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Robertson EG, Roberts NJ, Le Marne F, Beavis E, Macintosh R, Kelada L, Best S, Goranitis I, Pierce K, Gill D, Sachdev R, Bye A, Palmer EE. "Somewhere to turn to with my questions": A pre-post pilot of an information linker service for caregivers who have a child with a Developmental and Epileptic Encephalopathy. Eur J Paediatr Neurol 2023; 47:94-104. [PMID: 37832466 DOI: 10.1016/j.ejpn.2023.09.010] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 09/03/2023] [Accepted: 09/29/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Caregivers of a child with a Developmental and Epileptic Encephalopathy (DEE) often report challenges accessing relevant and understandable information regarding their child's condition. We developed GenE Compass, an information linker service where caregivers are invited to submit questions and receive high-quality, personalised reports. We conducted a pilot evaluation to determine the feasibility and acceptability of GenE Compass. METHODS We invited eligible caregivers to complete a baseline questionnaire (Q1) prior to receiving three months access to submit an unlimited number of questions to GenE Compass. We then invited caregivers to complete a follow-up questionnaire (Q2) and optional interview. Caregivers also had the opportunity to share report-specific feedback at the time of receiving each report. RESULTS Seventy-two caregivers completed Q1, of which 41 submitted at least one question (range = 1-7). We received a total of 76 questions. The median turnaround time was 12 working days for our information linker (range = 1-28). Thirty-seven caregivers completed Q2, of whom 32 submitted at least one question (87 %). Overall, caregivers were highly satisfied with GenE Compass and their reports, and indicated that they would use it in the future if they had another question. Caregivers' qualitative data from Q1 and interviews highlighted the ongoing need for an information linker service like GenE Compass due to a lack of understandable information and limited resources, and the benefit in reducing burden of constant information searching. CONCLUSION Our study shows that GenE Compass is feasible with the appropriate allocation of resources and highly acceptable to caregivers who have a child with a DEE.
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Affiliation(s)
- Eden G Robertson
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Randwick, Australia.
| | - Natalie J Roberts
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Randwick, Australia
| | - Fleur Le Marne
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Randwick, Australia; Department of Neurology, Sydney Children's Hospitals Network, Randwick, NSW, Australia
| | - Erin Beavis
- Department of Neurology, Sydney Children's Hospitals Network, Randwick, NSW, Australia
| | - Rebecca Macintosh
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Randwick, Australia; Centre for Clinical Genetics, Sydney Children's Hospitals Network, Randwick, NSW, Australia
| | - Lauren Kelada
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Randwick, Australia; Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, High Street, Randwick, Australia
| | - Stephanie Best
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Victorian Comprehensive Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Cancer Centre Dept of Oncology, University of Melbourne, Melbourne, VIC, Australia; Australian Genomics Health Alliance, Murdoch Children's Research Institute, Melbourne, Australia
| | - Ilias Goranitis
- Australian Genomics Health Alliance, Murdoch Children's Research Institute, Melbourne, Australia; Health Economics Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Kristine Pierce
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Randwick, Australia; Epilepsy Foundation, Surrey Hills, Melbourne, Victoria, Australia
| | - Deepak Gill
- TY Nelson Department of Neurology and Neurosurgery, The Children's Hospital at Westmead, Sydney, Australia; Kids Neuroscience Centre, Sydney, Australia
| | - Rani Sachdev
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Randwick, Australia; Centre for Clinical Genetics, Sydney Children's Hospitals Network, Randwick, NSW, Australia
| | - Ann Bye
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Randwick, Australia; Department of Neurology, Sydney Children's Hospitals Network, Randwick, NSW, Australia
| | - Elizabeth E Palmer
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Randwick, Australia; Centre for Clinical Genetics, Sydney Children's Hospitals Network, Randwick, NSW, Australia
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Robertson EG, Kelada L, Best S, Goranitis I, Grainger N, Le Marne F, Pierce K, Nevin SM, Macintosh R, Beavis E, Sachdev R, Bye A, Palmer EE. Acceptability and feasibility of an online information linker service for caregivers who have a child with genetic epilepsy: a mixed-method pilot study protocol. BMJ Open 2022; 12:e063249. [PMID: 36288836 PMCID: PMC9615979 DOI: 10.1136/bmjopen-2022-063249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Developmental and epileptic encephalopathies (DEEs) are rare epilepsy conditions that collectively impact 1 in 2000 children. They are highly genetically heterogeneous, resulting in significant barriers to accurate and adequate information for caregivers. This can lead to increased distress and dissatisfaction with the healthcare system. To address this gap, we developed 'GenE Compass' to provide caregivers with the highest-quality possible, understandable and relevant information in response to specific questions about their child's DEE. Using a mixed-method design, we will now pilot GenE Compass to evaluate the acceptability