCD clinics and their primary caregivers completed a battery of questionnaires. Parents reported on parenting stress, parent mental and physical health, and family functioning. Children completed measures of pain characteristics, depressive symptoms, catastrophic thinking, functional disability, and quality of life. RESULTS Patients (N = 73, Mage = 14.2 years, 57% female) and their caregivers (Mage = 41.1 years, 88% mothers, 88% Black) participated. Worse parent functioning was associated with worse child pain, functioning, quality of life, and depressive symptoms. Beyond the effects of SCD, chronic SCD pain magnified the negative associations between parenting stress frequency and child quality of life, parent physical health and child quality of life, and parent depressive symptoms and child depressive symptoms. CONCLUSIONS Chronic pain may exacerbate the relations between parent and child functioning beyond the effects of SCD alone. The management of both SCD and chronic pain may present additional challenges for parents that limit their psychosocial functioning. Family-focused interventions to support parents and youth with chronic SCD pain are warranted to optimize health outcomes.
Collapse
Affiliation(s)
- Soumitri Sil
- Department of Pediatrics
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta
| | - Kerri E Woodward
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta
- Department of Psychiatry and Behavioral Science, Emory University School of Medicine
| | - Yelena L Johnson
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta
- Department of Psychiatry and Behavioral Science, Emory University School of Medicine
| | - Carlton Dampier
- Department of Pediatrics
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta
| | - Lindsey L Cohen
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta
- Department of Psychology, Georgia State University
| |
Collapse
|
16
|
Moody KL. Paternal Stress and Child Outcomes in Youth with Sickle Cell Disease. J Pediatr Psychol 2021; 46:1140-1147. [PMID: 34051095 DOI: 10.1093/jpepsy/jsab059] [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: 10/22/2020] [Revised: 04/14/2021] [Accepted: 05/05/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The objective of this study was to investigate the relationship between parental stress and health-related quality of life (HRQOL) among children with sickle cell disease (SCD). METHODS A cross-sectional correlational survey research design was used for this quantitative study. One hundred-fifty patients between the ages of 8-17 years old and their caregivers were enrolled from an outpatient comprehensive sickle cell program within a hospital setting. Patients completed the Pediatric Quality of Life Scale 3.0 SCD Module, whereas parents completed the Parental Stress Scale and demographic information questionnaire. Multiple regression analysis was used to determine if parental stress scores predicted the HRQOL of children diagnosed with SCD after controlling for demographic variables. RESULTS The sample included 150 patients (median age: 12 years old; female: 52%) who were diagnosed with SCD along with 150 of their caregivers. Higher levels of parental stress predicted lower HRQOL scores (p < .001). CONCLUSION As parents reported elevated levels of stress related to caring for their child with SCD, patients reported worsening HRQOL. More evidence is needed in order to determine, which constructs of parental stress had a significant impact on HRQOL. It may be helpful for healthcare workers to be aware of familial influences of reduced HRQOL among children diagnosed with SCD. Parents reporting increased stress related to raising their child with SCD may benefit from additional support and resources.
Collapse
|
17
|
Kinahan JY, Graham JMI, Hébert YV, Sampson M, O'Hearn K, Klaassen RJ. Patient-reported Outcome Measures in Pediatric Non-Malignant Hematology: A Systematic Review. J Pediatr Hematol Oncol 2021; 43:121-134. [PMID: 33136776 DOI: 10.1097/mph.0000000000001984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 09/28/2020] [Indexed: 01/19/2023]
Abstract
Patient-reported outcome measures (PROMs) are questionnaires completed by patients or caregivers without influence by health care professionals. As such, PROMs show subjective health experiences, enhance the clinical information available to providers, and inform clinical action. The objective of this systematic review is to identify and list which validated PROMs have been used to monitor health-related quality of life in pediatric patients with nonmalignant hematology (hemophilia, immune thrombocytopenia, sickle cell disease, and thalassemia). Databases (MEDLINE, Embase, HaPI, CINAHL, and PsycTESTS) were searched to identify publications that validated or used PROMs as an outcome measure in the 4 disease groups. Overall, 209 articles met the inclusion criteria, identifying 113 PROMs. Of the 113 identified PROMs, 95 are generic and can be used in multiple disease groups. The Pediatric Quality of Life Generic Core Scales was the most frequently used generic PROM (68 studies). The 18 remaining PROMs were disease specific. The results of this review, together with the COSMIN tool for selecting outcome measures, will allow clinicians to evaluate the PROMs that are best suited to their patient population. In addition, the focus groups are currently being conducted with patients, parents, and clinicians to determine the optimal use of PROMs in the clinical environment.
Collapse
Affiliation(s)
- Julia Y Kinahan
- Children's Hospital of Eastern Ontario Research Institute
- University of Ottawa, Ottawa, ON
| | - Johann M I Graham
- Children's Hospital of Eastern Ontario Research Institute
- Regional Hospital Center of Lanaudiere, Saint-Charles-Borromée
- Laval University, Quebec City, QC, Canada
| | - Yamilée V Hébert
- Children's Hospital of Eastern Ontario Research Institute
- University of Ottawa, Ottawa, ON
| | | | - Katie O'Hearn
- Children's Hospital of Eastern Ontario Research Institute
| | - Robert J Klaassen
- Children's Hospital of Eastern Ontario Research Institute
- Division of Hematology/Oncology, Department of Pediatrics
- University of Ottawa, Ottawa, ON
| |
Collapse
|
18
|
Alishlash AS, Rutland SB, Friedman AJ, Hampton JI, Nourani A, Lebensburger J, Oates GR. Acute chest syndrome in pediatric sickle cell disease: Associations with racial composition and neighborhood deprivation. Pediatr Blood Cancer 2021; 68:e28877. [PMID: 33405365 DOI: 10.1002/pbc.28877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/10/2020] [Accepted: 12/12/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUND Acute chest syndrome (ACS) is the leading cause of death for children with sickle cell disease (SCD). Recurrent ACS has detrimental effects on pulmonary health and health care costs. Neighborhood characteristics affect the outcomes of many pediatric chronic diseases, but their role in SCD is not well studied. In this study, we investigated the effects of area-level socioeconomic deprivation and racial composition on the recurrence of ACS. STUDY DESIGN We performed a retrospective cross-sectional analysis of clinical data from a large pediatric SCD center. Patients' residential addresses were geocoded and linked to a composite area deprivation index (ADI) and percent African American population at the level of Census block groups. The association of recurrent ACS with neighborhood characteristics was evaluated using logistic regression analysis. RESULTS The sample included 709 children with SCD. Residence in a socioeconomically deprived neighborhood was associated with 27% less risk of recurrent ACS, and residence in a predominantly African American neighborhood was associated with 41% less risk of ACS recurrence. The racial composition explained the protective effect of living in a high-deprivation area after adjusting for sociodemographic and clinical covariates. Demographic and clinical factors associated with recurrent ACS included older age, male gender, asthma, hydroxyurea use, and chronic transfusion therapy. CONCLUSIONS This is the first study to report a protective effect of residing in a predominantly African American community for ACS recurrence. Further prospective studies are needed to confirm the association and to understand the mechanisms of such relationship.
Collapse
Affiliation(s)
| | - Sarah B Rutland
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Jane I Hampton
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Anis Nourani
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jeffrey Lebensburger
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Gabriela R Oates
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| |
Collapse
|
19
|
Keenan ME, Loew M, Berlin KS, Hodges J, Alberts NM, Hankins JS, Porter JS. Empirically Derived Profiles of Health-Related Quality of Life in Youth and Young Adults with Sickle Cell Disease. J Pediatr Psychol 2021; 46:293-303. [PMID: 33249456 PMCID: PMC7977438 DOI: 10.1093/jpepsy/jsaa104] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 10/11/2020] [Accepted: 10/12/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Determining how the health-related quality of life (HRQOL) is impacted by living with Sickle Cell Disease (SCD) can inform psychosocial interventions. The purpose of the present study is to determine if demographic and treatment variables predict membership into empirically derived subgroups of HRQOL among youth and young adults with SCD. METHODS Three hundred and seven youth and young adults with SCD (mean 17.63 years ± 3.74 years, 50.5% female) completed the Pediatric Quality of Life InventoryTM Sickle Cell Disease Module. Latent profile analysis examined subgroups/classes of HRQOL and relationships with demographic and treatment variables. RESULTS Three distinct classes emerged: High HRQOL (34% of the sample), Moderate HRQOL (44% of the sample), and Low HRQOL (22% of the sample). Being female was associated with increased odds of being in the moderate or low groups. Living with more severe SCD (genotypes HbSS and HbSβ0 thalassemia) was associated with increased odds of being in the Low HRQOL group. Treatment with chronic red blood cell transfusion therapy was associated with increased odds of being in the High HRQOL group. Older age predicted a small increase in the odds of being in the Low versus High HRQOL group. CONCLUSIONS The present study adds to the literature on HRQOL in SCD by exploring person-centered, empirically derived groups of HRQOL. Identification of demographic and treatment factors that predict membership into those groups within a large sample assists in tailoring needed psychosocial interventions for youth with SCD.
