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Yazdani PA, St-Jean ML, Matovic S, Spahr A, Tran LT, Boucher RM, Poulin C, Osterman B, Srour M, Rosenblatt B, Chénier S, Soucy JF, Laberge AM, D'Agostino MD, Nguyen CTE, Morsa M, Bernard G. The Experience of Parents of Children With Genetically Determined Leukoencephalopathies With the Health Care System: A Qualitative Study. J Child Neurol 2023:8830738231176672. [PMID: 37225698 DOI: 10.1177/08830738231176672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Parents of children with genetically determined leukoencephalopathies play a major role in their children's health care. We sought to gain a better understanding of their experience with the public health care system in Quebec, Canada, to obtain suggestions for improving their services, and to identify modifiable factors to improve their quality of life. We conducted interviews with 13 parents. Data was analyzed thematically. Five themes were identified: challenges of the diagnostic odyssey, limited access to services, excessive parental responsibilities, positive relationships with health care professionals as a facilitator of care, and benefits of a specialized leukodystrophy clinic. Parents felt like waiting for the diagnosis was extremely stressful, and they expressed their need for transparency during this period. They identified multiple gaps and barriers in the health care system, which burdened them with many responsibilities. Parents emphasized the importance of a positive relationship with their child's health care professionals. They also felt grateful for being followed at a specialized clinic as it improved the quality of care received.
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Affiliation(s)
- Pouneh Amir Yazdani
- Child Health and Human Development Program, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
- Department of Neurology and Neurosurgery, McGill University, Montréal, Québec Canada
- Department of Pediatrics, McGill University, Montréal, Québec, Canada
- Université Laval, Québec, Québec, Canada
| | - Marie-Lou St-Jean
- Child Health and Human Development Program, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
- Department of Neurology and Neurosurgery, McGill University, Montréal, Québec Canada
- Department of Pediatrics, McGill University, Montréal, Québec, Canada
- Université de Montréal, Montréal, Québec, Canada
| | - Sara Matovic
- Child Health and Human Development Program, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
- Department of Neurology and Neurosurgery, McGill University, Montréal, Québec Canada
- Department of Pediatrics, McGill University, Montréal, Québec, Canada
| | - Aaron Spahr
- Child Health and Human Development Program, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
- Department of Neurology and Neurosurgery, McGill University, Montréal, Québec Canada
| | - Luan T Tran
- Child Health and Human Development Program, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
- Department of Neurology and Neurosurgery, McGill University, Montréal, Québec Canada
| | - Renée-Myriam Boucher
- Department of Pediatrics, Division of Pediatric Neurology, Centre Hospitalier de l'Université Laval, Québec, Québec, Canada
| | - Chantal Poulin
- Department of Neurology and Neurosurgery, McGill University, Montréal, Québec Canada
- Department of Pediatrics, McGill University, Montréal, Québec, Canada
| | - Bradley Osterman
- Department of Neurology and Neurosurgery, McGill University, Montréal, Québec Canada
- Department of Pediatrics, McGill University, Montréal, Québec, Canada
| | - Myriam Srour
- Child Health and Human Development Program, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
- Department of Neurology and Neurosurgery, McGill University, Montréal, Québec Canada
- Department of Pediatrics, McGill University, Montréal, Québec, Canada
| | - Bernard Rosenblatt
- Department of Neurology and Neurosurgery, McGill University, Montréal, Québec Canada
- Department of Pediatrics, McGill University, Montréal, Québec, Canada
| | - Sébastien Chénier
- Department of Medical Genetics, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Jean-Francois Soucy
- Department of Pediatrics, Université de Montréal, Montréal, Québec Canada
- Medical Genetics Division, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Québec Canada
| | - Anne-Marie Laberge
- Department of Pediatrics, Université de Montréal, Montréal, Québec Canada
- Medical Genetics Division, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Québec Canada
| | - Maria Daniela D'Agostino
- Department of Human Genetics, McGill University, Montreal, Québec, Canada
- Department of Specialized Medicine, Division of Medical Genetics, McGill University Health Centre, Montréal, Québec, Canada
| | - Cam-Tu Emilie Nguyen
