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Schwartz KE, Nye RT, Colt S, Hill DL, Feudtner C. Association of Very Low Birth Weight Infants With Parental and Sibling Mental Health Care Usage. Pediatrics 2024; 153:e2023064143. [PMID: 38572556 DOI: 10.1542/peds.2023-064143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/05/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Parents and siblings of very low birth weight, premature infants are at risk for poor mental health outcomes with increased mental health care usage. Knowledge regarding mental health care use patterns could guide interventions. METHODS This retrospective cohort study included US families with commercial insurance coverage from a single carrier. Neonates born at ≤30 weeks' gestational age or with a birth weight <1500 g were identified by insurance claim data between July 1, 2015, and June 30, 2016. Each case neonate family was matched with up to 4 control families. RESULTS The study included 1209 case and 1884 control neonates (with 134 deaths among only the case neonates [11.1% of cases]); 2003 case and 3336 control parents (mean [SD] age, 34.6 [5.4] years; 2858 [53.5%] female); and 884 case and 1878 control siblings (mean [SD] age, 6.8 [5.5] years; 1375 [49.8%] female). Compared with controls, more case parents used mental health care over the first year after birth hospitalization discharge. Higher usage was observed for bereaved case parents soon after their child's death. A smaller proportion of bereaved case siblings received mental health care compared with controls. Although nonbereaved case parents returned toward the proportion of use observed in controls, nonbereaved case female siblings, bereaved case female and male siblings, and bereaved male parents experienced continued differences. CONCLUSIONS Understanding and meeting the mental health care needs of parents and siblings of very low birth weight premature neonates can be guided by these findings, including elevated and prolonged needs of bereaved parents and siblings.
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Affiliation(s)
- Katherine E Schwartz
- Division of Neonatal-Perinatal Medicine, Cohen Children's Medical Center, Northwell Health and Zucker School of Medicine at Hofstra/Northwell, New Hyde Park
| | - Russell T Nye
- Justin Michael Ingerman Center for Palliative Care
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Susannah Colt
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Chris Feudtner
- Justin Michael Ingerman Center for Palliative Care
- Division of General Pediatrics, Department of Pediatrics
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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2
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Feudtner C, Beight LJ, Boyden JY, Hill DL, Hinds PS, Johnston EE, Friebert SE, Bogetz JF, Kang TI, Hall M, Nye RT, Wolfe J. Goals of Care Among Parents of Children Receiving Palliative Care. JAMA Pediatr 2023; 177:800-807. [PMID: 37306979 PMCID: PMC10262061 DOI: 10.1001/jamapediatrics.2023.1602] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 02/15/2023] [Indexed: 06/13/2023]
Abstract
Importance While knowing the goals of care (GOCs) for children receiving pediatric palliative care (PPC) are crucial for guiding the care they receive, how parents prioritize these goals and how their priorities may change over time is not known. Objective To determine parental prioritization of GOCs and patterns of change over time for parents of children receiving palliative care. Design, Setting, and Participants A Pediatric Palliative Care Research Network's Shared Data and Research cohort study with data collected at 0, 2, 6, 12, 18, and 24 months in hospital, outpatient, or home settings from April 10, 2017, to February 15, 2022, at 7 PPC programs based at children's hospitals across the US. Participants included parents of patients, birth to 30 years of age, who received PPC services. Exposures Analyses were adjusted for demographic characteristics, number of complex chronic conditions, and time enrolled in PPC. Main Outcomes Parents' importance scores, as measured using a discrete choice experiment, of 5 preselected GOCs: seeking quality of life (QOL), health, comfort, disease modification, or life extension. Importance scores for the 5 GOCs summed to 100. Results A total of 680 parents of 603 patients reported on GOCs. Median patient age was 4.4 (IQR, 0.8-13.2) years and 320 patients were male (53.1%). At baseline, parents scored QOL as the most important goal (mean score, 31.5 [SD, 8.4]), followed by health (26.3 [SD, 7.5]), comfort (22.4 [SD, 11.7]), disease modification (10.9 [SD, 9.2]), and life extension (8.9 [SD, 9.9]). Importantly, parents varied substantially in their baseline scores for each goal (IQRs more than 9.4), but across patients in different complex chronic conditions categories, the mean scores varied only slightly (means differ 8.7 or less). For each additional study month since PPC initiation, QOL was scored higher by 0.06 (95% CI, 0.04-0.08) and comfort scored higher by 0.3 (95% CI, 0-0.06), while the importance score for life extension decreased by 0.07 (95% CI, 0.04-0.09) and disease modification by 0.02 (95% CI, 0-0.04); health scores did not significantly differ from PPC initiation. Conclusions and Relevance Parents of children receiving PPC placed the highest value on QOL, but with considerable individual-level variation and substantial change over time. These findings emphasize the importance of reassessing GOCs with parents to guide appropriate clinical intervention.
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Affiliation(s)
- Chris Feudtner
- Justin Ingerman Center for Palliative Care, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Medical Ethics and Health Policy, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Leah J. Beight
- Doctor of Medicine Program, Georgetown University School of Medicine, Washington, DC
| | - Jackelyn Y. Boyden
- Justin Ingerman Center for Palliative Care, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia
| | - Douglas L. Hill
- Justin Ingerman Center for Palliative Care, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Pamela S. Hinds
- Children’s National Hospital, Department of Nursing Science, Professional Practice & Quality, Department of Pediatrics, the George Washington University, Washington, DC
| | - Emily E. Johnston
- Department of Pediatrics, Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham
| | - Sarah E. Friebert
- Department of Pediatrics, Division of Palliative Care, Akron Children’s Hospital and Rebecca D. Considine Research Institute, Akron, Ohio
| | - Jori F. Bogetz
- Department of Pediatrics, Division of Bioethics and Palliative Care, University of Washington School of Medicine, Seattle
| | - Tammy I. Kang
- Department of Pediatrics, Section of Palliative Care, Texas Children’s Hospital and Baylor College of Medicine, Houston, Texas
| | - Matt Hall
- Children’s Hospital Association, Lenexa, Kansas
| | - Russell T. Nye
- Justin Ingerman Center for Palliative Care, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Joanne Wolfe
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute and Department of Pediatrics Boston Children’s Hospital, Boston, Massachusetts
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Hill DL, Boyden JY, Feudtner C. Hope in the context of life-threatening illness and the end of life. Curr Opin Psychol 2023; 49:101513. [PMID: 36481600 DOI: 10.1016/j.copsyc.2022.101513] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 11/13/2022]
Abstract
Recent research shows the importance of hope in the context of life-threatening illness and the end of life for patients and their families. While some patients and family members continue to hope for a cure or extending life, others may develop more complex hopes related to quality of life and making the most of the time left. Clinicians often worry about taking hope away with bad news about the patient's prognosis, but patients and family members often appreciate honesty without losing hope. Clinicians should recognize that hopes in the context of serious, progressive illness may be complex, contradictory, culturally based, and evolve over time. Recent interventions have been developed to support hope for these patients, caregivers, and parents.
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Affiliation(s)
- Douglas L Hill
- Justin Ingerman Center for Palliative Care, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Jackelyn Y Boyden
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Chris Feudtner
- Justin Ingerman Center for Palliative Care, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Division of General Pediatrics, Department of Pediatrics, Medical Ethics and Health Policy, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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4
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Nye RT, Hill DL, Carroll KW, Boyden JY, Katcoff H, Griffis H, Campos D, Hall M, Wolfe J, Feudtner C. The Design of a Data Management System for a Multicenter Palliative Care Cohort Study. J Pain Symptom Manage 2022; 64:e53-e60. [PMID: 35339611 PMCID: PMC10484234 DOI: 10.1016/j.jpainsymman.2022.03.006] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/10/2022] [Accepted: 03/16/2022] [Indexed: 11/23/2022]
Abstract
CONTEXT Prospective cohort studies of individuals with serious illness and their family members, such as children receiving palliative care and their parents, pose challenges regarding data management. OBJECTIVE To describe the design and lessons learned regarding the data management system for the Pediatric Palliative Care Research Network's Shared Data and Research (SHARE) project, a multicenter prospective cohort study of children receiving pediatric palliative care (PPC) and their parents, and to describe important attributes of this system, with specific considerations for the design of future studies. METHODS The SHARE study consists of 643 PPC patients and up to two of their parents who enrolled from April 2017 to December 2020 at seven children's hospitals across the United States. Data regarding demographics, patient symptoms, goals of care, and other characteristics were collected directly from parents or patients at 6 timepoints over a 24-month follow-up period and stored electronically in a centralized location. Using medical record numbers, primary collected data was linked to administrative hospitalization data containing diagnostic and procedure codes and other data elements. Important attributes of the data infrastructure include linkage of primary and administrative data; centralized availability of multilingual questionnaires; electronic data collection and storage system; time-stamping of instrument completion; and a separate but connected study administrative database used to track enrollment. CONCLUSIONS Investigators planning future multicenter prospective cohort studies can consider attributes of the data infrastructure we describe when designing their data management system.
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Affiliation(s)
- Russell T Nye
- Justin Ingerman Center for Palliative Care (R.T.N., D.L.H., K.W.C., J.Y.B., C.F.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Data Science and Biostatistics Unit (R.T.N., H.K., H.G.), Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
| | - Douglas L Hill
- Justin Ingerman Center for Palliative Care (R.T.N., D.L.H., K.W.C., J.Y.B., C.F.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Division of General Pediatrics (D.L.H., J.Y.B., C.F.), The Children's Hospital of Philadelphia Philadelphia, Pennsylvania, USA
| | - Karen W Carroll
- Justin Ingerman Center for Palliative Care (R.T.N., D.L.H., K.W.C., J.Y.B., C.F.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jackelyn Y Boyden
- Justin Ingerman Center for Palliative Care (R.T.N., D.L.H., K.W.C., J.Y.B., C.F.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Division of General Pediatrics (D.L.H., J.Y.B., C.F.), The Children's Hospital of Philadelphia Philadelphia, Pennsylvania, USA
| | - Hannah Katcoff
- Data Science and Biostatistics Unit (R.T.N., H.K., H.G.), Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Heather Griffis
- Data Science and Biostatistics Unit (R.T.N., H.K., H.G.), Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Diego Campos
- Department of Biomedical and Health Informatics (D.C.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Matt Hall
- Children's Hospital Association (M.H.), Lenexa, Kansas, USA
| | - Joanne Wolfe
- Department of Psychosocial Oncology and Palliative Care (J.W.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Department of Pediatrics, Boston Children's Hospital (J.W.), Boston, Massachusetts, USA
| | - Chris Feudtner
- Justin Ingerman Center for Palliative Care (R.T.N., D.L.H., K.W.C., J.Y.B., C.F.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Division of General Pediatrics (D.L.H., J.Y.B., C.F.), The Children's Hospital of Philadelphia Philadelphia, Pennsylvania, USA
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5
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Affiliation(s)
- Douglas L Hill
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Chris Feudtner
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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6
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Dolan JG, Hill DL, Palmer L, Feudtner C. Addressing spiritual distress in pediatric oncology. Pediatr Blood Cancer 2022; 69:e29552. [PMID: 35029327 DOI: 10.1002/pbc.29552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/08/2021] [Accepted: 12/14/2021] [Indexed: 11/06/2022]
Affiliation(s)
- J Gregory Dolan
- Division of Oncology, University of Utah/Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Douglas L Hill
- The Justin Michael Ingerman Center for Palliative Care, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Laura Palmer
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Spiritual Care, Patient and Family Services, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Chris Feudtner
- Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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7
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Madrigal VN, Hill DL, Shults J, Feudtner C. Trust in Physicians, Anxiety and Depression, and Decision-Making Preferences among Parents of Children with Serious Illness. J Palliat Med 2022; 25:428-436. [PMID: 34516933 PMCID: PMC8968833 DOI: 10.1089/jpm.2021.0063] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective: To assess parental decision-making preferences when caring for a child with serious illness and to evaluate for an association between preferences and parental trust in physicians, and potential modification of this association by parental anxiety or depression. Methods: We analyzed cross-sectional data from 200 parents of 158 children in the United States who had life-threatening illnesses and whose attending physicians thought that the parents would have to make major medical decision in the next 12 to 24 months. Parents completed measures of decision-making preferences, trust in physicians, anxiety, and depression. Results: Higher reported levels of trust were associated with lower preferences for autonomous decision making (Spearman correlation = -0.24; 95% confidence interval [CI] = -0.36 to -0.01; p < 0.008). Among parents with higher levels of trust, increasing anxiety scores were associated with decreasing preference for autonomy, whereas among parents with lower levels of trust, increasing anxiety scores showed an increasing preference for autonomy (regression coefficient = -0.01; 95% CI = -0.02 to -0.001; p ≤ 0.03). Conclusions: Decreasing trust in physicians is associated with a higher preference for autonomous decision making. Parents who have higher levels of anxiety exhibit this association more strongly. Decision support for parents of children with serious illness should use strategies to respect parental decision-making preferences, address potential distrust, and provide mental health support to parents who are anxious or depressed.