Collapse
Affiliation(s)
- Mary E Keenan
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Psychology, The University of Memphis, Memphis, TN
| | - Megan Loew
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | | | - Jason Hodges
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Nicole M Alberts
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Psychology, Concordia University, Montreal, Canada
| | - Jane S Hankins
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Jerlym S Porter
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| |
Collapse
|
20
|
Khanjari S, Tehrani FJ, Panahi SS, Saidee A. Translational cultural adaptation and psychometric study of the Persian version of pediatric inventory for parents. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2021; 10:65. [PMID: 34084812 PMCID: PMC8057186 DOI: 10.4103/jehp.jehp_842_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 08/11/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Cancer, as a life-threatening disease in children, poses several challenges for parents. It is necessary to have a tool that can comprehensively examine the stressful events for parents of children with cancer. The aim this present study was done with the aim of study the Persian version of pediatric inventory for parents (PIP). MATERIALS AND METHODS The study was a conducted based on methodological research design. Four hundred and fifteen parents of children with cancer referring to Alia Asghar Children's Hospital and Children's Medical Centre in Tehran answered the Persian version of PIP questionnaire in 2019. a confirmatory factor analysis was carried out using LISREL (software version 8.8) to test the construct validity of PIP. The two tools of parental stress scale and state-trait anxiety inventory (STAI-Y) were used for concurrent validity purposes. RESULTS The results showed that, the overall score of the questionnaire was higher than the average and related to emotional distress. The internal correlation coefficient (Cronbach's alpha) in both parts of the PIP was between 0.808 and 0.957 and acceptable. Concurrent validity analysis indicated positive and significant correlation of this tool in the difficulty section of the scale with both Parental Stress Scale and STAI-Y. The results of confirmatory factor analysis indicated that the factor loads of all items except three items in the frequency section were more than 0.3 and were appropriate. CONCLUSION The Persian version of PIP can be available to health and family experts as a valid and reliable tool to assess stressful events of parents of children with cancer.
Collapse
Affiliation(s)
- Sedigheh Khanjari
- Center for Nursing Care Research, School of Nursing and Midwifery, Faculty of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Fereshteh Javaheri Tehrani
- Center for Nursing Care Research, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Shabnam Shariat Panahi
- Center for Nursing Care Research, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Saidee
- Department of Statistical Research and Information Technology, Institute for Research and Planning in Higher Education, Tehran, Iran
| |
Collapse
|
21
|
Reader SK, Keeler CN, Chen FF, Ruppe NM, Rash-Ellis DL, Wadman JR, Miller RE, Kazak AE. Psychosocial Screening in Sickle Cell Disease: Validation of the Psychosocial Assessment Tool. J Pediatr Psychol 2021; 45:423-433. [PMID: 32142136 DOI: 10.1093/jpepsy/jsaa002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 01/14/2020] [Accepted: 01/18/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Families of youth with Sickle Cell Disease (SCD) can face psychosocial adversity including emotional distress, functional impairments, and sociodemographic risk factors. Systematic screening of psychosocial risk can identify families who may benefit from further assessment and evidence-based care. The Psychosocial Assessment Tool (PAT) is a brief caregiver-report screener based on the tri-level Pediatric Psychosocial Preventative Health Model (PPPHM). METHODS Findings are presented from the baseline assessment of a longitudinal study validating a Sickle Cell version of the PAT 2.0. Primary caregivers of 136 youth with SCD receiving care through a multidisciplinary SCD clinic in a children's hospital completed the PAT and validation measures. A subset of 25 caregivers completed the PAT a second time within 3-5 weeks. RESULTS Internal consistency for the total score was strong (α = .87), and for the subscales was moderate to strong (α = .74-.94), with the exception of the Family Structure (α = .38), Caregiver Beliefs (α = .48), and Stress Reactions (α = .56) subscales. Test-retest reliability was also strong (r = .86, p < .001). Moderate to strong correlations with all except two criteria measures provided validation for the total and subscale scores. Validation measures varied significantly across the three levels of the PPPHM. CONCLUSIONS Results provide support for the reliability and validity of the PAT in SCD. Systematic screening with the PAT can help identify families of youth with SCD at risk for psychosocial problems and potentially help connect them to appropriate services.
Collapse
Affiliation(s)
- Steven K Reader
- Center for Healthcare Delivery Science, Nemours Children's Health System.,Sidney Kimmel Medical College, Thomas Jefferson University
| | - Colleen N Keeler
- Center for Healthcare Delivery Science, Nemours Children's Health System
| | - Fang Fang Chen
- Center for Healthcare Delivery Science, Nemours Children's Health System
| | - Nicole M Ruppe
- Center for Healthcare Delivery Science, Nemours Children's Health System
| | - Diana L Rash-Ellis
- Nemours Center for Cancer and Blood Disorders, Nemours Children's Health System
| | - Jean R Wadman
- Nemours Center for Cancer and Blood Disorders, Nemours Children's Health System
| | - Robin E Miller
- Sidney Kimmel Medical College, Thomas Jefferson University.,Nemours Center for Cancer and Blood Disorders, Nemours Children's Health System
| | - Anne E Kazak
- Center for Healthcare Delivery Science, Nemours Children's Health System.,Sidney Kimmel Medical College, Thomas Jefferson University
| |
Collapse
|
22
|
Crosby LE, Hood A, Kidwell K, Nwankwo C, Strong H, Quinn C, Britto MT. Improving self-management in adolescents with sickle cell disease. Pediatr Blood Cancer 2020; 67:e28492. [PMID: 32697889 PMCID: PMC7722105 DOI: 10.1002/pbc.28492] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 04/29/2020] [Accepted: 05/24/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Sickle cell disease (SCD) is associated with significant medical challenges that often worsen in adolescence when caregivers are beginning to transfer responsibility for disease management. Behavioral activation (BA) is an important precedent to improvements in self-management and ultimately health outcomes; however, few interventions targeting BA have been developed for the SCD population. The goal of the present study was to evaluate a technology-enhanced self-management intervention for adolescents and young adults (AYA) with SCD targeting BA domains (ie, disease knowledge, self-efficacy, motivation, and self-management skills). DESIGN/METHODS Participants were randomized to one of two study arms. SCThrive participants (N = 26) completed six weekly group sessions, an in-person booster session, and used a companion app (iManage) to record symptoms, progress on goals, and connect with other group members. Each SCHealthEd participant (N = 27) received six weekly phone calls on SCD-related and general health education topics. All AYA completed questionnaires assessing BA at baseline and posttreatment. RESULTS Separate mixed ANOVA analyses to assess for the effects of group (SCThrive/SCHealthEd), time (baseline/posttreatment), and group × time interaction indicated that there was a clinically meaningful improvement (8-point change) in self-efficacy, with a medium effect size, P = .09, η2 = .06, and there was statistically significant improvement in one self-management skill (tracking health), P = .001, d = .71, among SCThrive participants. CONCLUSIONS The results support the potential for a self-management intervention to improve self-efficacy in AYA with SCD. Health care providers are encouraged to target BA skills to support self-management of AYA with SCD.
Collapse
Affiliation(s)
- Lori E. Crosby
- Division of Behavioral Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Anna Hood
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Katherine Kidwell
- Division of Behavioral Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Cara Nwankwo
- Division of Behavioral Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Oklahoma State University, Department of Psychology, Stillwater, OK
| | - Heather Strong
- Division of Behavioral Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Charles Quinn
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Cancer and Blood Diseases Institute, Division of Hematology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Maria T. Britto
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Division of Adolescent and Transition Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| |
Collapse
|
23
|
Larson MR, Latendresse SJ, Teasdale A, Limbers CA. The Pediatric Inventory for Parents: Development of a short-form in fathers of children with type 1 diabetes (T1D). Child Care Health Dev 2020; 46:468-484. [PMID: 32297367 DOI: 10.1111/cch.12769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 02/17/2020] [Accepted: 03/05/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND The Pediatric Inventory for Parents (PIP) is a 42-item measure of paediatric parenting stress that results in 84 responses. Although this measure has been extensively validated, the number of items in the instrument may hinder clinical applicability. METHODS The current study reports on the development of a short-form of the PIP using data from 344 fathers of children with type 1 diabetes. Recommendations for short-form development as well as item response theory (IRT) were used to construct a 13-item PIP Short-Form that results in 26 responses. RESULTS The retained items were chosen to reflect the content domains of the original form of the PIP and demonstrated acceptable item fit under the partial credit model (PCM; Infit and Outfit indices closest to one and items with thresholds across the span of the latent trait). CONCLUSIONS The PIP Short-Form may allow health care professionals to more feasibly assess paediatric parenting stress among parents of children with chronic health conditions. Future studies are needed to validate this new short-form.