to caregivers and clinicians, feasibility and impact to caregivers. METHODS AND ANALYSIS We will recruit 88 caregivers (estimated final sample of 50 at follow-up) who have a child under 18 years of age with a suspected or confirmed DEE diagnosis. Following consent and a baseline questionnaire (questionnaire 1 (Q1)), participants will be able to submit questions to GenE Compass over a 3-month period. After 3 months, participants will complete a follow-up questionnaire (Q2) and an optional telephone interview to answer the research questions. Primary outcomes are acceptability of GenE Compass and feasibility of delivering the intervention (eg, cost of the intervention, number of questions submitted and time taken to respond to questions). Secondary outcomes include the impact of GenE Compass on caregivers' quality of life, information searching behaviours, perceptions of their child's illness and activation. ETHICS AND DISCUSSION The study protocol (V.2, dated 16 September 2021) has been approved by the Sydney Children's Hospitals Network Human Research Ethics Committee (ETH11277). The results will be disseminated in peer-reviewed journals and at scientific conferences. A lay summary will be disseminated to all participants. TRIAL REGISTRATION NUMBER ACTRN12621001544864.
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Affiliation(s)
- Eden G Robertson
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW, Randwick, New South Wales, Australia
| | - Lauren Kelada
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW, Randwick, New South Wales, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital Randwick, Randwick, New South Wales, Australia
| | - Stephanie Best
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Sydney, New South Wales, Australia
- Australian Genomics Health Alliance, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - I Goranitis
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Natalie Grainger
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW, Randwick, New South Wales, Australia
| | - Fleur Le Marne
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW, Randwick, New South Wales, Australia
- Department of Neurology, Sydney Children's Hospitals Network Randwick, Randwick, New South Wales, Australia
| | - Kristine Pierce
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW, Randwick, New South Wales, Australia
- Epilepsy Foundation, Melbourne, Victoria, Australia
| | - Suzanne M Nevin
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW, Randwick, New South Wales, Australia
| | - Rebecca Macintosh
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW, Randwick, New South Wales, Australia
- Centre for Clinical Genetics, Sydney Children's Hospitals Network Randwick, Randwick, New South Wales, Australia
| | - Erin Beavis
- Department of Neurology, Sydney Children's Hospitals Network Randwick, Randwick, New South Wales, Australia
| | - Rani Sachdev
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW, Randwick, New South Wales, Australia
- Centre for Clinical Genetics, Sydney Children's Hospitals Network Randwick, Randwick, New South Wales, Australia
| | - Annie Bye
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW, Randwick, New South Wales, Australia
- Department of Neurology, Sydney Children's Hospitals Network Randwick, Randwick, New South Wales, Australia
| | - Elizabeth E Palmer
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW, Randwick, New South Wales, Australia
- Centre for Clinical Genetics, Sydney Children's Hospitals Network Randwick, Randwick, New South Wales, Australia
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3
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Bye AM, Le Marne FA, Beavis E, Macintosh R, Nevin SM, Palmer EE, Sachdev R, Nunn K. Hope in the uncertainties and certainty for parents of children with rare neurological disorders: Part 3 (of 3): Hope. J Paediatr Child Health 2022; 58:1726-1728. [PMID: 36062939 DOI: 10.1111/jpc.16187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 07/31/2022] [Revised: 08/07/2022] [Accepted: 08/13/2022] [Indexed: 12/14/2022]
Abstract
This is the third article of a three-part series and addresses how clinicians provide hopefulness meaningfully to families coping with life-limiting and quality of life impairing neurological conditions. The first two articles addressed the enormous challenges faced by carers and also explored the struggles of clinicians trying to provide relief and comfort. Can these families, and those helping clinically, legitimately hope? It is expectation that consolidates desire into a substantial hope that may motivate finding a way forward. Hope must be realistic and directed to something in particular and in someone in particular. Hope and despair are not monolithic but often travel together for both children, families and clinicians. Hope is not denial but a belief that there are positive possibilities. Finding what can be helpfully hoped for and what must be realistically despaired of, is the discerning struggle. Clinicians aim to change what we can and accept what we cannot. Acceptance and grief are arrived at slowly for carers and families. Similarly, clinicians struggle with the hopes of bringing meaningful solace and are supported by trusted colleagues who have shared the same experience. Clinicians strive to respond appropriately and effectively in a dynamic process based on trust, providing presence and compassion when cure is not possible. Clinicians help find the small doable things that foster hope and lessen isolation and abandonment, mindful of the limits of their medical expertise. Surprisingly these modest hopes and faltering acceptances often provide a different form of strength and comfort to sustain a family.
