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Gowda NC, Chatterjee R, Balakrishnan A, Lawrence A, Aggarwal A. Caregiver burden in families of children with juvenile idiopathic arthritis in India. Clin Rheumatol 2024; 43:2009-2019. [PMID: 38662098 DOI: 10.1007/s10067-024-06975-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/16/2024] [Accepted: 04/19/2024] [Indexed: 04/26/2024]
Abstract
Juvenile Idiopathic Arthritis (JIA) causes caregiver burden on families with children affected with it. Our study aimed to explore this multifaceted burden in the Indian context. In this cross-sectional study, we administered the Hindi translated CAREGIVER questionnaire to adult caregivers in the families of JIA patients ≤ 18 years. The responses to the 28 items were used to calculate the burden scores in various dimensions. The relationship of the global burden scores with demographic and socioeconomic factors were analysed. Non parametric tests were used. Two hundred twenty-one caregivers participated with a median age of 39 years (IQR 32-45). This included 116 fathers, 50 mothers, 32 brothers, 18 uncles, three grandfathers, one sister, and one grandmother. The JIA patients had a median age of 15 (12-17) years, and the male-to-female ratio was 3.2:1. Enthesitis-related arthritis was the predominant subtype (72.4%). Most caregivers (70.6%) expressed sadness at diagnosis, and 29.9% continued to express sadness. Nearly two-thirds (65.6%) had to borrow money from others. More than half (59.3%) of the caregivers neglected their health, and 9.0% became sick. Male gender of the child, systemic JIA subtype, low socioeconomic status, high disease activity, extra-articular damage, high parent-reported disease activity and poor quality of life were associated with higher global caregiver burden. JIA has a significant emotional, social, economic, and labour impact on caregivers. Economic and psychosocial support needs to be given to family caregivers caring for children with JIA.
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Affiliation(s)
- Nikhil C Gowda
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India, 226014
| | - Rudrarpan Chatterjee
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India, 226014
| | - Anu Balakrishnan
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India, 226014
| | - Able Lawrence
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India, 226014
| | - Amita Aggarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India, 226014.
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France E, Uny I, Turley R, Thomson K, Noyes J, Jordan A, Forbat L, Caes L, Silveira Bianchim M. A meta-ethnography of how children and young people with chronic non-cancer pain and their families experience and understand their condition, pain services, and treatments. Cochrane Database Syst Rev 2023; 10:CD014873. [PMID: 37795766 PMCID: PMC10552070 DOI: 10.1002/14651858.cd014873.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
BACKGROUND Chronic non-cancer pain in childhood is widespread, affecting 20% to 35% of children and young people worldwide. For a sizeable number of children, chronic non-cancer pain has considerable negative impacts on their lives and quality of life, and leads to increased use of healthcare services and medication. In many countries, there are few services for managing children's chronic non-cancer pain, with many services being inadequate. Fourteen Cochrane Reviews assessing the effects of pharmacological, psychological, psychosocial, dietary or physical activity interventions for managing children's chronic non-cancer pain identified a lack of high-quality evidence to inform pain management. To design and deliver services and interventions that meet the needs of patients and their families, we need to understand how children with chronic non-cancer pain and their families experience pain, their views of services and treatments for chronic pain, and which outcomes are important to them. OBJECTIVES 1. To synthesise qualitative studies that examine the experiences and perceptions of children with chronic non-cancer pain and their families regarding chronic non-cancer pain, treatments and services to inform the design and delivery of health and social care services, interventions and future research. 2. To explore whether our review findings help to explain the results of Cochrane Reviews of intervention effects of treatments for children's chronic non-cancer pain. 3. To determine if programme theories and outcomes of interventions match children and their families' views of desired treatments and outcomes. 4. To use our findings to inform the selection and design of patient-reported outcome measures for use in chronic non-cancer pain studies and interventions and care provision to children and their families. The review questions are: 1. How do children with chronic non-cancer pain and their families conceptualise chronic pain? 2. How do children with chronic non-cancer pain and their families live with chronic pain? 3. What do children with chronic non-cancer pain and their families think of how health and social care services respond to and manage their child's chronic pain? 4. What do children with chronic non-cancer pain and their families conceptualise as 'good' chronic pain management and what do they want to achieve from chronic pain management interventions and services? SEARCH METHODS Review strategy: we comprehensively searched 12 bibliographic databases including MEDLINE, CINAHL, PsycInfo and grey literature sources, and conducted supplementary searches in 2020. We updated the database searches in September 2022. SELECTION CRITERIA To identify published and unpublished qualitative research with children aged 3 months to 18 years with chronic non-cancer pain and their families focusing on their perceptions, experiences and views of chronic pain, services and treatments. The final inclusion criteria were agreed with a patient and public involvement group of children and young people with chronic non-cancer pain and their families. DATA COLLECTION AND ANALYSIS We conducted a qualitative evidence synthesis using meta-ethnography, a seven-phase, systematic, interpretive, inductive methodology that takes into account the contexts and meanings of the original studies. We assessed the richness of eligible studies and purposively sampled rich studies ensuring they addressed the review questions. Cochrane Qualitative Methods Implementation Group guidance guided sampling. We assessed the methodological limitations of studies using the Critical Appraisal Skills Programme tool. We extracted data on study aims, focus, characteristics and conceptual findings from study reports using NVivo software. We compared these study data to determine how the studies related to one another and grouped studies by pain conditions for synthesis. We used meta-ethnography to synthesise each group of studies separately before synthesising them all together. Analysis and interpretation of studies involved children with chronic non-cancer pain and their families and has resulted in theory to inform service design and delivery. Sampling, organising studies for synthesis, and analysis and interpretation involved our patient and public involvement group who contributed throughout the conduct of the review. We used the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach to assess our confidence in each review finding. We used a matrix approach to integrate our findings with existing Cochrane Reviews on treatment effectiveness for children's chronic non-cancer pain. MAIN RESULTS We synthesised 43 studies sampled from 170 eligible studies reported in 182 publications. Included studies involved 633 participants. GRADE-CERQual assessments of findings were mostly high (n = 21, 58%) or moderate (n = 12, 33%) confidence with three (8%) low or very low confidence. Poorly managed, moderate or severe chronic non-cancer pain had profound adverse impacts on family dynamics and relationships; family members' emotions, well-being, autonomy and sense of self-identity; parenting strategies; friendships and socialising; children's education and future employment prospects; and parental employment. Most children and parents understood chronic non-cancer pain as having an underlying biological cause and wanted curative treatment. However, families had difficulties seeking and obtaining support from health services to manage their child's pain and its impacts. Children and parents felt that healthcare professionals did not always listen to their experiences and expertise, or believe the child's pain. Some families repeatedly visited health services seeking a diagnosis and cure. Over time, some children and families gave up hope of effective treatment. Outcomes measured within trials and Cochrane Reviews of intervention effects did not include some outcomes of importance to children and families, including impacts of pain on the whole family and absence of pain. Cochrane Reviews have mainly neglected a holistic biopsychosocial approach, which specifies the interrelatedness of biological, psychological and social aspects of illness, when selecting outcome measures and considering how chronic pain management interventions work. AUTHORS' CONCLUSIONS We had high or moderate confidence in the evidence contributing to most review findings. Further research, especially into families' experiences of treatments and services, could strengthen the evidence for low or very low confidence findings. Future research should also explore families' experiences in low- to middle-income contexts; of pain treatments including opioid use in children, which remains controversial; and of social care services. We need development and testing of family-centred interventions and services acceptable to families. Future trials of children's chronic non-cancer pain interventions should include family-centred outcomes.
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Affiliation(s)
- Emma France
- NMAHP Research Unit, University of Stirling, Stirling, UK
| | - Isabelle Uny
- Institute of Social Marketing, University of Stirling, Stirling, UK
| | - Ruth Turley
- Development Directorate, Cochrane Central Executive, Cochrane, London, UK
| | - Katie Thomson
- Occupational Therapy, Human Nutrition & Dietetics, Glasgow Caledonian University, Glasgow, UK
| | - Jane Noyes
- Centre for Health-Related Research, Fron Heulog, Bangor University, Bangor, UK
| | - Abbie Jordan
- Department of Psychology, University of Bath, Bath, UK
- Bath Centre for Pain Research, University of Bath, Bath, UK
| | - Liz Forbat
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Line Caes
- Department of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, UK
| | - Mayara Silveira Bianchim
- NMAHP Research Unit, University of Stirling, Stirling, UK
- Centre for Population Health and Wellbeing Research, School of Medical and Health Sciences, Bangor University, Bangor, UK
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Prins S, Linn AJ, van Kaam AHLC, van de Loo M, van Woensel JBM, van Heerde M, Dijk PH, Kneyber MCJ, de Hoog M, Simons SHP, Akkermans AA, Smets EMA, de Vos MA. Diversity of Parent Emotions and Physician Responses During End-of-Life Conversations. Pediatrics 2023; 152:e2022061050. [PMID: 37575087 DOI: 10.1542/peds.2022-061050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/26/2023] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND AND OBJECTIVES To provide support to parents of critically ill children, it is important that physicians adequately respond to parents' emotions. In this study, we investigated emotions expressed by parents, physicians' responses to these expressions, and parents' emotions after the physicians' responses in conversations in which crucial decisions regarding the child's life-sustaining treatment had to be made. METHODS Forty-nine audio-recorded conversations between parents of 12 critically ill children and physicians working in the neonatal and pediatric intensive care units of 3 Dutch university medical centers were coded and analyzed by using a qualitative inductive approach. RESULTS Forty-six physicians and 22 parents of 12 children participated. In all 49 conversations, parents expressed a broad range of emotions, often intertwining, including anxiety, anger, devotion, grief, relief, hope, and guilt. Both implicit and explicit expressions of anxiety were prevalent. Physicians predominantly responded to parental emotions with cognition-oriented approaches, thereby limiting opportunities for parents. This appeared to intensify parents' expressions of anger and protectiveness, although their anxiety remained under the surface. In response to more tangible emotional expressions, for instance, grief when the child's death was imminent, physicians provided parents helpful support in both affect- and cognition-oriented ways. CONCLUSIONS Our findings illustrate the diversity of emotions expressed by parents during end-of-life conversations. Moreover, they offer insight into the more and less helpful ways in which physicians may respond to these emotions. More training is needed to help physicians in recognizing parents' emotions, particularly implicit expressions of anxiety, and to choose helpful combinations of responses.
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Affiliation(s)
- Sanne Prins
- Department of Pediatrics, Emma Children's Hospital
| | - Annemiek J Linn
- Amsterdam School of Communication Research, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Moniek van de Loo
- Department of Pediatrics, Division of Neonatology, Emma Children's Hospital
| | - Job B M van Woensel
- Department of Pediatrics, Division of Pediatric Intensive Care, Emma Children's Hospital
| | - Marc van Heerde
- Department of Pediatrics, Division of Pediatric Intensive Care, Emma Children's Hospital
| | | | - Martin C J Kneyber
- Pediatric Critical Care Medicine, Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Sinno H P Simons
- Neonatology, Department of Pediatrics, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Aranka A Akkermans
- Department of Medical Psychology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology, Amsterdam University Medical Center, Amsterdam, The Netherlands
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Wakefield EO, Belamkar V, Sandoval A, Puhl RM, Edelheit B, Zempsky WT, Rodrigues HA, Litt MD. Does Diagnostic Certainty Matter?: Pain-Related Stigma in Adolescents with Juvenile Idiopathic Arthritis. J Pediatr Psychol 2023; 48:341-351. [PMID: 36892594 PMCID: PMC10118850 DOI: 10.1093/jpepsy/jsac092] [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: 07/28/2022] [Revised: 12/05/2022] [Accepted: 12/06/2022] [Indexed: 03/10/2023] Open
Abstract
OBJECTIVES Childhood chronic pain conditions are common and vulnerable to stigma. Adolescents with chronic primary pain experience diagnostic uncertainty and describe pain-related stigma experiences across multiple social contexts. Juvenile idiopathic arthritis (JIA) is a childhood autoimmune, inflammatory condition with associated chronic pain, but with well-defined diagnostic criteria. The current study examined pain-related stigma experiences in adolescents with JIA. METHODS Four focus groups of 3-7 adolescents with JIA (N = 16), ages 12-17 (Mage = 15.42, SD = 1.82), and parents (N = 13) were conducted to examine experiences of, and reaction to, pain-related stigma. Patients were recruited from an outpatient pediatric rheumatology clinic. Focus group length ranged from 28 to 99 minutes long. Two coders used directed content analysis resulting in 82.17% inter-rater level of agreement. RESULTS Adolescents with JIA described pain-related stigma experiences predominantly from school teachers and peers, and less from medical providers (e.g., school nurses), and family members after a diagnosis. The primary categories that emerged were (1) Felt Stigma, (2) Internalized Stigma, (3) Anticipatory Stigma/Concealment, and (4) Contributions to Pain-Related Stigma. A common experience of pain-related stigma was the perception by others that the adolescent was too young to have arthritis. CONCLUSIONS In common with adolescents with unexplained chronic pain, our findings indicate that adolescents with JIA experience pain-related stigma in certain social contexts. Diagnostic certainty may contribute to greater support among medical providers and within families. Future research should investigate the impact of pain-related stigma across childhood pain conditions.
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Affiliation(s)
- Emily O Wakefield
- Divisions of Pain and Palliative Medicine and Pediatric Psychology, Connecticut Children’s Medical Center, Hartford, CT
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT
| | - Vaishali Belamkar
- Department of Research, Connecticut Children’s Medical Center, Hartford, CT
| | - Ashley Sandoval
- Department of Psychological Science, Central Connecticut State University, New Britain, CT
| | - Rebecca M Puhl
- Rudd Center for Food Policy & Obesity, University of Connecticut, Hartford, CT
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT
| | - Barbara Edelheit
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT
- Division of Rheumatology, Connecticut Children’s Medical Center, Hartford, CT
| | - William T Zempsky
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT
- Division of Pain and Palliative Medicine, Connecticut Children’s Medical Center, Hartford, CT
| | - Hannah A Rodrigues
- Department of Psychological Science, Central Connecticut State University, New Britain, CT
| | - Mark D Litt
- Division of Behavioral Sciences and Community Health, University of Connecticut Health Center, Farmington, CT
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Smith AD, Saqib B, Lee RR, Shoop-Worrall S, Hyrich KL, McDonagh JE, Cordingley L. Is time a healer? How quality of life changes over time reported by parents of children and young people with juvenile idiopathic arthritis. Rheumatology (Oxford) 2023; 62:794-803. [PMID: 35608307 PMCID: PMC9891422 DOI: 10.1093/rheumatology/keac312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 05/13/2022] [Accepted: 05/13/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To investigate changes in health-related quality of life (HRQoL) in children and young people with JIA (Juvenile Idiopathic Arthritis) over 3 years following diagnosis. METHODS Data on children and young people recruited to the Childhood Arthritis Prospective Study (CAPS) were selected if >5 years of age at diagnosis. HRQoL was assessed at diagnosis (baseline), 1 year and 3 years using the proxy-reported Child Health Questionnaire (CHQ) completed by a parent or guardian. The CHQ measures aspects of HRQoL including physical functioning and mental health. Analyses included descriptive statistics, comparison with a US reference population and analysis of CHQ scores longitudinally and by gender and age of onset. RESULTS Using CHQ data from parents/guardians of 182 CAPS study participants [median age 9.6 years (interquartile range 7.2-12.2)], all HRQoL domains significantly improved over the 3 year follow-up, except general health perceptions. Physical health domains showed greater improvement than psychosocial domains, although psychosocial scores were generally higher than physical scores throughout. Although similar at diagnosis, at 1 year females had significantly worse HRQoL than males in physical functioning (P = 0.03), bodily pain (P = 0.03), mental health (P = 0.00), social-emotional (P = 0.02) and social-physical (P < 0.001). Differences largely remained at 3 years. Age at onset was not significantly associated with HRQoL. CONCLUSION Children and young people with JIA have low HRQoL across domains compared with the reference population. This improves within 3 years of diagnosis, with the greatest improvement within the first year. Early developmentally appropriate clinical intervention is recommended to reduce both psychosocial and physical impact of JIA. The lower HRQoL scores of females require further investigation.