Collapse
Affiliation(s)
- Madeline R Larson
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA
| | | | - Ashley Teasdale
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA.,Texas Children's Hospital, Houston, TX, USA
| | | |
Collapse
|
24
|
Martin J, Le Faucheur L, Pondarré C, Carlier-Gonod A, Baeza-Velasco C. [Effects of a standardized musical intervention on the management of pain and anxiety-state of sickle-cell adolescents]. SOINS. PEDIATRIE, PUERICULTURE 2020; 41:35-41. [PMID: 32771206 DOI: 10.1016/j.spp.2020.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The effect of a standardized musical intervention for adolescents with sickle cell disease was studied. Two groups were evaluated using the visual analog scale of pain and the anxiety-state inventory before and after a standardized musical intervention or breathing intervention. A significant decrease in scores was observed, most notably for the group benefiting from the standardized musical intervention. This intervention could be integrated into the overall management of adolescents with sickle cell disease.
Collapse
Affiliation(s)
- Jérémy Martin
- Service d'hospitalisation à domicile, Fondation Œuvre de la Croix-Saint-Simon, 35 rue du Plateau, 75019 Paris, France; Laboratoire de psychopathologie et processus de santé (EA 4057), Université de Paris, 71 avenue Édouard-Vaillant, 92774 Boulogne-Billancourt, France.
| | - Loïc Le Faucheur
- Service de médecine de l'adolescent, Centre hospitalier intercommunal de Créteil, 40 avenue de Verdun, 94000 Créteil, France
| | - Corinne Pondarré
- Service de médecine de l'adolescent, Centre hospitalier intercommunal de Créteil, 40 avenue de Verdun, 94000 Créteil, France
| | - Adèle Carlier-Gonod
- Service de médecine de l'adolescent, Centre hospitalier intercommunal de Créteil, 40 avenue de Verdun, 94000 Créteil, France
| | - Carolina Baeza-Velasco
- Laboratoire de psychopathologie et processus de santé (EA 4057), Université de Paris, 71 avenue Édouard-Vaillant, 92774 Boulogne-Billancourt, France; Département d'urgences & post-urgences psychiatriques, Hôpital Lapeyronie, CHU de Montpellier, 371 avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| |
Collapse
|
25
|
Valrie C, Floyd A, Sisler I, Redding-Lallinger R, Fuh B. Depression and Anxiety as Moderators of the Pain-Social Functioning Relationship in Youth with Sickle Cell Disease. J Pain Res 2020; 13:729-736. [PMID: 32308472 PMCID: PMC7152544 DOI: 10.2147/jpr.s238115] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 03/19/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Youth with sickle cell disease (SCD), a genetic disorder of red blood cells, may experience acute pain episodes lasting 2 to 3 days on average. While existing research has demonstrated associations between SCD pain and poor social functioning in youth with SCD, there are no data on whether symptoms of depression and anxiety modify the relationship between pain and functional outcomes in pediatric pain populations. It was hypothesized that more symptoms of depression and anxiety would exacerbate the relationship between high pain and poor social functioning in youth with SCD. Patients and Methods We conducted a cross-sectional study of 114 youth with SCD and their guardians assessing the youth’s pain, social functioning, and symptoms of depression and anxiety. Results Analyses indicated that elevated levels of depressive symptoms were related to poorer self-reported interpersonal skills. More anxiety symptoms were related to better guardian-reported social skills and weakened the relationship between high pain frequency and poor self-reported interpersonal skills. Conclusion Findings build on previous work supporting the need for multidisciplinary approaches to care for youth with SCD who experience pain, and provide rationale for future studies to investigate the direct and possible moderating effects of depression and anxiety symptoms on other functional outcomes in youth with SCD and other pediatric pain populations.
Collapse
Affiliation(s)
- Cecelia Valrie
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA.,Institute for Inclusion, Inquiry, and Innovation, Virginia Commonwealth University, Richmond, VA, USA
| | - Alfonso Floyd
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - India Sisler
- Department of Pediatrics, Virginia Commonwealth University, Richmond, VA, USA
| | - Rupa Redding-Lallinger
- Departments of Pediatrics and Internal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Beng Fuh
- Department of Pediatrics, East Carolina University, Greenville, NC, USA
| |
Collapse
|
26
|
Varughese TE, Hoyt CR, L’Hotta AJ, Ikemenogo PA, Howdeshell SG, Housten AJ, Abel RA, King AA. Stress and the Home Environment in Caregivers of Children with Sickle Cell. J Pediatr Psychol 2020; 45:521-529. [DOI: 10.1093/jpepsy/jsaa016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 02/19/2020] [Accepted: 02/25/2020] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objective
Caregivers of young children with chronic illnesses are at high risk for elevated levels of stress and mental health symptoms. This study examined stress and mental health symptoms as well as the socioeconomic status (SES) and home environments of a cohort of caregivers of infants and toddlers with sickle cell disease (SCD).
Methods
Forty-two caregivers of infants and toddlers (aged 1–34 months) with SCD completed the Brief Symptom Inventory (BSI) and Parent Stress Index (PSI). The Home Observation for Measurement of the Environment (HOME) was used to assess family living environments.
Results
Compared to test norms, caregivers reported high levels of situational/demographic life stress [mean difference (MD) 5.7, p = .003] and child distractibility/hyperactivity (MD 3.62, p = .001) on the PSI. However, no significant differences in psychological symptoms of distress were noted on the BSI. Caregivers scored significantly lower than norms on PSI subdomains of acceptability (MD −1.88, p = .03), competence (MD −3.11, p = .002), depression (MD −3.94, p < .001), and the overall parent domain (MD −12.55, p = .005). Significant correlations were found between PSI scores and the HOME and between SES and the HOME.
Conclusion
Caregivers of infants and toddlers with SCD experience elevated levels of life stress but, in turn, endorse high acceptance of their child and self-competence in parenting. Although life stress may be high in this population, symptoms of psychological distress were not identified. Caregivers reporting elevated life and illness-specific stressors may benefit from environmental supports and interventions.
Collapse
Affiliation(s)
- Taniya E Varughese
- Program in Occupational Therapy, Washington University School of Medicine
| | - Catherine R Hoyt
- Program in Occupational Therapy, Washington University School of Medicine
| | - Allison J L’Hotta
- Program in Occupational Therapy, Washington University School of Medicine
| | | | - Seth G Howdeshell
- Department of Medicine, University of Iowa Hospitals and Clinics
- Department of Psychiatry, University of Iowa Hospitals and Clinics
| | - Ashley J Housten
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine
| | - Regina A Abel
- Program in Occupational Therapy, Washington University School of Medicine
| | - Allison A King
- Program in Occupational Therapy, Division of Hematology and Oncology, Department of Pediatrics, Washington University School of Medicine, St. Louis Children’s Hospital
| |
Collapse
|
27
|
Parent cognitive, behavioural, and affective factors and their relation to child pain and functioning in pediatric chronic pain: a systematic review and meta-analysis. Pain 2020; 161:1401-1419. [DOI: 10.1097/j.pain.0000000000001833] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
28
|
Krishnamurti L, Ross D, Sinha C, Leong T, Bakshi N, Mittal N, Veludhandi D, Pham AP, Taneja A, Gupta K, Nwanze J, Matthews AM, Joshi S, Vazquez Olivieri V, Arjunan S, Okonkwo I, Lukombo I, Lane P, Bakshi N, Loewenstein G. Comparative Effectiveness of a Web-Based Patient Decision Aid for Therapeutic Options for Sickle Cell Disease: Randomized Controlled Trial. J Med Internet Res 2019; 21:e14462. [PMID: 31799940 PMCID: PMC6934048 DOI: 10.2196/14462] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 08/18/2019] [Accepted: 09/04/2019] [Indexed: 01/30/2023] Open
Abstract
Background Hydroxyurea, chronic blood transfusions, and bone marrow transplantation are efficacious, disease-modifying therapies for sickle cell disease but involve complex risk-benefit trade-offs and decisional dilemma compounded by the lack of comparative studies. A patient decision aid can inform patients about their treatment options, the associated risks and benefits, help them clarify their values, and allow them to participate in medical decision making. Objective The objective of this study was to develop a literacy-sensitive Web-based patient decision aid based on the Ottawa decision support framework, and through a randomized clinical trial estimate the effectiveness of the patient decision aid in improving patient knowledge and their involvement in decision making. Methods We conducted population decisional needs assessments in a nationwide sample of patients, caregivers, community advocates, policy makers, and health care providers using qualitative interviews to identify decisional conflict, knowledge and expectations, values, support and resources, decision types, timing, stages and learning, and personal clinical characteristics. Interview transcripts were coded using QSR NVivo 10. Alpha testing of the patient decision aid prototype was done to establish usability and the accuracy of the information it conveyed, and then was followed by iterative cycles of beta testing. We conducted a randomized clinical trial of adults and of caregivers of pediatric patients to evaluate the efficacy of the patient decision aid. Results In a decisional needs assessment, 223 stakeholders described their preferences, helping to guide the development of the patient decision aid, which then underwent alpha testing by 30 patients and 38 health care providers and iterative cycles of beta testing by 87 stakeholders. In a randomized clinical trial, 120 participants were assigned to either the patient decision aid or standard care (SC) arm. Qualitative interviews revealed high levels of usability, acceptability, and utility of the patient decision aid in education, values clarification, and preparation for decision making. On the acceptability survey, 72% (86/120) of participants rated the patient decision aid as good or excellent. Participants on the patient decision aid arm compared to the SC arm demonstrated a statistically significant improvement in decisional self-efficacy (P=.05) and a reduction in the informed sub-score of decisional conflict (P=.003) at 3 months, with an improvement in preparation for decision making (P<.001) at 6 months. However, there was no improvement in terms of the change in knowledge, the total or other domain scores of decisional conflicts, or decisional self-efficacies at 6 months. The large amount of missing data from survey completion limited our ability to draw conclusions about the effectiveness of the patient decision aid. The patient decision aid met 61 of 62 benchmarks of the international patient decision aid collaboration standards for content, development process, and efficacy. Conclusions We have developed a patient decision aid for sickle cell disease with extensive input from stakeholders and in a randomized clinical trial demonstrated its acceptability and utility in education and decision making. We were unable to demonstrate its effectiveness in improving patient knowledge and involvement in decision making. Trial Registration ClinicalTrials.gov NCT03224429; https://clinicaltrials.gov/ct2/show/NCT03224429 and ClinicalTrials.gov NCT02326597; https://clinicaltrials.gov/ct2/show/NCT02326597