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Affiliation(s)
- Vanessa N. Madrigal
- Division Critical Care Medicine, Department of Pediatrics, George Washington University, Washington, DC, USA.,Pediatric Ethics Program, Children's National Hospital, Washington, DC, USA
| | - Douglas L. Hill
- Department of Medical Ethics, Roberts Center for Pediatric Research, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Justine Shults
- Department of Biostatistics, Pediatrics, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Chris Feudtner
- Department of Medical Ethics, Roberts Center for Pediatric Research, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Medical Ethics and Health Policy, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Address correspondence to: Chris Feudtner, MD, PhD, MPH, Department of Medical Ethics, Roberts Center for Pediatric Research, The Children's Hospital of Philadelphia, 2716 South Street, Philadelphia, PA 19146, USA
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8
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Boyden JY, Hill DL, Nye RT, Bona K, Johnston EE, Hinds P, Friebert S, Kang TI, Hays R, Hall M, Wolfe J, Feudtner C. Pediatric Palliative Care Parents' Distress, Financial Difficulty, and Child Symptoms. J Pain Symptom Manage 2022; 63:271-282. [PMID: 34425212 PMCID: PMC8816828 DOI: 10.1016/j.jpainsymman.2021.08.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/11/2021] [Accepted: 08/13/2021] [Indexed: 02/03/2023]
Abstract
CONTEXT Parents of patients with a serious illness experience psychological distress, which impacts parents' wellbeing and, potentially, their ability to care for their children. Parent psychological distress may be influenced by children's symptom burden and by families' financial difficulty. OBJECTIVES This study examined the associations among parent psychological distress, parent-reported patient symptoms, and financial difficulty, seeking to determine the relative association of financial difficulty and of patient symptoms to parent psychological distress. METHODS Cross-sectional study of baseline data for 601 parents of 532 pediatric palliative care patients enrolled in a prospective cohort study conducted at seven US children's hospitals. Data included self-reported parent psychological distress and parent report of child's symptoms and family financial difficulty. We used ordinary least squares multiple regressions to examine the association between psychological distress and symptom score, between psychological distress and financial difficulty, and whether the degree of financial difficulty modified the relationship between psychological distress and symptom score. RESULTS The majority of parents were moderately to severely distressed (69%) or severely distressed (17%) and experienced some degree of financial difficulty (65%). While children's symptom scores and family financial difficulty together explained more of the variance in parental psychological distress than either variable alone, parental distress was associated more strongly, and to a larger degree, with financial difficulty than with symptom scores alone. CONCLUSIONS Parent psychological distress was associated with parent-reported patient symptoms and financial difficulty. Future work should examine these relationships longitudinally, and whether interventions to improve symptom management and ameliorate financial difficulties improve parental outcomes.
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Affiliation(s)
- Jackelyn Y Boyden
- Justin Ingerman Center for Palliative Care (J.Y.B., D.L.H., R.T.N., C.F.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Douglas L Hill
- Justin Ingerman Center for Palliative Care (J.Y.B., D.L.H., R.T.N., C.F.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Russell T Nye
- Justin Ingerman Center for Palliative Care (J.Y.B., D.L.H., R.T.N., C.F.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kira Bona
- Department of Pediatric Oncology and Division of Population Sciences (K.B.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Harvard Medical School (K.B.), Boston, Massachusetts, USA
| | - Emily E Johnston
- Department of Pediatrics (E.E.J.), Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Pamela Hinds
- Children's National Hospital (P.H.), Department of Nursing Science, Professional Practice & Quality, Department of Pediatrics, The George Washington University, Washington, District of Columbia, USA
| | - Sarah Friebert
- Department of Pediatrics( S.F.), Division of Palliative Care, Akron Children's Hospital and Rebecca D. Considine Research Institute, Akron, Ohio, USA
| | - Tammy I Kang
- Department of Pediatrics (T.I.K.), Section of Palliative Care, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Ross Hays
- Department of Pediatrics (R.H.), Division of Bioethics and Palliative Care, University of Washington School of Medicine, Seattle, Washington, USA
| | - Matt Hall
- Children's Hospital Association (M.H.), Lenexa, Kansas, USA
| | - Joanne Wolfe
- Department of Psychosocial Oncology (J.W.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Department of Pediatrics (J.W.), Boston Children's Hospital, Boston, Massachusetts, USA
| | - Chris Feudtner
- Justin Ingerman Center for Palliative Care (J.Y.B., D.L.H., R.T.N., C.F.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Department of Pediatrics (C.F.), Medical Ethics and Health Policy, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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Abstract
BACKGROUND Pre-transplant evaluation is mandated by Centers for Medicare and Medicaid Services, but there is wide institutional variation in implementation, and the family experience of the process is incompletely understood. Current literature largely focuses on adult transplant recipients. METHODS This qualitative study begins to fill the knowledge gap about family experience of the pre-transplant evaluation for children through interviews with caregivers at a large pediatric transplant center. RESULTS Prominent themes heard from caregivers include (1) the pre-transplant evaluation is overwhelming and emotional, (2) prior experiences and background knowledge frame the evaluation experience, and (3) frustration with communication among teams is common. CONCLUSIONS These findings are relevant to efforts by transplant centers to optimize information delivery, minimize concrete barriers, and address healthcare systems issues. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Eloise C Salmon
- University of Michigan, 1540 Hospital Drive, Ann Arbor, MI, 48109-4297, USA.
| | - Laura G Barr
- University of Pennsylvania, Philadelphia, PA, USA
| | - Douglas L Hill
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Judy A Shea
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sandra Amaral
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
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10
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Walter JK, Hill DL, Schall TE, Szymczak JE, Parikh S, DiDomenico C, Carroll KW, Nye RT, Feudtner C. An Interprofessional Team-Based Intervention to Address Barriers to Initiating Palliative Care in Pediatric Oncology: A Multiple-Method Evaluation of Feasibility, Acceptability, and Impact. J Pain Symptom Manage 2021; 62:1135-1144. [PMID: 34153461 PMCID: PMC8648922 DOI: 10.1016/j.jpainsymman.2021.06.008] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/08/2021] [Accepted: 06/11/2021] [Indexed: 10/21/2022]
Abstract
CONTEXT Many children with advanced cancer are not referred to palliative care despite both professional recommendations to do so and bereaved parental preference for earlier support from sub-specialty palliative care. OBJECTIVES To assess the feasibility, acceptability, and impact of an adaptive intervention to address individual and team-level barriers to specialty palliative care referrals. METHODS A multiple-method approach assessed feasibility and acceptability among clinicians from pediatric oncology teams at a single institution. Quantitative measures of comfort with palliative care consultations, team cohesion, and team collaboration were conducted before and after the intervention. Number of palliative care consults were examined before, during, and after sessions. Intervention satisfaction surveys and qualitative interviews were conducted after the intervention. RESULTS Twenty-six team members (90% of consented) attended at least one intervention session with 20 (69%) participants completing 75% or more sessions. The intervention was modified in response to participant feedback. After the intervention, participants reported greater team cohesion, comfort discussing palliative care consultation, team collaboration, process satisfaction, and decision satisfaction. Participants agreed that the training was useful, effective, helpful, and worthwhile, that they would use the skills, and that they would recommend the training to other providers. The numbers of palliative care consults increased before intervention sessions were conducted, but did not significantly change during or after the sessions. In the interviews, participants reported overall favorably regarding the intervention with some participants reporting changes in practice. CONCLUSION An adaptive intervention to reduce barriers to initiating palliative care for pediatric oncology teams is feasible and acceptable.
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Affiliation(s)
- Jennifer K Walter
- Children's Hospital of Philadelphia (J.K.W., D.L.H., T.E.S., S.P., C.D., K.W.C., C.F.,), Philadelphia, Pennsylvania, USA; Justin Ingerman Center for Palliative Care (J.K.W., S.P., C.F.), Philadelphia, Pennsylvania, USA
| | - Douglas L Hill
- Children's Hospital of Philadelphia (J.K.W., D.L.H., T.E.S., S.P., C.D., K.W.C., C.F.,), Philadelphia, Pennsylvania, USA.
| | - Theodore E Schall
- Children's Hospital of Philadelphia (J.K.W., D.L.H., T.E.S., S.P., C.D., K.W.C., C.F.,), Philadelphia, Pennsylvania, USA
| | - Julia E Szymczak
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania (J.E.S.), Philadelphia, Pennsylvania, USA
| | - Shefali Parikh
- Children's Hospital of Philadelphia (J.K.W., D.L.H., T.E.S., S.P., C.D., K.W.C., C.F.,), Philadelphia, Pennsylvania, USA; Justin Ingerman Center for Palliative Care (J.K.W., S.P., C.F.), Philadelphia, Pennsylvania, USA
| | - Connie DiDomenico
- Children's Hospital of Philadelphia (J.K.W., D.L.H., T.E.S., S.P., C.D., K.W.C., C.F.,), Philadelphia, Pennsylvania, USA; Division of Pediatric Oncology (C.D.), Philadelphia, Pennsylvania, USA
| | - Karen W Carroll
- Children's Hospital of Philadelphia (J.K.W., D.L.H., T.E.S., S.P., C.D., K.W.C., C.F.,), Philadelphia, Pennsylvania, USA
| | - Russell T Nye
- Children's Hospital of Philadelphia (J.K.W., D.L.H., T.E.S., S.P., C.D., K.W.C., C.F.,), Philadelphia, Pennsylvania, USA
| | - Chris Feudtner
- Children's Hospital of Philadelphia (J.K.W., D.L.H., T.E.S., S.P., C.D., K.W.C., C.F.,), Philadelphia, Pennsylvania, USA; Justin Ingerman Center for Palliative Care (J.K.W., S.P., C.F.), Philadelphia, Pennsylvania, USA
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11
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Feudtner C, Nye RT, Boyden JY, Schwartz KE, Korn ER, Dewitt AG, Waldman AT, Schwartz LA, Shen YA, Manocchia M, Xiao R, Lord BT, Hill DL. Association Between Children With Life-Threatening Conditions and Their Parents' and Siblings' Mental and Physical Health. JAMA Netw Open 2021; 4:e2137250. [PMID: 34928360 PMCID: PMC8689391 DOI: 10.1001/jamanetworkopen.2021.37250] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
IMPORTANCE Despite concerns regarding the potential deleterious physical and mental health outcomes among family members of a child with a life-threatening condition (LTC), few studies have examined empirical measures of health outcomes among these family members. OBJECTIVES To examine whether mothers, fathers, sisters, and brothers of children with 1 of 4 types of pediatric LTCs have higher rates of health care encounters, diagnoses, and prescriptions compared with families of children without these conditions. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study included US families with commercial insurance coverage from a single carrier. Children who had 1 of 4 LTCs (substantial prematurity, critical congenital heart disease, cancer, or a condition resulting in severe neurologic impairment) were identified by a diagnosis in their insurance claim data between July 1, 2015, and June 30, 2016. Each case child and their family was matched with up to 4 control children and their families based on the age of the case and control children. Data were analyzed between August 2020 and March 2021. EXPOSURES Having a child or sibling with substantial prematurity, critical congenital heart disease, cancer, or a condition resulting in severe and progressive neurologic impairment. MAIN OUTCOMES Rates of occurrence of health care encounters, physical and mental health diagnoses, and physical and mental health medication prescriptions, identified from insurance claims data, were compared between case and control families using a multivariable negative binomial regression model. The statistical analysis adjusted for observed differences between case and control families and accounted for clustering at the family level. RESULTS The study included 25 528 children (6909 case children [27.1%] and 18 619 control children [72.9%]; median age, 6.0 years [IQR, 1-13 years]; 13 294 [52.1%] male), 43 357 parents (11 586 case parents [26.7%] and 31 771 control parents [73.3%]; mean [SD] age, 40.4 [8.1] years; 22 318 [51.5%] female), and 25 706 siblings (7664 case siblings [29.8%] and 18 042 control siblings [70.2%]; mean [SD] age, 12.1 [6.5] years; 13 114 [51.0%] male). Overall, case mothers had higher rates of the composite outcome of health care encounters, diagnoses, and prescriptions compared with control mothers (incident rate ratio [IRR], 1.61; 95% CI, 1.54-1.68), as did case fathers compared with control fathers (IRR, 1.55; 95% CI, 1.46-1.64). Sisters of children with LTCs had higher rates of the composite outcome compared with sisters of children without LTCs (IRR, 1.68; 95% CI, 1.55-1.82), as did brothers of children with LTCs compared with brothers of children without LTCs (IRR, 1.70; 95% CI, 1.56-1.85). CONCLUSIONS AND RELEVANCE In this cohort study, mothers, fathers, sisters, and brothers who had a child or sibling with 1 of 4 types of LTCs had higher rates of health care encounters, diagnoses, and medication prescriptions compared with families who did not have a child with that condition. The findings suggest that family members of children with LTCs may experience poorer mental and physical health outcomes. Interventions for parents and siblings of children with LTCs that aim to safeguard their mental and physical well-being appear to be warranted.