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Affiliation(s)
- Andrew D Smith
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre
| | - Bishma Saqib
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research
| | - Rebecca Rachael Lee
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre
| | - Stephanie Shoop-Worrall
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester
- Centre for Health Informatics, University of Manchester
| | - Kimme L Hyrich
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre
| | - Janet E McDonagh
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre
- Department of Paediatric and Adolescent Rheumatology, Royal Manchester Children’s Hospital, Manchester University Hospitals Trust, Manchester, UK
| | - Lis Cordingley
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre
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6
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Brandelli YN, Tutelman PR, Chambers CT, Parker JA, Stinson JN, Huber AM, Stirling Cameron E, Wilson JP. "Every Little Furrow of Her Brow Makes Me Want To Stop": An Interpretative Phenomenologic Analysis of Mothers' Experiences With Juvenile Idiopathic Arthritis Treatments. Arthritis Care Res (Hoboken) 2022; 74:1761-1769. [PMID: 34151534 DOI: 10.1002/acr.24735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 04/29/2021] [Accepted: 06/17/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Children with juvenile idiopathic arthritis (JIA) are faced with a complex medical journey requiring consistent adherence to treatments to achieve disease management. Parents are intimately involved in JIA treatments; however, little is known about their experiences in this role. This is relevant as many treatments necessitate procedural pain (e.g., self-injections) or side effects (e.g., nausea), which may impact a parents' ability to follow treatment plans. The objective of this study was to explore the lived experiences of parents who identified challenges with their child's JIA treatments. METHODS Parents of children with JIA who identified challenges with their child's treatments were invited to take part in semistructured interviews. Data were analyzed using interpretative phenomenological analysis. RESULTS Ten mothers of children with JIA (60% female with a mean age of 11.83 years [range 4-16 years]) participated. Four superordinate themes were present in mothers' experiences: 1) treatments altered mothers' roles within the family, increasing their caregiver burden and advocacy; 2) treatments positively and negatively impacted their relationships (e.g., increased support from others, decreased time with others); 3) treatments elicited various emotional responses (e.g., frustration, grief), which affected their well-being; and 4) treatments were at times a source of internal conflict, affecting mothers' actions and adherence. CONCLUSION Mothers' experiences with their child's JIA treatments affects them in various ways that can subsequently impact treatment adherence. Results highlight the value of supporting parents through these complex treatment regimens and incorporating their experiences in treatment decisions to help promote optimal outcomes for children with JIA and their families.
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Affiliation(s)
- Yvonne N Brandelli
- Dalhousie University and IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Perri R Tutelman
- Dalhousie University and IWK Health Centre, Halifax, Nova Scotia, Canada
| | | | | | - Jennifer N Stinson
- University of Toronto and Hospital for Sick Children, Toronto, Ontario, Canada
| | - Adam M Huber
- Dalhousie University and IWK Health Centre, Halifax, Nova Scotia, Canada
| | | | - Jennifer P Wilson
- Cassie & Friends: A Society for Children With Juvenile Arthritis and Other Rheumatic Diseases, Vancouver, British Columbia, Canada
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Frye WS, Milojevic D. The Role of Psychology in Pediatric Rheumatic Diseases. Pediatr Clin North Am 2022; 69:965-974. [PMID: 36207106 DOI: 10.1016/j.pcl.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Pediatric rheumatic diseases (PRDs) are a heterogeneous group of diseases that can have a chronic unpredictable disease course that can negatively affect mood, functioning, and quality of life. Given the range of difficulties faced in managing PRDs, as well as the psychosocial issues youth with these diseases experience, pediatric psychologists can be well suited to address concerns that arise in care for youth with PRDs including adherence, cognitive assessment, pain management, functional disability, and mood. Potential ways that pediatric psychologists can address these concerns and be embedded within an interdisciplinary treatment plan for youth with PRDs are described.
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Affiliation(s)
- William S Frye
- Department of Psychology, Johns Hopkins All Children's Hospital, 880 6th Street South, Suite 460, St Petersburg, FL 33701, USA.
| | - Diana Milojevic
- Department of Medicine, Johns Hopkins All Children's Hospital, 601 5th Street South, Suite 502, Street, St Petersburg, FL 33701, USA
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8
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Bramanti SM, Manippa V, Babore A, Dilillo A, Marcellino A, Martucci V, Mallardo S, Isoldi S, Bloise S, Sanseviero M, Iorfida D, De Luca E, Trumello C, D’Alleva F, Ventriglia F, Lubrano R, Del Giudice E. Comparing parental distress and children's difficulties between parents of children with rheumatic diseases and parents of healthy children in families facing the COVID-19 pandemic. CURRENT PSYCHOLOGY 2022; 42:1-10. [PMID: 35967493 PMCID: PMC9361970 DOI: 10.1007/s12144-022-03589-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2022] [Indexed: 11/03/2022]
Abstract
The COVID-19 pandemic could be a threat for the health status of children with a chronic condition. The present study aimed to explore parents' and children's psychological adjustment during the current pandemic, pursuing a triple objective: to compare the psychological adjustment of parents of children with pediatric rheumatic diseases (PRDs) and parents of healthy children; to analyze children's psychological symptoms (emotional problems and hyperactivity) before and during the COVID-19 pandemic, and with or without a PRDs diagnosis; to explore the associations of children's emotional problems and hyperactivity with parents' psychological adjustment, parent-child interactions and belonging or not to families with PRDs. This cross-sectional study involved 56 parents of children with PRDs and 53 parents of healthy children. Self-report questionnaires about parents' depression, anxiety, parenting stress, and children's emotional symptoms and hyperactivity-inattention were administered. No differences were detected on psychological adjustment between parents of children with PRDs and parents of healthy children. Parents of children with PRDs reported statistically significant higher levels of children's emotional problems and hyperactivity before the pandemic, compared to parents of healthy children; during COVID-19 pandemic, emotional symptoms increased for both groups, while hyperactivity-inattention symptoms increased only in the group of healthy children. Children's emotional difficulties were associated with higher levels of parental anxiety, worse parent-child interaction and having PRDs; children's hyperactivity symptoms were related to parent-child difficult interaction and higher levels of parental depression. Findings suggest the importance to target the children in relation to their parents, when approaching the psychological aspects of PRDs.
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Affiliation(s)
- Sonia M. Bramanti
- Department of Psychological, Health and Territorial Sciences, University “G. d’Annunzio” of Chieti-Pescara, Via dei Vestini, 31, 66100 Chieti, Italy
| | - Valerio Manippa
- Department of Psychological, Health and Territorial Sciences, University “G. d’Annunzio” of Chieti-Pescara, Via dei Vestini, 31, 66100 Chieti, Italy
- Department of Education, Psychology and Communication, University of Bari Aldo Moro, Bari, Italy
| | - Alessandra Babore
- Department of Psychological, Health and Territorial Sciences, University “G. d’Annunzio” of Chieti-Pescara, Via dei Vestini, 31, 66100 Chieti, Italy
| | - Anna Dilillo
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Latina, Italy
| | - Alessia Marcellino
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Latina, Italy
| | - Vanessa Martucci
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Latina, Italy
| | - Saverio Mallardo
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Latina, Italy
| | - Sara Isoldi
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Latina, Italy
| | - Silvia Bloise
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Latina, Italy
| | - Mariateresa Sanseviero
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Latina, Italy
| | - Donatella Iorfida
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Latina, Italy
| | - Enrica De Luca
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Latina, Italy
| | - Carmen Trumello
- Department of Psychological, Health and Territorial Sciences, University “G. d’Annunzio” of Chieti-Pescara, Via dei Vestini, 31, 66100 Chieti, Italy
| | - Francesca D’Alleva
- Department of Psychological, Health and Territorial Sciences, University “G. d’Annunzio” of Chieti-Pescara, Via dei Vestini, 31, 66100 Chieti, Italy
| | - Flavia Ventriglia
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Latina, Italy
| | - Riccardo Lubrano
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Latina, Italy
| | - Emanuela Del Giudice
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Latina, Italy
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Kukafka R, Hirani SP, Harris S, Taylor J, Wedderburn LR, Newman S. The Effects of a Web-Based Tool for Parents of Children With Juvenile Idiopathic Arthritis: Randomized Controlled Trial. J Med Internet Res 2022; 24:e29787. [PMID: 35551065 PMCID: PMC9136652 DOI: 10.2196/29787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 12/10/2021] [Accepted: 12/17/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Juvenile idiopathic arthritis (JIA) is a group of autoinflammatory diseases that cause pain and disability if not controlled by treatment. Parenting a child with JIA is stressful for parents, who express concerns about their child's treatment and may experience anxiety and powerlessness concerning their child's illness. Parenting stress is greater in parents of children with chronic illness than in those with healthy children and is related to poorer psychological adjustment in both parents and children. It is therefore important to develop interventions to support parents. This paper reports the evaluation of a web-based tool that provides information and practical skills to help increase parents' confidence in managing their child's illness and reduce parenting stress. OBJECTIVE The aim of this study is to evaluate the benefits of a web-based tool (WebParC) for parents of children with recently diagnosed JIA. METHODS A multicentered randomized controlled trial was conducted at pediatric rheumatology centers in England. We recruited parents of children aged ≤12 years who had been diagnosed with JIA within the previous 6 months. They were randomized to the intervention (WebParC access plus standard care) or the control (standard care alone) and followed up 4 months and 12 months after randomization. Where both parents participated, they were randomized by household to the same trial arm. The WebParC intervention consists of information about JIA and its treatment plus a toolkit, based on cognitive behavioral therapy, to help parents develop skills to manage JIA-related issues. The primary outcome was the self-report Pediatric Inventory for Parents measure of illness-related parenting stress. The secondary outcomes were parental mood, self-efficacy, coping, effectiveness of participation in their child's health care, satisfaction with health care, and child's health-related quality of life. RESULTS A total of 203 households comprising 220 parents were randomized to the intervention (100/203, 49.3%) or control (103/203, 50.7%) arm. Follow-up assessments were completed by 65.5% (133/203) of the households at 4 months (intervention 60/100, 60%, and control 73/103, 70.9%) and 61.1% (124/203) of the households at 12 months (intervention 58/100, 58%, and control 66/103, 64.1%). A main effect of the trial arm was found on the Pediatric Inventory for Parents: the intervention participants reported less frequency (subscales communication F1,120627=5.37; P=.02, and role function F1,27203=5.40; P=.02) and difficulty (subscales communication F1,2237=7.43; P=.006, medical care F1,2907=4.04; P=.04, and role function F1,821=4.37, P=.04) regarding illness-related stressful events than the control participants. CONCLUSIONS The WebParC website for parents of children with JIA reduced illness-related parenting stress. This web-based intervention offers a feasible preventive approach for parents of children with JIA and potentially could be adapted and evaluated for parents of children with other chronic illnesses. TRIAL REGISTRATION International Standard Randomized Controlled Trial Number (ISRCTN) 13159730; http://www.isrctn.com/ISRCTN13159730.
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Affiliation(s)
| | - Shashivadan P Hirani
- Centre for Health Services Research, School of Health Sciences, City, University of London, London, United Kingdom
| | - Sally Harris
- Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Jo Taylor
- Centre for Health Services Research, School of Health Sciences, City, University of London, London, United Kingdom
| | - Lucy R Wedderburn
- University College London Great Ormond Street Institute of Child Health, University College London, London, United Kingdom.,Centre for Adolescent Rheumatology Versus Arthritis, London, United Kingdom.,National Institute for Health Research Biomedical Research Centre at Great Ormond Street Hospital, London, United Kingdom
| | - Stanton Newman
- Centre for Health Services Research, School of Health Sciences, City, University of London, London, United Kingdom
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Onel KB, Horton DB, Lovell DJ, Shenoi S, Cuello CA, Angeles-Han ST, Becker ML, Cron RQ, Feldman BM, Ferguson PJ, Gewanter H, Guzman J, Kimura Y, Lee T, Murphy K, Nigrovic PA, Ombrello MJ, Rabinovich CE, Tesher M, Twilt M, Klein-Gitelman M, Barbar-Smiley F, Cooper AM, Edelheit B, Gillispie-Taylor M, Hays K, Mannion ML, Peterson R, Flanagan E, Saad N, Sullivan N, Szymanski AM, Trachtman R, Turgunbaev M, Veiga K, Turner AS, Reston JT. 2021 American College of Rheumatology Guideline for the Treatment of Juvenile Idiopathic Arthritis: Therapeutic Approaches for Oligoarthritis, Temporomandibular Joint Arthritis, and Systemic Juvenile Idiopathic Arthritis. Arthritis Care Res (Hoboken) 2022; 74:521-537. [PMID: 35233986 PMCID: PMC10124899 DOI: 10.1002/acr.24853] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/29/2021] [Accepted: 11/23/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To provide updated guidelines for pharmacologic management of juvenile idiopathic arthritis (JIA), focusing on treatment of oligoarthritis, temporomandibular joint (TMJ) arthritis, and systemic JIA with and without macrophage activation syndrome. Recommendations regarding tapering and discontinuing treatment in inactive systemic JIA are also provided. METHODS We developed clinically relevant Patient/Population, Intervention, Comparison, and Outcomes questions. After conducting a systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation approach was used to rate the quality of evidence (high, moderate, low, or very low). A Voting Panel including clinicians and patients/caregivers achieved consensus on the direction (for or against) and strength (strong or conditional) of recommendations. RESULTS Similar to those published in 2019, these JIA recommendations are based on clinical phenotypes of JIA, rather than a specific classification schema. This guideline provides recommendations for initial and subsequent treatment of JIA with oligoarthritis, TMJ arthritis, and systemic JIA as well as for tapering and discontinuing treatment in subjects with inactive systemic JIA. Other aspects of disease management, including factors that influence treatment choice and medication tapering, are discussed. Evidence for all recommendations was graded as low or very low in quality. For that reason, more than half of the recommendations are conditional. CONCLUSION This clinical practice guideline complements the 2019 American College of Rheumatology JIA and uveitis guidelines, which addressed polyarthritis, sacroiliitis, enthesitis, and uveitis. It serves as a tool to support clinicians, patients, and caregivers in decision-making. The recommendations take into consideration the severity of both articular and nonarticular manifestations as well as patient quality of life. Although evidence is generally low quality and many recommendations are conditional, the inclusion of caregivers and patients in the decision-making process strengthens the relevance and applicability of the guideline. It is important to remember that these are recommendations. Clinical decisions, as always, should be made by the treating clinician and patient/caregiver.
