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McWilliams D, Thornton M, Hotton M, Swan MC, Marie Stock N. "It's On Your Shoulders Now" Transitioning from Child-to-Adult UK Cleft Lip/Palate Services: An Exploration of Young Adults' Narratives. Cleft Palate Craniofac J 2024:10556656241236006. [PMID: 38438120 DOI: 10.1177/10556656241236006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024] Open
Abstract
OBJECTIVES Treatment for cleft lip and/or palate (CL/P) in the United Kingdom is administered on a standardised pathway from diagnosis to early adulthood, with options to be re-referred in later life. At age 16, patients become responsible for their treatment decisions. Evidence from the wider health literature indicates this transition can be challenging and that this population may require additional support. The present study explored young people's experiences of transition to adult care in the context of CL/P services, with the aim of identifying support needs and informing future service delivery. DESIGN Individual semi-structured interviews were conducted with 15 individuals with CL/P (aged 17-25 years) to explore transition experiences. Interviews lasted an average of 69 min and data were analysed using reflexive thematic analysis. RESULTS Four themes, with subthemes, were identified: 1) Readiness for Transition covered feelings of preparedness and how health professionals approached transition; 2) Making Decisions as an Adult described concerns and considerations when making treatment decisions; 3) Finding and Using Support, reflected the roles of caregivers and peers in developing self-advocacy; and 4) Reflections on Transition Care offered insight into how care could be improved. CONCLUSION Individuals born with CL/P may experience challenges in becoming responsible for their own care and treatment decisions. The findings of this study indicate that a dedicated transition protocol may be beneficial, such that adolescents are prepared to confidently access and manage their care into adulthood. Opportunities for improvements in transition planning and provision are discussed.
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Affiliation(s)
- Danielle McWilliams
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Maia Thornton
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Matthew Hotton
- Spires Cleft Centre, Level 2 Children's Hospital, John Radcliffe Hospital, Oxford, UK
| | - Marc C Swan
- Spires Cleft Centre, Level 2 Children's Hospital, John Radcliffe Hospital, Oxford, UK
| | - Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, UK
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Costa B, Edwards W, Wilkinson-Bell K, Stock NM. Raising a Child with Craniosynostosis: Psychosocial Adjustment in Caregivers. Cleft Palate Craniofac J 2023; 60:1284-1297. [PMID: 35786018 DOI: 10.1177/10556656221102043] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE While knowledge of the psychosocial impact of craniofacial conditions is growing, literature regarding the impact on parents remains limited. Parents of children born with a health condition may be at risk of experiencing a range of psychosocial challenges. This study conducted an initial investigation of psychosocial adjustment of parents of individuals with craniosynostosis to inform support provision for families. SETTING An online UK-wide mixed-methods survey was distributed to members of Headlines Craniofacial Support. DESIGN Quantitative data including standardized measures were analysed using descriptive statistics and independent samples t-tests, and inductive content analysis was used for open-ended questions. PARTICIPANTS Mothers (n = 109) and fathers (n = 9) of individuals ages 3 months to 49 years with single suture (63%) or syndromic (33%) craniosynostosis participated. RESULTS Compared to the general population, parents of individuals with craniosynostosis reported higher levels of stress, anxiety, and depression; lower levels of resilience and optimism. Qualitative responses provided insight into parents' experiences of birth, diagnosis, healthcare provision, familial wellbeing, and relationships. Parents reported several unmet information and support needs, alongside a range of positive outcomes. CONCLUSIONS This study illustrates the potential long-term psychosocial implications for parents raising children with craniosynostosis. There is a need for routine psychological screening for family members and provision of appropriate psychological support for those at risk for distress. Non-specialist health professionals may benefit from additional training about craniofacial conditions so they are better equipped to support and refer families.
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Affiliation(s)
- Bruna Costa
- Centre for Appearance Research, University of the West of England, Coldharbour Lane, Bristol, BS16 1QY, UK
| | - Wendy Edwards
- Headlines Craniofacial Support, St Albans, Hertfordshire, UK
| | | | - Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Coldharbour Lane, Bristol, BS16 1QY, UK
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Johns AL, Stock NM, Costa B, Feragen KB, Crerand CE. Psychosocial and Health-Related Experiences of Individuals With Microtia and Craniofacial Microsomia and Their Families: Narrative Review Over 2 Decades. Cleft Palate Craniofac J 2023; 60:1090-1112. [PMID: 35382590 PMCID: PMC10803131 DOI: 10.1177/10556656221091699] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This paper describes 20 years of microtia and craniofacial microsomia (CFM) psychosocial and healthcare studies and suggests directions for clinical care and research. A narrative review of papers January 2000 to July 2021 related to psychosocial and healthcare experiences of individuals with microtia and CFM and their families. Studies (N = 64) were mainly cross-sectional (69%), included a range of standardized measures (64%), and were with European (31%), American (27%), or multinational (23%) samples. Data were generally collected from both patients and caregivers (38%) or patient self-report (35%). Sample sizes were 11 to 25 (21%), 26 to 50 (19%), 51 to 100 (22%), or over 100 (38%). Studies addressed 5 primary topics: (1) Healthcare Experiences, including Medical Care, Hearing Loss/Amplification, Diagnostic Experiences, and Information Preferences; (2) Psychosocial Experiences, including Teasing, Behavioral Adjustment, Psychosocial Support, and Public Perception; (3) Neurocognitive Functioning and Academic Assistance; (4) Pre- and Post-Operative Psychosocial Outcomes of Ear Reconstruction/Canaloplasty; and (5) Quality of Life and Patient Satisfaction. Care involved multiple specialties and was often experienced as stressful starting at diagnosis. Psychosocial and neurocognitive functioning were generally in the average range, with possible risk for social and language concerns. Coping and resiliency were described into adulthood. Satisfaction and positive benefit of ear reconstruction/canaloplasty were high. Care recommendations include increasing: hearing amplification use, microtia and CFM knowledge among providers, efficient treatment coordination, psychosocial support, academic assistance, and advances to minimize surgical scarring. This broad literature overview informs clinical practice and research to improve psychosocial outcomes.