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Affiliation(s)
- Ann Me Bye
- Discipline of Paediatrics and Child Health, School of Clinical Medicine Randwick Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.,Department of Neurology, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Fleur A Le Marne
- Discipline of Paediatrics and Child Health, School of Clinical Medicine Randwick Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.,Department of Neurology, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Erin Beavis
- Discipline of Paediatrics and Child Health, School of Clinical Medicine Randwick Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.,Department of Neurology, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Rebecca Macintosh
- Discipline of Paediatrics and Child Health, School of Clinical Medicine Randwick Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.,Centre for Clinical Genetics, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Suzanne M Nevin
- Discipline of Paediatrics and Child Health, School of Clinical Medicine Randwick Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.,Centre for Clinical Genetics, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Elizabeth E Palmer
- Discipline of Paediatrics and Child Health, School of Clinical Medicine Randwick Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.,Centre for Clinical Genetics, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Rani Sachdev
- Discipline of Paediatrics and Child Health, School of Clinical Medicine Randwick Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.,Centre for Clinical Genetics, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Kenneth Nunn
- Department of Psychological Medicine, Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Psychological Medicine, University of Sydney, Sydney, New South Wales, Australia
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Nevin SM, Beavis E, Macintosh R, Palmer EE, Sachdev R, Le Marne FA, Bye AM, Nunn K. Hope in the uncertainties and certainty for parents of children with rare neurological disorders: Part 2 (of 3): Certainty. J Paediatr Child Health 2022; 58:1722-1725. [PMID: 36069627 DOI: 10.1111/jpc.16202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 07/31/2022] [Revised: 08/07/2022] [Accepted: 08/13/2022] [Indexed: 12/14/2022]
Abstract
This is the second of a three-part series that explores different aspects of uncertainty, certainty and hope in the context of providing clinical care for children with rare and life-limiting neurological disorders. When caring for families impacted by an overwhelming complex disorder in a child, complicated by threatening uncertainties and potentially more threatening certainties, clinicians utilise skills drawn from differing fields to make the load of information, and the emotional impact more manageable. The first article in this series addressed how clinicians might manage the 'accumulation of uncertainties' and to provide compassionate care not only to their patients, and their families, but also to themselves. This second paper delves into the less helpful aspects of 'certainty', including the associated losses and griefs endured by parents responding to threatening fears associated with their child's condition. In the extreme, disconnection and psychological isolation borne by parents can lead to a sense of hopelessness and desperation. Facing unwelcome certainties - clinicians and parents together - forms the basis of future trust and hope. Clinicians who share the field of trust with families and show commitment to helping parents, even when cure remains elusive, build a sense of hope. This is the sort of hopefulness that clinicians need to have and to offer as they share the journey with families. In this series, we seek to harness a shared approach to face unwelcome certainties and to kindle a sense of hope that is both credible and meaningful to the parents, family and clinician.