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Affiliation(s)
- Karen B Onel
- Hospital for Special Surgery, New York, New York
| | - Daniel B Horton
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Daniel J Lovell
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
| | - Susan Shenoi
- Seattle Children's Hospital and Research Center and University of Washington, Seattle
| | | | - Sheila T Angeles-Han
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
| | | | | | | | | | - Harry Gewanter
- Children's Hospital of Richmond at VCU, Richmond, Virginia
| | - Jaime Guzman
- BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Yukiko Kimura
- Hackensack Meridian School of Medicine, Hackensack, New Jersey
| | | | | | - Peter A Nigrovic
- Boston Children's Hospital and Brigham and Women's Hospital, Boston, Massachusetts
| | | | | | | | - Marinka Twilt
- University of Calgary and Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Marisa Klein-Gitelman
- Ann & Robert Lurie Children's Hospital of Chicago and Northwestern University, Chicago, Illinois
| | | | | | | | | | - Kimberly Hays
- Penn State Health Children's Hospital, Hershey, Pennsylvania
| | | | | | | | | | | | | | | | | | - Keila Veiga
- Maria Fareri Children's Hospital, Valhalla, New York
| | - Amy S Turner
- American College of Rheumatology, Atlanta, Georgia
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11
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Onel KB, Horton DB, Lovell DJ, Shenoi S, Cuello CA, Angeles-Han ST, Becker ML, Cron RQ, Feldman BM, Ferguson PJ, Gewanter H, Guzman J, Kimura Y, Lee T, Murphy K, Nigrovic PA, Ombrello MJ, Rabinovich CE, Tesher M, Twilt M, Klein-Gitelman M, Barbar-Smiley F, Cooper AM, Edelheit B, Gillispie-Taylor M, Hays K, Mannion ML, Peterson R, Flanagan E, Saad N, Sullivan N, Szymanski AM, Trachtman R, Turgunbaev M, Veiga K, Turner AS, Reston JT. 2021 American College of Rheumatology Guideline for the Treatment of Juvenile Idiopathic Arthritis: Therapeutic Approaches for Oligoarthritis, Temporomandibular Joint Arthritis, and Systemic Juvenile Idiopathic Arthritis. Arthritis Rheumatol 2022; 74:553-569. [PMID: 35233993 PMCID: PMC10161784 DOI: 10.1002/art.42037] [Citation(s) in RCA: 69] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/29/2021] [Accepted: 11/23/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To provide updated guidelines for pharmacologic management of juvenile idiopathic arthritis (JIA), focusing on treatment of oligoarthritis, temporomandibular joint (TMJ) arthritis, and systemic JIA with and without macrophage activation syndrome. Recommendations regarding tapering and discontinuing treatment in inactive systemic JIA are also provided. METHODS We developed clinically relevant Patient/Population, Intervention, Comparison, and Outcomes questions. After conducting a systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation approach was used to rate the quality of evidence (high, moderate, low, or very low). A Voting Panel including clinicians and patients/caregivers achieved consensus on the direction (for or against) and strength (strong or conditional) of recommendations. RESULTS Similar to those published in 2019, these JIA recommendations are based on clinical phenotypes of JIA, rather than a specific classification schema. This guideline provides recommendations for initial and subsequent treatment of JIA with oligoarthritis, TMJ arthritis, and systemic JIA as well as for tapering and discontinuing treatment in subjects with inactive systemic JIA. Other aspects of disease management, including factors that influence treatment choice and medication tapering, are discussed. Evidence for all recommendations was graded as low or very low in quality. For that reason, more than half of the recommendations are conditional. CONCLUSION This clinical practice guideline complements the 2019 American College of Rheumatology JIA and uveitis guidelines, which addressed polyarthritis, sacroiliitis, enthesitis, and uveitis. It serves as a tool to support clinicians, patients, and caregivers in decision-making. The recommendations take into consideration the severity of both articular and nonarticular manifestations as well as patient quality of life. Although evidence is generally low quality and many recommendations are conditional, the inclusion of caregivers and patients in the decision-making process strengthens the relevance and applicability of the guideline. It is important to remember that these are recommendations. Clinical decisions, as always, should be made by the treating clinician and patient/caregiver.
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Affiliation(s)
- Karen B Onel
- Hospital for Special Surgery, New York, New York
| | - Daniel B Horton
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Daniel J Lovell
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
| | - Susan Shenoi
- Seattle Children's Hospital and Research Center and University of Washington, Seattle
| | | | - Sheila T Angeles-Han
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
| | | | | | | | | | - Harry Gewanter
- Children's Hospital of Richmond at VCU, Richmond, Virginia
| | - Jaime Guzman
- BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Yukiko Kimura
- Hackensack Meridian School of Medicine, Hackensack, New Jersey
| | | | | | - Peter A Nigrovic
- Boston Children's Hospital and Brigham and Women's Hospital, Boston, Massachusetts
| | | | | | | | - Marinka Twilt
- University of Calgary and Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Marisa Klein-Gitelman
- Ann & Robert Lurie Children's Hospital of Chicago and Northwestern University, Chicago, Illinois
| | | | | | | | | | - Kimberly Hays
- Penn State Health Children's Hospital, Hershey, Pennsylvania
| | | | | | | | | | | | | | | | | | - Keila Veiga
- Maria Fareri Children's Hospital, Valhalla, New York
| | - Amy S Turner
- American College of Rheumatology, Atlanta, Georgia
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12
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Paediatric Multiple Sclerosis: A Scoping Review of Patients’ and Parents’ Perspectives. CHILDREN 2021; 9:children9010011. [PMID: 35053636 PMCID: PMC8773986 DOI: 10.3390/children9010011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/13/2021] [Accepted: 12/20/2021] [Indexed: 11/17/2022]
Abstract
Dealing with paediatric-onset multiple sclerosis is particularly challenging for the young patients and their families, due to its unpredictable symptoms and uncertain outcome. This review aimed at synthesising the qualitative evidence regarding the perspectives about paediatric-onset multiple sclerosis, as expressed by the patients and/or their parents. A literature search was conducted on PubMed and CINAHL. The advanced multi-field search allowed to perform an abstract/title search in both databases, using keywords, combined through Boolean operators. Additional search strategies were adopted: searching the reference list of the selected papers; searching for key authors in the field. All the relevant papers were thoroughly revised using The Joanna Briggs Institute’s data extraction form for qualitative evidence as a guidance. Eight papers were selected. The analysis of these papers allowed to identify some common issues pertaining paediatric-onset multiple sclerosis: (1) onset of symptoms, (2) diagnostic process, (3) reaction to the diagnosis, (4) management and acceptance of multiple sclerosis. The burden of multiple sclerosis was confirmed. However, the young patients and their parents can adjust to the disease. Both the community and the health care professionals must strive to prevent the families dealing with multiple sclerosis from experiencing solitude and rejection.
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13
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Livermore P, Gibson F, Mulligan K, Wedderburn LR, McCann LJ, Gray S. Mapping the current psychology provision for children and young people with juvenile dermatomyositis. Rheumatol Adv Pract 2021; 5:rkab062. [PMID: 34671713 PMCID: PMC8522803 DOI: 10.1093/rap/rkab062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 08/16/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives Juvenile Dermatomyositis (JDM) is a rare, chronic autoimmune condition of
childhood, with known psychosocial implications. In this study, we sought to
establish current psychological support for children and young people across
the UK with rheumatic conditions, with a specific focus on those with
JDM. Methods Electronic surveys were distributed to the 15 centres that belong to the JDM
Research Group in the UK, collecting responses from health-care
professionals in the fields of medicine, nursing and psychology. Results One hundred per cent of professionals from medicine and nursing replied from
all 15 centres. Of these, 7 (47%) did not have a named psychologist
as part of their rheumatology team, despite the majority [13 (87%)]
having >200 paediatric rheumatology patients. Of the remaining
centres, hospital psychology provision varied considerably. When rating
their service, only 3 (8%) of 40 professionals scored their service
as five (where one is poor and five is excellent); there were wide
discrepancies in these scores. Many challenges were discussed, including
limited psychology provision, lack of time and difficulties in offering
support across large geographical areas. Conclusion Many of the challenges discussed are applicable to other centres worldwide.
Suggestions have been proposed that might help to improve the situation for
children and young people with rheumatic conditions, including JDM. Based on
these findings, we suggest that rheumatology teams maximize use of these
data to advocate and work toward more comprehensive psychology provision and
support in their individual centres.
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Affiliation(s)
- Polly Livermore
- Rheumatology Department, University College London Great Ormond Street Institute of Child Health.,Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust.,NIHR Biomedical Research Centre at Great Ormond Street Hospital.,Centre for Adolescent Rheumatology Versus Arthritis at UCL, UCLH and GOSH, London
| | - Faith Gibson
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust.,School of Health Sciences, University of Surrey, Guildford
| | - Kathleen Mulligan
- Centre of Health Services Research, University of London.,East London NHS Foundation Trust, London
| | - Lucy R Wedderburn
- Rheumatology Department, University College London Great Ormond Street Institute of Child Health.,NIHR Biomedical Research Centre at Great Ormond Street Hospital.,Centre for Adolescent Rheumatology Versus Arthritis at UCL, UCLH and GOSH, London
| | - Liza J McCann
- Rheumatology Department, Alder Hey Children's NHS Foundation Trust, Liverpool
| | - Suzanne Gray
- Psychological Services, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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14
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Min M, Hancock DG, Aromataris E, Crotti T, Boros C. Experiences of living with Juvenile Idiopathic Arthritis: a qualitative systematic review. JBI Evid Synth 2021; 20:60-120. [PMID: 34669687 DOI: 10.11124/jbies-21-00139] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this review was to investigate the available qualitative evidence to enhance understanding of the experiences of children, young adults, and their carers living with Juvenile Idiopathic Arthritis in any setting. INTRODUCTION Juvenile Idiopathic Arthritis is the most common chronic rheumatic disease in childhood. Despite the availability of effective treatments, persistent pain, growth retardation, physical disability, and psychological problems can occur. This may reduce the quality of life for Juvenile Idiopathic Arthritis patients by negatively affecting their family, educational, and social well-being. Patient-centered management and care for Juvenile Idiopathic Arthritis patients requires increasing attention to their self-reported quality of life and experiences, in addition to clinically measured disease activity. Furthermore, taking care of children with Juvenile Idiopathic Arthritis may have negative impacts on the lives of their carers and families. The experiences of carers have been poorly understood and studied. This review describes experiences and perspectives from patients and carers in order to inform the needs of families throughout their Juvenile Idiopathic Arthritis journey. INCLUSION CRITERIA Studies describing the experiences of patients aged <21 years who have been diagnosed with Juvenile Idiopathic Arthritis according to the International League of Associations for Rheumatology criteria, as well as the experiences of their carers, have been considered. METHODS A comprehensive search using PubMed, CINAHL, Embase, PsycINFO, Web of Science, and Google Scholar, as well as relevant conference proceedings of the American College of Rheumatology (ACR; 2018-2019), the European Pediatric Rheumatology Congress (PReS) 2018, the European League Against Rheumatism (EULAR; 2018-2019), and the Asia Pacific League of Associations for Rheumatology (APLAR; 2018-2019), was undertaken in December 2020 to identify pertinent published and unpublished studies. Studies published in English from 2001 to 2020 were included. The JBI approach to study selection, critical appraisal, data extraction, and data synthesis was used. RESULTS Ten studies were included in this review. A total of 61 findings were extracted and aggregated to form 12 categories. From the 12 categories, five synthesized findings were developed: i) Self-management of Juvenile Idiopathic Arthritis requires pain management, medication management, and the acquisition of knowledge and professional support; ii) A promising relationship with health care professionals but unbalanced access to services; iii) Parental financial burden and their adjustment to maintain family happiness; iv) Patients and parents support the web-based approach to communicate and develop self-management skills and acknowledge the importance of clinical trials; v) Desire to live a normal life without prejudice from school, social settings, and the workplace. CONCLUSIONS This review has provided a comprehensive overview of experiences and perceptions of Juvenile Idiopathic Arthritis patients and their parents. It is important to understand what they need to know and understand about the disease. This review also highlights the importance of appropriate web-based programs, career counseling, infrastructures, and school facilities. Findings in this review can guide future policy and practice in order to improve care for families and children with Juvenile Idiopathic Arthritis. Further research is required to develop management strategies for medication intolerance and evaluate the longitudinal benefits of relevant Juvenile Idiopathic Arthritis programs. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO (CRD42019133165).
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Affiliation(s)
- Ming Min
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia University of Adelaide Discipline of Paediatrics, Women's and Children's Hospital, Adelaide, SA, Australia Women's and Children's Hospital Department of Rheumatology, Adelaide, SA, Australia JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
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15
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Oen K, Tian J, Loughin TM, Shiff NJ, Tucker LB, Huber AM, Berard RA, Levy DM, Rumsey DG, Tse SM, Chan M, Feldman BM, Duffy CM, Guzman J. Causal pathways to health-related quality of life in children with juvenile idiopathic arthritis: results from the ReACCh-Out cohort. Rheumatology (Oxford) 2021; 60:4691-4702. [PMID: 33506861 DOI: 10.1093/rheumatology/keab079] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 01/04/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Structural equation modelling was applied to data from the Research in Arthritis in Canadian Children emphasizing Outcomes (ReACCh-Out) cohort to help elucidate causal pathways to decreased health-related quality of life (HRQoL) in children with JIA. METHODS Based on published literature and clinical plausibility, a priori models were constructed with explicit root causes (disease activity, treatment intensity) and mediators (pain, disease symptoms, functional impairments) leading to HRQoL [measured by the Quality of my Life (QoML) scale and the Juvenile Arthritis Quality of Life Questionnaire (JAQQ)] at five disease stages: (i) diagnosis, (ii) 3-9 months after diagnosis, (iii) flare, (iv) remission on medications, (v) remission off medications. Following structural equation modelling, a posteriori models were selected based on data fit and clinical plausibility. RESULTS We included 561, 887, 137, 186 and 182 patients at each stage, respectively. In a posteriori models for active disease stages, paths from disease activity led through pain, functional impairments, and disease symptoms, directly or through restrictions in participation, to decreased QoML scores. Treatment intensity had detrimental effects through psychosocial domains; while treatment side effects had a lesser role. Pathways were similar for QoML and JAQQ, but JAQQ models provided greater specificity. Models for remission stages were not supported by the data. CONCLUSION Our findings support disease activity and treatment intensity as being root causes of decreased HRQoL in children with JIA, with pain, functional impairments, and participation restrictions being mediators for disease activity; they support psychosocial effects and side effects as being mediators for treatment intensity.