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Affiliation(s)
- Chris Feudtner
- Justin Michael Ingerman Center for Palliative Care, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Division of General Pediatrics, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Russell T. Nye
- Justin Michael Ingerman Center for Palliative Care, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jackelyn Y. Boyden
- Justin Michael Ingerman Center for Palliative Care, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Katherine E. Schwartz
- Division of Neonatology, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Emilie R. Korn
- Division of General Pediatrics, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Aaron G. Dewitt
- Division of Cardiology, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Amy T. Waldman
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Lisa A. Schwartz
- Division of Oncology, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | | | - Michael Manocchia
- Cigna, Bloomfield, Connecticut
- Department of Sociology, University of North Florida, Jacksonville
| | - Rui Xiao
- Division of General Pediatrics, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | | | - Douglas L. Hill
- Justin Michael Ingerman Center for Palliative Care, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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12
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Feudtner C, Nye R, Hill DL, Hall M, Hinds P, Johnston EE, Friebert S, Hays R, Kang TI, Wolfe J. Polysymptomatology in Pediatric Patients Receiving Palliative Care Based on Parent-Reported Data. JAMA Netw Open 2021; 4:e2119730. [PMID: 34351400 PMCID: PMC8343495 DOI: 10.1001/jamanetworkopen.2021.19730] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
IMPORTANCE Pediatric palliative care treats patients with a wide variety of advanced illness conditions, often with substantial levels of pain and other symptoms. Clinical and research advancements regarding symptom management for these patients are hampered by the scarcity of data on symptoms as well as an overreliance on clinician report. OBJECTIVE To provide a detailed description of the symptoms among patients receiving pediatric palliative care based on parental report via a validated, structured symptom assessment measure. DESIGN, SETTING, AND PARTICIPANTS Baseline data for this cross-sectional analysis were collected between April 10, 2017, and February 5, 2020, from pediatric palliative care programs in 7 children's hospitals located in Akron, Ohio; Boston, Massachusetts; Birmingham, Alabama; Houston, Texas; Minneapolis, Minnesota; Philadelphia, Pennsylvania; and Seattle, Washington. Data were collected in the hospital, outpatient, and home setting from patients 30 years of age or younger who were receiving pediatric palliative care at 1 of the study sites. EXPOSURES Analyses were stratified by patients' demographic characteristics, including age, and by whether the patients had received a diagnosis of any of 10 non-mutually exclusive complex chronic condition categories. MAIN OUTCOMES AND MEASURES Twenty symptoms measured via the modified Memorial Symptom Assessment Scale, which scores the frequency and severity of any symptom that is present and provides a total symptom score. RESULTS Among the first 501 patients enrolled, the median age was 4.1 years (interquartile range, 0.8-12.9 years), 267 (53.3%) were male, and 356 (71.1%) were White. The most prevalent complex chronic conditions included gastrointestinal (357 [71.3%]), neurologic (289 [57.7%]), and cardiovascular (310 [61.9%]) conditions; 438 patients (87.4%) were technology dependent. Parents reported a mean (SD) of 6.7 (3.4) symptoms per patient and a median of 7 symptoms (interquartile range, 4-9 symptoms). A total of 367 patients (73.3%) had 5 or more symptoms. The 5 most prevalent symptoms were pain (319 [63.7%]; 95% CI, 59.4%-67.8%), lack of energy (295 [58.9%]; 95% CI, 54.5%-63.1%), irritability (280 [55.9%]; 95% CI, 51.5%-60.2%), drowsiness (247 [49.3%]; 95% CI, 44.9%-53.7%), and shortness of breath (232 [46.3%]; 95% CI, 41.9%-50.7%). Although older patients were reported by parents as having experienced more symptoms and having higher total symptom scores, variation across condition categories was relatively minor. Patients in the upper 10th percentile of total symptom scores had a median of 12.0 symptoms (interquartile range, 11-13). CONCLUSIONS AND RELEVANCE In this cross-sectional study, most children receiving palliative care were experiencing polysymptomatology. An important subgroup of patients frequently experienced numerous severe symptoms. Assessment and management of patients with polysymptomatology are critical aspects of pediatric palliative care.
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Affiliation(s)
- Chris Feudtner
- Justin Ingerman Center for Palliative Care, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Medical Ethics and Health Policy, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Russell Nye
- Justin Ingerman Center for Palliative Care, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Douglas L. Hill
- Justin Ingerman Center for Palliative Care, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Matt Hall
- Children’s Hospital Association, Lenexa, Kansas
| | - Pam Hinds
- Department of Nursing Science, Professional Practice & Quality, Children’s National Hospital, Washington, DC
- Department of Pediatrics, George Washington University, Washington, DC
| | - Emily E. Johnston
- Division of Hematology and Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham
| | - Sarah Friebert
- Division of Palliative Care, Department of Pediatrics, Akron Children’s Hospital and Rebecca D. Considine Research Institute, Akron, Ohio
| | - Ross Hays
- Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine, Seattle
| | - Tammy I. Kang
- Department of Pediatrics, Section of Palliative Care, Texas Children’s Hospital and Baylor College of Medicine, Houston
| | - Joanne Wolfe
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts
- Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
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13
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Dolan JG, Hill DL, Faerber JA, Palmer LE, Barakat LP, Feudtner C. Association of psychological distress and religious coping tendencies in parents of children recently diagnosed with cancer: A cross-sectional study. Pediatr Blood Cancer 2021; 68:e28991. [PMID: 33844421 PMCID: PMC8285076 DOI: 10.1002/pbc.28991] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 02/09/2021] [Accepted: 02/11/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE Parents of children with cancer exhibit high levels of psychological distress. Parents of children with serious illness report religion and spirituality are important coping resources. We sought to describe characteristics of religion, religious coping, social support, and resiliency in parents of children newly diagnosed with cancer and examine associations between psychological distress and self-reported religious coping, religiosity, resiliency, and social support. PATIENTS AND METHODS Cross-sectional observational study of 100 parents of 81 unique children recently diagnosed with cancer. Parents provided demographic information and completed measures of psychological distress, importance of religion, religious coping, resiliency, and social support. Patients' type of tumor and intensity of treatment were collected by medical record abstraction. RESULTS Compared to nationally reported data for adults, parents of children with cancer reported high scores for psychological distress but similar levels of religiosity, religious coping, and resiliency. Negative religious coping (feelings of negativity related to the divine) was associated with higher levels of psychological distress. This effect was most prominent in parents who reported the highest levels of religiosity. Positive religious coping, religiosity, and social support were not associated with levels of psychological distress. DISCUSSION Findings confirm high levels of distress for parents of children with cancer. Negative religious coping was associated with higher levels of psychological distress but positive religious coping, religiosity, and other coping factors were not found to be significantly associated with distress. Further assessment of negative religious coping to inform interventions to promote resiliency is warranted as they may impact parental decision-making and care.
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Affiliation(s)
- J. Gregory Dolan
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Douglas L. Hill
- The Justin Michael Ingerman Center for Palliative Care, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jennifer A. Faerber
- Healthcare Analytics Unit, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Laura E. Palmer
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA,Dept of Spiritual Care, Patient and Family Services, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Lamia P. Barakat
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA,Department of Pediatrics, Division of Oncology, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Chris Feudtner
- The Justin Michael Ingerman Center for Palliative Care, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA,Department of Pediatrics, Medical Ethics and Health Policy, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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14
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Abstract
Families of children with medical complexity (CMC) face many types of health-related decisions. These decisions vary in magnitude of consequences, degree of risk, time scale, degree of tradeoffs, degree of uncertainty, degree of linkage with other decisions, and reversibility. There are many influences on decision-making, including evidence, hopes, and values. Primary care pediatricians are in a unique position to assist families of CMC with decision-making. Pediatric clinicians have an opportunity to establish a trusting relationship with a family over time and to understand the family's values, beliefs, and preferences during periods of relative health and stability. This allows primary care pediatricians to support families in decision-making by helping to clarify their values and goals and apply those values to the decision at hand. [Pediatr Ann. 2020;49(11):e473-e477.].
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15
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Wrotniak BH, Georger L, Hill DL, Zemel BS, Stettler N. Association of dairy intake with weight change in adolescents undergoing obesity treatment. J Public Health (Oxf) 2020; 41:338-345. [PMID: 29659918 DOI: 10.1093/pubmed/fdy064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 01/10/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The role of dairy products in obesity treatment for adolescents is unclear. The study purpose was to assess the association between dairy intake and changes in BMI z-score (zBMI) during adolescent obesity treatment. METHODS Observational study nested within a randomized control trial. Linear mixed-effects regression models were adjusted for important non-lifestyle factors then further adjusted for dietary and physical activity variables. In total, 91 adolescents were studied. RESULTS Each serving of total dairy (β = -0.0054, P < 0.01), unflavored milk (β = -0.012, P < 0.01), reduced fat (β = -0.0078, P < 0.05), and low fat/fat-free products (β = -0.0149, P < 0.01) was associated with a decrease in zBMI over 12 months. These associations were no longer significant after adjustment for other dietary and physical activity factors. Sugar-sweetened beverage intake was inversely associated with intake of total dairy (β = -0.186, P = 0.001), unflavored milk (β = -0.115, P = 0.003) and low fat/fat-free dairy (β = -0.125, P = 0.001). CONCLUSIONS Intakes of total dairy, unflavored milk, reduced fat dairy and low fat/fat-free dairy products are associated with improved obesity treatment outcomes among adolescents. This could be due to co-occurring healthy lifestyle behaviors or to replacement of other food and beverages associated with obesity, such as sugar-sweetened beverages, by dairy products.
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Affiliation(s)
- Brian H Wrotniak
- The Children Hospital of Philadelphia, Philadelphia, PA, USA.,D'Youville College, 320 Porter Avenue, Buffalo, NY, USA
| | | | - Douglas L Hill
- The Children Hospital of Philadelphia, Philadelphia, PA, USA
| | - Babette S Zemel
- The Children Hospital of Philadelphia, Philadelphia, PA, USA
| | - Nicolas Stettler
- The Children Hospital of Philadelphia, Philadelphia, PA, USA.,The Lewin Group (NS), Falls Church, VA, USA
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16
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Parks EP, Finnerty DD, Panganiban J, Frasso R, Bishop-Gilyard C, Tewksbury CM, Williams NN, Dumon KR, Cordero G, Hill DL, Sarwer DB. Perspectives of adolescents with severe obesity on social Media in Preparation for weight-loss surgery: a qualitative study. BMC Pediatr 2020; 20:96. [PMID: 32122314 PMCID: PMC7050129 DOI: 10.1186/s12887-020-1992-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 02/20/2020] [Indexed: 01/01/2023] Open
Abstract
Background Currently the most effective treatment for severe obesity in adolescents is weight-loss surgery coupled with lifestyle behavior change. In preparation for weight-loss surgery, adolescents are required to make changes to eating and activity habits (lifestyle changes) to promote long term success. Social media support groups, which are popular among adolescents, have the potential to augment preoperative lifestyle changes. The purpose of this study was to qualitatively assess the perceived role of social media as a support tool for weight-loss, and to identify motivators and constraints to lifestyle changes and social media use in adolescents preparing for weight-loss surgery. Methods Thematic analysis of social media comments from 13 (3 male, 10 female) adolescents aged 16 ± 1.3 years with a body mass index (BMI) 45 ± 7.3 kg/m2 enrolled in a weight-management program preparing for bariatric surgery and who participated in a 12-week pilot social media intervention was performed. Participants commented on moderator posts and videos of nutrition, physical activity, and motivation that were shared three to four times per week. Social media comments were coded using NVivo 11.0 to identify recurrent themes and subthemes. Results 1) Social media provided accountability, emotional support, and shared behavioral strategies. 2) Motivators for lifestyle changes included family support, personal goals, and non-scale victories. 3) Challenges included negative peers, challenges with planning and tracking, and time constraints. Conclusion Adolescents considering bariatric surgery identified social media as a tool for social support and reinforcement of strategies for successful behavior change. Important motivators and challenges to lifestyle changes were identified.
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Affiliation(s)
- Elizabeth Prout Parks
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104-4399, USA. .,The Healthy Weight Program, Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104-4399, USA. .,Perelman School of Medicine at the University of Pennsylvania, 423 Guardian Drive, 1139 Blockley Hall, Philadelphia, PA, 19104, USA. .,Children's Hospital of Philadelphia, 2716 South Street, Room 14361, Philadelphia, PA, 19146, USA.
| | - Darra D Finnerty
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104-4399, USA.,Perelman School of Medicine at the University of Pennsylvania, 423 Guardian Drive, 1139 Blockley Hall, Philadelphia, PA, 19104, USA
| | - Jennifer Panganiban
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104-4399, USA
| | - Rosemary Frasso
- Center for Public Health Initiatives at the University of Pennsylvania, 144 Anatomy Chemistry Building, 3620 Hamilton Walk, Philadelphia, PA, 19104, USA
| | - Chanelle Bishop-Gilyard
- The Healthy Weight Program, Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104-4399, USA.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Colleen M Tewksbury
- Penn Metabolic Bariatric Surgery Program, Department of Surgery, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Noel N Williams
- Penn Metabolic Bariatric Surgery Program, Department of Surgery, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Kristoffel R Dumon
- Penn Metabolic Bariatric Surgery Program, Department of Surgery, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Gaby Cordero
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104-4399, USA
| | - Douglas L Hill
- Pediatrics Advanced Care Team, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - David B Sarwer
- College of Public Health, Center for Obesity Research and Education, Temple University, 3223 N. Broad St., Suite 175, Philadelphia, PA, 19140, USA
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17
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Hill DL, Walter JK, Szymczak JE, DiDomenico C, Parikh S, Feudtner C. Seven Types of Uncertainty When Clinicians Care for Pediatric Patients With Advanced Cancer. J Pain Symptom Manage 2020; 59:86-94. [PMID: 31425822 PMCID: PMC6942218 DOI: 10.1016/j.jpainsymman.2019.08.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 08/05/2019] [Accepted: 08/08/2019] [Indexed: 11/18/2022]
Abstract
CONTEXT Clinicians deciding whether to refer a patient or family to specialty palliative care report facing high levels of uncertainty. Most research on medical uncertainty has focused on prognostic uncertainty. As part of a pediatric palliative referral intervention for oncology teams we explored how uncertainty might influence palliative care referrals. OBJECTIVES To describe distinct meanings of the term "uncertainty" that emerged during the qualitative evaluation of the development and implementation of an intervention to help oncologists overcome barriers to palliative care referrals. METHODS We conducted a phenomenological qualitative analysis of "uncertainty" as experienced and described by interdisciplinary pediatric oncology team members in discussions, group activities and semistructured interviews regarding the introduction of palliative care. RESULTS We found that clinicians caring for patients with advanced cancer confront seven broad categories of uncertainty: prognostic, informational, individual, communication, relational, collegial, and inter-institutional. Each of these kinds of uncertainty can contribute to delays in referring patients to palliative care. CONCLUSION Various types of uncertainty arise in the care of pediatric patients with advanced cancer. To manage these forms of uncertainty, providers need to develop strategies and techniques to handle professionally challenging situations, communicate bad news, manage difficult interactions with families and colleagues, and collaborate with other organizations.