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Affiliation(s)
- Suzanne M Nevin
- Discipline of Paediatrics and Child Health, School of Clinical Medicine Randwick Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.,Centre for Clinical Genetics, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Erin Beavis
- Discipline of Paediatrics and Child Health, School of Clinical Medicine Randwick Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.,Department of Neurology, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Rebecca Macintosh
- Discipline of Paediatrics and Child Health, School of Clinical Medicine Randwick Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.,Centre for Clinical Genetics, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Elizabeth E Palmer
- Discipline of Paediatrics and Child Health, School of Clinical Medicine Randwick Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.,Centre for Clinical Genetics, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Rani Sachdev
- Discipline of Paediatrics and Child Health, School of Clinical Medicine Randwick Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.,Centre for Clinical Genetics, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Fleur A Le Marne
- Discipline of Paediatrics and Child Health, School of Clinical Medicine Randwick Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.,Department of Neurology, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Ann Me Bye
- Discipline of Paediatrics and Child Health, School of Clinical Medicine Randwick Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.,Department of Neurology, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Kenneth Nunn
- Department of Psychological Medicine, Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Psychological Medicine, University of Sydney, Sydney, New South Wales, Australia
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5
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Palmer EE, Sachdev R, Beavis E, Macintosh R, Le Marne FA, Nevin SM, Bye AM, Nunn K. Hope in the uncertainties and certainty for parents of children with rare neurological disorders. Part I (of 3): Uncertainty. J Paediatr Child Health 2022; 58:1718-1721. [PMID: 36069374 DOI: 10.1111/jpc.16165] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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] [Received: 07/31/2022] [Accepted: 08/01/2022] [Indexed: 12/14/2022]
Abstract
This is the first of three articles exploring the aspects of clinical care for children with rare neurological disorders including uncertainties old and new. The disruptive technologies of genomic sequencing and advanced therapeutics such as gene-based therapies offer parents of children with severe but rare neurological conditions for the first-time unprecedented opportunities for 'precision medicine'. At the same time, the realities of limited genomic diagnostic yields and not infrequent detection of variants of uncertain significance, lack of natural history study data and management guidelines for individually rare neurogenetic conditions, means that high pre-genomic test expectations are all too often replaced by an accumulation of new uncertainties. This can add to the chronic traumatic stress experienced by many families but may also have under-recognised impacts for their clinicians, contributing to 'burn-out' and attendant negative psychosocial impacts. This first article aims to address how clinicians might manage the accumulation of uncertainties to be more helpful to patients and their families. Moreover, it seeks to address how clinicians can move forward providing compassionate care to their patients and a little more consideration for themselves.
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Affiliation(s)
- Elizabeth E Palmer
- Discipline of Paediatrics and Child Health, School of Clinical Medicine Randwick Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.,Centre for Clinical Genetics, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Rani Sachdev
- Discipline of Paediatrics and Child Health, School of Clinical Medicine Randwick Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.,Centre for Clinical Genetics, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Erin Beavis
- Discipline of Paediatrics and Child Health, School of Clinical Medicine Randwick Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.,Department of Neurology, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Rebecca Macintosh
- Discipline of Paediatrics and Child Health, School of Clinical Medicine Randwick Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.,Centre for Clinical Genetics, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Fleur A Le Marne
- Discipline of Paediatrics and Child Health, School of Clinical Medicine Randwick Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.,Department of Neurology, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Suzanne M Nevin
- Discipline of Paediatrics and Child Health, School of Clinical Medicine Randwick Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.,Centre for Clinical Genetics, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Ann Me Bye
- Discipline of Paediatrics and Child Health, School of Clinical Medicine Randwick Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.,Department of Neurology, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Kenneth Nunn
- Department of Psychological Medicine, Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Psychological Medicine, University of Sydney, Sydney, New South Wales, Australia
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6
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Nevin SM, Wakefield CE, Dadich A, LeMarne F, Macintosh R, Beavis E, Sachdev R, Bye A, Nunn K, Palmer EE. Hearing parents' voices: A priority-setting workshop to inform a suite of psychological resources for parents of children with rare genetic epilepsies. PEC Innov 2021; 1:100014. [PMCID: PMC10194388 DOI: 10.1016/j.pecinn.2021.100014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 12/07/2021] [Accepted: 12/14/2021] [Indexed: 06/14/2023]
Abstract
Objective To understand parents' of children with developmental and epileptic encephalopathies needs and preferences for psychological resources. Methods Using a person-based approach, a multidisciplinary panel of clinician and researchers (n = 9) hosted a priority-setting workshop to 1) understand parents' needs and preferences for psychological resources and 2) to develop ‘guiding principles’ to inform a future suite of psychological resources. The multidisciplinary panel analysed the parent priority-setting workshop data, using a combination of thematic and lexical analysis. Results Thematic analysis identified six key domains wherein parents (n = 8) prioritised a need for psychological resources to support adaptation to their child's genetic DEE diagnosis. Lexical analysis revealed that connection to diagnosis-specific resources provided a pathway to promote enhanced psychological adaptation, by reducing social isolation and reorienting parents towards feelings of hope. Combination of both analyses generated six thematic informed ‘guiding principles’. Conclusion Codesigned psychological resources may help parents to cope with the unique and complex interplay of stressors associated with their child's DEE diagnosis and treatment. Our ‘guiding principles’ will be translated to inform a future suite of tailored psychological resources. Innovation This study demonstrates an innovative codesign approach to inform tailored psychological resources for families of children with rare genetic conditions. There is a deficit of research exploring the psychological impacts of parenting children with genetic DEEs. Tailored and codesigned psychological resources are essential due to the complexity and uniqueness of genetic DEEs. We collaborated with parents to codesign the content and scope of a future suite of person-based psychological resources. Thematic and lexical analyses combined identified that person-based resources reduced parent isolation and promoted hope. Insights generated from this study will be applied to inform psychological resources tailored for rare disease families.