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Affiliation(s)
- Kiem Oen
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba
| | - Jiahao Tian
- Department of Statistics and Actuarial Science, Simon Fraser University, Burnaby, British Columbia
| | - Thomas M Loughin
- Department of Statistics and Actuarial Science, Simon Fraser University, Burnaby, British Columbia
| | - Natalie J Shiff
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan
| | - Lori B Tucker
- Division of Pediatric Rheumatology, British Columbia Children's Hospital.,Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Adam M Huber
- Division of Pediatric Rheumatology, IWK Health Centre and Dalhousie University, Halifax, Nova Scotia
| | - Roberta A Berard
- Pediatric Rheumatology, Children's Hospital, London Health Sciences Centre, London
| | - Deborah M Levy
- Division of Rheumatology, The Hospital for Sick Children and Department of Pediatrics, University of Toronto, Toronto, Ontario
| | - Dax G Rumsey
- Department of Pediatrics, University of Alberta, Edmonton, Alberta
| | - Shirley M Tse
- Division of Rheumatology, The Hospital for Sick Children and Department of Pediatrics, University of Toronto, Toronto, Ontario
| | - Mercedes Chan
- Division of Pediatric Rheumatology, British Columbia Children's Hospital.,Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Brian M Feldman
- Division of Rheumatology, The Hospital for Sick Children and Departments of Pediatrics, Medicine, and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto
| | - Ciaran M Duffy
- Children's Hospital of Eastern Ontario and Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Jaime Guzman
- Division of Pediatric Rheumatology, British Columbia Children's Hospital.,Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
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Pearce C, Newman S, Mulligan K. Illness Uncertainty in Parents of Children with Juvenile Idiopathic Arthritis. ACR Open Rheumatol 2021; 3:250-259. [PMID: 33710801 PMCID: PMC8063149 DOI: 10.1002/acr2.11238] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 01/22/2021] [Indexed: 01/21/2023] Open
Abstract
Objective To gain a better understanding of uncertainty regarding the illness experienced by parents of children with juvenile idiopathic arthritis (JIA). Methods Parents/guardians of a child or young person (aged less than 18 years) diagnosed JIA were recruited in the United Kingdom via the National Rheumatoid Arthritis Society JIA group. Semistructured telephone interviews were conducted with the parents. Results Twenty parents took part, including 19 mothers and one father. Their children with JIA were mostly female (n = 15; 75%) with polyarticular arthritis (n = 12; 60%), averaged 8 years of age, and had been diagnosed for a mean of 3.7 (SD 2.3) years. Parents expressed uncertainty in the following five key domains: diagnosis, cause, symptoms, and prognosis; medical management; impact; parenting uncertainty; and awareness of JIA. All participants expressed uncertainty in at least four of the five domains. Although parents’ uncertainty in the early stages of the disease related to lack of information and understanding of JIA, much uncertainty could not be resolved by receipt of information. These included concerns about their child’s future and a lack of support with managing the emotional aspects of living with JIA. Conclusion We found that parents’ experiences of uncertainty went beyond dealing with the purely medical aspects of JIA. Provision of information about JIA, although essential, is not sufficient to help parents manage the considerable uncertainty they experience about many aspects of their child’s JIA. Identifying ways to incorporate support for coping with uncertainty into routine care will be an important way of supporting parents to care for their child with JIA.
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Affiliation(s)
- Caroline Pearce
- School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB, United Kingdom
| | - Stanton Newman
- School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB, United Kingdom
| | - Kathleen Mulligan
- School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB, United Kingdom.,East London NHS Foundation Trust, 9 Alie St, London, E1 8DE, United Kingdom
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17
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Postavaru GI, Swaby H, Swaby R. A meta-ethnographic study of fathers' experiences of caring for a child with a life-limiting illness. Palliat Med 2021; 35:261-279. [PMID: 33339475 PMCID: PMC7897781 DOI: 10.1177/0269216320979153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is a growing body of qualitative studies examining parents' experiences of caring for a child with a life-limiting condition, coinciding with recent evidence that indicates an increasing incidence of paediatric life-limiting conditions. However, research focusing on fathers' needs remains sparse and is often diluted among a predominant 'mother's voice', raising questions about whether practices in clinical settings meet fathers' needs. AIM To provide an in-depth assembly of the current state of knowledge around fathers' experiences of caring for their children diagnosed with life-limiting conditions and understand the implications for healthcare services and policies. DESIGN A meta-ethnography was conducted to synthesise findings from existing qualitative studies exploring fathers' experiences of caring. DATA SOURCES Four electronic databases (PubMed, PsycINFO, CINAHL and Science Direct) were searched up until April 2020. Qualitative studies exploring fathers' care experience and published in English language were included. The Critical Appraisal Skills Programme (CASP) checklist was employed for study quality appraisal. No temporal limits were used. RESULTS Sixty-three studies met the inclusion criteria. Thirty life-limiting conditions were included. Based on responses from 496 fathers, a conceptual model was developed which translates key experiences within the fathers' caregiving journeys. The overarching concepts identified were: the paradox of support, challenges in the caring process, 'nobody thinks of men', impact on family life and the fall of the curtain: an irrevocably altered world. These and associated sub-concepts are discussed, with recommendations for future research and practice provided. CONCLUSION The findings indicate the value of a family-oriented approach to develop psychosocial interventions and support channels for fathers, thus empowering them whilst reducing the care-giving burden on the family unit.
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Affiliation(s)
| | | | - Rabbi Swaby
- Nottingham University Hospitals NHS Trust, Nottingham, UK
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Sørensen K, Skirbekk H, Kvarstein G, Wøien H. I don't want to think about it: a qualitative study of children (6-18 years) with rheumatic diseases and parents' experiences with regular needle injections at home. Pediatr Rheumatol Online J 2021; 19:8. [PMID: 33482852 PMCID: PMC7821489 DOI: 10.1186/s12969-021-00495-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 01/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Overall outcomes of pediatric rheumatic diseases (RD) have improved due to treatment with biologic agents and methotrexate. For many children, this treatment often entails regular needle injections. Pain and fear of needle injections are common in childhood, but how children and parents handle long-term needle injections at home has not been fully explored. This study aimed to explore how regular needle injections affect children with RD and their parents in their daily living. METHODS This explorative qualitative study used individual interviews and focus groups to ensure a comprehensive investigation of the topic. Children aged 6 to 16 years (n = 7) and their parents (n = 8) were interviewed individually 4 to 6 months after the onset of needle injection treatment. The focus groups included children aged 11 to 17 years (n = 9) and parents (n = 8) with a minimum of 6 months of experience with injection treatment. Data were analyzed using thematic analysis. RESULTS The main themes; "challenges," "motivational factors," and "routines" captured experiences and strategies that influenced the continuation of needle injections at home. Many children feared the moment immediately before the needle stick, although they had become accustomed to the pain. Most parents felt insecure about handling needle injections and lacked follow-up from healthcare providers. The children's experience of treatment effects and self-confidence were essential to maintain motivation for further injections. A number of coping strategies helped children focus away from injection related discomfort, often discovered by chance. Facilitating firm routines and shared responsibility within families helped children develop self-confidence during the procedure. Children and parents struggled to find suitable information on the Internet. CONCLUSIONS Children and parents experienced long-term needle injections challenging. They used their own limited resources and cooperated within the families to create routines and to introduce coping strategies necessary to manage and keep up with the procedure. Although the injection itself was not experienced very painful, the discomfort, worries and impact on daily life represented far more than a little needle stick, and thus needs more attention from healthcare providers.
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Affiliation(s)
- Kari Sørensen
- Department of Nursing Science, University of Oslo, Oslo, Norway
- Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Department of Undergraduate Studies Lovisenberg Diaconal University College, Oslo, Norway
| | - Helge Skirbekk
- Department of Undergraduate Studies Lovisenberg Diaconal University College, Oslo, Norway
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Gunnvald Kvarstein
- Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Hilde Wøien
- Department of Nursing Science, University of Oslo, Oslo, Norway
- Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
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Ardalan K, Adeyemi O, Wahezi DM, Caliendo AE, Curran ML, Neely J, Kim S, Correll CK, Brunner EJ, Knight AM. Parent Perspectives on Addressing Emotional Health for Children and Young Adults With Juvenile Myositis. Arthritis Care Res (Hoboken) 2020; 73:18-29. [PMID: 32986925 DOI: 10.1002/acr.24466] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 09/22/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To assess parent perspectives regarding the emotional health impact of juvenile myositis (JM) on patients and families, and to assess preferences for emotional health screening and interventions. METHODS Parents of children and young adults with JM were purposively sampled for participation in focus groups at the Cure JM Foundation National Family Conference in 2018. Groups were stratified by patient age group (6-12, 13-17, and 18-21 years), and conversations were audiorecorded, transcribed verbatim, and co-coded via content analysis, with subanalysis by age group. A brief survey assessed preferences for specific emotional health interventions. RESULTS Forty-five parents participated in 6 focus groups. Themes emerged within 2 domains: emotional challenges, and screening and interventions. Themes for emotional challenges comprised the impact of JM on: 1) patient emotional health, particularly depression and anxiety; 2) parent emotional health characterized by sadness, grief, anger, guilt, and anxiety; and 3) family dynamics, including significant sibling distress. Subanalysis revealed similar themes across age groups, but the theme of resiliency emerged specifically for young adults. Themes for emotional health screening and interventions indicated potential issues with patient transparency, several barriers to resources, the facilitator role of rheumatology providers, and preferred intervention modalities of online and in-person resources, with survey responses most strongly supporting child/parent counseling and peer support groups. CONCLUSION JM is associated with intense patient and family distress, although resiliency may emerge by young adulthood. Despite existing barriers, increasing access to counseling, peer support groups, and online resources with rheumatology facilitation may be effective intervention strategies.
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Affiliation(s)
- Kaveh Ardalan
- Duke University Medical Center, Durham, North Carolina, and Ann and Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | - Anne E Caliendo
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Jessica Neely
- University of California San Francisco Medical Center, San Francisco
| | - Susan Kim
- University of California San Francisco Medical Center, San Francisco
| | | | | | - Andrea M Knight
- Hospital for Sick Children and University of Toronto Faculty of Medicine, Toronto, Ontario, Canada, and University of Pennsylvania Perelman School of Medicine, Philadelphia
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20
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Waite-Jones JM, Swallow V, Madill A. From 'neurotic' to 'managing' mother: The 'medical career' experienced by mothers of a child diagnosed with Juvenile Idiopathic Arthritis. Br J Health Psychol 2020; 25:324-338. [PMID: 32150659 DOI: 10.1111/bjhp.12409] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 02/13/2020] [Indexed: 11/27/2022]
Abstract
Objective Despite increased research into how caring for a child diagnosed with juvenile idiopathic arthritis (JIA) affects mothers, more needs to be known about ways in which such experiences transform their lives. Insight into the experiences of such mothers was sought through analysis of interviews with eight mothers and one father caring for a child with JIA. Design The study is situated within a larger project involving families with a child with JIA. A social constructionist approach was adopted and grounded theory including a 'negative case,' guided gathering and analysing data. Individual, semi-structured interviews were conducted based on the research question: 'What is it like to be the mother of a child with juvenile idiopathic arthritis?' Results Findings suggest that mothers find difficulty living up to the 'ideal mother' expected within Western society when forced to provide competing demands of age-related, yet illness-relevant care. The unpredictable nature of JIA means mothers face a lack of understanding from professionals so become hyper-vigilant, 'battling' on behalf of their ill child. A self-perpetuating loop develops if this is misperceived as being overprotective, leaving mothers vulnerable to being judged 'neurotic'. However, with experience, often at an emotional cost, such mothers' confidence in managing the competing demands of caring for their ill child increases such they can navigate a positive journey from 'neurotic' to 'managing' mother. Conclusions Understanding this process could help health care professionals reduce stressful experiences faced by mothers when caring for a chronically ill child. Statement of contribution What is already known on this subject? Mothers of chronically ill children are often diagnosed with anxiety and depression. Such mothers will have taken over managing their child's condition, and this can include negative experiences within the health care system. Qualitative methods enable deeper understanding of the experiences of mothers of chronically ill children. What does the study add? Potentially gendered position of mothers of children with chronic conditions. Taken for granted assumptions implicitly underpin interactions between mothers and some professionals. Greater partnership between mothers and professionals ultimately improves the care of the ill child.
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Affiliation(s)
| | - Veronica Swallow
- Department of Nursing and Midwifery, Sheffield Hallam University, UK
| | - Anna Madill
- School of Psychology, University of Leeds, UK
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21
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Sørensen K, Skirbekk H, Kvarstein G, Wøien H. Children's fear of needle injections: a qualitative study of training sessions for children with rheumatic diseases before home administration. Pediatr Rheumatol Online J 2020; 18:13. [PMID: 32033566 PMCID: PMC7007654 DOI: 10.1186/s12969-020-0406-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 01/09/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Treatment of rheumatic diseases in children often includes long-term needle injections, which represent a risk for refusing medication based on potential needle-fear. How nurses manage children's fear and pain during the initial educational training session of subcutaneous injections, may affect the management of the subsequent injections in the home settings. The aim of this study was to explore how children expressed fear and pain during these training sessions, and how adults' communication affected children's expressed emotions. METHODS This qualitative explorative study used video observations and short interviews during training sessions in a rheumatic hospital ward. Participants were children between five and fifteen years (n = 8), their parents (n = 11) and nurses (n = 7) in nine training sessions in total. The analysis followed descriptions of thematic analysis and interaction analysis. RESULTS The children expressed fears indirectly as cues and nonverbal signs more often than direct statements. Three children stated explicit being afraid or wanting to stop. The children worried about needle-pain, but experienced the stinging pain after the injection more bothersome. The technical instructions were detailed and comprehensive and each nurse shaped the structure of the sessions. Both nurses and parents frequently offered coping strategies unclearly without sufficient time for children to understand. We identified three main adult communication approaches (acknowledging, ambiguous and disregarding) that influenced children's expressed emotions during the training session. CONCLUSIONS Children's expression of fear was likely to be indirectly, and pain was mostly related to the injection rather than the needle stick. When adults used an acknowledging communication and offered sufficient coping strategies, children seemed to become involved in the procedure and acted with confidence. The initial educational training session may have a great impact on long-term repeated injections in a home setting by providing children with confidence at the onset.