Collapse
Affiliation(s)
- Lakshmanan Krishnamurti
- Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Diana Ross
- Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Cynthia Sinha
- Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Traci Leong
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Namita Bakshi
- Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Nonita Mittal
- Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Divya Veludhandi
- Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Anh-Phuong Pham
- Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Alankrita Taneja
- Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Kamesh Gupta
- Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Julum Nwanze
- Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Andrea Marie Matthews
- Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Saumya Joshi
- Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Veronica Vazquez Olivieri
- Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Santhi Arjunan
- Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Ifechi Okonkwo
- Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Ines Lukombo
- Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Peter Lane
- Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Nitya Bakshi
- Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - George Loewenstein
- Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, United States.,Center for Behavioral Decision Research, Department of Social and Decision Sciences, Carnegie Mellon University, Pittsburgh, PA, United States
| |
Collapse
|
29
|
Connolly ME, Bills SE, Hardy SJ. Neurocognitive and psychological effects of persistent pain in pediatric sickle cell disease. Pediatr Blood Cancer 2019; 66:e27823. [PMID: 31131984 DOI: 10.1002/pbc.27823] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 04/15/2019] [Accepted: 05/01/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Pain is a major complication of sickle cell disease (SCD), spanning vaso-occlusive crises and persistent pain. Although it is known that persistent pain is associated with considerable impairment in youth without SCD, little is known about the functional effects of persistent pain in SCD. The current study aimed to (a) characterize persistent pain in youth with SCD and (b) determine the extent to which youth with SCD and persistent pain differ in disease morbidity, functional impairment, and neurocognitive and psychological functioning. PROCEDURE Eighty-nine participants (ages 7-16) and caregivers completed questionnaires (BRIEF [Behavior Rating Inventory of Executive Function], Conners-3 [Conners-third edition], and PedsQL™-SCD Module, where PedsQL is Pediatric Quality of Life Inventory). Participants completed neurocognitive tests WISC-V [Wechsler Intelligence Scale for Children-fifth edition], WJ-III [Woodcock Johnson Tests of Achievement-third edition], and WIAT-III [Wechsler Individual Achievement Test-third edition]). Youth were classified as having persistent pain if they reported daily pain for 7 days. Chi-square and independent sample t-test analyses were used to assess group differences (those with vs without persistent pain). RESULTS Patients with persistent pain (n = 18) reported lower health-related quality of life (P = .000). Caregivers were more likely to rate youth with persistent pain as having lower planning/organization abilities (P = .011) and clinically elevated symptoms of defiance/aggression and oppositional defiance (Ps = .00; .01). Patients with persistent pain demonstrated poorer working memory (P = .023) and processing speed (P = .027), and fewer demonstrating reading fluency abilities in the average or above range (P = .026). CONCLUSIONS Youth with SCD and persistent pain are at risk for psychosocial and neurocognitive impairments, suggesting that persistent pain may be an important indicator of disease burden. Furthermore, disease management may be enhanced by assessing cognitive and psychosocial functioning and incorporating interdisciplinary treatments addressing impairment associated with persistent pain.
Collapse
Affiliation(s)
- Megan E Connolly
- Departments of Pediatrics and Psychiatry and Behavioral Sciences, George Washington University School of Medicine and Health Sciences, Washington, DC.,Divisions of Hematology and Oncology, Children's National Health System, Washington, DC
| | - Sarah E Bills
- Department of Psychology, University of South Carolina, Columbia, South Carolina
| | - Steven J Hardy
- Departments of Pediatrics and Psychiatry and Behavioral Sciences, George Washington University School of Medicine and Health Sciences, Washington, DC.,Divisions of Hematology and Oncology, Children's National Health System, Washington, DC
| |
Collapse
|
30
|
Reader SK, Rockman LM, Okonak KM, Ruppe NM, Keeler CN, Kazak AE. Systematic Review: Pain and Emotional Functioning in Pediatric Sickle Cell Disease. J Clin Psychol Med Settings 2019; 27:343-365. [PMID: 31414278 DOI: 10.1007/s10880-019-09647-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The objective of this systematic review was to assess the relationship between pain (frequency/intensity/duration, impairment, coping) and emotional functioning in pediatric Sickle Cell Disease, and evaluate the state of the literature. Studies were included if they met each of the following criteria: (a) primarily pediatric sample of youth or young adults up to age 21 years with SCD, (b) examined emotional functioning including anxiety and/or depressive and/or internalizing symptoms, and/or affect, (c) examined pain intensity/frequency/duration and/or pain-related impairment and/or pain coping as it relates to emotional functioning, as defined above. Using the established guidelines for systematic reviews, we searched PsycINFO, PubMED, and CINAHL databases for studies published through June 2018. Screening resulted in 33 studies meeting inclusion criteria. Study data were extracted and evaluated for scientific merit, resulting in four studies being removed. 29 studies were included in the final synthesis. Studies provide strongest evidence of a relationship between increased pain frequency and higher depressive and anxiety symptoms. There are moderate-to-strong associations between pain-related impairment and depressive symptoms, and small-to-strong associations between pain-related impairment and anxiety. When examining pain-coping strategies, maladaptive cognitive strategies show the strongest association with emotional functioning. There is a need for more adequately powered, prospective studies based on theoretical frameworks in order to advance our understanding of the relationship between pain and emotional functioning in pediatric SCD.
Collapse
Affiliation(s)
- Steven K Reader
- Center for Healthcare Delivery Science, The Nemours Children's Health System, 1701 Rockland Road, Suite 160, Wilmington, DE, 19803, USA. .,Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.
| | | | - Katherine M Okonak
- Center for Healthcare Delivery Science, The Nemours Children's Health System, 1701 Rockland Road, Suite 160, Wilmington, DE, 19803, USA
| | - Nicole M Ruppe
- Center for Healthcare Delivery Science, The Nemours Children's Health System, 1701 Rockland Road, Suite 160, Wilmington, DE, 19803, USA
| | - Colleen N Keeler
- Center for Healthcare Delivery Science, The Nemours Children's Health System, 1701 Rockland Road, Suite 160, Wilmington, DE, 19803, USA
| | - Anne E Kazak
- Center for Healthcare Delivery Science, The Nemours Children's Health System, 1701 Rockland Road, Suite 160, Wilmington, DE, 19803, USA.,Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| |
Collapse
|
31
|
Smaldone A, Manwani D, Green NS. Greater number of perceived barriers to hydroxyurea associated with poorer health-related quality of life in youth with sickle cell disease. Pediatr Blood Cancer 2019; 66:e27740. [PMID: 30941907 PMCID: PMC6538386 DOI: 10.1002/pbc.27740] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 02/28/2019] [Accepted: 03/12/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Despite medical benefits, hydroxyurea adherence in adolescents is often poor. As part of a baseline assessment of 28 youth (10-18 years) parent dyads who participated in a 6-month feasibility trial to improve hydroxyurea adherence, we measured the relationship between greater barriers to adherence and health-related quality of life (HRQL) from youth and parent perspectives. PROCEDURE Barriers were measured using the Adolescent and Parent Medication Barriers Scales with nine hydroxyurea items added. Barriers reported by ≥25% of the sample were considered common. Generic and disease-specific HRQL were measured by PedsQL and PedsQL Sickle Cell Disease modules. Data were analyzed using descriptive statistics, Cronbach alpha, Spearman correlation coefficients, and paired t tests. RESULTS Fifty-six subjects (28 dyads) participated. Youth reported greater barriers compared with parents (5.0 ± 3.9 and 3.5 ± 3.2; P = 0.03), with >80% of respondents reporting ≥1 barriers. Twelve barriers were reported by ≥25% of adolescents, whereas six were reported by ≥25% of parents. Of these, only two were common to both dyad members. Approximately one-third of youth had generic and disease-specific HRQL scores that fell at or below cutoff scores, suggesting being at risk for impaired HRQL. Greater barriers were inversely associated with poorer generic (parent r = -0.43, P = 0.03; youth r = -0.44, P < 0.001) and disease-specific HRQL (parent r = -0.53, P = 0.005; youth r = -0.53, P < 0.001). CONCLUSIONS Hydroxyurea barriers were frequently reported but differed by dyad members' perspective. Greater barriers were associated with poorer generic and disease-specific HRQL. To reduce barriers to hydroxyurea in youth with sickle cell disease, perspectives of both dyad members should be addressed.