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Affiliation(s)
- Suzanne M. Nevin
- School of Women's and Children's Health, UNSW Medicine and Health, UNSW Sydney, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Claire E. Wakefield
- School of Women's and Children's Health, UNSW Medicine and Health, UNSW Sydney, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Ann Dadich
- School of Business, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia
| | - Fleur LeMarne
- School of Women's and Children's Health, UNSW Medicine and Health, UNSW Sydney, Australia
- Department of Neurology, Sydney Children's Hospital, Randwick, Australia
| | - Rebecca Macintosh
- Centre for Clinical Genetics, Sydney Children's Hospital, Randwick, Australia
| | - Erin Beavis
- Department of Neurology, Sydney Children's Hospital, Randwick, Australia
| | - Rani Sachdev
- School of Women's and Children's Health, UNSW Medicine and Health, UNSW Sydney, Australia
- Centre for Clinical Genetics, Sydney Children's Hospital, Randwick, Australia
| | - Ann Bye
- School of Women's and Children's Health, UNSW Medicine and Health, UNSW Sydney, Australia
- Department of Neurology, Sydney Children's Hospital, Randwick, Australia
| | - Kenneth Nunn
- Department of Psychological Medicine, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Elizabeth E. Palmer
- School of Women's and Children's Health, UNSW Medicine and Health, UNSW Sydney, Australia
- Centre for Clinical Genetics, Sydney Children's Hospital, Randwick, Australia
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7
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Nevin SM, Wakefield CE, Barlow‐Stewart K, McGill BC, Bye A, Palmer EE, Dale RC, Gill D, Kothur K, Boggs K, Le Marne F, Beavis E, Macintosh R, Sachdev R. Psychosocial impact of genetic testing on parents of children with developmental and epileptic encephalopathy. Dev Med Child Neurol 2021. [DOI: 10.1111/dmcn.14971] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Suzanne M Nevin
- School of Women’s and Children’s Health UNSW Medicine UNSW Sydney Sydney NSWAustralia
- Behavioural Sciences Unit Kids Cancer Centre Sydney Children’s Hospital Randwick NSWAustralia
| | - Claire E Wakefield
- School of Women’s and Children’s Health UNSW Medicine UNSW Sydney Sydney NSWAustralia
- Behavioural Sciences Unit Kids Cancer Centre Sydney Children’s Hospital Randwick NSWAustralia
| | - Kristine Barlow‐Stewart
- School of Women’s and Children’s Health UNSW Medicine UNSW Sydney Sydney NSWAustralia
- Northern Clinical School Faculty of Medicine and Health University of Sydney Sydney NSW Australia
| | - Brittany C McGill
- School of Women’s and Children’s Health UNSW Medicine UNSW Sydney Sydney NSWAustralia
- Behavioural Sciences Unit Kids Cancer Centre Sydney Children’s Hospital Randwick NSWAustralia
| | - Ann Bye
- School of Women’s and Children’s Health UNSW Medicine UNSW Sydney Sydney NSWAustralia
- Department of Neurology Sydney Children’s HospitalRandwick NSW Australia
| | - Elizabeth E Palmer
- School of Women’s and Children’s Health UNSW Medicine UNSW Sydney Sydney NSWAustralia
- Centre for Clinical Genetics Sydney Children’s HospitalRandwick NSW Australia
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8
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Le Marne FA, Towns SJ, Gaskin C, Ho J, Baker R, Beavis E, Bye AM. Implementing a new adolescent epilepsy service: Improving patient experience and readiness for transition. J Paediatr Child Health 2019; 55:819-825. [PMID: 30474164 DOI: 10.1111/jpc.14301] [Citation(s) in RCA: 9] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 09/21/2018] [Accepted: 10/14/2018] [Indexed: 11/30/2022]
Abstract