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Affiliation(s)
- Kari Sørensen
- Department of Nursing Science, University of Oslo, Oslo, Norway
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
- Department of Undergraduate Studies, Lovisenberg Diaconal University College, Oslo, Norway
| | - Helge Skirbekk
- Department of Undergraduate Studies, Lovisenberg Diaconal University College, Oslo, Norway
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Gunnvald Kvarstein
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
- Department of Clinical Medicine, the Arctic University of Norway, Tromsø, Norway
| | - Hilde Wøien
- Department of Nursing Science, University of Oslo, Oslo, Norway
- Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
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22
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Wright J, Curran J, Rose-Davis B, Cellucci T, Duffy CM, Tucker LB, Batthish M, Huber AM, Lang B, Levy DM, Rumsey DG, Watanabe Duffy KN, Stringer E. Parental Perspectives about Research and Knowledge Translation in Juvenile Idiopathic Arthritis. ACR Open Rheumatol 2020; 2:138-146. [PMID: 31997575 PMCID: PMC7077774 DOI: 10.1002/acr2.11111] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 12/04/2019] [Indexed: 11/11/2022] Open
Abstract
Objective To identify barriers and facilitators to the uptake of information from research by parents of children with juvenile idiopathic arthritis (JIA). Methods Parents of children with JIA participated in focus group and telephone interviews at four Canadian pediatric rheumatology centers. The semistructured interviews focused on perceptions about JIA research, how new information about JIA was obtained and used, and what information was of most interest. Transcripts were analyzed using a general inductive approach. Results Twenty‐eight parents participated in the study. Parents were very interested in research that addresses the outcomes of JIA and side effects of medications. Parents communicated an expectation that information from research be communicated to them by their child's pediatric rheumatologist as part of clinical care. Parents felt that it would be helpful to have information available to them in a variety of formats including written, video, and online. The timing of information delivery is an important factor, with parents being most interested and engaged in learning about new information about JIA at diagnosis and disease flares. We found that parents were overall unaware of new findings from JIA research and therefore may not be optimally utilizing this potentially helpful information in the care of their children. Conclusion This study has led to an understanding of Canadian parents’ perceptions about research and existing gaps in the translation of research knowledge. This information will facilitate the development, implementation, and evaluation of future knowledge translation interventions aimed at improving the uptake of research information in the care of children with JIA.
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Affiliation(s)
- Julia Wright
- IWK Health Care Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Janet Curran
- IWK Health Care Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Benjamin Rose-Davis
- IWK Health Care Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Tania Cellucci
- McMaster Children's Hospital and McMaster University, Hamilton, Ontario, Canada
| | - Ciarån M Duffy
- Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada
| | - Lori B Tucker
- British Columbia Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Michelle Batthish
- McMaster Children's Hospital and McMaster University, Hamilton, Ontario, Canada
| | - Adam M Huber
- IWK Health Care Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Bianca Lang
- IWK Health Care Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Deborah M Levy
- Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Dax G Rumsey
- Stollery Children's Hospital and University of Alberta, Edmonton, Alberta, Canada
| | - Karen N Watanabe Duffy
- Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada
| | - Elizabeth Stringer
- IWK Health Care Centre and Dalhousie University, Halifax, Nova Scotia, Canada
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23
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Torres-Made MD, Peláez-Ballestas I, García-Rodríguez F, Villarreal-Treviño AV, Fortuna-Reyna BDJ, de la O-Cavazos ME, Rubio-Pérez NE. Development and validation of the CAREGIVERS questionnaire: multi-assessing the impact of juvenile idiopathic arthritis on caregivers. Pediatr Rheumatol Online J 2020; 18:3. [PMID: 31937332 PMCID: PMC6961380 DOI: 10.1186/s12969-020-0400-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 01/06/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The primary caregiver is an important person in the life of patients with JIA. Their reactions depend on social, emotional and economic factors that affect the therapeutic alliance. Some generic instruments have been used to evaluate burden, anxiety, or quality of life of caregivers. This study aims to develop a specific instrument to measure the psychosocial and economic impacts on primary caregivers of patients with JIA. METHODOLOGY This is a mixed methods research, that includes qualitative and quantitative data, and was carried out in two phases. First phase: a pragmatic qualitative study (questionnaire construction) was conducted in two parts, a non-systematic literature review followed by interviews with primary caregivers. Second phase: a cross-sectional study (questionnaire validation) to complete validation and estimate Cronbach's alphas based on tetrachoric correlation coefficients, correlation matrix and Cohen's kappa coefficient test. RESULTS There were 38 articles found related to the experience of caregivers. 15 primary caregivers were interviewed (female 93%, median age 45 years). Thematic analysis identified 9 important topics from the perspective of participants (economic impact, coping, family roles, impact of diagnosis, mental health, couple/mate relationships, impact at work, religion, and knowledge of the disease). These topics were combined to create the interview questionnaire (56 items). Later, it was modified to 62 items that were divided into five dimensions: impact of the disease (psychosocial, economic, family, and relationships), knowledge of the disease, alternative medicine, future, and religion. The interview questionnaire was applied to 32 primary caregivers (female 93%, median age 37 years), results identify depression on 29 (90%), 18 (56%) feel sadness at diagnosis, 20 (63%) mentioned that JIA has influenced in their financial situation, 23 (72%) feel anxiety about the future, and 11 (37%) considered that their family relationships have changed. Statistical analysis identified inconsistencies during convergent and divergent validity of the construct. Consequently, 11 items were eliminated, 3 relocated, 6 modified, and 39 compacted obtaining the "Impact of Pediatric Rheumatic Diseases on Caregivers Multi-assessment Questionnaire" (CAREGIVERS questionnaire). This final version resulted on an eight-dimension (28 items) instrument. CONCLUSIONS The CAREGIVERS questionnaire captures perspectives of both the participants and clinicians. It will be helpful to measure the impact of the disease and thus, to improve the quality of care of children with JIA and their families.
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Affiliation(s)
- Marcia Daniela Torres-Made
- 0000 0004 1760 058Xgrid.464574.0Department of Pediatrics, Universidad Autónoma de Nuevo León, Hospital Universitario “Dr. José E. González”, Monterrey, Mexico
| | - Ingris Peláez-Ballestas
- 0000 0001 2221 3638grid.414716.1Rheumatology Unit, Hospital General de México “Dr. Eduardo Liceaga”, Mexico City, Mexico
| | - Fernando García-Rodríguez
- 0000 0004 1760 058Xgrid.464574.0Department of Pediatrics, Universidad Autónoma de Nuevo León, Hospital Universitario “Dr. José E. González”, Monterrey, Mexico
| | - Ana Victoria Villarreal-Treviño
- 0000 0004 1760 058Xgrid.464574.0Department of Pediatrics, Universidad Autónoma de Nuevo León, Hospital Universitario “Dr. José E. González”, Monterrey, Mexico
| | - Brenda de Jesús Fortuna-Reyna
- 0000 0004 1760 058Xgrid.464574.0Department of Pediatrics, Universidad Autónoma de Nuevo León, Hospital Universitario “Dr. José E. González”, Monterrey, Mexico
| | - Manuel Enrique de la O-Cavazos
- 0000 0004 1760 058Xgrid.464574.0Department of Pediatrics, Universidad Autónoma de Nuevo León, Hospital Universitario “Dr. José E. González”, Monterrey, Mexico
| | - Nadina Eugenia Rubio-Pérez
- Department of Pediatrics, Universidad Autónoma de Nuevo León, Hospital Universitario "Dr. José E. González", Monterrey, Mexico.
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24
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Horton DB, Salas J, Wec A, Kohlheim M, Kapadia P, Beukelman T, Boneparth A, Haverkamp K, Mannion ML, Moorthy LN, Ringold S, Rosenthal M. Making Decisions About Stopping Medicines for Well-Controlled Juvenile Idiopathic Arthritis: A Mixed-Methods Study of Patients and Caregivers. Arthritis Care Res (Hoboken) 2019; 73:374-385. [PMID: 31880862 DOI: 10.1002/acr.24129] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 12/17/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Improved treatments for juvenile idiopathic arthritis (JIA) have increased remission rates. We conducted this study to investigate how patients and caregivers make decisions about stopping medications when JIA is inactive. METHODS We performed a mixed-methods study of caregivers and patients affected by JIA, recruited through social media and flyers, and selected by purposive sampling. Participants discussed their experiences with JIA, medications, and decision-making through recorded telephone interviews. Of 44 interviewees, 20 were patients (50% ages <18 years), and 24 were caregivers (50% caring for children ages ≤10 years). We evaluated characteristics associated with high levels of reported concerns about JIA or medicines using Fisher's exact testing. RESULTS Decisions about stopping medicines were informed by competing risks between disease activity and treatment. Participants who expressed more concerns about JIA were more likely to report disease-related complications (P = 0.002) and more motivated to continue treatment. However, participants expressing more concern about medicines were more likely to report treatment-related complications (P = 0.04) and felt more compelled to stop treatment. Additionally, participants considered how JIA or treatments facilitated or interfered with their sense of normalcy and safety, expressed feelings of guilt and regret about previous or potential adverse events, and reflected on uncertainty and unpredictability of future harms. Decision-making was also informed by trust in rheumatologists and other information sources (e.g., family and online support groups). CONCLUSION When deciding whether to stop medicines whenever JIA is inactive, patients and caregivers weigh competing risks between disease activity and treatment. Based on our results, we suggest specific approaches for clinicians to perform shared decision-making regarding stopping medicines for JIA.
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Affiliation(s)
- Daniel B Horton
- Rutgers Robert Wood Johnson Medical School and Rutgers Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, New Brunswick, New Jersey, and Rutgers School of Public Health, Piscataway, New Jersey
| | | | | | - Melanie Kohlheim
- Pediatric Rheumatology Care and Outcomes Improvement Network, Cincinnati, Ohio
| | - Pooja Kapadia
- Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
| | | | | | - Ky Haverkamp
- University of Washington School of Medicine, Seattle
| | | | - L Nandini Moorthy
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | | | - Marsha Rosenthal
- Institute for Health, Health Care Policy and Aging Research, New Brunswick, New Jersey
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25
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Livermore P, Gray S, Mulligan K, Stinson JN, Wedderburn LR, Gibson F. Being on the juvenile dermatomyositis rollercoaster: a qualitative study. Pediatr Rheumatol Online J 2019; 17:30. [PMID: 31215480 PMCID: PMC6582587 DOI: 10.1186/s12969-019-0332-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 05/22/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Juvenile Dermatomyositis is a rare, potentially life-threatening condition with no known cure. There is no published literature capturing how children and young people feel about their condition, from their perspective. This study was therefore unique in that it asked children and young people what is it like to live with Juvenile Dermatomyositis. METHODS Data were obtained from fifteen young people with Juvenile Dermatomyositis, between eight and nineteen years of age from one Paediatric Rheumatology department using audio-recorded interpretive phenomenology interviews. Data were analyzed phenomenologically, using a process that derives narratives from transcripts resulting in a collective composite of participants shared experiences, called a 'phenomenon'. RESULTS The overarching metaphor of a rollercoaster captures the phenomenon of living with Juvenile Dermatomyositis as a young person, with the ups and downs at different time points clearly described by those interviewed. The five themes plotted on the rollercoaster, began with confusion; followed by feeling different, being sick, steroidal and scared from the medications; uncertainty; and then ended with acceptance of the disease over time. CONCLUSION Young people were able to talk about their experiences about having Juvenile Dermatomyositis. Our findings will aid clinicians in their practice by gaining a deeper understanding of what daily life is like and highlighting ways to enhance psychosocial functioning. Hopefully, this study and any further resulting studies, will raise understanding of Juvenile Dermatomyositis worldwide and will encourage health care professionals to better assess psychosocial needs in the future.
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Affiliation(s)
- Polly Livermore
- University College London Great Ormond Street Institute of Child Health, London, UK. .,Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK. .,Centre for Adolescent Rheumatology Versus Arthritis at UCL UCLH and GOSH, London, UK. .,NIHR Clinical Doctoral Research Nursing Fellow, Infection, Immunity and Inflammation, 6th Floor, Institute of Child Health, University College London Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.
| | - Suzanne Gray
- 0000 0004 5345 7223grid.483570.dEvelina London Children’s Hospital, GSTT NHS Foundation Trust, London, UK
| | - Kathleen Mulligan
- 0000 0004 1936 8497grid.28577.3fCity, University of London, London, UK ,0000 0004 0426 7183grid.450709.fEast London NHS Foundation Trust, London, UK
| | - Jennifer N. Stinson
- 0000 0004 0473 9646grid.42327.30Hospital for Sick Children, Toronto, Canada ,0000 0001 2157 2938grid.17063.33Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Lucy R. Wedderburn
- 0000000121901201grid.83440.3bUniversity College London Great Ormond Street Institute of Child Health, London, UK ,0000 0001 2116 3923grid.451056.3NIHR Biomedical Research Centre at Great Ormond Street Hospital, London, UK ,0000000121901201grid.83440.3bCentre for Adolescent Rheumatology Versus Arthritis at UCL UCLH and GOSH, London, UK
| | - Faith Gibson
- 0000 0004 5902 9895grid.424537.3Centre for Outcomes and Experience Research in Children’s Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK ,0000 0004 0407 4824grid.5475.3School of Health Sciences, University of Surrey, Surrey, UK
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26
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Knight A, Vickery M, Faust L, Muscal E, Davis A, Harris J, Hersh AO, Rodriguez M, Onel K, Rubinstein T, Washington N, Weitzman ER, Conlon H, Woo JMP, Gerstbacher D, von Scheven E. Gaps in Mental Health Care for Youth With Rheumatologic Conditions: A Mixed Methods Study of Perspectives From Behavioral Health Providers. Arthritis Care Res (Hoboken) 2019; 71:591-601. [PMID: 29953741 DOI: 10.1002/acr.23683] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 06/26/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To identify behavioral health provider perspectives on gaps in mental health care for youth with rheumatologic conditions. METHODS Social workers (n = 34) and psychologists (n = 8) at pediatric rheumatology centers in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) completed an online survey assessing current practices and mental health care needs of youth with rheumatologic conditions. Responses were compared to a published survey of CARRA rheumatologists (n = 119). Thematic analysis of 20 semi-structured interviews with behavioral health providers was performed. RESULTS One-third of CARRA centers (n = 100) had no affiliated social worker or psychologist. Only 1 behavioral health provider reported current universal mental health screening at their rheumatology clinic, yet routine depression screening was supported by >85% of behavioral health providers and rheumatologists. Support for anxiety screening was higher among behavioral health providers (90% versus 65%; P < 0.01). Interviews illustrated a need for interventions addressing illness-related anxiety, adjustment/coping/distress, transition, parent/caregiver mental health, and peer support. Limited resources, lack of protocols, and patient cost/time burden were the most frequent barriers to intervention. Inadequate follow-up of mental health referrals was indicated by 52% of providers. More behavioral health providers than rheumatologists favored mental health services in rheumatology settings (55% versus 19%; P < 0.01). Only 7 social workers (21%) provided counseling/therapy, and interviews indicated their perceived underutilization of these services. CONCLUSION Behavioral health providers indicated an unmet need for mental health interventions that address illness-related issues affecting youth with rheumatologic conditions. Implementation of mental health protocols and optimizing utilization of social workers may improve mental health care for these youth.