Collapse
Affiliation(s)
- Arlene Smaldone
- Columbia University School of Nursing, New York, New York
- College of Dental Medicine, Columbia University Medical Center, New York, New York
| | - Deepa Manwani
- Department of Pediatrics, Albert Einstein College of Medicine, New York, New York
| | - Nancy S. Green
- Department of Pediatrics, Columbia University Medical Center, New York, New York
| |
Collapse
|
32
|
Jones PC, Salamon KS. Treating Pediatric Chronic Pain in Schools: A Primer for School Psychologists. JOURNAL OF APPLIED SCHOOL PSYCHOLOGY 2019. [DOI: 10.1080/15377903.2019.1619646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Paul C. Jones
- Pediatric Dentistry and Community Oral Health Sciences, Temple University Kornberg School of Dentistry, Philadelphia, Pennsylvania, USA
| | | |
Collapse
|
33
|
Robbins MA, McGill LS, Holloway BM, Bediako SM. Sickle Cell Disease, More Than Just Pain: The Mediating Role of Psychological Symptoms. South Med J 2019; 112:253-258. [PMID: 31050789 DOI: 10.14423/smj.0000000000000972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Perceived stress is associated with sickle cell disease (SCD) pain; however, little is known about psychological mechanisms that may clarify this link among adult patients. This study explored whether anxiety and depression symptoms explained the relation between perceived stress and SCD pain episode frequency among 70 African-American adults (51.4% women, mean age 35.6 years). METHODS Participants completed measures of perceived stress, pain, and psychological symptoms in an outpatient clinical setting. RESULTS A serial multiple mediation model showed that psychological symptoms collectively reduced the association between perceived stress and SCD pain frequency (b = 0.116, P = 0.141). However, only the indirect effect of stress on pain frequency through anxiety symptoms was significant (b = 0.089). CONCLUSIONS Anxiety but not depression symptoms best explain the association between stress and SCD pain. Further research is needed to identify the specific components of negative affect that drive the experience of SCD pain.
Collapse
Affiliation(s)
- Mona A Robbins
- From the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, and the Department of Psychology, University of Maryland, Baltimore County, Baltimore
| | - Lakeya S McGill
- From the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, and the Department of Psychology, University of Maryland, Baltimore County, Baltimore
| | - Breanna M Holloway
- From the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, and the Department of Psychology, University of Maryland, Baltimore County, Baltimore
| | - Shawn M Bediako
- From the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, and the Department of Psychology, University of Maryland, Baltimore County, Baltimore
| |
Collapse
|
34
|
Emotion-Focused Avoidance Coping Mediates the Association Between Pain and Health-Related Quality of Life in Children With Sickle Cell Disease. J Pediatr Hematol Oncol 2019; 41:194-201. [PMID: 30720675 PMCID: PMC6461213 DOI: 10.1097/mph.0000000000001429] [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] [Indexed: 11/25/2022]
Abstract
Sickle cell disease (SCD) is associated with pain and decreased health-related quality of life (HRQOL). Coping strategies influence pain but have not been evaluated as mediating the relation between pain and HRQOL in pediatric SCD. The current study examined whether pain-related coping mediates the association between pain and HRQOL in children and adolescents with SCD. In total, 104 children and adolescents 8 to 18 years of age (Mage=12.93 y) with SCD attending outpatient clinics completed pain intensity, HRQOL, and pain-related coping measures. Multiple mediation analyses were used to examine whether pain-related coping mediated the pain and HRQOL relation and whether types of coping (ie, approach, emotion-focused avoidance, problem-focused avoidance) were independent mediators. Total indirect effects for models examining physical and psychosocial HRQOL were not significant. After controlling for covariates, emotion-focused avoidance significantly mediated the association between pain and physical HRQOL (effect: -0.023; bootstrapped SE: 0.018; 95% confidence interval: -0.0751, -0.0003) but not the pain and psychosocial HRQOL relation. Approach and problem-focused avoidance were not significant mediators. Coping with pain in pediatric SCD is an important avenue for clinical intervention and additional research. Among children with SCD reporting high pain intensity, interventions should emphasize negative impacts of emotion-focused avoidance coping and integrate other empirically supported coping strategies to improve HRQOL.
Collapse
|
35
|
Ludwig NN, Sil S, Khowaja MK, Cohen LL, Dampier C. Executive Functioning Mediates the Relationship Between Pain Coping and Quality of Life in Youth With Sickle Cell Disease. J Pediatr Psychol 2018; 43:1160-1169. [PMID: 30053072 PMCID: PMC6199175 DOI: 10.1093/jpepsy/jsy057] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 07/02/2018] [Accepted: 07/03/2018] [Indexed: 02/02/2023] Open
Abstract
Objective Sickle cell disease (SCD) is a lifelong condition characterized by pain, which is associated with reduced health-related quality of life (HRQL). Data suggest that patients with SCD vary in how they cope and their neurocognitive abilities. This study aimed to characterize executive functioning and pain coping styles in children with SCD experiencing a range of pain frequency (i.e., chronic, episodic, and asymptomatic) and to examine whether executive functioning mediates the relationship between pain coping and HRQL. Method Participants included 100 children and adolescents with SCD between the ages of 8 and 18 years (M = 13.53, SD = 2.8) and their parents who were recruited during outpatient SCD clinic visits in a children's hospital. Children completed questionnaires related to pain experience and pain coping. Parents completed questionnaires about demographic information, their child's executive functioning, and HRQL. Results Pain intensity, executive dysfunction, and engagement in emotion-focused coping (i.e., internalizing/catastrophizing and externalizing) predicted poor HRQL. In addition, engagement in emotion-focused coping predicted executive dysfunction. Multivariate analysis of covariance revealed executive functioning did not differ based on pain frequency; however, executive functioning was a significant mediator that helped explain the relationships between distraction and emotion-focused coping techniques on HRQL. Conclusion Findings support that executive functioning is an important factor in understanding the relationship between pain coping and HRQL in youth with SCD. Future research is warranted to examine the potential impact of executive functioning on the utility of interventions targeting adaptive pain coping in youth with SCD.
Collapse
Affiliation(s)
| | - Soumitri Sil
- Department of Pediatrics, Aflac Cancer and Blood Disorders Center, Emory University School of Medicine
- Children’s Healthcare of Atlanta
| | | | - Lindsey L Cohen
- Department of Psychology, Georgia State University
- Children’s Healthcare of Atlanta
| | - Carlton Dampier
- Department of Pediatrics, Aflac Cancer and Blood Disorders Center, Emory University School of Medicine
- Children’s Healthcare of Atlanta
| |
Collapse
|
36
|
Does sickle cell disease have a psychosomatic component? A particular focus on anxiety and depression. Life Sci 2018; 210:96-105. [PMID: 30171881 DOI: 10.1016/j.lfs.2018.08.066] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 08/04/2018] [Accepted: 08/27/2018] [Indexed: 11/23/2022]
Abstract
Sickle cell disease, an early-age genetic condition, encompasses a range of blood disorders with severe complications. This disease is characterized by the synthesis of abnormal hemoglobin molecules, which tend to polymerize due to their low solubility upon deoxygenation in the peripheral capillary beds, resulting in sickle-like red blood cells. Sickled cells lose their normal functioning and hemodynamic properties, leading to chronic fatigue as well as to episodes of painful crises. Over the last two decades, a growing body of clinical evidence has pointed out that these somatic complaints can give rise to neuropsychiatric disorders, among which anxiety and depression are the most common, that worsen the health-related quality of life in patients. At first glance, this somatic influence may be unsurprising, as both anxiety and depressive signs are prevalent in almost all chronic diseases. However, in the case of a genetic condition such as sickle cell disease whose somatic disturbances are predetermined, the fact that mood disorders can increase fatigue and pain through a psychosomatic component has attracted increasing attention. In this review, we address the hypothesis of a psychosomatic component in patients with sickle cell disease by underlining the most relevant clinical studies that have highlighted the existence of a bidirectional link between physical and psychological sequelae, which are reported to be relieved not only by pharmacological cotreatments but also by the concomitant application of cognitive behavioral therapy.