AIM To implement and appraise a new model of care in terms of: patient experience, knowledge of epilepsy, readiness for transition and emotional and behavioural support in a new purpose-built facility for adolescents and young adults. METHODS The new model of care included: upskilling of neurology staff in adolescent engagement and provision of group education sessions on epilepsy and mental health (MH), along with MH support, in a new purpose-built adolescent facility. Parameters examined pre- and post-attendance at the new clinic included: adolescent experience of service delivery, transition readiness, emotional and behavioural well-being, epilepsy knowledge and medication adherence. RESULTS A total of 45 adolescents (mean age 15.7 years) attended the new epilepsy clinic between February 2017 and December 2017. Adolescents felt significantly better informed following education in relation to epilepsy and driving, alcohol/street drugs and birth control/pregnancy. There was no significant improvement in self-reported medication adherence, transition readiness or mental well-being at follow-up. While MH education was ranked highly in terms of importance by adolescents and parents at baseline, attendance at MH education and engagement with MH support was low. CONCLUSIONS This paper documents what is important to young people with epilepsy regarding service delivery. The new adolescent service was well received. Based on feedback from adolescents and parents relating to the service, and the suboptimal uptake of MH supports, the model of care has been revised to reduce attendance burden on families and improve patient experience.
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Affiliation(s)
- Fleur A Le Marne
- Department of Neurology, Sydney Children's Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Susan J Towns
- Department of Adolescent Medicine, Sydney Children's Hospital Network, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Claire Gaskin
- Consultation-Liaison Psychiatry, Department of Psychological Medicine, Sydney Children's Hospital Network, Sydney, New South Wales, Australia.,Faculty of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Jane Ho
- Department of Adolescent Medicine, Sydney Children's Hospital Network, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Richard Baker
- Consultation-Liaison Psychiatry, Department of Psychological Medicine, Sydney Children's Hospital Network, Sydney, New South Wales, Australia
| | - Erin Beavis
- Department of Neurology, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Anne M Bye
- Department of Neurology, Sydney Children's Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
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Le Marne FA, Butler S, Beavis E, Gill D, Bye AME. EpApp: Development and evaluation of a smartphone/tablet app for adolescents with epilepsy. J Clin Neurosci 2018; 50:214-220. [PMID: 29422360 DOI: 10.1016/j.jocn.2018.01.065] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [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] [Received: 10/25/2017] [Revised: 12/22/2017] [Accepted: 01/11/2018] [Indexed: 11/16/2022]
Abstract
The study aimed to comprehensively evaluate a mobile application (EpApp), designed with stakeholder input, to educate and facilitate management of adolescents with epilepsy. A prospective cohort of adolescents with epilepsy (13-19 years) and their parent/carer participated between June 2015 and December 2016. Primary outcome measure was knowledge acquisition. Secondary outcomes were psychosocial variables (attitude towards illness and seizure self-efficacy) and clinical parameters (medication adherence, seizure burden). Functionality, design, content and app utility were appraised via survey and open-ended questions. 51 adolescents completed baseline surveys (mean age 14.49 years), 36 follow-up surveys. Both self and general epilepsy knowledge increased following intervention (p ≤ 0.005). Significantly fewer medication reminders were required during intervention (M = 2.93, p = .002) and follow-up (M = 3.54, p = .030) compared to baseline (M = 6.64). Measures of app design, content, functionality and utility were very favourable. There was no significant improvement in seizure burden, or psychosocial parameters. Educational page-visits reflected interests and concerns. This study demonstrates that EpApp increases knowledge and is engaging. The app is available free, internationally via Android/Apple platforms.