- Department of Neurosciences and Pediatrics, Division of Pediatric Neurology, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Québec, Canada
| | - Maxime Morsa
- Université de Montréal, Montréal, Québec, Canada
- Laboratory of Health Education and Promotion, Sorbonne Paris Nord University, Villetaneuse, France
| | - Geneviève Bernard
- Child Health and Human Development Program, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
- Department of Neurology and Neurosurgery, McGill University, Montréal, Québec Canada
- Department of Pediatrics, McGill University, Montréal, Québec, Canada
- Department of Human Genetics, McGill University, Montreal, Québec, Canada
- Department of Specialized Medicine, Division of Medical Genetics, McGill University Health Centre, Montréal, Québec, Canada
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Amir Yazdani P, St-Jean ML, Matovic S, Spahr A, Tran LT, Boucher RM, Poulin C, Osterman B, Srour M, Rosenblatt B, Chenier S, Soucy JF, Laberge AM, Braverman N, D’Agostino MD, Nguyen CTE, Morsa M, Bernard G. Experience of Parents of Children with Genetically Determined Leukoencephalopathies Regarding the Adapted Health Care Services During the COVID-19 Pandemic. J Child Neurol 2022; 37:237-245. [PMID: 34986037 PMCID: PMC9066235 DOI: 10.1177/08830738211065317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Parents of children with genetically determined leukoencephalopathies play a major role in their children's health care. Because of the COVID-19 pandemic, many health care services were suspended, delayed or delivered remotely with telemedicine. We sought to explore the experience of parents of children with genetically determined leukoencephalopathies during the pandemic given the adapted health care services. We conducted semistructured interviews with 13 parents of 13 affected children. Three main themes were identified using thematic analysis: perceived impact of COVID-19 on health care services, benefits and challenges of telemedicine, and expectations of health care after the pandemic. Parents perceived a loss/delay in health care services while having a positive response to telemedicine. Parents wished telemedicine would remain in their care after the pandemic. This is the first study assessing the impact of COVID-19 on health care services in this population. Our results suggest that parents experience a higher level of stress owing to the shortage of services and the children's vulnerability.
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Affiliation(s)
- Pouneh Amir Yazdani
- Child Health and Human Development Program, Research Institute of the McGill University Health Center, Montréal, Québec, Canada,Department of Neurology and Neurosurgery, McGill University, Montréal, Québec Canada,Department of Pediatrics, McGill University, Montréal, Québec, Canada,Université Laval, Québec, Québec, Canada,Geneviève Bernard, MD, MSc, FRCPc; Research Institute of the McGill University Health Centre, 1001 boul Décarie, Montréal, QC H4A 3J1, Canada.
| | - Marie-Lou St-Jean
- Child Health and Human Development Program, Research Institute of the McGill University Health Center, Montréal, Québec, Canada,Department of Neurology and Neurosurgery, McGill University, Montréal, Québec Canada,Department of Pediatrics, McGill University, Montréal, Québec, Canada,Université de Montréal, Montréal, Québec, Canada
| | - Sara Matovic
- Child Health and Human Development Program, Research Institute of the McGill University Health Center, Montréal, Québec, Canada,Department of Neurology and Neurosurgery, McGill University, Montréal, Québec Canada,Department of Pediatrics, McGill University, Montréal, Québec, Canada
| | - Aaron Spahr
- Child Health and Human Development Program, Research Institute of the McGill University Health Center, Montréal, Québec, Canada,Department of Neurology and Neurosurgery, McGill University, Montréal, Québec Canada,Department of Pediatrics, McGill University, Montréal, Québec, Canada
| | - Luan T. Tran
- Child Health and Human Development Program, Research Institute of the McGill University Health Center, Montréal, Québec, Canada,Department of Neurology and Neurosurgery, McGill University, Montréal, Québec Canada,Department of Pediatrics, McGill University, Montréal, Québec, Canada
| | - Renée-Myriam Boucher
- Department of Pediatrics, Division of Pediatric Neurology, Centre Hospitalier de l’Université Laval, Québec, Canada
| | - Chantal Poulin
- Department of Neurology and Neurosurgery, McGill University, Montréal, Québec Canada,Department of Pediatrics, McGill University, Montréal, Québec, Canada
| | - Bradley Osterman
- Department of Neurology and Neurosurgery, McGill University, Montréal, Québec Canada,Department of Pediatrics, McGill University, Montréal, Québec, Canada
| | - Myriam Srour