Collapse
|
37
|
Olsson C, Björk M, Ringnér A. The Pediatric Inventory for Parents - Swedish Translation and Psychometric Testing. J Pediatr Nurs 2018; 42:e97-e102. [PMID: 29627285 DOI: 10.1016/j.pedn.2018.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 02/16/2018] [Accepted: 02/16/2018] [Indexed: 10/17/2022]
Abstract
UNLABELLED The Pediatric Inventory for Parents (PIP) measures parental stress related to caring for a child with an illness. However, no Swedish translation is available. PURPOSE This study reports a Swedish translation of the PIP and psychometric properties of the instrument. DESIGN AND METHODS This is a descriptive/methodological paper. The PIP was translated and culturally adapted to Swedish, and comprehensibility was tested. Data were collected twice from 48 parents of children with different illnesses, and initial psychometric properties of the instrument were examined. The IES-R (Impact of Event Scale-Revised) was used for concurrent validity. RESULTS The Swedish version of the PIP demonstrated good correlations with the IES-R, and temporal changes were similar. Endorsement frequencies and test-retest were also satisfactory. When comparing groups of parents, the parents of children with cancer were statistically significantly more distressed, both on total score and for emotional distress and role function. Discriminative validity was demonstrated by comparing parents of children with cancer with parents of children with other diseases. CONCLUSIONS The Swedish version of the PIP seems to be a valid and reliable instrument. However, as we used relatively small sample, for the future, we suggest further testing with larger samples. PRACTICE IMPLICATIONS Clinicians and researchers seeking to measure parental distress in chronic illness could use the Swedish version of the PIP.
Collapse
Affiliation(s)
- Cecilia Olsson
- Karlstad University, Department of Health Sciences, Karlstad, Sweden.
| | - Maria Björk
- Jönköping University, CHILD research group, Department of Nursing, School of Health and Welfare, Jönköping, Sweden.
| | - Anders Ringnér
- Umeå University, Department of Nursing, Umeå, Sweden; Umeå University Hospital, Department of Pediatrics, Umeå, Sweden.
| |
Collapse
|
38
|
Casaña-Granell S, Lacomba-Trejo L, Valero-Moreno S, Prado-Gasco V, Montoya-Castilla I, Pérez-Marín M. A brief version of the Pediatric Inventory for Parents (PIP) in Spanish population: Stress of main family carers of chronic paediatric patients. PLoS One 2018; 13:e0201390. [PMID: 30048532 PMCID: PMC6062103 DOI: 10.1371/journal.pone.0201390] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 07/13/2018] [Indexed: 02/07/2023] Open
Abstract
A chronic illness in childhood has a negative impact on the paediatric patient and on family functioning. Psychological stress in parents influences the level of adjustment to the illness of their children. The Pediatric Inventory for Parents (PIP) was designed to measure stress in parents whose child has a chronic illness or requires prolonged medical monitoring. The main objective of this study is to provide a brief version of the Spanish translation of the PIP, across a sample consisting of 465 main familial caregivers (85.2% female, n = 396) between 27 and 67 years old ( X¯ = 44.13; SD = 5.35) of paediatric patients between 9 and 18 years old ( X¯ = 12.10, SD = 2.20; 56.8% men, n = 264) diagnosed with diabetes mellitus type I (20.9% of the sample; n = 97), short stature (32.5% of the sample; n = 151), or a chronic respiratory disease (asthma, cystic fibrosis, bronchiolitis obliterans and bronchiectasis) (46.6% of the sample; n = 217). After performing several EFAs (Exploratory Factor Analyses) and CFAs (Confirmatory Factorial Analyses), it was decided that 30 items need to be removed. Reliability and validity results suggest that the new 12-item version possesses appropriate psychometric properties. Cronbach’s alpha value ranging between α = .42 and α = .81 and fit values obtained indicate a good fit: χ2/df (88.393/48) = 1.84 (α < .01); S-B χ2(df) = 88.393 (48); CFI = .95; IFI = .95; RMSEA = .05 (.033 - .074) for the frequency scales and χ2/df (72.002/48) = 1.5 (α < .01); S-Bχ2(df) = 72.002 (48); CFI = .97; IFI = .97; RMSEA = .04 (.011 - .063) for the difficulty scales. The PIP also showed predictive ability in regards to anxiety and depression, a positive relationship between the instrument's own scales and a negative relationship with the caregiver's age. Finally, depending on the paediatric patient's diagnosis, differences in stress levels were found.
Collapse
Affiliation(s)
- Sara Casaña-Granell
- Departament of Personality, Assessment and Psychological Treatments, Faculty of Psychology, University of Valencia, Valencia, Spain
| | - Laura Lacomba-Trejo
- Departament of Personality, Assessment and Psychological Treatments, Faculty of Psychology, University of Valencia, Valencia, Spain
| | - Selene Valero-Moreno
- Departament of Personality, Assessment and Psychological Treatments, Faculty of Psychology, University of Valencia, Valencia, Spain
| | - Vicente Prado-Gasco
- Departament of Personality, Assessment and Psychological Treatments, Faculty of Psychology, University of Valencia, Valencia, Spain
| | - Inmaculada Montoya-Castilla
- Departament of Personality, Assessment and Psychological Treatments, Faculty of Psychology, University of Valencia, Valencia, Spain
| | - Marián Pérez-Marín
- Departament of Personality, Assessment and Psychological Treatments, Faculty of Psychology, University of Valencia, Valencia, Spain
- * E-mail:
| |
Collapse
|
39
|
Goldstein-Leever A, Cohen LL, Dampier C, Sil S. Parent pain catastrophizing predicts child depressive symptoms in youth with sickle cell disease. Pediatr Blood Cancer 2018; 65. [PMID: 29512881 PMCID: PMC5980707 DOI: 10.1002/pbc.27027] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Youth with sickle cell disease (SCD) are at risk for recurrent pain and depressive symptoms, both of which contribute to poorer health outcomes. Furthermore, youth and family coping with child pain, including pain catastrophizing, is known to be associated with poorer psychosocial adjustment and greater functional disability among youth with SCD. In particular, child catastrophizing about pain and parent catastrophizing about their child's pain have been linked to increased pain and depressive symptoms in youth with chronic pain conditions. Despite this, the impact of child and parent pain catastrophizing on depressive symptoms remains unexplored in pediatric SCD. PROCEDURE The current study evaluated the predictive value of child and parent pain catastrophizing on child depressive symptoms in a sample of 100 youth with SCD. Differences in child and parent pain catastrophizing across youth with and without clinically elevated depressive symptoms were also examined. RESULTS Pain frequency and parent and child pain catastrophizing accounted for 35.9% of variance in child depressive symptoms, with only pain frequency and parent pain catastrophizing emerging as unique predictors of clinically elevated depressive symptoms. Additionally, parents of youth with clinically elevated depressive symptoms showed increased helplessness relative to parents of youth with minimal to mild depressive symptoms. CONCLUSIONS Findings support the value of depression screening and interventions to promote parent self-efficacy in managing childhood SCD pain.
Collapse
Affiliation(s)
- Alana Goldstein-Leever
- Nationwide Children’s Hospital, Division of Pediatric Psychology and Neuropsychology,The Ohio State University, Department of Pediatrics
| | - Lindsey L. Cohen
- Georgia State University, Department of Psychology,Children’s Healthcare of Atlanta, Aflac Cancer and Blood Disorders Center
| | - Carlton Dampier
- Children’s Healthcare of Atlanta, Aflac Cancer and Blood Disorders Center,Emory University School of Medicine, Department of Pediatrics
| | - Soumitri Sil
- Children’s Healthcare of Atlanta, Aflac Cancer and Blood Disorders Center,Emory University School of Medicine, Department of Pediatrics
| |
Collapse
|
40
|
Karafin MS, Singavi A, Hussain J, Wandersee N, Heinrich T, Hurley RW, Zhang L, Simpson P, Field JJ. Predictive factors of daily opioid use and quality of life in adults with sickle cell disease. ACTA ACUST UNITED AC 2018; 23:856-863. [PMID: 29848208 DOI: 10.1080/10245332.2018.1479997] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVES In adults with sickle cell disease (SCD), pain often necessitates opioid use. Few studies have examined the relationship between opioid use and health-related quality of life (HRQOL) in adults with SCD. We tested the hypothesis that higher doses of opioids are associated with worse HRQOL. METHODS A cross-sectional cohort study was performed in adults with SCD who completed standardized and validated HRQOL questionnaires: Patient Health Questionnaire-15 (PHQ-15), Patient Health Questionnaire-9 (PHQ-9), Medical Outcome Study 36 Item Short Form (SF-36), and Generalized Anxiety Disorder questionnaire (GAD-7). Daily outpatient opioid dose was converted into morphine milligram equivalents (MME) and categorized as < 90 mg/day or ≥ 90 mg/day. Subject's questionnaire scores were compared by opioid dose. RESULTS Ninety-nine adults completed questionnaires. The majority had HbSS and median age was 30 years. The median MME was 80 mg/day. When the association between HRQOL and opioid dose was compared, those prescribed ≥ 90 MME had significantly lower SF-36 subscale scores in 7 of 8 domains, and significantly higher severity scores in the PHQ-15, GAD-7, and the PHQ-9 in comparison those prescribed < 90 MME. Using a multivariable regression tree analysis, in addition to the presence of chronic pain, mental health, physical health, and somatic burden were key predictors of ≥ 90 MME opioid use. CONCLUSION Higher daily opioid dose is associated with chronic pain. Among those with chronic pain, opioid dose ≥ 90 MME is associated with worse HRQOL.