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Affiliation(s)
- Fleur A Le Marne
- Department of Neurology, Level 4 Emergency Wing, Sydney Children's Hospitals Network, High Street, Randwick, NSW 2031, Australia; School of Women's and Children's Health, University of New South Wales, High Street, Randwick, NSW 2031, Australia.
| | - Sharlene Butler
- Department of Neurology, Level 4 Emergency Wing, Sydney Children's Hospitals Network, High Street, Randwick, NSW 2031, Australia
| | - Erin Beavis
- Department of Neurology, Level 4 Emergency Wing, Sydney Children's Hospitals Network, High Street, Randwick, NSW 2031, Australia
| | - Deepak Gill
- TY Nelson Department of Neurology and Neurosurgery, Children's Hospital at Westmead, Westmead, NSW 2145, Australia
| | - Ann M E Bye
- Department of Neurology, Level 4 Emergency Wing, Sydney Children's Hospitals Network, High Street, Randwick, NSW 2031, Australia; School of Women's and Children's Health, University of New South Wales, High Street, Randwick, NSW 2031, Australia
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10
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Connolly AM, Beavis E, Mugica-Cox B, Bye AME, Lawson JA. Exploring carer perceptions of training in out-of-hospital use of buccal midazolam for emergency management of seizures (2008-2012). J Paediatr Child Health 2015; 51:704-7. [PMID: 25594133 DOI: 10.1111/jpc.12811] [Citation(s) in RCA: 7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/14/2014] [Indexed: 11/28/2022]
Abstract
AIM This study aims to explore carer perceptions of training in out-of-hospital use of buccal midazolam for emergency management of seizures. METHODS A random sample of 100 families (from n = 198) who underwent training at the Sydney Children's Hospitals Network, Randwick campus (2008-2012) were invited to participate in a telephone questionnaire. RESULTS Sixty-three carers participated. Thirty-three children were female, median age at training was 4 years and seizure onset 2.75 years. Seizures were generalised in 26 children and focal in 37. Common reasons for prescription included history of prolonged seizures (38%), recent diagnosis of epilepsy (33%) and overseas travel (11%). Ninety-eight per cent of carers reported that training instructions were clear, and 94% reported the risks of using benzodiazepines were satisfactorily explained. Ninety per cent felt confident to administer the drug following training and 62% completed first aid training as recommended. Suggestions for improvement included follow-up/review and additional demonstration/practice. Twenty-one carers (33%) reported giving buccal midazolam a median five times, 67% reported it was effective in terminating the seizure and 71% called an ambulance as instructed. Problems reported in administration included excessive secretions and difficulties drawing up the solution. One child experienced breathing difficulties requiring oxygen by the paramedics. Four children were admitted to children's intensive care unit with status epilepticus requiring intubation. CONCLUSIONS Training for out-of-hospital use of buccal midazolam was considered valuable by carers. Only a third of the sample subsequently used midazolam. Half of these carers reported problems in administration and one reported respiratory difficulty. These results highlight the importance of drug safety and efficacious training programmes.