- Child Health and Human Development Program, Research Institute of the McGill University Health Center, Montréal, Québec, Canada,Department of Neurology and Neurosurgery, McGill University, Montréal, Québec Canada,Department of Pediatrics, McGill University, Montréal, Québec, Canada
| | - Bernard Rosenblatt
- Department of Neurology and Neurosurgery, McGill University, Montréal, Québec Canada,Department of Pediatrics, McGill University, Montréal, Québec, Canada
| | - Sébastien Chenier
- Department of Medical Genetics, University of Sherbrooke, Sherbrooke, Québec, Canada
| | - Jean-Francois Soucy
- Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada,Medical Genetics Division, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Québec, Canada
| | - Anne-Marie Laberge
- Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada,Medical Genetics Division, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Québec, Canada
| | - Nancy Braverman
- Child Health and Human Development Program, Research Institute of the McGill University Health Center, Montréal, Québec, Canada,Department of Pediatrics, McGill University, Montréal, Québec, Canada,Department of Human Genetics, McGill University, Montreal, Québec, Canada,Division of Medical Genetics, Montreal Children's Hospital, Montréal, Québec, Canada,Department of Specialized Medicine, Division of Medical Genetics, McGill University Health Centre, Montréal, Québec, Canada
| | - Maria Daniela D’Agostino
- Department of Human Genetics, McGill University, Montreal, Québec, Canada,Department of Specialized Medicine, Division of Medical Genetics, McGill University Health Centre, Montréal, Québec, Canada
| | - Cam-Tu Emilie Nguyen
- Department of Neurosciences and Pediatrics, Division of Pediatric Neurology, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Québec, Canada
| | - Maxime Morsa
- Université de Montréal, Montréal, Québec, Canada,Sorbonne Paris Nord University, Laboratory of Health Education and Practice, Bobigny, France
| | - Geneviève Bernard
- Child Health and Human Development Program, Research Institute of the McGill University Health Center, Montréal, Québec, Canada,Department of Neurology and Neurosurgery, McGill University, Montréal, Québec Canada,Department of Pediatrics, McGill University, Montréal, Québec, Canada,Department of Human Genetics, McGill University, Montreal, Québec, Canada,Department of Specialized Medicine, Division of Medical Genetics, McGill University Health Centre, Montréal, Québec, Canada
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Spahr A, Rosli Z, Legault M, Tran LT, Fournier S, Toutounchi H, Darbelli L, Madjar C, Lucia C, St-Jean ML, Das S, Evans AC, Bernard G. The LORIS MyeliNeuroGene rare disease database for natural history studies and clinical trial readiness. Orphanet J Rare Dis 2021; 16:328. [PMID: 34301277 PMCID: PMC8299589 DOI: 10.1186/s13023-021-01953-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/11/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Rare diseases are estimated to affect 150-350 million people worldwide. With advances in next generation sequencing, the number of known disease-causing genes has increased significantly, opening the door for therapy development. Rare disease research has therefore pivoted from gene discovery to the exploration of potential therapies. With impending clinical trials on the horizon, researchers are in urgent need of natural history studies to help them identify surrogate markers, validate outcome measures, define historical control patients, and design therapeutic trials. RESULTS We customized a browser-accessible multi-modal (e.g. genetics, imaging, behavioral, patient-determined outcomes) database to increase cohort sizes, identify surrogate markers, and foster international collaborations. Ninety data entry forms were developed including family, perinatal, developmental history, clinical examinations, diagnostic investigations, neurological evaluations (i.e. spasticity, dystonia, ataxia, etc.), disability measures, parental stress, and quality of life. A customizable clinical letter generator was created to assist in continuity of patient care. CONCLUSIONS Small cohorts and underpowered studies are a major challenge for rare disease research. This online, rare disease database will be accessible from all over the world, making it easier to share and disseminate data. We have outlined the methodology to become Title 21 Code of Federal Regulations Part 11 Compliant, which is a requirement to use electronic records as historical controls in clinical trials in the United States. Food and Drug Administration compliant databases will be life-changing for patients and families when historical control data is used for emerging clinical trials. Future work will leverage these tools to delineate the natural history of several rare diseases and we are confident that this database will be used on a larger scale to improve care for patients affected with rare diseases.