Collapse
Affiliation(s)
- Matthew S Karafin
- a Medical Sciences Institute, BloodCenter of Wisconsin , Milwaukee , WI , USA.,b Department of Pathology , Medical College of Wisconsin , Milwaukee , WI , USA
| | - Arun Singavi
- c Department of Medicine, Division of Hematology , Medical College of Wisconsin , Milwaukee , WI , USA
| | - Jawad Hussain
- d Department of Medicine, Division of Pulmonary, Critical Care, Allergy, and Sleep , University of Illinois , Chicago , IL , USA
| | - Nancy Wandersee
- a Medical Sciences Institute, BloodCenter of Wisconsin , Milwaukee , WI , USA
| | - Thomas Heinrich
- e Department of Medicine, Division of Psychiatry , Medical College of Wisconsin , Milwaukee , WI , USA
| | - Robert W Hurley
- f Department of Anesthesiology and Public Health Sciences , Wake Forest School of Medicine , Winston-Salem , NC , USA
| | - Liyun Zhang
- g Department of Pediatrics , Medical College of Wisconsin , Milwaukee , WI , USA
| | - Pippa Simpson
- g Department of Pediatrics , Medical College of Wisconsin , Milwaukee , WI , USA
| | - Joshua J Field
- a Medical Sciences Institute, BloodCenter of Wisconsin , Milwaukee , WI , USA.,c Department of Medicine, Division of Hematology , Medical College of Wisconsin , Milwaukee , WI , USA
| |
Collapse
|
41
|
Bakshi N, Lukombo I, Belfer I, Krishnamurti L. Pain catastrophizing is associated with poorer health-related quality of life in pediatric patients with sickle cell disease. J Pain Res 2018; 11:947-953. [PMID: 29773954 PMCID: PMC5947835 DOI: 10.2147/jpr.s151198] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Sickle cell disease (SCD) is an inherited disorder of the red blood cells and is associated with chronic multisystem involvement. While SCD has been associated with poorer health-related quality of life (HRQoL), there is a paucity of data on the relationship of psychological covariates other than anxiety and depression and quality of life (QoL) in children with SCD. Materials and methods We performed a cross-sectional study of psychological factors, HRQoL, and pain-related outcomes in participants with SCD and race-matched controls as part of a larger study of experimental pain phenotyping. Results Pain catastrophizing was inversely correlated with HRQoL measured by the PedsQL™ Generic Core Scale in children with SCD, while this was not noted in control participants. Psychological factors, such as anxiety and depressive symptoms, were also associated with poorer HRQoL in both children with SCD and controls. We did not find an association of psychological factors with prior health care utilization. Psychological factors such as anxiety and depressive symptoms were inversely correlated with pain interference, but not pain intensity in SCD. Conclusion Catastrophizing is associated with poorer HRQoL in SCD, but in this study, it was not associated with pain intensity or interference and health care utilization in children with SCD. Further studies are needed to fully define the association of psychological factors including catastrophizing with QoL, pain burden, and SCD outcomes.
Collapse
Affiliation(s)
- Nitya Bakshi
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | - Ines Lukombo
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA.,University of Pittsburgh, Pittsburgh, PA, USA
| | - Inna Belfer
- Department of Anesthesiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lakshmanan Krishnamurti
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| |
Collapse
|
42
|
Hardy SJ, Bills SE, Wise SM, Hardy KK. Cognitive Abilities Moderate the Effect of Disease Severity on Health-Related Quality of Life in Pediatric Sickle Cell Disease. J Pediatr Psychol 2018; 43:882-894. [DOI: 10.1093/jpepsy/jsy019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 03/02/2018] [Indexed: 12/23/2022] Open
Affiliation(s)
- Steven J Hardy
- Children’s National Health System
- George Washington University School of Medicine and Health Sciences
| | | | | | - Kristina K Hardy
- Children’s National Health System
- George Washington University School of Medicine and Health Sciences
| |
Collapse
|
43
|
Pantaleao A, DiPlacido J, Guite JW, Zempsky WT. Caregiver factors related to emergency department utilization for youth with sickle cell disease. CHILDRENS HEALTH CARE 2018. [DOI: 10.1080/02739615.2018.1454838] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Ashley Pantaleao
- Department of Family Science, School of Public Health, University of Maryland, College Park, MD, USA
| | - Joanne DiPlacido
- Department of Psychological Science, Central Connecticut State University, New Britain, CT, USA
| | - Jessica W. Guite
- The Center for Behavioral Health, Connecticut Children’s Medical Center, Hartford, CT, USA
| | - William T. Zempsky
- Division of Pain & Palliative Medicine, Connecticut Children’s Medical Center, Hartford, CT, USA
| |
Collapse
|
44
|
Junghans-Rutelonis AN, Weiss KE, Tamula MA, Karvounides D, Harbeck-Weber C, Martin S. Pain Assessment Methods and Interventions Used by Pediatric Psychologists: A Survey by the Pain Special Interest Group of the Society of Pediatric Psychology. ACTA ACUST UNITED AC 2018; 48:445-452. [PMID: 29403147 DOI: 10.1037/pro0000156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although many valid pain-related assessment instruments and interventions exist, little is known about which are actually utilized in practice and the factors that contribute to pediatric psychologist's decisions about their use. The aim of this survey study was to present a summary of current clinical practice among pediatric psychologists in the area of pediatric pain and to identify the needs and possible resources that would enable practitioners to better implement evidence-based assessments and interventions. To accomplish this aim, the Pain Special Interest Group of the Society of Pediatric Psychology (SPP) constructed an online survey that was sent electronically to current members of the SPP list serve. Results indicated the majority of participants are guided by a theoretical model and are using evidence-based assessments and interventions, although they are not always familiar with the literature supporting their use. Providers noted evidence-based pain intervention is facilitated by assessment tools, intervention resources, and appreciation of pain interventions by multidisciplinary team members. Barriers are both logistical (clinic space and time constraints) and knowledge-based (lack of familiarity with assessments/interventions). Thus, while pediatric psychologists are progressing towards better translation of research to practice, continued educational efforts and communication among practitioners about available resources are warranted.
Collapse
Affiliation(s)
- Ashley N Junghans-Rutelonis
- Department of Pain, Palliative Care, and Integrative Medicine, Children's Hospitals and Clinics of Minnesota, Minneapolis, USA
| | - Karen E Weiss
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine & Seattle Children's Hospital, Seattle, USA
| | - Mary Anne Tamula
- Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, Inc., NCI Campus at Frederick, Frederick, Maryland 21702, USA
| | - Dina Karvounides
- Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia Philadelphia, USA
| | | | - Staci Martin
- Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, USA
| |
Collapse
|
45
|
Karafin MS, Singh M, Ceesay M, Koduri S, Zhang L, Simpson P, Field JJ. Dyspareunia is associated with chronic pain in premenopausal women with sickle cell disease. ACTA ACUST UNITED AC 2018; 23:531-536. [PMID: 29376481 DOI: 10.1080/10245332.2018.1430521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Pain is common in women with sickle cell disease (SCD), but the prevalence of dyspareunia in this unique patient population is unknown. In this study, we sought to determine whether chronic pain is associated with an increased prevalence of dyspareunia in premenopausal women with SCD. METHODS A cross-sectional study of premenopausal women with SCD was systematically assessed for symptoms of dyspareunia and chronic pain using a standard questionnaire. These results were correlated with each subject's clinical pain phenotype determined by a review of the patient's electronic medical record. RESULTS Ninety-one premenopausal women with SCD were examined. Thirty-two percent of the women reported dyspareunia. Women with dyspareunia were more likely to have a history of chronic pain (90% versus 61%, p = .006), report more pain days per week (median (interquartile range): 6 (4-7) vs. 3 (0-7), p = .005)), and had a higher oral morphine equivalent dose (145 (45-226) mg vs. 60 (9-160) mg, p = .030). Using a multivariable classification tree analysis, number of days of pain experienced per week was an important predictor of dyspareunia (p = .001). CONCLUSION Dyspareunia is common in women with SCD, and more common in women with SCD and chronic pain. Providers should assess women with SCD for dyspareunia, especially those with a chronic pain syndrome.