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Affiliation(s)
- Andrea Knight
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Lauren Faust
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Eyal Muscal
- Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Alaina Davis
- Monroe Carell Junior Children's Hospital, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Julia Harris
- Children's Mercy Kansas City, University of Missouri, Kansas City
| | | | - Martha Rodriguez
- Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana
| | - Karen Onel
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - Tamar Rubinstein
- Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Nina Washington
- Mississippi Center for Advanced Medicine, Madison, Mississippi
| | - Elissa R Weitzman
- Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts
| | - Hana Conlon
- Columbia University Medical Center, New York, New York
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Khair K, Klukowska A, Myrin Westesson L, Kavakli K, Escuriola C, Uitslager N, Santoro C, Holland M, von Mackensen S. The burden of bleeds and other clinical determinants on caregivers of children with haemophilia (the BBC Study). Haemophilia 2019; 25:416-423. [PMID: 30925018 DOI: 10.1111/hae.13736] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 02/19/2019] [Accepted: 02/19/2019] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Treatment burden for the people with haemophilia has been documented, as has the burden of caring for a child with a common chronic disease such as asthma or diabetes. However, there remains a paucity of data about caregiver burden in haemophilia. AIMS The aim of this study was to evaluate the impact of bleeding on caregivers of children with haemophilia. Caregiver burden was stratified by the clinical status of their child. METHODS A multinational, non-interventional study of caregivers of children with severe or moderate haemophilia, using the HEMOCABquestionnaire to evaluate caregiver burden. RESULTS A total of 144 caregivers from seven EU countries participated in the study. Differences in caregiver burden were identified based on the clinical situation of the child. Greater burden was seen in caregivers of children who experienced joint bleeding in the preceding 12 months, or had target joints or reduced range of motion in most domains of the HEMOCAB. Caring for a child with a current inhibitor also caused significantly higher burden for caregivers when compared to caring for a child with tolerized inhibitor or without inhibitor. Caregivers of children with chronic pain reported significantly higher burden in all domains of the HEMOCAB except for "interaction with the father." CONCLUSION Caregiver burden can be affected by the child's haemophilia status, particularly if joint health is impacted (eg bleeds, decreased mobility) or if the child suffers from chronic pain which was moderately correlated with joint bleeds.
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Affiliation(s)
- Kate Khair
- Centre for Outcomes and Experience Research in Childhood Health, Illness and Disability (ORCHID) Great Ormond Street Hospital for Children NHS Trust, London, UK.,Haemophilia Centre, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Anna Klukowska
- Department of Paediatrics, Haematology Oncology, Warsaw Medical University, Warsaw, Poland
| | - Linda Myrin Westesson
- Department of Medicine/Haematology and Coagulation Disorders, Coagulation Centre, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Carmen Escuriola
- Haemophilia Centre Rhein Main (HZRM), Mörfelden-Walldorf, Germany
| | - Nanda Uitslager
- Van Creveldkliniek, Division of Internal Medicine and Dermatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | - Sylvia von Mackensen
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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Bose M, Mahadevan M, Schules DR, Coleman RK, Gawron KM, Gamble MB, Roullet JB, Gibson KM, Rizzo WB. Emotional experience in parents of children with Zellweger spectrum disorders: A qualitative study. Mol Genet Metab Rep 2019; 19:100459. [PMID: 30815361 PMCID: PMC6377409 DOI: 10.1016/j.ymgmr.2019.100459] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 02/01/2019] [Indexed: 01/04/2023] Open
Abstract
Zellweger spectrum disorders (ZSDs) are rare, debilitating genetic diseases of peroxisome biogenesis that require constant management and lifelong care. Nevertheless, the experience of family caregivers for children diagnosed with ZSD is not well understood. In this study, we sought to characterize the emotional experience of ZSD family caregivers. Three 90-min focus groups were conducted with thirty-seven parents (25 mothers and 12 fathers) of children with ZSD during a family advocacy conference. Focus groups were arranged by age of proband (Group 1: 0–4 years, Group 2: 5–10 years, Group 3: >11 years). Audio recordings of focus groups were transcribed and analyzed using software for coding purposes. Analyzed content was validated using peer debriefing, member checking, and method triangulation. Focus group results showed that nearly a third of ZSD caregivers described their overall emotional experience as a “rollercoaster.” Additionally, three interconnected themes were identified: 1) range of emotions, 2) stressors, and 3) coping. Feeling overwhelmed and devastated were the most frequently described emotional responses. Corresponding stressors to these emotions included the burden of caregiver tasks associated with ZSD, and negative interactions with healthcare professionals. The most common coping strategies were acceptance of limitations of the diseases, redefining “normal” in the parenting experience, and advocating on behalf of the child and the patient community. This study underscores the profound emotional impact on parents who are caregivers for children with ZSDs, highlighting the utility of patient community feedback and qualitative approaches to fully characterize the overall family experience. Simple, targeted approaches focusing on improved communication between healthcare professionals and families, as well as offering resources for emotional support may greatly improve the lives of families living with ZSD and other rare pediatric diseases.
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Affiliation(s)
- Mousumi Bose
- Department of Nutrition and Food Studies, Montclair State University, 1 Normal Avenue, UN 2159, Montclair, NJ 07043, USA
| | - Meena Mahadevan
- Department of Nutrition and Food Studies, Montclair State University, 1 Normal Avenue, UN 2157, Montclair, NJ 07043, USA
| | - Dana R Schules
- Department of Nutrition and Food Studies, Montclair State University, 1 Normal Avenue, UN 2154, Montclair, NJ 07043, USA
| | - Rory K Coleman
- Department of Nutrition and Food Studies, Montclair State University, 1 Normal Avenue, UN 2154, Montclair, NJ 07043, USA
| | - Kelly M Gawron
- Department of Nutrition and Food Studies, Montclair State University, 1 Normal Avenue, UN 2154, Montclair, NJ 07043, USA
| | - Melissa B Gamble
- Global Foundation for Peroxisomal Disorders, P.O. Box 33238, Tulsa, OK 74153, USA
| | - Jean-Baptiste Roullet
- Department of Pharmacotherapy, College of Pharmacy and Pharmaceutical Sciences, Washington State University, PO Box 1495, Spokane, WA 99210, USA
| | - K Michael Gibson
- Department of Pharmacotherapy, College of Pharmacy and Pharmaceutical Sciences, Washington State University, PO Box 1495, Spokane, WA 99210, USA
| | - William B Rizzo
- Department of Pediatrics, University of Nebraska Medical Center, University of Nebraska, 985940 Nebraska Medical Center - DRC II 4064, Omaha, NE 68198-5940, USA
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29
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Sherratt FC, Roper L, Stones SR, McErlane F, Peak M, Beresford MW, Foster H, Ramanan AV, Rooney M, Baildam E, Young B. Protective parents and permissive children: what qualitative interviews with parents and children can tell us about the feasibility of juvenile idiopathic arthritis trials. Pediatr Rheumatol Online J 2018; 16:76. [PMID: 30514320 PMCID: PMC6278083 DOI: 10.1186/s12969-018-0293-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 11/13/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Patient recruitment can be very challenging in paediatric studies, especially in relatively uncommon conditions, such as juvenile idiopathic arthritis (JIA). However, involving children and young people (CYP) in the design of such trials could promise a more rapid trajectory towards making evidence-based treatments available. Studies involving CYP are advocated in the literature but we are not aware of any early stage feasibility studies that have qualitatively accessed the perspectives of parents and CYP with a long term condition to inform design and conduct of a trial. In the context of a feasibility study to inform the design of a proposed randomised controlled trial of corticosteroid induction regimen in JIA, we explored families' perspectives on the proposed trial and on JIA trials generally. METHODS We analysed interviews with 27 participants (8 CYP aged 8-16 years and 19 parents) from four UK paediatric rheumatology centres. CYP had recently received corticosteroids to treat JIA. Audio-recorded interviews were transcribed and analysed thematically, drawing on the Framework Method. RESULTS Both parents and CYP were capable of engaging with the logic of the proposed trial but pointed to challenges with its design. Treatment preferences influenced willingness to participate in the proposed trial. The preferences of older children and their parents often differed, with CYP being more willing to participate in the proposed trial than parents. Families' current treatment preferences were largely informed by past positive and negative treatment experiences. Some participants also indicated that their treatment preferences were influenced by those of their clinicians. CONCLUSION Previous research has typically focused on deficits in patients' understandings of trials. We found that both parents and CYP understood trial concepts and were able to identify potential flaws in the proposed trial. We propose recommendations to optimise the design of a planned corticosteroid induction regimen trial in JIA. Accessing both parents' and CYP's perspectives helps to identify and address recruitment challenges, which will ultimately optimise informed consent and future recruitment.
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Affiliation(s)
- Frances C. Sherratt
- 0000 0004 1936 8470grid.10025.36Department of Psychological Sciences, University of Liverpool, Whelan Building, Brownlow Hill, Liverpool, L69 3GB UK
| | - Louise Roper
- 0000 0004 1936 8470grid.10025.36Department of Psychological Sciences, University of Liverpool, Whelan Building, Brownlow Hill, Liverpool, L69 3GB UK
| | - Simon R. Stones
- 0000 0004 1936 8403grid.9909.9School of Healthcare, University of Leeds, Leeds, UK
| | - Flora McErlane
- 0000 0004 4904 7256grid.459561.aGreat North Children’s Hospital, Newcastle upon Tyne, UK ,0000 0001 0462 7212grid.1006.7Institute Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Matthew Peak
- 0000 0004 0421 1374grid.417858.7Clinical Research Division, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - Michael W. Beresford
- 0000 0004 0421 1374grid.417858.7Department of Paediatric Rheumatology, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK ,0000 0004 1936 8470grid.10025.36Department of Women’s and Children’s Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Helen Foster
- 0000 0004 4904 7256grid.459561.aGreat North Children’s Hospital, Newcastle upon Tyne, UK ,0000 0001 0462 7212grid.1006.7Institute Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Athimalaipet V. Ramanan
- 0000 0004 1936 7603grid.5337.2University Hospitals Bristol NHS Foundation Trust & Bristol Medical School, University of Bristol, Bristol, UK
| | - Madeleine Rooney
- 0000 0004 0374 7521grid.4777.3School of Medicine, Dentistry and Biomedical Sciences, Queens University of Belfast, Belfast, UK
| | - Eileen Baildam
- 0000 0004 0421 1374grid.417858.7Department of Paediatric Rheumatology, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - Bridget Young
- 0000 0004 1936 8470grid.10025.36Department of Psychological Sciences, University of Liverpool, Whelan Building, Brownlow Hill, Liverpool, L69 3GB UK
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30
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Postavaru GI. A meta-ethnography of parents’ experiences of their children’s life-limiting conditions. QUALITATIVE RESEARCH IN PSYCHOLOGY 2018. [DOI: 10.1080/14780887.2018.1543068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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31
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Rose-Davis B, Curran J, Wright J, Cellucci T, Duffy CM, Tucker LB, Batthish M, Huber AM, Lang B, Levy DM, Rumsey DG, Watanabe Duffy KN, Stringer E. Factors Influencing the Uptake of Canadian Research Findings into the Care of Children with Arthritis: A Healthcare Provider Perspective. J Rheumatol 2018; 46:294-300. [PMID: 30442824 DOI: 10.3899/jrheum.180282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2018] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To determine barriers and facilitators to the uptake of findings from the Research in Arthritis in Canadian Children emphasizing Outcomes (ReACCh-Out) study into clinical care by pediatric rheumatologists (PR) and allied health professionals (AHP) caring for children with juvenile idiopathic arthritis (JIA) in Canada. METHODS PR and AHP participated in this qualitative study through telephone interviews. Interview guides were developed using the Theoretical Domains Framework and focused on the use of information from the ReACCh-Out study in the practice of counseling patients and families. A directed content analysis approach was used for coding. RESULTS Nineteen interviews (8 PR and 11 AHP) were completed. All PR had knowledge of the ReACCh-Out study. Three major themes were identified: (1) both groups are motivated to use information from research in clinical care; (2) volume and emotional effect of information on families are barriers; and (3) specific timepoints in care trigger providing this information. AHP had less knowledge of the ReACCh-Out study, did not feel it was their primary role to provide this information, and have a desire for more opportunity to participate in academic forums related to research. CONCLUSION We have described a comprehensive overview of the barriers and facilitators perceived by healthcare providers in the translation of knowledge from JIA research into use in clinical practice. These findings provide a foundation for the development of knowledge translation strategies in the care of children with JIA and other rheumatic diseases.