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Affiliation(s)
- Douglas L Hill
- Pediatric Advanced Care Team, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jennifer K Walter
- Pediatric Advanced Care Team, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Julia E Szymczak
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Concetta DiDomenico
- Division of Pediatric Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Shefali Parikh
- Pediatric Advanced Care Team, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Chris Feudtner
- Pediatric Advanced Care Team, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
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18
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Walter JK, Hill DL, DiDomenico C, Parikh S, Feudtner C. A conceptual model of barriers and facilitators to primary clinical teams requesting pediatric palliative care consultation based upon a narrative review. BMC Palliat Care 2019; 18:116. [PMID: 31864331 PMCID: PMC6925857 DOI: 10.1186/s12904-019-0504-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 07/15/2019] [Accepted: 12/09/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Despite evidence that referral to pediatric palliative care reduces suffering and improves quality of life for patients and families, many clinicians delay referral until the end of life. The purpose of this article is to provide a conceptual model for why clinical teams delay discussing palliative care with parents. DISCUSSION Building on a prior model of parent regoaling and relevant research literature, we argue for a conceptual model of the challenges and facilitators a clinical team might face in shifting from a restorative-focused treatment plan to a plan that includes palliative aspects, resulting in a subspecialty palliative care referral. Like patients and families, clinicians and clinical teams may recognize that a seriously ill patient would benefit from palliative care and shift from a restorative mindset to a palliative approach. We call this transition "clinician regoaling". Clinicians may experience inhibitors and facilitators to this transition at both the individual and team level which influence the clinicians' willingness to consult subspecialty palliative care. The 8 inhibitors to team level regoaling include: 1) team challenges due to hierarchy, 2) avoidance of criticizing colleagues, 3) structural communication challenges, 4) group norms in favor of restorative goals, 5) diffusion of responsibility, 6) inhibited expression of sorrow, 7) lack of social support, 8) reinforcement of labeling and conflict. The 6 facilitators of team regoaling include: 1) processes to build a shared mental model, 2) mutual trust to encourage dissent, 3) anticipating conflict and team problem solving, 4) processes for reevaluation of goals, 5) sharing serious news as a team, 6) team flexibility. CONCLUSIONS Recognizing potential team level inhibitors to transitioning to palliative care can help clinicians develop strategies for making the transition more effectively when appropriate.
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Affiliation(s)
- Jennifer K. Walter
- The Children’s Hospital of Philadelphia, 2716 South St 11th Floor, Philadelphia, PA 19146 USA
| | - Douglas L. Hill
- The Children’s Hospital of Philadelphia, 2716 South St 11th Floor, Philadelphia, PA 19146 USA
| | - Concetta DiDomenico
- The Children’s Hospital of Philadelphia, 2716 South St 11th Floor, Philadelphia, PA 19146 USA
| | - Shefali Parikh
- The Children’s Hospital of Philadelphia, 2716 South St 11th Floor, Philadelphia, PA 19146 USA
| | - Chris Feudtner
- The Children’s Hospital of Philadelphia, 2716 South St 11th Floor, Philadelphia, PA 19146 USA
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20
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Boyden JY, Hill DL, Carroll KW, Morrison WE, Miller VA, Feudtner C. The Association of Perceived Social Support with Anxiety over Time in Parents of Children with Serious Illnesses. J Palliat Med 2019; 23:527-534. [PMID: 31697175 DOI: 10.1089/jpm.2019.0387] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Background: Parenting a child with a serious life-threatening illness (SLTI) may impact parents' mental health. The protective association of social support with anxiety over time following an acute medical event has not been empirically tested in a sample of parents of children with oncologic and nononcologic serious illnesses. Objective: To test the potential association of perceived social support with anxiety in parents of children with SLTIs over time. Design: Prospective cohort study. Setting/Subjects: Two hundred parents of 158 children in the Decision Making in Serious Pediatric Illness study, conducted at the Children's Hospital of Philadelphia. Measurements: Parental anxiety and perceived social support were assessed using the Hospital Anxiety and Depression Scale (HADS) and the Social Provisions Scale (SPS). We performed bivariate linear regressions to test cross-sectional and longitudinal associations between the SPS and anxiety scores at baseline, 12 months, and 24 months. Results: The average SPS total and subscale scores decreased significantly from baseline to 12 months, and increased from 12 to 24 months. The average HADS-Anxiety scores decreased significantly from baseline to 12 months, and remained stable at 24 months. Cross-sectionally, total SPS scores were negatively associated with anxiety scores at each time point. Longitudinally, SPS scores were associated with anxiety scores, although this association weakened in adjusted modeling. Conclusions: Over a two-year period, higher levels of perceived social support were associated with lower levels of anxiety in parents of seriously ill children. Clinicians and researchers should work to optimize social support for families to improve parental mental health outcomes.
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Affiliation(s)
- Jackelyn Y Boyden
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Douglas L Hill
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Karen W Carroll
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Wynne E Morrison
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Victoria A Miller
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Chris Feudtner
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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21
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Hill DL, Faerber JA, Li Y, Miller VA, Carroll KW, Morrison W, Hinds PS, Feudtner C. Changes Over Time in Good-Parent Beliefs Among Parents of Children With Serious Illness: A Two-Year Cohort Study. J Pain Symptom Manage 2019; 58:190-197. [PMID: 31026508 PMCID: PMC6679776 DOI: 10.1016/j.jpainsymman.2019.04.018] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/15/2019] [Accepted: 04/15/2019] [Indexed: 11/20/2022]
Abstract
CONTEXT Parents of seriously ill children hold personal beliefs about what they should do to be good parents. How these beliefs change over time is unknown. OBJECTIVES The objectives of this study were to describe the pattern of Good-Parent Beliefs over time, and determine whether parents' hopeful patterns of thinking, affect, and perceived child's health are associated with changes in beliefs at 12 and 24 months. METHODS Our longitudinal sample included 124 parents of 100 children hospitalized with serious illness. We used latent transition models to classify parents into groups with similar Good-Parent Beliefs during the baseline and follow-up periods and modeled the change in good-parent beliefs over time as a function of covariates using generalized linear mixed models. RESULTS Two parent belief profiles emerged from the latent transition model: Loved ("Making sure my child feels loved," n = 61 at baseline) and Informed ("Making informed decisions," n = 63 at baseline). At 12 months, 21 parents (20.4%) had moved into the Loved group and no parents transitioned to the Informed group. By 24 months, eight parents transitioned to the Loved group and four to the Informed group (13.04%). Transition into the Loved group was associated with parents' baseline degree of hopeful thinking and positive perceptions of child's health at baseline. CONCLUSION Some parents change their parenting priorities over time. Hopeful patterns of thinking and perception of child health appear to predict change. Clinicians should regularly reevaluate Good-Parent Beliefs over time to promote priority-congruent dialogue.
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Affiliation(s)
- Douglas L Hill
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jennifer A Faerber
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Yimei Li
- Departments of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Victoria A Miller
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Karen W Carroll
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Wynne Morrison
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Pamela S Hinds
- Department of Nursing Science, Professional Practice, and Quality, Children's National Health System, Washington, DC, USA; Department of Pediatrics, School of Medicine and the Health Sciences, George Washington University, Washington, DC, USA
| | - Chris Feudtner
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
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Hill DL, Carroll KW, Snyder KJG, Mascarenhas M, Erlichman J, Patterson CA, Barakat LP, Feudtner C. Development and Pilot Testing of a Coping Kit for Parents of Hospitalized Children. Acad Pediatr 2019; 19:454-463. [PMID: 30415078 DOI: 10.1016/j.acap.2018.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 10/20/2018] [Accepted: 11/02/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Serious pediatric illness places great stress on families. Parents who learn coping skills may better manage these stressors. This study sought to develop and refine a stress coping intervention for parents of hospitalized children, assess the intervention acceptability among these parents, and gather preliminary data on stress, negative and positive affect, anxiety, depression, and self-efficacy. METHODS We conducted an observational study in 2 phases, enrolling parents of children who were inpatients with serious illness, 10 in Phase 1 and 40 in Phase 2. All parents completed at baseline measures of stress and psychological well-being and were introduced to the Coping Kit for Parents. Follow-up interviews were conducted at 1 week (all parents) and 1 month (Phase 2 parents only) regarding the acceptability of the intervention. RESULTS At baseline, parents reported that stressful situations were frequent (mean = 30.6, standard deviation [SD] = 6.8) and difficult (mean = 26.2, SD = 7.1) and revealed elevated levels of negative affect (mean = 27.3, SD = 7.7), depression (mean = 8.5, SD = 3.7), and anxiety (mean = 11.3, SD = 3.1) and moderate levels of self-efficacy related to their child's illness (mean = 3.3, SD = 0.5). The majority of parents used the kit regularly and on a scale of 1 to 7 agreed that the kit was helpful (mean = 6.0, SD = 0.9), interesting (mean = 5.7, SD = 1.3), practical (mean = 5.7, SD = 1.4), enjoyable (mean = 6.0, SD = 1.3), and they would recommend it to other parents (mean = 6.4, SD = 0.9). CONCLUSIONS The Coping Kit for Parents is an acceptable stress management intervention that could be made available to parents of children with serious illness at pediatric hospitals with minimal staff training or time commitment.
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Affiliation(s)
- Douglas L Hill
- Pediatric Advanced Care Team (DL Hill, KW Carroll, KJG Snyder, C Feudtner), Division of Gastroenterology (M Mascarenhas, J Erlichman), Division of Neonatology (CA Patterson), and Division of Oncology (LP Barakat), The Children's Hospital of Philadelphia, Philadelphia, Pa.
| | - Karen W Carroll
- Pediatric Advanced Care Team (DL Hill, KW Carroll, KJG Snyder, C Feudtner), Division of Gastroenterology (M Mascarenhas, J Erlichman), Division of Neonatology (CA Patterson), and Division of Oncology (LP Barakat), The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - K J G Snyder
- Pediatric Advanced Care Team (DL Hill, KW Carroll, KJG Snyder, C Feudtner), Division of Gastroenterology (M Mascarenhas, J Erlichman), Division of Neonatology (CA Patterson), and Division of Oncology (LP Barakat), The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Maria Mascarenhas
- Pediatric Advanced Care Team (DL Hill, KW Carroll, KJG Snyder, C Feudtner), Division of Gastroenterology (M Mascarenhas, J Erlichman), Division of Neonatology (CA Patterson), and Division of Oncology (LP Barakat), The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Jessi Erlichman
- Pediatric Advanced Care Team (DL Hill, KW Carroll, KJG Snyder, C Feudtner), Division of Gastroenterology (M Mascarenhas, J Erlichman), Division of Neonatology (CA Patterson), and Division of Oncology (LP Barakat), The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Chavis A Patterson
- Pediatric Advanced Care Team (DL Hill, KW Carroll, KJG Snyder, C Feudtner), Division of Gastroenterology (M Mascarenhas, J Erlichman), Division of Neonatology (CA Patterson), and Division of Oncology (LP Barakat), The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Lamia P Barakat
- Pediatric Advanced Care Team (DL Hill, KW Carroll, KJG Snyder, C Feudtner), Division of Gastroenterology (M Mascarenhas, J Erlichman), Division of Neonatology (CA Patterson), and Division of Oncology (LP Barakat), The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Chris Feudtner
- Pediatric Advanced Care Team (DL Hill, KW Carroll, KJG Snyder, C Feudtner), Division of Gastroenterology (M Mascarenhas, J Erlichman), Division of Neonatology (CA Patterson), and Division of Oncology (LP Barakat), The Children's Hospital of Philadelphia, Philadelphia, Pa
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Hill DL, Feudtner C. Hopes for the research agenda about hope. Pediatr Blood Cancer 2018; 65:e27018. [PMID: 29480540 DOI: 10.1002/pbc.27018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 01/24/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Douglas L Hill
- Department of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Chris Feudtner
- Department of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Szymczak JE, Schall T, Hill DL, Walter JK, Parikh S, DiDomenico C, Feudtner C. Pediatric Oncology Providers' Perceptions of a Palliative Care Service: The Influence of Emotional Esteem and Emotional Labor. J Pain Symptom Manage 2018; 55:1260-1268. [PMID: 29425881 PMCID: PMC5908218 DOI: 10.1016/j.jpainsymman.2018.01.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 01/28/2018] [Accepted: 01/30/2018] [Indexed: 11/30/2022]
Abstract
CONTEXT Pediatric palliative care consults for children with cancer often occur late in the course of disease and close to death, when earlier involvement would reduce suffering. The perceptions that pediatric oncology providers hold about the pediatric palliative care service (PPCS) may shape referral patterns. OBJECTIVES To explore how pediatric oncology providers at one institution perceived the hospital's PPCS and the way these perceptions may influence the timing of consultation. METHODS We conducted semistructured qualitative interviews with pediatric oncology providers at a large children's hospital. Interviews were audio-recorded, transcribed, and analyzed by two coders using a modified grounded theory approach. RESULTS We interviewed 16 providers (10 physicians, one nurse practitioner, two social workers, two psychologists, and one child life specialist). Three core perceptions emerged: 1) the PPCS offers a diverse range of valuable contributions to the care of children with advancing cancer; 2) providers held favorable opinions about the PPCS owing to positive interactions with individual palliative care specialists deemed extraordinarily emotionally skilled; and 3) there is considerable emotional labor involved in calling a PPCS consult that serves as a barrier to early initiation. CONCLUSION The pediatric oncology providers in our study held a highly favorable opinion about their institution's PPCS and agreed that early consultation is ideal. However, they also described that formally consulting PPCS is extremely difficult because of what the PPCS symbolizes to families and the emotional labor that the provider must manage in introducing them. Interventions to encourage the early initiation of palliative care in this population may benefit from a focus on the emotional experiences of providers.