Collapse
Affiliation(s)
- Matthew S Karafin
- a Medical Sciences Institute, Blood Center of Wisconsin , Milwaukee , WI , USA.,b Medical College of Wisconsin , Milwaukee , WI , USA
| | - Meenu Singh
- b Medical College of Wisconsin , Milwaukee , WI , USA
| | | | - Sumana Koduri
- b Medical College of Wisconsin , Milwaukee , WI , USA
| | - Liyun Zhang
- b Medical College of Wisconsin , Milwaukee , WI , USA
| | - Pippa Simpson
- b Medical College of Wisconsin , Milwaukee , WI , USA
| | - Joshua J Field
- a Medical Sciences Institute, Blood Center of Wisconsin , Milwaukee , WI , USA.,b Medical College of Wisconsin , Milwaukee , WI , USA
| |
Collapse
|
46
|
Sil S, Dampier C, Cohen LL. Pediatric Sickle Cell Disease and Parent and Child Catastrophizing. THE JOURNAL OF PAIN 2016; 17:963-71. [DOI: 10.1016/j.jpain.2016.05.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 04/29/2016] [Accepted: 05/24/2016] [Indexed: 12/22/2022]
|
47
|
Physicians' Perception of Sickle-cell Disease Pain. J Natl Med Assoc 2016; 108:113-8. [PMID: 27372471 DOI: 10.1016/j.jnma.2016.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 04/20/2016] [Indexed: 11/22/2022]
Abstract
The aim of this study was to evaluate the physician's perception of pain experienced by patients with sickle-cell disease (SCD). Pain experiences reported by patients were compared with physicians' perception of the patient's pain, and the treatment decision-making process was evaluated. Fifty-two patient-physician pairs were assessed. Before the clinic visit, the patients completed a 3-item on pain experienced 24 h prior to the visit and the PHQ-9. After the patient visit, the physicians completed a questionnaire assessing their perception of the patient's pain and a questionnaire on the factors taken into consideration when evaluating the patient's pain experience. The physicians rated the patients' pain as more intense than did the patients themselves; and there was agreement between pain intensity measurements (p < 0.05). The physicians' perception was influenced by the pain intensity reported by the patient, results of blood count at the time of the patient visit, and medication availability in the public health services. However, these factors were not predictive of the patient's pain intensity perceived by the physician. Patients' depressive symptoms were not predictive factor of the physicians' perception. Biochemical, genetic and symptomatic characteristics of SCD influenced the physicians' perception of the patient's pain experience, while psychosocial aspects did not.
Collapse
|
48
|
Pierce L, Hocking MC, Schwartz LA, Alderfer MA, Kazak AE, Barakat LP. Caregiver distress and patient health-related quality of life: psychosocial screening during pediatric cancer treatment. Psychooncology 2016; 26:1555-1561. [PMID: 27321897 DOI: 10.1002/pon.4171] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 03/31/2016] [Accepted: 05/08/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND Reports of acceptability of psychosocial screening are limited, and the utility of screening in identifying risk factors for health-related quality of life (HRQL) of children with cancer has not been established. This study aimed to assess acceptability of screening for parents and evaluate associations between family risk factors and patient HRQL in the first year post-diagnosis. PROCEDURE Sixty-seven parents of children with cancer completed the Psychosocial Assessment Tool (family risk), Distress Thermometer (caregiver distress), Posttraumatic Stress Disorder Checklist-Civilian 6 (caregiver traumatic stress), PedsQL 4.0 (parent-proxy report of patient HRQL) and four acceptability questions via a tablet (iPad). RESULTS Patients (Mage = 9.5 SD = 5.5 years) were equally distributed across major pediatric cancer diagnoses. The majority of parents endorsed electronic screening as acceptable (70%-97%). Patient gender, diagnosis, intensity of treatment and time since diagnosis were not significantly correlated with family risk, caregiver distress, traumatic stress, or patient HRQL. The full regression model predicting total HRQL was significant (R2 = .42, F(4,64) = 10.7, p = .000). Age (older) was a significant covariate, family risk and caregiver distress were significant independent predictors of poorer total HRQL. The full regression models for physical and psychosocial HRQL were significant; age and caregiver distress were independent predictors of physical HRQL, and age and family risk were independent predictors of psychosocial HRQL. CONCLUSIONS Screening is acceptable for families and important for identifying risk factors associated with poorer patient HRQL during childhood cancer treatment. Targeted interventions addressing family resource needs as well as parent distress identified through screening may be effective in promoting patient HRQL. Copyright © 2016 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Lisa Pierce
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Matthew C Hocking
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lisa A Schwartz
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Melissa A Alderfer
- The Center for Healthcare Delivery Science, Nemours Children's Health System, Wilmington, DE, USA.,Department of Pediatrics, Sidney Kimmel Medical School of Thomas Jefferson University, Philadelphia, PA, USA
| | - Anne E Kazak
- The Center for Healthcare Delivery Science, Nemours Children's Health System, Wilmington, DE, USA.,Department of Pediatrics, Sidney Kimmel Medical School of Thomas Jefferson University, Philadelphia, PA, USA
| | - Lamia P Barakat
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
49
|
da Matta Felisberto Fernandes ML, Kawachi I, Fernandes AM, Corrêa-Faria P, Paiva SM, Pordeus IA. Oral health-related quality of life of children and teens with sickle cell disease. Rev Bras Hematol Hemoter 2016; 38:106-12. [PMID: 27208568 PMCID: PMC4877612 DOI: 10.1016/j.bjhh.2016.01.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 01/06/2016] [Accepted: 01/19/2016] [Indexed: 11/21/2022] Open
Abstract
Background Children with sickle cell disease may have their quality of life affected by oral alterations. However, there is still little data on oral health-related quality of life in these children. The aim of this study was to investigate the influence of sickle cell disease, socioeconomic characteristics, and oral conditions on oral health-related quality of life of children and teens. Method One hundred and six children and teens with sickle cell disease were compared to a similar sample of 385 healthy peers. Data were collected through oral examinations, interviews to assess quality of life (Child Perceptions Questionnaire for children aged 8–10 and 11–14) and questionnaires containing questions on socioeconomic status. Results There were no statistically significant differences in the total scores of the Child Perceptions Questionnaires or domain scores comparing sickle cell disease patients to control subjects. When sub-scales were compared, oral symptoms and functional limitations had a greater negative impact on the quality of life of adolescents with sickle cell disease (p-value <0.001 and p-value <0.01, respectively) when compared to healthy controls. The only statistically significant determinants of negative impact on oral health-related quality of life in the overall sample was home overcrowding (more than two people/room) in the younger children's group, and dental malocclusion among teens. Conclusion There was no significant difference in the negative impact on the oral health-related quality of life between the group with sickle cell disease and the control group. Of the oral alterations, there was a significant difference in the oral health-related quality of life between adolescents with sickle cell disease and controls only in relation to malocclusion. Among the socioeconomic characteristics, only overcrowding was significantly associated with a negative impact on oral health-related quality of life.
Collapse
|
50
|
Geense WW, van Gaal BG, Knoll JL, Cornelissen EA, Schoonhoven L, Kok G. Online Support Program for Parents of Children With a Chronic Kidney Disease Using Intervention Mapping: A Development and Evaluation Protocol. JMIR Res Protoc 2016; 5:e1. [PMID: 26764218 PMCID: PMC4730104 DOI: 10.2196/resprot.4837] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 08/27/2015] [Accepted: 09/20/2015] [Indexed: 12/26/2022] Open
Abstract
Background The care for children with a chronic kidney disease (CKD) is complex. Parents of these children may experience high levels of stress in managing their child’s disease, potentially leading to negative effects on their child’s health outcomes. Although the experienced problems are well known, adequate (online) support for these parents is lacking. Objective The objective of the study is to describe the systematic development of an online support program for parents of children with CKD, and how this program will be evaluated. Methods Intervention Mapping (IM) was used for the development of the program. After conducting a needs assessment, defining program objectives, searching for theories, and selecting practical applications, the online program e-Powered Parents was developed. e-Powered Parents consist of three parts: (1) an informative part with information about CKD and treatments, (2) an interactive part where parents can communicate with other parents and health care professionals by chat, private messages, and a forum, and (3) a training platform consisting of four modules: Managing stress, Setting limits, Communication, and Coping with emotions. In a feasibility study, the potential effectiveness and effect size of e-Powered Parents will be evaluated using an explorative randomized controlled trial with parents of 120 families. The outcomes will be the child’s quality of life, parental stress and fatigue, self-efficacy in the communication with health care professionals, and family management. A process evaluation will provide insight in parents’ experiences, including their experienced level of support. Results Study results are expected to be published in the summer of 2016. Conclusions Although the development of e-Powered Parents using IM was time-consuming, IM has been a useful protocol. IM provided us with a systematic framework for structuring the development process. The participatory planning group was valuable as well; knowledge, experiences, and visions were shared, ensuring us that parents and health care professionals support the program. Trial Registration Dutch Trial Registration: NTR4808; www.trialregister.nl (Archived by WebCite at http://www.webcitation.org/6cfAYHcYb)
Collapse
Affiliation(s)
- Wytske W Geense
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands.
| | | | | | | | | | | |
Collapse
|