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Affiliation(s)
- Benjamin Rose-Davis
- From the IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; British Columbia Children's Hospital, Division of Rheumatology, and University of British Columbia, Vancouver, British Columbia; McMaster Children's Hospital, Division of Rheumatology, and McMaster University, Hamilton; Hospital for Sick Children and University of Toronto, Toronto, Ontario; Stollery Children's Hospital and University of Alberta, Edmonton, Alberta, Canada.,B. Rose-Davis, BA, IWK Health Centre; J. Curran, BN, MEd, PhD, Clinician Scientist, Pediatrics and Emergency Medicine, Associate Professor of Nursing, IWK Health Centre; J. Wright, BSc, Dalhousie University; T. Cellucci, MD, FRCPC, MScCH, Pediatric Rheumatologist, Associate Professor of Pediatrics, McMaster University; C.M. Duffy, MB, BCh, MSc, FRCPC, FRCPI, Pediatric Rheumatologist, Professor of Pediatrics, Children's Hospital of Eastern Ontario; L.B. Tucker, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, British Columbia Children's Hospital, Division of Rheumatology; M. Batthish, MSc, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, McMaster Children's Hospital, Division of Rheumatology; A.M. Huber, MD, MSc, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; B. Lang, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; D.M. Levy, MD, MS, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Hospital for Sick Children and University of Toronto; D.G. Rumsey, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, University of Alberta; K.N. Watanabe Duffy, MD, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Children's Hospital of Eastern Ontario; E. Stringer, MD, MSc, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, IWK Health Centre
| | - Janet Curran
- From the IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; British Columbia Children's Hospital, Division of Rheumatology, and University of British Columbia, Vancouver, British Columbia; McMaster Children's Hospital, Division of Rheumatology, and McMaster University, Hamilton; Hospital for Sick Children and University of Toronto, Toronto, Ontario; Stollery Children's Hospital and University of Alberta, Edmonton, Alberta, Canada.,B. Rose-Davis, BA, IWK Health Centre; J. Curran, BN, MEd, PhD, Clinician Scientist, Pediatrics and Emergency Medicine, Associate Professor of Nursing, IWK Health Centre; J. Wright, BSc, Dalhousie University; T. Cellucci, MD, FRCPC, MScCH, Pediatric Rheumatologist, Associate Professor of Pediatrics, McMaster University; C.M. Duffy, MB, BCh, MSc, FRCPC, FRCPI, Pediatric Rheumatologist, Professor of Pediatrics, Children's Hospital of Eastern Ontario; L.B. Tucker, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, British Columbia Children's Hospital, Division of Rheumatology; M. Batthish, MSc, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, McMaster Children's Hospital, Division of Rheumatology; A.M. Huber, MD, MSc, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; B. Lang, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; D.M. Levy, MD, MS, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Hospital for Sick Children and University of Toronto; D.G. Rumsey, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, University of Alberta; K.N. Watanabe Duffy, MD, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Children's Hospital of Eastern Ontario; E. Stringer, MD, MSc, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, IWK Health Centre
| | - Julia Wright
- From the IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; British Columbia Children's Hospital, Division of Rheumatology, and University of British Columbia, Vancouver, British Columbia; McMaster Children's Hospital, Division of Rheumatology, and McMaster University, Hamilton; Hospital for Sick Children and University of Toronto, Toronto, Ontario; Stollery Children's Hospital and University of Alberta, Edmonton, Alberta, Canada.,B. Rose-Davis, BA, IWK Health Centre; J. Curran, BN, MEd, PhD, Clinician Scientist, Pediatrics and Emergency Medicine, Associate Professor of Nursing, IWK Health Centre; J. Wright, BSc, Dalhousie University; T. Cellucci, MD, FRCPC, MScCH, Pediatric Rheumatologist, Associate Professor of Pediatrics, McMaster University; C.M. Duffy, MB, BCh, MSc, FRCPC, FRCPI, Pediatric Rheumatologist, Professor of Pediatrics, Children's Hospital of Eastern Ontario; L.B. Tucker, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, British Columbia Children's Hospital, Division of Rheumatology; M. Batthish, MSc, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, McMaster Children's Hospital, Division of Rheumatology; A.M. Huber, MD, MSc, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; B. Lang, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; D.M. Levy, MD, MS, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Hospital for Sick Children and University of Toronto; D.G. Rumsey, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, University of Alberta; K.N. Watanabe Duffy, MD, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Children's Hospital of Eastern Ontario; E. Stringer, MD, MSc, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, IWK Health Centre
| | - Tania Cellucci
- From the IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; British Columbia Children's Hospital, Division of Rheumatology, and University of British Columbia, Vancouver, British Columbia; McMaster Children's Hospital, Division of Rheumatology, and McMaster University, Hamilton; Hospital for Sick Children and University of Toronto, Toronto, Ontario; Stollery Children's Hospital and University of Alberta, Edmonton, Alberta, Canada.,B. Rose-Davis, BA, IWK Health Centre; J. Curran, BN, MEd, PhD, Clinician Scientist, Pediatrics and Emergency Medicine, Associate Professor of Nursing, IWK Health Centre; J. Wright, BSc, Dalhousie University; T. Cellucci, MD, FRCPC, MScCH, Pediatric Rheumatologist, Associate Professor of Pediatrics, McMaster University; C.M. Duffy, MB, BCh, MSc, FRCPC, FRCPI, Pediatric Rheumatologist, Professor of Pediatrics, Children's Hospital of Eastern Ontario; L.B. Tucker, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, British Columbia Children's Hospital, Division of Rheumatology; M. Batthish, MSc, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, McMaster Children's Hospital, Division of Rheumatology; A.M. Huber, MD, MSc, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; B. Lang, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; D.M. Levy, MD, MS, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Hospital for Sick Children and University of Toronto; D.G. Rumsey, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, University of Alberta; K.N. Watanabe Duffy, MD, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Children's Hospital of Eastern Ontario; E. Stringer, MD, MSc, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, IWK Health Centre
| | - Ciarån M Duffy
- From the IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; British Columbia Children's Hospital, Division of Rheumatology, and University of British Columbia, Vancouver, British Columbia; McMaster Children's Hospital, Division of Rheumatology, and McMaster University, Hamilton; Hospital for Sick Children and University of Toronto, Toronto, Ontario; Stollery Children's Hospital and University of Alberta, Edmonton, Alberta, Canada.,B. Rose-Davis, BA, IWK Health Centre; J. Curran, BN, MEd, PhD, Clinician Scientist, Pediatrics and Emergency Medicine, Associate Professor of Nursing, IWK Health Centre; J. Wright, BSc, Dalhousie University; T. Cellucci, MD, FRCPC, MScCH, Pediatric Rheumatologist, Associate Professor of Pediatrics, McMaster University; C.M. Duffy, MB, BCh, MSc, FRCPC, FRCPI, Pediatric Rheumatologist, Professor of Pediatrics, Children's Hospital of Eastern Ontario; L.B. Tucker, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, British Columbia Children's Hospital, Division of Rheumatology; M. Batthish, MSc, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, McMaster Children's Hospital, Division of Rheumatology; A.M. Huber, MD, MSc, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; B. Lang, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; D.M. Levy, MD, MS, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Hospital for Sick Children and University of Toronto; D.G. Rumsey, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, University of Alberta; K.N. Watanabe Duffy, MD, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Children's Hospital of Eastern Ontario; E. Stringer, MD, MSc, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, IWK Health Centre
| | - Lori B Tucker
- From the IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; British Columbia Children's Hospital, Division of Rheumatology, and University of British Columbia, Vancouver, British Columbia; McMaster Children's Hospital, Division of Rheumatology, and McMaster University, Hamilton; Hospital for Sick Children and University of Toronto, Toronto, Ontario; Stollery Children's Hospital and University of Alberta, Edmonton, Alberta, Canada.,B. Rose-Davis, BA, IWK Health Centre; J. Curran, BN, MEd, PhD, Clinician Scientist, Pediatrics and Emergency Medicine, Associate Professor of Nursing, IWK Health Centre; J. Wright, BSc, Dalhousie University; T. Cellucci, MD, FRCPC, MScCH, Pediatric Rheumatologist, Associate Professor of Pediatrics, McMaster University; C.M. Duffy, MB, BCh, MSc, FRCPC, FRCPI, Pediatric Rheumatologist, Professor of Pediatrics, Children's Hospital of Eastern Ontario; L.B. Tucker, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, British Columbia Children's Hospital, Division of Rheumatology; M. Batthish, MSc, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, McMaster Children's Hospital, Division of Rheumatology; A.M. Huber, MD, MSc, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; B. Lang, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; D.M. Levy, MD, MS, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Hospital for Sick Children and University of Toronto; D.G. Rumsey, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, University of Alberta; K.N. Watanabe Duffy, MD, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Children's Hospital of Eastern Ontario; E. Stringer, MD, MSc, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, IWK Health Centre
| | - Michelle Batthish
- From the IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; British Columbia Children's Hospital, Division of Rheumatology, and University of British Columbia, Vancouver, British Columbia; McMaster Children's Hospital, Division of Rheumatology, and McMaster University, Hamilton; Hospital for Sick Children and University of Toronto, Toronto, Ontario; Stollery Children's Hospital and University of Alberta, Edmonton, Alberta, Canada.,B. Rose-Davis, BA, IWK Health Centre; J. Curran, BN, MEd, PhD, Clinician Scientist, Pediatrics and Emergency Medicine, Associate Professor of Nursing, IWK Health Centre; J. Wright, BSc, Dalhousie University; T. Cellucci, MD, FRCPC, MScCH, Pediatric Rheumatologist, Associate Professor of Pediatrics, McMaster University; C.M. Duffy, MB, BCh, MSc, FRCPC, FRCPI, Pediatric Rheumatologist, Professor of Pediatrics, Children's Hospital of Eastern Ontario; L.B. Tucker, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, British Columbia Children's Hospital, Division of Rheumatology; M. Batthish, MSc, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, McMaster Children's Hospital, Division of Rheumatology; A.M. Huber, MD, MSc, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; B. Lang, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; D.M. Levy, MD, MS, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Hospital for Sick Children and University of Toronto; D.G. Rumsey, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, University of Alberta; K.N. Watanabe Duffy, MD, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Children's Hospital of Eastern Ontario; E. Stringer, MD, MSc, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, IWK Health Centre
| | - Adam M Huber
- From the IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; British Columbia Children's Hospital, Division of Rheumatology, and University of British Columbia, Vancouver, British Columbia; McMaster Children's Hospital, Division of Rheumatology, and McMaster University, Hamilton; Hospital for Sick Children and University of Toronto, Toronto, Ontario; Stollery Children's Hospital and University of Alberta, Edmonton, Alberta, Canada.,B. Rose-Davis, BA, IWK Health Centre; J. Curran, BN, MEd, PhD, Clinician Scientist, Pediatrics and Emergency Medicine, Associate Professor of Nursing, IWK Health Centre; J. Wright, BSc, Dalhousie University; T. Cellucci, MD, FRCPC, MScCH, Pediatric Rheumatologist, Associate Professor of Pediatrics, McMaster University; C.M. Duffy, MB, BCh, MSc, FRCPC, FRCPI, Pediatric Rheumatologist, Professor of Pediatrics, Children's Hospital of Eastern Ontario; L.B. Tucker, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, British Columbia Children's Hospital, Division of Rheumatology; M. Batthish, MSc, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, McMaster Children's Hospital, Division of Rheumatology; A.M. Huber, MD, MSc, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; B. Lang, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; D.M. Levy, MD, MS, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Hospital for Sick Children and University of Toronto; D.G. Rumsey, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, University of Alberta; K.N. Watanabe Duffy, MD, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Children's Hospital of Eastern Ontario; E. Stringer, MD, MSc, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, IWK Health Centre
| | - Bianca Lang
- From the IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; British Columbia Children's Hospital, Division of Rheumatology, and University of British Columbia, Vancouver, British Columbia; McMaster Children's Hospital, Division of Rheumatology, and McMaster University, Hamilton; Hospital for Sick Children and University of Toronto, Toronto, Ontario; Stollery Children's Hospital and University of Alberta, Edmonton, Alberta, Canada.,B. Rose-Davis, BA, IWK Health Centre; J. Curran, BN, MEd, PhD, Clinician Scientist, Pediatrics and Emergency Medicine, Associate Professor of Nursing, IWK Health Centre; J. Wright, BSc, Dalhousie University; T. Cellucci, MD, FRCPC, MScCH, Pediatric Rheumatologist, Associate Professor of Pediatrics, McMaster University; C.M. Duffy, MB, BCh, MSc, FRCPC, FRCPI, Pediatric Rheumatologist, Professor of Pediatrics, Children's Hospital of Eastern Ontario; L.B. Tucker, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, British Columbia Children's Hospital, Division of Rheumatology; M. Batthish, MSc, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, McMaster Children's Hospital, Division of Rheumatology; A.M. Huber, MD, MSc, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; B. Lang, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; D.M. Levy, MD, MS, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Hospital for Sick Children and University of Toronto; D.G. Rumsey, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, University of Alberta; K.N. Watanabe Duffy, MD, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Children's Hospital of Eastern Ontario; E. Stringer, MD, MSc, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, IWK Health Centre
| | - Deborah M Levy
- From the IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; British Columbia Children's Hospital, Division of Rheumatology, and University of British Columbia, Vancouver, British Columbia; McMaster Children's Hospital, Division of Rheumatology, and McMaster University, Hamilton; Hospital for Sick Children and University of Toronto, Toronto, Ontario; Stollery Children's Hospital and University of Alberta, Edmonton, Alberta, Canada.,B. Rose-Davis, BA, IWK Health Centre; J. Curran, BN, MEd, PhD, Clinician Scientist, Pediatrics and Emergency Medicine, Associate Professor of Nursing, IWK Health Centre; J. Wright, BSc, Dalhousie University; T. Cellucci, MD, FRCPC, MScCH, Pediatric Rheumatologist, Associate Professor of Pediatrics, McMaster University; C.M. Duffy, MB, BCh, MSc, FRCPC, FRCPI, Pediatric Rheumatologist, Professor of Pediatrics, Children's Hospital of Eastern Ontario; L.B. Tucker, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, British Columbia Children's Hospital, Division of Rheumatology; M. Batthish, MSc, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, McMaster Children's Hospital, Division of Rheumatology; A.M. Huber, MD, MSc, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; B. Lang, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; D.M. Levy, MD, MS, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Hospital for Sick Children and University of Toronto; D.G. Rumsey, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, University of Alberta; K.N. Watanabe Duffy, MD, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Children's Hospital of Eastern Ontario; E. Stringer, MD, MSc, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, IWK Health Centre
| | - Dax G Rumsey
- From the IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; British Columbia Children's Hospital, Division of Rheumatology, and University of British Columbia, Vancouver, British Columbia; McMaster Children's Hospital, Division of Rheumatology, and McMaster University, Hamilton; Hospital for Sick Children and University of Toronto, Toronto, Ontario; Stollery Children's Hospital and University of Alberta, Edmonton, Alberta, Canada.,B. Rose-Davis, BA, IWK Health Centre; J. Curran, BN, MEd, PhD, Clinician Scientist, Pediatrics and Emergency Medicine, Associate Professor of Nursing, IWK Health Centre; J. Wright, BSc, Dalhousie University; T. Cellucci, MD, FRCPC, MScCH, Pediatric Rheumatologist, Associate Professor of Pediatrics, McMaster University; C.M. Duffy, MB, BCh, MSc, FRCPC, FRCPI, Pediatric Rheumatologist, Professor of Pediatrics, Children's Hospital of Eastern Ontario; L.B. Tucker, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, British Columbia Children's Hospital, Division of Rheumatology; M. Batthish, MSc, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, McMaster Children's Hospital, Division of Rheumatology; A.M. Huber, MD, MSc, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; B. Lang, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; D.M. Levy, MD, MS, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Hospital for Sick Children and University of Toronto; D.G. Rumsey, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, University of Alberta; K.N. Watanabe Duffy, MD, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Children's Hospital of Eastern Ontario; E. Stringer, MD, MSc, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, IWK Health Centre
| | - Karen N Watanabe Duffy
- From the IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; British Columbia Children's Hospital, Division of Rheumatology, and University of British Columbia, Vancouver, British Columbia; McMaster Children's Hospital, Division of Rheumatology, and McMaster University, Hamilton; Hospital for Sick Children and University of Toronto, Toronto, Ontario; Stollery Children's Hospital and University of Alberta, Edmonton, Alberta, Canada.,B. Rose-Davis, BA, IWK Health Centre; J. Curran, BN, MEd, PhD, Clinician Scientist, Pediatrics and Emergency Medicine, Associate Professor of Nursing, IWK Health Centre; J. Wright, BSc, Dalhousie University; T. Cellucci, MD, FRCPC, MScCH, Pediatric Rheumatologist, Associate Professor of Pediatrics, McMaster University; C.M. Duffy, MB, BCh, MSc, FRCPC, FRCPI, Pediatric Rheumatologist, Professor of Pediatrics, Children's Hospital of Eastern Ontario; L.B. Tucker, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, British Columbia Children's Hospital, Division of Rheumatology; M. Batthish, MSc, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, McMaster Children's Hospital, Division of Rheumatology; A.M. Huber, MD, MSc, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; B. Lang, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; D.M. Levy, MD, MS, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Hospital for Sick Children and University of Toronto; D.G. Rumsey, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, University of Alberta; K.N. Watanabe Duffy, MD, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Children's Hospital of Eastern Ontario; E. Stringer, MD, MSc, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, IWK Health Centre
| | - Elizabeth Stringer
- From the IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; British Columbia Children's Hospital, Division of Rheumatology, and University of British Columbia, Vancouver, British Columbia; McMaster Children's Hospital, Division of Rheumatology, and McMaster University, Hamilton; Hospital for Sick Children and University of Toronto, Toronto, Ontario; Stollery Children's Hospital and University of Alberta, Edmonton, Alberta, Canada. .,B. Rose-Davis, BA, IWK Health Centre; J. Curran, BN, MEd, PhD, Clinician Scientist, Pediatrics and Emergency Medicine, Associate Professor of Nursing, IWK Health Centre; J. Wright, BSc, Dalhousie University; T. Cellucci, MD, FRCPC, MScCH, Pediatric Rheumatologist, Associate Professor of Pediatrics, McMaster University; C.M. Duffy, MB, BCh, MSc, FRCPC, FRCPI, Pediatric Rheumatologist, Professor of Pediatrics, Children's Hospital of Eastern Ontario; L.B. Tucker, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, British Columbia Children's Hospital, Division of Rheumatology; M. Batthish, MSc, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, McMaster Children's Hospital, Division of Rheumatology; A.M. Huber, MD, MSc, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; B. Lang, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; D.M. Levy, MD, MS, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Hospital for Sick Children and University of Toronto; D.G. Rumsey, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, University of Alberta; K.N. Watanabe Duffy, MD, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Children's Hospital of Eastern Ontario; E. Stringer, MD, MSc, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, IWK Health Centre.