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Affiliation(s)
- Julia E Szymczak
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Theodore Schall
- Department of Medical Ethics, Pediatric Advanced Care Team, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Douglas L Hill
- Department of Medical Ethics, Pediatric Advanced Care Team, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jennifer K Walter
- Department of Medical Ethics, Pediatric Advanced Care Team, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Shefali Parikh
- Department of Medical Ethics, Pediatric Advanced Care Team, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Concetta DiDomenico
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Chris Feudtner
- Department of Medical Ethics, Pediatric Advanced Care Team, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Collins LN, Hill DL, Brunjes PC. Myelination of the developing lateral olfactory tract and anterior commissure. J Comp Neurol 2018; 526:1843-1858. [PMID: 29665005 DOI: 10.1002/cne.24452] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 03/20/2018] [Accepted: 03/21/2018] [Indexed: 12/15/2022]
Abstract
Both the lateral olfactory tract (LOT) and anterior limb of the anterior commissure (AC) carry olfactory information. The LOT forms the projection from the olfactory bulb to the ipsilateral olfactory cortices, while the AC carries odor information across the midline to the contralateral olfactory cortex and bulb. The LOT and AC differ on a number of dimensions, including early development and functional onset. The present work, examining their myelination in mice, reveals additional important differences. For example, the LOT initiates myelination 3-4 days earlier than the AC, evidenced by both an earlier increase in myelin basic protein staining seen with immunohistochemistry and an earlier appearance of myelinated fibers using electron microscopy. While both exhibit a period of rapid myelination, it occurs 4-5 days earlier in the LOT than the AC. The tracts also respond differently to early sensory restriction. Unilateral naris occlusion from the day after birth to postnatal day 30 had no consistent effects on the AC but resulted in significantly thinner myelin sheaths relative to axon caliber in the LOT. Finally, the two tracts differ structurally (the LOT contains larger, more densely packed axons with significantly thicker myelin sheaths resulting in a conduction velocity that is more than twice as fast as the AC). The findings indicate that these two large, accessible tracts provide an important means for studying brain maturation due to basic differences in both the timing of their maturation and general organization.
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Affiliation(s)
- L N Collins
- Department Psychology, University of Virginia, Charlottesville, Virginia
| | - D L Hill
- Department Psychology, University of Virginia, Charlottesville, Virginia
| | - P C Brunjes
- Department Psychology, University of Virginia, Charlottesville, Virginia
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26
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Hill DL, Nathanson PG, Carroll KW, Schall TE, Miller VA, Feudtner C. Changes in Parental Hopes for Seriously Ill Children. Pediatrics 2018; 141:peds.2017-3549. [PMID: 29567813 PMCID: PMC5869332 DOI: 10.1542/peds.2017-3549] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/16/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Hopes of parents of children with serious illness play an important role in decision-making and coping. Little is known about how parent hopes change over time. We describe the changes in parent hopes across multiple domains and time intervals, examine hopes in a subgroup of parents whose child died, and explore the maintenance of domains over time. METHODS In a mixed-methods prospective cohort study on decision-making, parents of seriously ill children reported demographic characteristics and hopes at baseline and reported any changes in hopes at 4-, 8-, 12-, 16-, and 20-month follow-up visits. Hopes were coded into 9 domains. Hope changes and domain changes were identified for each parent at each visit. RESULTS One hundred and ninety-nine parents of 158 patients most often reported hopes in the domains of quality of life (75%), physical body (69%), future well-being (47%), and medical care (34%). Hope percentages increased over time for quality of life (84%), future well-being (64%), and broader meaning (21%). The hope domains reported by parents of children who died were similar to the rest of the sample. The majority of parents who completed 5 to 6 follow-up visits changed at least 1 domain. At the individual parent level, some domains revealed considerable change over time, whereas other domains were stable among a subset of parents. CONCLUSIONS The specific hopes and overall areas of hope of parents of seriously ill children vary over time, although most hopes fall within 4 major areas. Accordingly, clinicians should regularly check with parents about their current hopes.
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Affiliation(s)
| | | | | | | | | | - Chris Feudtner
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Prout Parks E, Moore RH, Li Z, Bishop-Gilyard CT, Garrett AR, Hill DL, Bruton YP, Sarwer DB. Assessing the Feasibility of a Social Media to Promote Weight Management Engagement in Adolescents with Severe Obesity: Pilot Study. JMIR Res Protoc 2018; 7:e52. [PMID: 29555623 PMCID: PMC5881040 DOI: 10.2196/resprot.8229] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 09/28/2017] [Accepted: 12/07/2017] [Indexed: 11/13/2022] Open
Abstract
Background Severe obesity in adolescents has deleterious physical and psychological complications necessitating frequent multi-disciplinary clinic visits. Greater treatment engagement has been equated with weight-loss. However, traditional medical weight-loss programs for adolescents have high attrition rates. Social media is widely used by adolescents and may enhance medical weight management engagement and success. Objective The first objective was to examine the acceptability and feasibility of using a private social media group as an adjunct to medical weight management in youth ages 14 to 20 years with severe obesity [body mass index (BMI) ≥ 35 kg/m2]. The second objective was to pilot test the use of social media to improve treatment engagement and decrease attrition rates. Methods In this single arm, 12 week pre-post study, participants attended individual clinic visits and participated in a moderated private social media group that received nutrition, exercise, and behavior change social media communications or “posts” 3 to 4 times/week. Youth commented and/or liked posts from the moderator and each other. Social media engagement was measured with the number of likes and comments on social media. Clinic attrition was compared, measuring clinic visit attendance 12 weeks prior, during, and after the intervention with mixed linear regression models. Correlations of social media engagement with changes from baseline for BMI, BMI-z score, and psychosocial measures were fit. Results All 13 enrolled youth completed the study and reported that the group was enjoyable, helpful, reinforced their weight management program, and would recommend using social media to support other youth. The pilot trial was acceptable and feasible. Youth mean weekly engagement (likes + comments) in social media was greater than once a day (8.6 ±3.6). Compared to 12 weeks prior to the intervention, there was no significant decrease in clinic visit attendance at the end of the intervention (M=.231, P=.69) or 12 weeks at the conclusion of the intervention (M=.589, P=.28). Increased social media comments correlated with weight change (r=–.633, P=.04). Conclusions This pilot trial demonstrated that the use of social media as an adjunct to medical weight management was feasible and acceptable to adolescents with severe obesity. Based upon these preliminary findings, social media may be an effective way to mitigate attrition from obesity treatment programs, and improve health outcomes in this high-risk population.
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Affiliation(s)
- Elizabeth Prout Parks
- Division of Gastreoenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Reneé H Moore
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, United States.,Biostatistics Collaboration Core, Emory University, Atlanta, GA, United States
| | - Ziyi Li
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, United States
| | | | - Andrew R Garrett
- Division of Gastreoenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, PA, United States.,College of Science and Technology, Temple University, Philadelphia, PA, United States
| | - Douglas L Hill
- Pediatrics Advanced Care Team, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Yasmeen P Bruton
- Division of Gastreoenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - David B Sarwer
- College of Public Health, Temple University, Philadelphia, PA, United States
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Bagheri A, Liu XC, Tassone C, Thometz J, Chaloupka A, Tarima S, Cohen L, Simic M, Dennis S, Refshauge K, Pappas E, Parent EC, Pietrosanu M, Redford E, Schmidt S, Hill D, Moreau M, Hedden D, Adeeb S, Lou E, Brink RC, Schlösser TPC, Colo D, Vincken KL, van Stralen M, Hui SCN, Chu WCW, Cheng JCY, Castelein RM, Kechagias V, Grivas TB, Vlasis K, Michas K, Grivas TB, Kechagias V, Vlasis K, Michas K, Tam EMS, Yu FWP, Hung VWY, Shi L, Qin L, Ng BKW, Chu WCW, Griffith J, Cheng JCY, Lam TP, Xue C, Shi L, Hui SCN, Lam TP, Ng BKW, Cheng JCY, Chu WCW, Hui SCN, Pialasse JP, Wong JYH, Lam TP, Ng BKW, Cheng JCY, Chu WCW, Vo QN, Le LH, Lou EHM, Zheng R, Hill DL, Moreau MJ, Hedden DM, Mahood JK, Southon S, Lou E, Brignol A, Cheriet F, Miron MC, Laporte C, Qiu Y, Liu H, Liu Z, Zhu ZZ, Qian BP, Liu X, Rizza R, Thometz J, Rosol D, Tassone C, Tarima S, North P, Zaina F, Pesenti F, Negrini S, Persani L, Capodaglio P, Polli N, Yip BHK, Yu FWP, Hung VWY, Lam TP, Qin L, Ng BKW, Cheng JCY, Zhang J, Lee WYW, Chen H, Tam EMS, Man GC, Lam TP, Ng BKW, Qiu Y, Cheng JCY, Liu H, Liu Z, Zhu Z, Qian BP, Qiu Y, Harasymczuk P, Andrusiewicz M, Janusz P, Biecek P, Kotwicki T, Kotwicka M, Lee JS, Shin JK, Goh TS, Son SM, Chen H, Lee WYW, Zhang J, Tam EMS, Man GCW, Lam TP, Ng BKW, Qiu Y, Cheng JCY, Schwartz M, Gilday S, Bylski-Austrow DI, Glos DL, Schultz L, O’Hara S, Jain VV, Sturm PF, Wang X, Crandall DG, Parent S, Larson N, Labelle H, Aubin CE, Fard NB, Southon S, Moreau M, Hedden D, Duke K, Southon S, Lukenchuk L, Kerslake M, Huynh G, Chorney J, Tsui B, Tobert D, Bakarania P, Berdishevsky H, Grimes K, Matsumoto H, Hyman J, Roye B, Roye D, Vitale M, Black J, Bradley M, Drake S, Glynn D, Maude E, Berdishevsky H, Lindgren A, Bakarania P, Grimes K, Matsumoto H, Feinberg N, Bloom Z, Roye D, Vitale M, Dupuis S, Fortin C, Caouette C, Aubin CÉ, Gur G, Yakut Y, Jevtić N, Schreiber S, Hennes A, Pantović M, de Mauroy JC, Barral F, Pourret S, de Mauroy JC, Barral F, Pourret S, Aulisa AG, Guzzanti V, Galli M, Falciglia F, Aulisa L, Bernard JC, Deceuninck J, Berthonnaud E, Rougelot A, Pickering ME, Chaleat-Valayer E, Webb R, Bettany-Saltikov J, Neil B, Zaina F, Poggio M, Donzelli S, Lusini M, Minnella S, Negrini S, de Mauroy JC, Barral F, Hoang A, Mao S, Shi B, Qian B, Zhu Z, Sun X, Qiu Y, Cobetto N, Aubin CÉ, Parent S, Barch S, Turgeon I, Labelle H, Raihan HMA, Kumar DT, Khasnabis C, Equbal A, Chakraborty AK, Biswas A, Gur G, Dilek B, Ayhan C, Simsek E, Aras O, Aksoy S, Yakut Y, Lou E, Hill D, Zheng R, Donauer A, Tilburn M, Raso J, Morau M, Hedden D, Chen H, Man-Sang W, Cohen L, Kobayashi S, Simic M, Dennis S, Refshauge K, Pappas E, Aslanzadeh F, Parent EC, MacIntosh B, Maragkoudakis EG, Grivas TB, Gelalis ID, Mazioti C, Tsilimidos G, Burwell RG, Zheng Y, Wu XJ, Dang YN, Sun N, Yang Y, Wang T, He CQ, Wong MS, Donzelli S, Martinez G, Negrini A, Zaina F, Negrini S, Matsumoto H, Feinberg N, Shirley M, Swindell H, Bloom Z, Roye DP, Akbarnia BA, Garg S, Sanders JO, Skaggs DL, Smith JT, Vitale MG, Rizza R, Liu X, Thometz J, Lou E, Hill D, Donauer A, Tilburn M, Hedden D, Moreau M, Healy A, Farmer S, Chockalingam N, Aulisa AG, Guzzanti V, Galli M, Pizzetti P, Aulisa L, Maruyama T, Kobayashi Y, Nakao Y, Liu H, Qian BP, Qiu Y, Mao SH, Wang B, Yu Y, Zhu Z, Berdishevsky H, Lindgren AM, Bakarania P, Grimes K, Makhni MC, Shillingford J, Vitale MG, Black J, Maude E, Turland A, Glynn D, Caronni A, Sciumè L, Donzelli S, Zaina F, Negrini S, Schreiber S, Parent EC, Moez EK, Hedden DM, Hill DL, Moreau M, Lou E, Watkins EM, Southon SC, Parent EC, Schreiber S, Moez EK, Sloan P, Hedden D, Moreau M, Hill D, Southon S, Watkins E, Parent EC, Ghaneei M, Adeeb S, Schreiber S, Moreau M, Hedden D, Hill D, Southon S, Karavidas N, Dritsa D, Bettany-Saltikov J, Hanchard N, Kim D, Kim J, Sbihli A, Parent E, Levey L, Holowka M, Davis L, Dolan LA, Weinstein SL, Larson JE, Meyer MA, Boody B, Sarwark JF, Schreiber S, Parent EC, Hedden DM, Hill DL, Thometz J, Liu X, Rizza R, Tassone C, Liu X, Gundlach B, Tarima S, Grant A, Kalyan R, Hekal W, Honeyman C, Cook T, Murray S, Pitruzzella M, Donzelli S, Zaina F, Negrini S, de Mauroy JC, Barral F, Pourret S, de Mauroy JC, Barral F, Pourret S, Grimes K, Feinberg N, Hope J, Berdishevsky H, Bakarania P, Matsumoto H, Swindell H, Yoshimachi J, Roye D, Vitale M, Touchette J, St-Jean A, Brousseau D, Marcotte L, Théroux J, Doucet C, Lin Y, Wong MS, MacMahon J, MacMahon E, Boyette J, Stikeleather L, Lebel A, Lebel VA, Pancholi-Parekh CA, Stolze L, Selthafner M, Hong K, Liu X, Thometz J, Tassone C, Morrison PR, Hanke TA, Knott P, Krumdick ND, Chockalingam N, Shannon T, Davenhill R, Needham R, Jasani V, Ahmed EN, St-Jean A, Touchette J, Drake S, Brousseau D, Marcotte L, Théroux J, Doucet C, Aulisa AG, Guzzanti V, Gordano M, Mastantuoni G, Aulisa L, Chandrinos M, Grivas TB, Kechagias V, Głowka P, Gaweł D, Kasprzak B, Nowak M, Morzyński M, Kotwicki T, Deceuninck J, Bernard JC, Lecante C, Berthonnaud E, Fortin C, Aubin-Fournier JF, Bettany-Saltikov J, Parent EC, Feldman DE, Bernard JC, Liu Z, Zhang W, Hu Z, Zhu W, Jin M, Han X, Qiu Y, Cheng JCY, Zhu Z, Liu Z, Guo J, Wu T, Qian B, Zhu Z, Zhu F, Jiang J, Qiu Y, Han X, Liu Z, Liu H, Qiu Y, Guo J, Yan H, Sun X, Cheng JCY, Zhu Z, Di Felice F, Zaina F, Pitruzzella M, Donzelli S, Negrini S, Needham RA, Chatzistergos P, Chockalingam N, Brink RC, Schlösser TPC, Colo D, Vincken KL, van Stralen M, Hui SCN, Chu WCW, Cheng JCY, Castelein RM, Bylski-Austrow DI, Glos DL, Jain VV, Reynolds JE, Sturm PF, Wall EJ, Igoumenou VG, Megaloikonomos PD, Tsiavos K, Panagopoulos GN, Mavrogenis AF, Grivas TB, Soultanis K, Papagelopoulos PJ, Fard NB, Duke K, Chan A, Parent EC, Lou E, Lee JS, Shin JK, Goh TS, Son SM, Kobayashi S, Togawa D, Hasegawa T, Yamato Y, Oe S, Banno T, Mihara Y, Matsuyama Y. 13th International Conference on Conservative Management of Spinal Deformities and First Joint Meeting of the International Research Society on Spinal Deformities and the Society on Scoliosis Orthopaedic and Rehabilitation Treatment – SOSORT-IRSSD 2016 meeting. Scoliosis 2017. [PMCID: PMC5461518 DOI: 10.1186/s13013-017-0124-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Hill DL, Nathanson PG, Fenderson RM, Carroll KW, Feudtner C. Parental Concordance Regarding Problems and Hopes for Seriously Ill Children: A Two-Year Cohort Study. J Pain Symptom Manage 2017; 53:911-918. [PMID: 28062346 PMCID: PMC6644049 DOI: 10.1016/j.jpainsymman.2016.11.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 11/02/2016] [Accepted: 11/18/2016] [Indexed: 10/20/2022]