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Affiliation(s)
- Anne M Connolly
- Department of Neurology, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Erin Beavis
- Department of Neurology, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Beatrice Mugica-Cox
- Department of Neurology, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Ann M E Bye
- Department of Neurology, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - John A Lawson
- Department of Neurology, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
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Wibisono C, Rowe N, Beavis E, Kepreotes H, Mackie FE, Lawson JA, Cardamone M. Ten-year single-center experience of the ketogenic diet: factors influencing efficacy, tolerability, and compliance. J Pediatr 2015; 166:1030-6.e1. [PMID: 25649120 DOI: 10.1016/j.jpeds.2014.12.018] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [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] [Received: 07/23/2014] [Revised: 11/17/2014] [Accepted: 12/09/2014] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To evaluate the efficacy, tolerability, and compliance of 3 ketogenic diets, the classical ketogenic diet, medium-chain triglyceride (MCT), and modified Atkins diet. STUDY DESIGN A single-center, retrospective study of 48 children with intractable epilepsy receiving ketogenic diets from 2003 to 2012. Patient demographics, epilepsy history, nutritional management, and side effects were collated. Compliance and tolerability were assessed by recording reasons for diet modification and cessation. The value of potassium citrate supplementation for preventing nephrolithiasis was reviewed. RESULTS Median age at ketogenic diet initiation was 3.8 years (IQR: 2.3-7 years). The majority had intractable epilepsy, and 33 of the 48 children (69%) had epileptic encephalopathies. Three (6%) patients became seizure free, 35 (73%) reported <50%-90% reduction, and 10 (21%) had 0%-50% reduction during a 2-year period. Diet duration or ketogenic diet type did not predict reduction in seizures (P = .381; P = .272). Constipation (n = 31, 65%) was very common. Food refusal (n = 3, 6%) and poor parental compliance (n = 5, 10%) were common reasons cited for cessation. There were lower rates of side effects for modified Atkins diet. Diet cessation was greatest for MCT; however, 3 patients on MCT ceased therapy because adequate seizure control was achieved. Nephrolithiasis was reported in 1 patient before potassium citrate was used and 2 patients noncompliant with potassium citrate supplementation developed hypercalciuria. CONCLUSION The 3 ketogenic diets were comparably effective in seizure control and generally well-tolerated. Potassium citrate supplementation is an effective prophylactic supplement for the prevention of nephrolithiasis.
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Affiliation(s)
- Cinthya Wibisono
- School of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Natalie Rowe
- Department of Dietetics and Nutrition, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Erin Beavis
- Department of Neurology, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Helen Kepreotes
- Department of Dietetics and Nutrition, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Fiona E Mackie
- Department of Nephrology, Sydney Children's Hospital, Randwick, New South Wales, Australia; School of Women's and Children's Health, Medicine University of New South Wales, University of New South Wales, Sydney, New South Wales, Australia
| | - John A Lawson
- Department of Neurology, Sydney Children's Hospital, Randwick, New South Wales, Australia; School of Women's and Children's Health, Medicine University of New South Wales, University of New South Wales, Sydney, New South Wales, Australia
| | - Michael Cardamone
- Department of Neurology, Sydney Children's Hospital, Randwick, New South Wales, Australia; School of Women's and Children's Health, Medicine University of New South Wales, University of New South Wales, Sydney, New South Wales, Australia.
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12
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Frizzell CK, Connolly AM, Beavis E, Lawson JA, Bye AME. Personalised epilepsy education intervention for adolescents and impact on knowledge acquisition and psychosocial function. J Paediatr Child Health 2011; 47:271-5. [PMID: 21244556 DOI: 10.1111/j.1440-1754.2010.01952.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [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: 11/30/2022]
Abstract
AIM Patients frequently have poor knowledge of epilepsy, and this is associated with low self-esteem in adolescence. There is a paucity of data determining whether education alone can improve psychosocial outcome. The study investigated whether an educational intervention in adolescence: 1 Increased understanding of epilepsy syndrome and general epilepsy knowledge. 2 Improved self-esteem, seizure self-efficacy and attitudes towards epilepsy. METHODS In session 1, adolescents were educated about their epilepsy syndrome in a one-on-one session, producing a personalised epilepsy medical record. In session 2, the impact of epilepsy on life-style was discussed. Pre- and post-intervention measures of knowledge, self-esteem, seizure self-efficacy and attitudes towards epilepsy were completed using validated scales. Focus groups explored the intervention's value. RESULTS Thirty adolescents with epilepsy participated (female: 24, male: 6; median age: 16 years; partial symptomatic epilepsy: 15, generalised idiopathic epilepsy: 15). Self-knowledge of syndrome (P < 0.0001), general knowledge of epilepsy (P < 0.0001), attitudes towards epilepsy (P= 0.008) and seizure self-efficacy (P= 0.049) improved. Focus group data indicated that sessions were enjoyable and valuable, and the medical record was helpful. CONCLUSIONS The intervention significantly improved self-knowledge and general knowledge of epilepsy, attitudes towards epilepsy and seizure self-efficacy. This is the first study to demonstrate a positive impact on psychosocial outcomes following an educational intervention without a psychological component. The model has widespread application.
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Affiliation(s)
- Claire K Frizzell
- Department of Paediatric Neurology, Sydney Children's Hospital, Randwick, New South Wales, Australia
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