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Schoemaker CG, Armbrust W, Swart JF, Vastert SJ, van Loosdregt J, Verwoerd A, Whiting C, Cowan K, Olsder W, Versluis E, van Vliet R, Fernhout MJ, Bookelman SL, Cappon J, van den Berg JM, Schatorjé E, Muller PCEH, Kamphuis S, de Boer J, Lelieveld OTHM, van der Net J, Jongsma KR, van Rensen A, Dedding C, Wulffraat NM. Dutch juvenile idiopathic arthritis patients, carers and clinicians create a research agenda together following the James Lind Alliance method: a study protocol. Pediatr Rheumatol Online J 2018; 16:57. [PMID: 30219072 PMCID: PMC6139167 DOI: 10.1186/s12969-018-0276-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 09/10/2018] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Research on Juvenile Idiopathic Arthritis (JIA) should support patients, caregivers/parents (carers) and clinicians to make important decisions in the consulting room and eventually to improve the lives of patients with JIA. Thus far these end-users of JIA-research have rarely been involved in the prioritisation of future research. MAIN BODY Dutch organisations of patients, carers and clinicians will collaboratively develop a research agenda for JIA, following the James Lind Alliance (JLA) methodology. In a 'Priority Setting Partnership' (PSP), they will gradually establish a top 10 list of the most important unanswered research questions for JIA. In this process the input from clinicians, patients and their carers will be equally valued. Additionally, focus groups will be organised to involve young people with JIA. The involvement of all contributors will be monitored and evaluated. In this manner, the project will contribute to the growing body of literature on how to involve young people in agenda setting in a meaningful way. CONCLUSION A JIA research agenda established through the JLA method and thus co-created by patients, carers and clinicians will inform researchers and research funders about the most important research questions for JIA. This will lead to research that really matters.
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Affiliation(s)
- Casper G. Schoemaker
- 0000000090126352grid.7692.aPediatric Rheumatology and Immunology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, Netherlands ,Netherlands JIA Patient and Parent Organisation, member of ENCA, Amsterdam, The Netherlands ,0000 0001 2208 0118grid.31147.30National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands ,0000 0004 0620 3132grid.417100.3Department of Paediatric Rheumatology, University Medical Centre Utrecht, Wilhelmina Children’s Hospital, Room KC.03.063.0, P.O. box 85090, 3508 AB Utrecht, The Netherlands
| | - Wineke Armbrust
- 0000 0004 0407 1981grid.4830.fUniversity Medical Center Groningen (UMCG), Beatrix Childrens Hospital, Dept Pediatric Rheumatology and Immunology, University of Groningen, Groningen, The Netherlands ,Dutch Association for Pediatric Rheumatology, Amsterdam, The Netherlands
| | - Joost F. Swart
- 0000000090126352grid.7692.aPediatric Rheumatology and Immunology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, Netherlands ,Dutch Association for Pediatric Rheumatology, Amsterdam, The Netherlands ,0000000120346234grid.5477.1Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | - Sebastiaan J. Vastert
- 0000000090126352grid.7692.aPediatric Rheumatology and Immunology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, Netherlands ,0000000120346234grid.5477.1Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | - Jorg van Loosdregt
- 0000000090126352grid.7692.aPediatric Rheumatology and Immunology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, Netherlands ,0000000120346234grid.5477.1Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | - Anouk Verwoerd
- 0000000090126352grid.7692.aPediatric Rheumatology and Immunology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, Netherlands ,0000000120346234grid.5477.1Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | - Caroline Whiting
- 0000 0004 1936 9297grid.5491.9James Lind Alliance, National Institute for Health Research Evaluation, Trials and Studies Coordinating Centre (NETSCC), based at the University of Southampton, Southampton, UK
| | - Katherine Cowan
- 0000 0004 1936 9297grid.5491.9James Lind Alliance, National Institute for Health Research Evaluation, Trials and Studies Coordinating Centre (NETSCC), based at the University of Southampton, Southampton, UK
| | - Wendy Olsder
- Youth-R-Well.com, Young Patient Organisation, The Netherlands, member of EULAR PARE, Amsterdam, The Netherlands
| | - Els Versluis
- Netherlands JIA Patient and Parent Organisation, member of ENCA, Amsterdam, The Netherlands
| | - Rens van Vliet
- 0000000090126352grid.7692.aPediatric Rheumatology and Immunology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, Netherlands ,Netherlands JIA Patient and Parent Organisation, member of ENCA, Amsterdam, The Netherlands
| | - Marlous J. Fernhout
- 0000000090126352grid.7692.aPediatric Rheumatology and Immunology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, Netherlands ,Netherlands JIA Patient and Parent Organisation, member of ENCA, Amsterdam, The Netherlands
| | - Sanne L. Bookelman
- Netherlands JIA Patient and Parent Organisation, member of ENCA, Amsterdam, The Netherlands
| | - Jeannette Cappon
- 0000 0004 0624 3484grid.418029.6Reade, Centre for Rehabilitation and Rheumatology, Department Rehabilitation, Amsterdam, The Netherlands ,Dutch Health Professionals in Pediatric Rheumatology (DHPPR), Amsterdam, The Netherlands
| | - J. Merlijn van den Berg
- Dutch Association for Pediatric Rheumatology, Amsterdam, The Netherlands ,0000 0004 0435 165Xgrid.16872.3aPaediatric rheumatology, Emma Children’s Hospital, University Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Ellen Schatorjé
- Dutch Association for Pediatric Rheumatology, Amsterdam, The Netherlands ,grid.461578.9Paediatric Rheumatology, Amalia Children’s Hospital, Radboudumc, Nijmegen, The Netherlands ,Paediatric Rheumatology, St. Maartenskliniek, Nijmegen, The Netherlands
| | - Petra C. E. Hissink Muller
- Dutch Association for Pediatric Rheumatology, Amsterdam, The Netherlands ,0000000089452978grid.10419.3dPaediatric Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands ,000000040459992Xgrid.5645.2Paediatric Rheumatology, Sophia Children’s Hospital, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Sylvia Kamphuis
- Dutch Association for Pediatric Rheumatology, Amsterdam, The Netherlands ,000000040459992Xgrid.5645.2Paediatric Rheumatology, Sophia Children’s Hospital, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Joke de Boer
- 0000000120346234grid.5477.1Faculty of Medicine, Utrecht University, Utrecht, The Netherlands ,0000000090126352grid.7692.aDepartment of Ophthalmology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Otto T. H. M. Lelieveld
- Dutch Health Professionals in Pediatric Rheumatology (DHPPR), Amsterdam, The Netherlands ,0000 0004 0407 1981grid.4830.fUniversity Medical Center Groningen, Center for Rehabilitation, University of Groningen, Groningen, The Netherlands
| | - Janjaap van der Net
- 0000000120346234grid.5477.1Faculty of Medicine, Utrecht University, Utrecht, The Netherlands ,Dutch Health Professionals in Pediatric Rheumatology (DHPPR), Amsterdam, The Netherlands ,0000000090126352grid.7692.aChild Development and Exercise Center, Division of Pediatrics. Wilhelmina Children’s Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Karin R. Jongsma
- 0000000090126352grid.7692.aJulius Center for Health Sciences and Primary Care Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Annemiek van Rensen
- PGOsupport, Dutch Networking Organisation for Patient Organisations, Utrecht, The Netherlands
| | - Christine Dedding
- Department of Medical Humanities, Amsterdam UMC, Amsterdam, The Netherlands
| | - Nico M. Wulffraat
- 0000000090126352grid.7692.aPediatric Rheumatology and Immunology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, Netherlands ,0000000120346234grid.5477.1Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
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Yuwen W, Lewis FM, Walker AJ, Ward TM. Struggling in the Dark to Help My Child: Parents' Experience in Caring for a Young Child with Juvenile Idiopathic Arthritis. J Pediatr Nurs 2017; 37:e23-e29. [PMID: 28778610 PMCID: PMC5681389 DOI: 10.1016/j.pedn.2017.07.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 06/28/2017] [Accepted: 07/18/2017] [Indexed: 01/04/2023]
Abstract
PURPOSE The purpose of this study is to describe parents' experiences in caring for 2-5-year-old children with juvenile idiopathic arthritis (JIA). DESIGN AND METHODS A qualitative study using single-occasion in-depth interviews was conducted. Nine parents (eight mothers and one father) were interviewed in-person or via telephone. Data were analyzed using inductive content analysis. Methods used to protect the trustworthiness of study results included maintenance of an audit trail, peer debriefing, and member checks. RESULTS The core construct Struggling in the Dark to Help My Child explained parents' experience in six domains: not knowing, trying to reach out in the dark, feeling my child's pain, working out the kinks to stay on top to manage, feeling drained by the whole process, and being hard on the entire household. Parents struggled with the unknown, searched for resources, witnessed their child's suffering without knowing how to help, and tried every possible way to stay on top of the child's illness and treatment, even when they felt drained physically and emotionally. JIA not only consumed their lives, but also affected the entire family, including the siblings and spouse, and the relationships among family members. CONCLUSION AND IMPLICATIONS Findings highlight the day-to-day lived challenges parents face when caring for a young child with JIA. Healthcare providers including nurses need to assess the particular needs of an ill child and parents as well as the impact of the illness on the physical and psychosocial health of the entire family so that proper resources can be provided.
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Affiliation(s)
- Weichao Yuwen
- Nursing and Healthcare Leadership, University of Washington Tacoma, Tacoma, WA, United States.
| | - Frances M Lewis
- Family and Child Nursing, University of Washington, Seattle, WA, United States
| | - Amy J Walker
- Family and Child Nursing, University of Washington, Seattle, WA, United States
| | - Teresa M Ward
- Family and Child Nursing, University of Washington, Seattle, WA, United States
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Chausset A, Gominon AL, Montmaneix N, Echaubard S, Guillaume-Czitrom S, Cambon B, Miele C, Rochette E, Merlin E. Why we need a process on breaking news of Juvenile Idiopathic Arthritis: a mixed methods study. Pediatr Rheumatol Online J 2016; 14:31. [PMID: 27209342 PMCID: PMC4875712 DOI: 10.1186/s12969-016-0092-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 05/11/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Juvenile Idiopathic Arthritis is the most common chronic pediatric rheumatic disease. The announcement of Juvenile Idiopathic Arthritis poses for parents a number of challenges that make it hard to accept a diagnosis of the disease for their child; yet to our knowledge, no study to date has focused on the time period immediately surrounding the diagnosis. This study sets out to describe parents' experiences in engaging with their child's diagnosis of Juvenile Idiopathic Arthritis. METHODS This is a mixed methods study. Semi-structured interviews of families with a Juvenile Idiopathic Arthritis child were conducted. A grounded-theory thematic analysis was performed. Items that emerged in the interviews were compiled into a self-administered questionnaire. RESULTS Eleven families participated in the qualitative study. Sixty families responded to the questionnaire. The path of parents was characterized by doubt (before, during and after diagnosis) while the disease tended to take center stage. Doubt was generated through mismatches in perspectives between the parents' circle of acquaintances, physicians, and the parents' own subjective experiences of symptoms. This study also found that social support and parent associations occupied an ambiguous position between help and stigmatization. CONCLUSIONS Doubt fuels self-energizing spirals that take root as parents learn the news that their child has Juvenile Idiopathic Arthritis. These spirals of doubt may influence parents' experiences at every stage throughout the course of disease. Our data support the implementation of a specific process dedicated to breaking the news of Juvenile Idiopathic Arthritis to parents.
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Affiliation(s)
- Aurélie Chausset
- Pédiatrie, CHU Estaing, Clermont-Ferrand, France. .,Pédiatrie, INSERM-CIC1405, CHU Estaing, 1, place Lucie & Raymond Aubrac, 63003, Clermont-Ferrand, cedex 1, France.
| | | | - Nathalie Montmaneix
- Pédiatrie, CHU Estaing, Clermont-Ferrand, France ,Pédiatrie, INSERM-CIC1405, CHU Estaing, 1, place Lucie & Raymond Aubrac, 63003 Clermont-Ferrand, cedex 1 France
| | | | | | - Benoit Cambon
- Département de médecine générale, Faculté de Médecine, Clermont-Ferrand, France
| | - Cécile Miele
- CRIAVS, Pôle Santé Publique, CHU Gabriel Montpied, Clermont-Ferrand, France
| | - Emmanuelle Rochette
- Pédiatrie, CHU Estaing, Clermont-Ferrand, France ,Pédiatrie, INSERM-CIC1405, CHU Estaing, 1, place Lucie & Raymond Aubrac, 63003 Clermont-Ferrand, cedex 1 France
| | - Etienne Merlin
- Pédiatrie, CHU Estaing, Clermont-Ferrand, France ,Pédiatrie, INSERM-CIC1405, CHU Estaing, 1, place Lucie & Raymond Aubrac, 63003 Clermont-Ferrand, cedex 1 France
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