Abstract
CONTEXT Parents of a seriously ill child may have different concerns and hopes for their child, and these concerns and hopes may change over time. OBJECTIVES In a mixed-method prospective cohort of parental dyads of children with serious illness, to describe the major problems and hopes perceived for their child, examine the degree of concordance between parents, and assess whether prevalence and concordance change over time. METHODS Eighty-four parents (42 dyads) of seriously ill children reported the major problems and hopes for their children at baseline. Thirty-two parents (16 dyads) answered the same questions at 24 months. Problems and hopes were classified into nine domains. Observed concordance was calculated between parents on each domain. Data for parents of 11 children who died are reported separately. RESULTS The most common major problem and hope domains at baseline were physical body, quality of life, future health and well-being, and medical care. Parental dyads demonstrated a moderately high percentage of concordance (69%) regarding reported problem domains and a slightly lower percentage of concordance on hopes (61%), with higher concordance for more common domains. Domain prevalence and concordance changed considerably at 24 months. Parents of children who later died showed markedly different patterns of domain prevalence and more extreme patterns of concordance. CONCLUSION Parents of children with serious illness may have different perspectives regarding major problems and hopes, and these perspectives change over time. Parents of sicker children are more likely to be in either complete agreement or disagreement regarding the problems and hopes they identify.
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Affiliation(s)
- Douglas L Hill
- The Pediatric Advanced Care Team, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Pamela G Nathanson
- The Pediatric Advanced Care Team, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Rebecca M Fenderson
- The Pediatric Advanced Care Team, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Karen W Carroll
- The Pediatric Advanced Care Team, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Chris Feudtner
- The Pediatric Advanced Care Team, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
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Schreiber S, Parent EC, Khodayari Moez E, Hedden DM, Hill DL, Moreau M, Lou E, Watkins EM, Southon SC. Schroth Physiotherapeutic Scoliosis-Specific Exercises Added to the Standard of Care Lead to Better Cobb Angle Outcomes in Adolescents with Idiopathic Scoliosis - an Assessor and Statistician Blinded Randomized Controlled Trial. PLoS One 2016; 11:e0168746. [PMID: 28033399 PMCID: PMC5198985 DOI: 10.1371/journal.pone.0168746] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 12/05/2016] [Indexed: 12/30/2022] Open
Abstract
Background The North American non-surgical standard of care for adolescent idiopathic scoliosis (AIS) includes observation and bracing, but not exercises. Schroth physiotherapeutic scoliosis-specific exercises (PSSE) showed promise in several studies of suboptimal methodology. The Scoliosis Research Society calls for rigorous studies supporting the role of exercises before including it as a treatment recommendation for scoliosis. Objectives To determine the effect of a six-month Schroth PSSE intervention added to standard of care (Experimental group) on the Cobb angle compared to standard of care alone (Control group) in patients with AIS. Methods Fifty patients with AIS aged 10–18 years, with curves of 10°-45° and Risser grade 0–5 were recruited from a single pediatric scoliosis clinic and randomized to the Experimental or Control group. Outcomes included the change in the Cobb angles of the Largest Curve and Sum of Curves from baseline to six months. The intervention consisted of a 30–45 minute daily home program and weekly supervised sessions. Intention-to-treat and per protocol linear mixed effects model analyses are reported. Results In the intention-to-treat analysis, after six months, the Schroth group had significantly smaller Largest Curve than controls (-3.5°, 95% CI -1.1° to -5.9°, p = 0.006). Likewise, the between-group difference in the square root of the Sum of Curves was -0.40°, (95% CI -0.03° to -0.8°, p = 0.046), suggesting that an average patient with 51.2° at baseline, will have a 49.3° Sum of Curves at six months in the Schroth group, and 55.1° in the control group with the difference between groups increasing with severity. Per protocol analyses produced similar, but larger differences: Largest Curve = -4.1° (95% CI -1.7° to -6.5°, p = 0.002) and Sum of Curves=−0.5° (95% CI -0.8 to 0.2, p = 0.006). Conclusion Schroth PSSE added to the standard of care were superior compared to standard of care alone for reducing the curve severity in patients with AIS. Trial Registration NCT01610908
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Affiliation(s)
- Sanja Schreiber
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
- * E-mail: (SS); (ECP)
| | - Eric C. Parent
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
- * E-mail: (SS); (ECP)
| | | | - Douglas M. Hedden
- Department of Surgery, University of Alberta, Alberta Health Services, Edmonton, Alberta, Canada
- Alberta Health Services, Edmonton, Alberta, Canada
| | - Douglas L. Hill
- Department of Surgery, University of Alberta, Alberta Health Services, Edmonton, Alberta, Canada
- Alberta Health Services, Edmonton, Alberta, Canada
| | - Marc Moreau
- Department of Surgery, University of Alberta, Alberta Health Services, Edmonton, Alberta, Canada
- Alberta Health Services, Edmonton, Alberta, Canada
| | - Edmond Lou
- Department of Surgery, University of Alberta, Alberta Health Services, Edmonton, Alberta, Canada
- Glenrose Rehabilitation Research Centre, Alberta Health Services, Edmonton, Alberta, Canada
| | - Elise M. Watkins
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Sarah C. Southon
- Department of Surgery, University of Alberta, Alberta Health Services, Edmonton, Alberta, Canada
- Alberta Health Services, Edmonton, Alberta, Canada
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Hill DL, Carroll KW, Dai D, Faerber JA, Dougherty SL, Feudtner C. Identifying Communication-Impaired Pediatric Patients Using Detailed Hospital Administrative Data. Hosp Pediatr 2016; 6:456-467. [PMID: 27381628 DOI: 10.1542/hpeds.2015-0154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND AND OBJECTIVES Pediatric inpatients with communication impairment may experience inadequate pain and symptom management. Research regarding potential variation in care among patients with and without communication impairment is hampered because existing pediatric databases do not include information about patient communication ability per se, even though these data sets do contain information about diagnoses and medical interventions that are probably correlated with the probability of communication impairment. Our objective was to develop and evaluate a classification model to identify patients in a large administrative database likely to be communication impaired. METHODS Our sample included 236 hospitalized patients aged ≥12 months whose ability to communicate about pain had been assessed. We randomly split this sample into development (n = 118) and validation (n = 118) sets. A priori, we developed a set of specific diagnoses, technology dependencies, procedures, and medications recorded in the Pediatric Health Information System likely to be strongly associated with communication impairment. We used logistic regression modeling to calculate the probability of communication impairment for each patient in the development set, assessed the model performance, and evaluated the performance of the 11-variable model in the validation set. RESULTS In the validation sample, the classification model showed excellent classification accuracy (area under the receiver operating characteristic curve 0.92; sensitivity 82.6%; 95% confidence interval, 74%-100%; specificity 86.3%; 95% confidence interval, 80%-97%). For the complete sample, the predicted probability of communication impairment demonstrated excellent calibration with the observed communication impairment status. CONCLUSIONS Hospitalized pediatric patients with communication impairment can be accurately identified in a large hospital administrative database.
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Affiliation(s)
- Douglas L Hill
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | - Karen W Carroll
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | - Dingwei Dai
- Infomatics, Independence Blue Cross, Philadelphia, Pennsylvania
| | - Jennifer A Faerber
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | - Susan L Dougherty
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | - Chris Feudtner
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
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Humphrey LM, Hill DL, Carroll KW, Rourke M, Kang TI, Feudtner C. Psychological Well-Being and Family Environment of Siblings of Children with Life Threatening Illness. J Palliat Med 2015; 18:981-4. [PMID: 26393493 DOI: 10.1089/jpm.2015.0150] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The psychological well-being of siblings of children with life threatening illness remains largely uncharted. Pediatric cancer research suggests that a supportive family environment may protect the psychological well-being of siblings. OBJECTIVE We hypothesized that (1) siblings of pediatric palliative care patients would show clinical/behavioral scores that were elevated but that rates of serious psychopathology would be comparable to the general population of children their age; and (2) higher family functioning scores would be associated with lower clinical scores and higher adaptive scores for these siblings. METHODS We conducted an observational study with families in which a patient receiving palliative care had one or more siblings between the ages of 6 and 11. Parents completed the Behavioral Assessment System for Children, Second Edition (BASC-2) to assess the siblings' psychological well-being and the Family Assessment Device (FAD) to assess the family environment. RESULTS Twenty-four parents reported data for 30 siblings. Only three siblings scored in the clinical range on a BASC-2 composite clinical scale, and 11 siblings scored in the at-risk range on one or more composite scales. Higher FAD scores predicted significantly higher externalization composite clinical scores (7.54, 95% CI: 1.12, 13.97, p < 0.05) and significantly higher behavioral composite scores (7.88, 95% CI: 1.55, 14.21, p < 0.05). DISCUSSION Siblings of pediatric palliative care patients are not experiencing lower psychological well-being than the general population. The prediction that a positive family environment would be associated with higher levels of psychological health was supported.
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Affiliation(s)
| | - Douglas L Hill
- 2 The Children's Hospital of Philadelphia , Philadelphia, Pennsylvania
| | - Karen W Carroll
- 2 The Children's Hospital of Philadelphia , Philadelphia, Pennsylvania
| | - Mary Rourke
- 3 Widener University , Chester, Pennsylvania
| | - Tammy I Kang
- 2 The Children's Hospital of Philadelphia , Philadelphia, Pennsylvania
| | - Chris Feudtner
- 2 The Children's Hospital of Philadelphia , Philadelphia, Pennsylvania
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Lou EHM, Hill DL, Raso JV, Moreau M, Hedden D. How quantity and quality of brace wear affect the brace treatment outcomes for AIS. Eur Spine J 2015; 25:495-9. [PMID: 26386869 DOI: 10.1007/s00586-015-4233-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 09/07/2015] [Accepted: 09/07/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To determine the reliability of a prognostic curve progression model and the role of the quantity and quality of brace wear for adolescent idiopathic scoliosis (AIS) brace treatment. METHODS To develop a curve progression model for full-time AIS brace treatment, 20 AIS subjects (Group 1) prescribed full-time thoracolumbar sacral orthosis (TLSO) were monitored and followed for 2 years beyond maturity. The developed curve progression model was: curve progression (in degrees) = 33 + 0.11 × Peterson risk (%) - 0.07 in-brace correction (%) - 0.45 × quality (%) - 0.48 × quantity (%) + 0.0062 × quantity × quality. To validate the model, 40 new (test) subjects (Group 2) who met the same inclusion criteria and used the same type of monitors, were monitored and followed for 2 years after bracing. RESULTS For the 40 test subjects (Group 2), the average in-brace correction was 40 ± 22 %. The average quantity and quality of the brace wear were 56 ± 19 and 55 ± 17 %, respectively. Twelve subjects (30 %) progressed of which 10 subjects (25 %) required surgery and 28 subjects (70 %) showed no progression. The accuracy of the model to determine which patients would progress was 88 % (35/40) which was better than the Peterson's risk model (68 %; 26/40) alone. Patients who had the combined quantity times the quality over a threshold 43 % had a success treatment rate of 95 %. CONCLUSIONS This study showed the prognostic model of brace treatment outcome on AIS patients treated with full-time TLSO was reliable. Both the quantity and quality of the brace wear were important factors in achieving successful brace treatment.