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Affiliation(s)
- Aaron Spahr
- Department of Neurology and Neurosurgery, McGill University, Montréal, Québec, Canada
- Department of Pediatrics, McGill University, Montréal, Québec, Canada
- Department of Human Genetics, McGill University, Montréal, Québec, Canada
- Department of Specialized Medicine, Division of Medical Genetics, McGill University Health Centre, Montréal, Québec, Canada
- Child Health and Human Development Program, Research Institute, McGill University Health Center, Montréal, Québec, Canada
| | - Zaliqa Rosli
- McGill Centre for Integrative Neuroscience, Montreal Neurological Institute, McGill University, Montréal, Québec, Canada
| | - Mélanie Legault
- McGill Centre for Integrative Neuroscience, Montreal Neurological Institute, McGill University, Montréal, Québec, Canada
| | - Luan T Tran
- Department of Neurology and Neurosurgery, McGill University, Montréal, Québec, Canada
- Department of Pediatrics, McGill University, Montréal, Québec, Canada
- Department of Human Genetics, McGill University, Montréal, Québec, Canada
- Department of Specialized Medicine, Division of Medical Genetics, McGill University Health Centre, Montréal, Québec, Canada
- Child Health and Human Development Program, Research Institute, McGill University Health Center, Montréal, Québec, Canada
| | - Simon Fournier
- Department of Neurology and Neurosurgery, McGill University, Montréal, Québec, Canada
- Department of Pediatrics, McGill University, Montréal, Québec, Canada
- Department of Human Genetics, McGill University, Montréal, Québec, Canada
- Department of Specialized Medicine, Division of Medical Genetics, McGill University Health Centre, Montréal, Québec, Canada
- Child Health and Human Development Program, Research Institute, McGill University Health Center, Montréal, Québec, Canada
| | - Helia Toutounchi
- Department of Neurology and Neurosurgery, McGill University, Montréal, Québec, Canada
- Department of Pediatrics, McGill University, Montréal, Québec, Canada
- Department of Human Genetics, McGill University, Montréal, Québec, Canada
- Department of Specialized Medicine, Division of Medical Genetics, McGill University Health Centre, Montréal, Québec, Canada
- Child Health and Human Development Program, Research Institute, McGill University Health Center, Montréal, Québec, Canada
| | - Lama Darbelli
- Department of Neurology and Neurosurgery, McGill University, Montréal, Québec, Canada
- Department of Pediatrics, McGill University, Montréal, Québec, Canada
- Department of Human Genetics, McGill University, Montréal, Québec, Canada
- Department of Specialized Medicine, Division of Medical Genetics, McGill University Health Centre, Montréal, Québec, Canada
- Child Health and Human Development Program, Research Institute, McGill University Health Center, Montréal, Québec, Canada
| | - Cécile Madjar
- McGill Centre for Integrative Neuroscience, Montreal Neurological Institute, McGill University, Montréal, Québec, Canada
| | - Cassandra Lucia
- Department of Neurology and Neurosurgery, McGill University, Montréal, Québec, Canada
- Department of Pediatrics, McGill University, Montréal, Québec, Canada
- Department of Human Genetics, McGill University, Montréal, Québec, Canada
- Department of Specialized Medicine, Division of Medical Genetics, McGill University Health Centre, Montréal, Québec, Canada
- Child Health and Human Development Program, Research Institute, McGill University Health Center, Montréal, Québec, Canada
| | - Marie-Lou St-Jean
- Department of Neurology and Neurosurgery, McGill University, Montréal, Québec, Canada
- Department of Pediatrics, McGill University, Montréal, Québec, Canada
- Department of Human Genetics, McGill University, Montréal, Québec, Canada
- Department of Specialized Medicine, Division of Medical Genetics, McGill University Health Centre, Montréal, Québec, Canada
- Child Health and Human Development Program, Research Institute, McGill University Health Center, Montréal, Québec, Canada
| | - Samir Das
- McGill Centre for Integrative Neuroscience, Montreal Neurological Institute, McGill University, Montréal, Québec, Canada
| | - Alan C Evans
- McGill Centre for Integrative Neuroscience, Montreal Neurological Institute, McGill University, Montréal, Québec, Canada
| | - Geneviève Bernard
- Department of Neurology and Neurosurgery, McGill University, Montréal, Québec, Canada.
- Department of Pediatrics, McGill University, Montréal, Québec, Canada.
- Department of Human Genetics, McGill University, Montréal, Québec, Canada.
- Department of Specialized Medicine, Division of Medical Genetics, McGill University Health Centre, Montréal, Québec, Canada.
- Child Health and Human Development Program, Research Institute, McGill University Health Center, Montréal, Québec, Canada.
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