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Affiliation(s)
- Edmond H M Lou
- Department of Surgery, University of Alberta, Edmonton, AB, T6G2R3, Canada. .,Alberta Health Services-Glenrose Rehabilitation Hospital, Edmonton, AB, T5G 0H1, Canada.
| | - Douglas L Hill
- Department of Surgery, University of Alberta, Edmonton, AB, T6G2R3, Canada.,Alberta Health Services-Glenrose Rehabilitation Hospital, Edmonton, AB, T5G 0H1, Canada
| | - Jim V Raso
- Department of Surgery, University of Alberta, Edmonton, AB, T6G2R3, Canada.,Alberta Health Services-Glenrose Rehabilitation Hospital, Edmonton, AB, T5G 0H1, Canada
| | - Marc Moreau
- Department of Surgery, University of Alberta, Edmonton, AB, T6G2R3, Canada
| | - Douglas Hedden
- Department of Surgery, University of Alberta, Edmonton, AB, T6G2R3, Canada
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Stettler N, Wrotniak BH, Hill DL, Kumanyika SK, Xanthopoulos MS, Nihtianova S, Shults J, Leff SS, Pinto A, Berkowitz RI, Faith MS. Prevention of excess weight gain in paediatric primary care: beverages only or multiple lifestyle factors. The Smart Step Study, a cluster-randomized clinical trial. Pediatr Obes 2015; 10:267-74. [PMID: 25251166 PMCID: PMC4372512 DOI: 10.1111/ijpo.260] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 06/19/2014] [Accepted: 07/22/2014] [Indexed: 01/08/2023]
Abstract
BACKGROUND Insufficient evidence exists to support obesity prevention in paediatric primary care. OBJECTIVES To test a theory-based behaviour modification intervention delivered by trained paediatric primary care providers for obesity prevention. METHODS Efficacy trial with cluster randomization (practice level) and a 12-session 12-month sweetened beverages decrease intervention or a comprehensive dietary and physical activity intervention, compared with a control intervention among children ages 8-12 years. RESULTS A low recruitment rate was observed. The increase in body mass index z-score (BMIz) for the 139 subjects (11 practices) randomized to any of the two obesity interventions (combined group) was less than that of the 33 subjects (five practices) randomized to the control intervention (-0.089, 95% confidence interval [CI]: -0.170 to -0.008, P = 0.03) with a -1.44 kg weight difference (95% CI: -2.98 to +0.10 kg, P = 0.095). The incidences of obesity and excess weight gain were lower in the obesity interventions, but the number of subjects was small. Post hoc analyses comparing the beverage only to the control intervention also showed an intervention benefit on BMIz (-0.083, 95% CI: -0.165 to -0.001, P = 0.048). CONCLUSIONS For participating families, an obesity prevention intervention delivered by paediatric primary care clinicians, who are compensated, trained and continuously supported by behavioural specialists, can impact children's BMIz.
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Affiliation(s)
| | - Brian H. Wrotniak
- D’Youville College, Buffalo, NY
- The Children’s Hospital of Philadelphia, Philadelphia, PA
| | | | | | | | | | - Justine Shults
- The Children’s Hospital of Philadelphia, Philadelphia, PA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Stephen S. Leff
- The Children’s Hospital of Philadelphia, Philadelphia, PA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Andres Pinto
- Case Western Reserve University School of Dental Medicine, Cleveland, OH
| | - Robert I. Berkowitz
- The Children’s Hospital of Philadelphia, Philadelphia, PA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Myles S. Faith
- Gillings School of Global Public Health University of North Carolina - Chapel Hill, Chapel Hill, NC
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Young M, Hill DL, Zheng R, Lou E. Reliability and accuracy of ultrasound measurements with and without the aid of previous radiographs in adolescent idiopathic scoliosis (AIS). Eur Spine J 2015; 24:1427-33. [PMID: 25753005 DOI: 10.1007/s00586-015-3855-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 12/30/2014] [Accepted: 03/01/2015] [Indexed: 02/07/2023]
Abstract
PURPOSE The objectives of this preliminary study were to assess the reliability and accuracy of ultrasound (US) for measuring coronal curvature with and without the aid of a previous radiograph, and to evaluate the ability of US to detect curve progression in adolescent idiopathic scoliosis (AIS) patients. METHODS Four raters measured 20 AIS US images twice at one-week intervals. Intra-rater reliability and correlation with radiograph were investigated with (rater 1) and without (raters 2-4) the aid of a previous radiograph. The center of lamina (COL) method was used to approximate the Cobb angle. RESULTS Thirty-six curves were identified. All raters showed high intra-rater reliability (ICC[2,1] >0.80). With the aid of a previous radiograph, rater 1 showed higher correlation with radiograph (ICC[2,1] = 0.86), better standard error of measurement (SEM = 2.2°), and improved error index of selecting end-vertebrae (EI = 1.34), but no statistical improvement of intra-rater reliability (p > 0.05). For rater 2-4, the range of the ICC[2,1] values between US and radiograph measurements, the SEM value, and the range of the EI values were 0.70°-0.72°, 3.3°, and 1.65°-2.36°, respectively. Specificity and sensitivity of US for detecting curve progression were 0.91 and 0.83, respectively. CONCLUSIONS Using a previous radiograph as a measurement aid helped the user to measure coronal curvature from US images, and improved the accuracy of end-vertebrae selection. US showed high sensitivity and specificity for detecting curve progression, indicating that US may be a suitable, radiation-free alternative for monitoring patients with AIS who have mild or moderate curves.
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Affiliation(s)
- Michelle Young
- Department of Surgery, University of Alberta, 8440 - 112 Street, Edmonton, AB, T6G 2B7, Canada
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Lou E, Zheng R, Chan ACY, Hill DL, Moreau MJ, Hedden DM, Mahood JK, Southon S. Reliability of coronal curvature measurements on 3D ultrasound images for AIS. Scoliosis 2015. [PMCID: PMC4340206 DOI: 10.1186/1748-7161-10-s1-o37] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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Feudtner C, Walter JK, Faerber JA, Hill DL, Carroll KW, Mollen CJ, Miller VA, Morrison WE, Munson D, Kang TI, Hinds PS. Good-parent beliefs of parents of seriously ill children. JAMA Pediatr 2015; 169:39-47. [PMID: 25419676 PMCID: PMC4946564 DOI: 10.1001/jamapediatrics.2014.2341] [Citation(s) in RCA: 149] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Parents' beliefs about what they need to do to be a good parent when their children are seriously ill influence their medical decisions, and better understanding of these beliefs may improve decision support. OBJECTIVE To assess parents' perceptions regarding the relative importance of 12 good-parent attributes. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional, discrete-choice experiment was conducted at a children's hospital. Participants included 200 parents of children with serious illness. MAIN OUTCOMES AND MEASURES Ratings of 12 good-parent attributes, with subsequent use of latent class analysis to identify groups of parents with similar ratings of attributes, and ascertainment of whether membership in a particular group was associated with demographic or clinical characteristics. RESULTS The highest-ranked good-parent attribute was making sure that my child feels loved, followed by focusing on my child's health, making informed medical care decisions, and advocating for my child with medical staff. We identified 4 groups of parents with similar patterns of good-parent-attribute ratings, which we labeled as: child feels loved (n=68), child's health (n=56), advocacy and informed (n=55), and spiritual well-being (n=21). Compared with the other groups, the child's health group reported more financial difficulties, was less educated, and had a higher proportion of children with new complex, chronic conditions. CONCLUSIONS AND RELEVANCE Parents endorse a broad range of beliefs that represent what they perceive they should do to be a good parent for their seriously ill child. Common patterns of how parents prioritize these attributes exist, suggesting future research to better understand the origins and development of good-parent beliefs among these parents. More important, engaging parents individually regarding what they perceive to be the core duties they must fulfill to be a good parent may enable more customized and effective decision support.
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Affiliation(s)
- Chris Feudtner
- Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jennifer K. Walter
- Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jennifer A. Faerber
- Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Douglas L. Hill
- Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Karen W. Carroll
- Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Cynthia J. Mollen
- Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Victoria A. Miller
- Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Wynne E. Morrison
- Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - David Munson
- Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Tammy I. Kang
- Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Pamela S. Hinds
- Department of Nursing Research and Quality Outcomes, Children’s National Health System, Washington, DC4Department of Pediatrics, School of Medicine and Health Sciences, George Washington University, Washington, DC
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Hill DL, Carroll KW, Dougherty S, Vega C, Feudtner C. Point prevalence study of pediatric inpatients who are unable to communicate effectively about pain. Hosp Pediatr 2014; 4:382-386. [PMID: 25362081 DOI: 10.1542/hpeds.2014-0006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Pediatric inpatients may be at risk for inadequate pain management if they are unable to communicate effectively because of age, physical or cognitive impairment, or medical procedures. We conducted a point prevalence study to estimate the proportion of inpatients at a children's hospital who have difficulty communicating to hospital staff. METHODS We obtained nurse reports of ability to communicate for all inpatients aged ≥12 months in a pediatric hospital. Demographic information was obtained from the medical record. RESULTS Questionnaires were completed for 254 inpatients. Forty percent of inpatients had some difficulty communicating, and 69% had experienced pain during the hospitalization. Patient ability to communicate was not related to experiencing pain (χ(2) test, P = .30) or effectiveness of pain management (χ(2) test, P = .80) but was associated with difficulty communicating about pain and nurses needing help from the caretaker to communicate with the patient (χ(2) tests, Ps < .001). CONCLUSIONS A substantial proportion of inpatients aged ≥12 months at a large children's hospital had difficulties communicating effectively and experienced pain during hospitalization. These communication difficulties were not associated with nurse reports of the effectiveness of pain management. However, patients who had difficulties communicating in general were also more likely to have difficulty communicating about pain specifically, and nurses were more likely to need help from the caregiver to understand these patients. Future directions include identifying which conditions, procedures, and medications are associated with inability to communicate.
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Affiliation(s)
- Douglas L Hill
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Karen W Carroll
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Susan Dougherty
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Cassandra Vega
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Chris Feudtner
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Hill DL, Miller V, Walter JK, Carroll KW, Morrison WE, Munson DA, Kang TI, Hinds PS, Feudtner C. Regoaling: a conceptual model of how parents of children with serious illness change medical care goals. BMC Palliat Care 2014; 13:9. [PMID: 24625345 PMCID: PMC3975157 DOI: 10.1186/1472-684x-13-9] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 03/07/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Parents of seriously ill children participate in making difficult medical decisions for their child. In some cases, parents face situations where their initial goals, such as curing the condition, may have become exceedingly unlikely. While some parents continue to pursue these goals, others relinquish their initial goals and generate new goals such as maintaining the child's quality of life. We call this process of transitioning from one set of goals to another regoaling. DISCUSSION Regoaling involves factors that either promote or inhibit the regoaling process, including disengagement from goals, reengagement in new goals, positive and negative affect, and hopeful thinking. We examine these factors in the context of parental decision making for a seriously ill child, presenting a dynamic conceptual model of regoaling. This model highlights four research questions that will be empirically tested in an ongoing longitudinal study of medical decision making among parents of children with serious illness. Additionally, we consider potential clinical implications of regoaling for the practice of pediatric palliative care. SUMMARY The psychosocial model of regoaling by parents of children with a serious illness predicts that parents who experience both positive and negative affect and hopeful patterns of thought will be more likely to relinquish one set of goals and pursue a new set of goals. A greater understanding of how parents undergo this transition may enable clinicians to better support them through this difficult process.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Chris Feudtner
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
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Schreiber S, Parent EC, Hedden DM, Watkins EM, Hill DL, Moreau M, Southon S, Mahood JK. Feasibility and three months preliminary results of an RCT on the effect of Schroth exercises in adolescent idiopathic scoliosis (AIS). Scoliosis 2013. [PMCID: PMC3675342 DOI: 10.1186/1748-7161-8-s1-o21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
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Hill DL, Miller VA, Hexem KR, Carroll KW, Faerber JA, Kang T, Feudtner C. Problems and hopes perceived by mothers, fathers and physicians of children receiving palliative care. Health Expect 2013; 18:1052-65. [PMID: 23683168 DOI: 10.1111/hex.12078] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2013] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The quality of shared decision making for children with serious illness may depend on whether parents and physicians share similar perceptions of problems and hopes for the child. OBJECTIVE (i) Describe the problems and hopes reported by mothers, fathers and physicians of children receiving palliative care; (ii) examine the observed concordance between participants; (iii) examine parental perceived agreement; and (iv) examine whether parents who identified specific problems also specified corresponding hopes, or whether the problems were left 'hopeless'. METHOD Seventy-one parents and 43 physicians were asked to report problems and hopes and perceived agreement for 50 children receiving palliative care. Problems and hopes were classified into eight domains. Observed concordance was calculated between parents and between each parent and the physicians. RESULTS The most common problem domains were physical body (88%), quality of life (74%) and medical knowledge (48%). The most common hope domains were quality of life (88%), suffering (76%) and physical body (39%). Overall parental dyads demonstrated a high percentage of concordance (82%) regarding reported problem domains and a lower percentage of concordance on hopes (65%). Concordance between parents and physicians regarding specific children was lower on problem (65-66%) and hope domains (59-63%). Respondents who identified problems regarding a child's quality of life or suffering were likely to also report corresponding hopes in these domains (93 and 82%, respectively). CONCLUSION Asking parents and physicians to talk about problems and hopes may provide a straightforward means to improve the quality of shared decision making for critically ill children.
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Affiliation(s)
- Douglas L Hill
- Pediatric Advanced Care Team, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Victoria A Miller
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kari R Hexem
- Pediatric Advanced Care Team, The University of Pennsylvania School of Dental Medicine, Philadelphia, PA, USA
| | - Karen W Carroll
- Pediatric Advanced Care Team, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jennifer A Faerber
- Pediatric Advanced Care Team, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Tammy Kang
- Pediatric Advanced Care Team, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Chris Feudtner
- Pediatric Advanced Care Team, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Hill DL, Parent EC, Lou E, Moreau MJ, Mahood JK, Hedden DM. Brace treatment for adolescent idiopathic scoliosis – Protocols of the Canadian Spinal Deformity Study Group Surgeons. Scoliosis 2010. [PMCID: PMC2938670 DOI: 10.1186/1748-7161-5-s1-o39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Abstract
As part of a larger study on television exposure, 1,276 shows from the 2001-2002 television season were coded for sexual content. Compared to previous research, this study sampled more networks targeted to adolescents and examined differences across additional program genres. A unique feature is the assessment of sexual content across network types. Three genres were distinguished by high percentages of shows with sexual behavior and talk and greater explicitness. This pattern characterized premium cable movie channels compared to broadcast and other cable networks. Few genres consistently offer programming that is free of sexual content during peak times for teen viewing.
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Affiliation(s)
| | | | - Joel W Grube
- Prevention Research Center, Pacific Institute for Research and Evaluation
| | - Enid L Gruber
- Department of Child & Adolescent Studies, California State University-Fullerton
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Parent EC, Damaraju S, Hill DL, Lou E, Smetaniuk D. Identifying the best surface topography parameters for detecting idiopathic scoliosis curve progression. Stud Health Technol Inform 2010; 158:78-82. [PMID: 20543404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
There is no consensus on which surface topography (ST) parameters may be used to detect scoliosis progression. The sensitivity to change of common ST parameters has not yet been compared. The goal of this study was to determine which ST parameters are most sensitive to scoliosis progression in patients with adolescent idiopathic scoliosis (AIS) receiving conservative treatment. Fifty-eight subjects with AIS were included whose Cobb angle had progressed by at least 5 degrees during a 1 year interval. All had had ST scans and frontal radiographs at a 12 month interval at our clinic. Commonly used back-only ST parameters and contributing scores were derived by one evaluator. Standardized response mean (SRM) and 95% confidence intervals (CI) were calculated using the absolute value of the changes between baseline and follow-up to reflect change in deformity, independent of direction. Decompensation, cosmetic score, Deformity in the Axial Plane Index (DAPI), trunk rotation, Hump Sum, and lordosis angle were highly sensitive to scoliosis progression (SRM>0.8). Cosmetic score, Posterior Trunk Symmetry Index (POTSI), and kyphosis angle had significantly poorer SRM values than the Cobb angle. All other ST parameters had SRM estimates that did not differ significantly from the Cobb angle, suggesting that they have a similar ability to detect progression The ST measures that were most sensitive to detection of scoliosis progression in the frontal, transverse, and sagittal planes were decompensation, trunk rotation, and lordosis angle, respectively. Absolute changes in surface parameters representing either worsening or improvement externally could reflect worsening of the internal deformity. The majority of ST parameters are potentially sensitive to scoliosis progression.
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Affiliation(s)
- E C Parent
- Alberta Health Services, Glenrose Rehabilitation Hospital, Edmonton, AB, Canada
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Zhang J, Lou E, Hill DL, Raso JV, Wang Y, Le LH, Shi X. Computer-aided assessment of scoliosis on posteroanterior radiographs. Med Biol Eng Comput 2009; 48:185-95. [PMID: 20012376 DOI: 10.1007/s11517-009-0556-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2009] [Accepted: 11/13/2009] [Indexed: 11/26/2022]
Abstract
In order to reduce the observer variability in radiographic scoliosis assessment, a computer-aided system was developed. The system semi-automatically measured the Cobb angle and vertebral rotation on posteroanterior radiographs based on Hough transform and snake model, respectively. Both algorithms were integrated with the shape priors to improve the performance. The system was tested twice by each of three observers. The intraobserver and interobserver reliability analyses resulted in the intraclass correlation coefficients higher than 0.9 and 0.8 for Cobb measurement on 70 radiographs and rotation measurement on 156 vertebrae, respectively. Both the Cobb and rotation measurements resulted in the average intraobserver and interobserver errors less than 2 degrees and 3 degrees , respectively. There were no significant differences in the measurement variability between groups of curve location, curve magnitude, observer experience, and vertebra location. Compared with the documented results, measurement variability is reduced by using the developed system. This system can help orthopedic surgeons assess scoliosis more reliably.
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Affiliation(s)
- Junhua Zhang
- Department of Electronic Engineering, Yunnan University, Kunming, China.
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46
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Fisher DA, Hill DL, Grube JW, Bersamin MM, Walker S, Gruber EL. Televised sexual content and parental mediation: Influences on adolescent sexuality. Media Psychol 2009; 12:121-147. [PMID: 21546986 PMCID: PMC3086268 DOI: 10.1080/15213260902849901] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Little research has been conducted to examine the influence of exposure to televised sexual content on adolescent sexuality or how parental intervention may reduce negative effects of viewing such content. This study uses self-report data from 1,012 adolescents to investigate the relations among exposure to sexually suggestive programming, parental mediation strategies, and three types of adolescent sexuality outcomes: participation in oral sex and sexual intercourse, future intentions to engage in these behaviors, and sex expectancies. As predicted, exposure to sexual content was associated with an increased likelihood of engaging in sexual behaviors, increased intentions to do so in the future, and more positive sex expectancies. Often, parental mediation strategies were a significant factor in moderating these potential media influences.
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47
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Thomas JE, Hill DL. The effects of dietary protein restriction on chorda tympani nerve taste responses and terminal field organization. Neuroscience 2008; 157:329-39. [PMID: 18845228 DOI: 10.1016/j.neuroscience.2008.09.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2006] [Revised: 08/13/2008] [Accepted: 09/01/2008] [Indexed: 11/30/2022]
Abstract
Prenatal dietary sodium restriction produces profound developmental effects on rat functional taste responses and formation of neural circuits in the brainstem. Converging evidence indicates that the underlying mechanisms for these effects are related to a compromised nutritional state and not to direct stimulus-receptor interactions. We explored whether early malnourishment produces similar functional and structural effects to those seen following dietary sodium restriction by using a protein deficient, sodium replete diet. To determine if early dietary protein-restriction affects the development of the peripheral gustatory system, multi-fiber neurophysiological recordings were made from the chorda tympani nerve and anterograde track tracing of the chorda tympani nerve into the nucleus of the solitary tract (NTS) was accomplished in rats fed a protein-restricted or a control diet (6% and 20%, respectively). The dietary regimens began on embryonic day 7 and continued until rats were used for neurophysiological recordings (postnatal days (P) 35-50) or for chorda tympani terminal field labeling (P40-50). Responses to a concentration series of NaCl, sodium acetate, KCl, and to 0.50 M sucrose, 0.03 M quinine-HCl, and 0.01 N HCl revealed attenuated responses (30-60%) to sodium-specific stimuli in rats fed the 6% protein diet compared with those fed the 20% protein diet. Responses to all other stimuli were similar between groups. Terminal field volumes were nearly twofold larger in protein-restricted rats compared with controls, with the differences located primarily in the dorsal-caudal zone of the terminal field. These results are similar to the results seen previously in rats fed a sodium-restricted diet throughout pre- and postnatal development, suggesting that dietary sodium- and protein-restriction share similar mechanisms in altering gustatory development.
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Affiliation(s)
- J E Thomas
- Virginia Commonwealth University, School of Medicine, 1101 East Marshall Street, Richmond, VA 23298, USA
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48
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Allen S, Parent E, Khorasani M, Hill DL, Lou E, Raso JV. Validity and reliability of active shape models for the estimation of cobb angle in patients with adolescent idiopathic scoliosis. J Digit Imaging 2008; 21:208-18. [PMID: 17340228 PMCID: PMC3043859 DOI: 10.1007/s10278-007-9026-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Choosing the most suitable treatment for scoliosis relies heavily on accurate and reproducible Cobb angle measurement from successive radiographs. The objective is to reduce variability of Cobb angle measurement by reducing user intervention and bias. Custom software to increase automation of the Cobb angle measurement from posteroanterior radiographs was developed using active shape models. Validity and reliability of the automated system against a manual and semiautomated measurement method was conducted by two examiners each performing measurements on three occasions from a test set (N = 22). A training set (N = 47) of radiographs representative of curves seen in a scoliosis clinic was used to train the software to recognize vertebrae from T4 to L4. Images with a maximum Cobb angle between 20 degrees and 50 degrees , excluding surgical cases, were selected for training and test sets. Automated Cobb angles were calculated using best-fit slopes of the detected vertebrae endplates. Intraclass correlation coefficient (ICC) and standard error of measurement (SEM) showed high intraexaminer (ICC > 0.90, SEM 2 degrees -3 degrees ) and interexaminer (ICC > 0.82, SEM 2 degrees -4 degrees ), but poor intermethod reliability (ICC = 0.30, SEM 8 degrees -9 degrees ). The automated method underestimated large curves. The reliability improved (ICC = 0.70, SEM 4 degrees -5 degrees ) with exclusion of the four largest curves (>40 degrees ) in the test set. The automated method was reliable for moderate-sized curves, and did detect vertebrae in larger curves with a modified training set of larger curves.
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Affiliation(s)
- Shannon Allen
- Department of Rehabilitation Technology, Capital Health, Glenrose Rehabilitation Hospital Site, 10230 111 Ave., Edmonton, Alberta T5G 0B7 Canada
| | - Eric Parent
- Department of Rehabilitation Technology, Capital Health, Glenrose Rehabilitation Hospital Site, 10230 111 Ave., Edmonton, Alberta T5G 0B7 Canada
| | - Maziyar Khorasani
- Department of Rehabilitation Technology, Capital Health, Glenrose Rehabilitation Hospital Site, 10230 111 Ave., Edmonton, Alberta T5G 0B7 Canada
| | - Douglas L. Hill
- Department of Rehabilitation Technology, Capital Health, Glenrose Rehabilitation Hospital Site, 10230 111 Ave., Edmonton, Alberta T5G 0B7 Canada
| | - Edmond Lou
- Department of Rehabilitation Technology, Capital Health, Glenrose Rehabilitation Hospital Site, 10230 111 Ave., Edmonton, Alberta T5G 0B7 Canada
| | - James V. Raso
- Department of Rehabilitation Technology, Capital Health, Glenrose Rehabilitation Hospital Site, 10230 111 Ave., Edmonton, Alberta T5G 0B7 Canada
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49
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Abstract
Many of the aches and pains of adults are the result not of injuries, but of the long-term effects of distortions in posture or alignment. Postural kyphosis in adolescence may be one of the effects of poor standing and sitting habits. Kyphosis is an excessive rounding of the upper spine. A smart garment that can monitor and provide vibration feedback to children has been developed to investigate an alternative treatment possibility. Laboratory tests verified that the accuracy of the system was +/-2 degrees within the full 180 degrees range. A clinical trial has been conducted and it showed that the system can aid subjects to improve by 20% the proportion of time in a more balanced posture. The long term effect is still under investigation.
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Affiliation(s)
- E Lou
- Capital Health - Glenrose Rehabilitation Hospital, Edmonton, AB Canada
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50
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Wang W, Wang H, Rayburn ER, Zhao Y, Hill DL, Zhang R. 20(S)-25-methoxyl-dammarane-3beta, 12beta, 20-triol, a novel natural product for prostate cancer therapy: activity in vitro and in vivo and mechanisms of action. Br J Cancer 2008; 98:792-802. [PMID: 18253123 PMCID: PMC2259179 DOI: 10.1038/sj.bjc.6604227] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We recently isolated 20(S)-25-methoxyl-dammarane-3β, 12β, 20-triol (25-OCH3-PPD), a natural product from Panax notoginseng, and demonstrated its cytotoxicity against a variety of cancer cells. Here we report the effects of this compound in vitro and in vivo on human prostate cancer cells, LNCaP (androgen-dependent) and PC3 (androgen-independent), in comparison with three structurally related ginsenosides, ginsenoside Rh2, ginsenoside Rg3, and 20(S)-protopanaxadiol. Of the four test compounds, 25-OCH3-PPD was most potent. It decreased survival, inhibited proliferation, induced apoptosis, and led to G1 cell cycle arrest in both cell lines. It also decreased the levels of proteins associated with cell proliferation (MDM2, E2F1, cyclin D1, and cdks 2 and 4) and increased or activated pro-apoptotic proteins (cleaved PARP, cleaved caspase-3, -8, and -9). In LNCaP cells, 25-OCH3-PPD inhibited the expression of the androgen receptor and prostate-specific antigen. Moreover, 25-OCH3-PPD inhibited the growth of prostate cancer xenograft tumours. Combining 25-OCH3-PPD with conventional chemotherapeutic agents or with radiation led to potent antitumour effects; tumour regression was almost complete following administration of 25-OCH3-PPD and either taxotere or gemcitabine. 25-OCH3-PPD also demonstrated low toxicity to noncancer cells and no observable toxicity in animals. In conclusion, our preclinical data indicate that 25-OCH3-PPD is a potential therapeutic agent against both androgen-dependent and androgen-independent prostate cancer.
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Affiliation(s)
- W Wang
- Department of Pharmacology and Toxicology, Division of Clinical Pharmacology, and Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham AL 35294, USA
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