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Affiliation(s)
- Alexis L Johns
- Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Nicola Marie Stock
- Center for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Bruna Costa
- Center for Appearance Research, University of the West of England, Bristol, United Kingdom
| | | | - Canice E Crerand
- Departments of Pediatrics and Plastic Surgery, The Ohio State University College of Medicine, Columbus, OH, USA and Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
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Stock NM, Costa B, Wilkinson-Bell K, Culshaw L, Kearney A, Edwards W. Psychological and Physical Health Outcomes in Adults With Craniosynostosis. Cleft Palate Craniofac J 2023; 60:257-267. [PMID: 34866454 PMCID: PMC9900192 DOI: 10.1177/10556656211059966] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES Within current research, little is known about the long-term outcomes of craniosynostosis. A priority-setting exercise by UK charity Headlines Craniofacial Support identified 2 key questions in this area: (1) What are the long-term physical and psychological effects for individuals with syndromic and non-syndromic craniosynostosis? and (2) Are individuals with craniosynostosis likely to suffer from mental health difficulties, or are they more resilient? The aim of the current study was to conduct an initial investigation of these priority questions. METHODS A comprehensive UK-wide survey consisting of 9 standardized psychological outcome measures and open-ended questions was distributed online. Thirty-six eligible adults (69.4% female) with a mean age of 30.8 years responded to the survey. Participants reported having single suture craniosynostosis (27.8%) or syndromic craniosynostosis (52.8%), with 19.4% being unsure of their diagnosis. Sample means were compared to published norms using independent samples t tests. Qualitative responses were analysed using inductive content analysis. RESULTS Compared to the general population, participants reported significantly less favorable scores related to appearance concerns, attachment in adult relationships, anxiety, optimism, and resilience. Self-worth, depression, and social anxiety scores were similar to norms. Qualitative responses provided additional insight into participants' satisfaction with appearance, physical health, medical treatment, employment, relationships, and recurrence risks. Few participants had accessed psychological support. DISCUSSION This preliminary study illustrates the potential long-term implications for individuals with craniosynostosis. Improved treatment protocols are needed to address physical health concerns in adulthood, while dedicated psychological resources are necessary to promote emotional well-being, social confidence, and resilience.
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Affiliation(s)
- Nicola Marie Stock
- Centre for Appearance Research, University of the West of England,
Coldharbour Lane, Bristol, United Kingdom
- Nicola Marie Stock, Centre for Appearance
Research, University of the West of England, Bristol BS16 1QY, United Kingdom.
| | - Bruna Costa
- Centre for Appearance Research, University of the West of England,
Coldharbour Lane, Bristol, United Kingdom
| | | | - Laura Culshaw
- Alder Hey Craniofacial Unit, Alder Hey Children's NHS Foundation
Trust, Liverpool, United Kingdom
| | - Anna Kearney
- Alder Hey Craniofacial Unit, Alder Hey Children's NHS Foundation
Trust, Liverpool, United Kingdom
| | - Wendy Edwards
- Headlines Craniofacial Support, St Albans, Hertfordshire, United
Kingdom
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Fladeboe KM, Stock NM, Heike CL, Evans KN, Junkins C, Stueckle L, O'Daffer A, Rosenberg AR, Yi-Frazier JP. Feasibility and Acceptability of the Promoting Resilience in Stress Management-Parent (PRISM-P) Intervention for Caregivers of Children with Craniofacial Conditions. Cleft Palate Craniofac J 2023:10556656231157449. [PMID: 36802967 DOI: 10.1177/10556656231157449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
OBJECTIVES Few evidence-based psychosocial programs exist within craniofacial care. This study (a) assessed feasibility and acceptability of the Promoting Resilience in Stress Management-Parent (PRISM-P) intervention among caregivers of children with craniofacial conditions and (b) described barriers and facilitators of caregiver resilience to inform program adaptation. DESIGN In this single-arm cohort study, participants completed a baseline demographic questionnaire, the PRISM-P program, and an exit interview. PARTICIPANTS Eligible individuals were English-speaking legal guardians of a child <12-years-old with a craniofacial condition. INTERVENTION PRISM-P included 4 modules (stress-management, goal-setting, cognitive-restructuring, meaning-making) delivered in 2 one-on-one phone or videoconference sessions 1-2 weeks apart. MAIN OUTCOME MEASURES Feasibility was defined as >70% program completion among enrolled participants; acceptability was defined as >70% willingness to recommend PRISM-P. Intervention feedback and caregiver-perceived barriers and facilitators of resilience were summarized qualitatively. RESULTS Twenty caregivers were approached and 12 (60%) enrolled. The majority were mothers (67%) of a child <1-year-old diagnosed with a cleft lip and/or palate (83%) or craniofacial microsomia (17%). Of these, 8 (67%) completed PRISM-P and 7 (58%) completed interviews; 4 (33%) were lost-to-follow-up before PRISM-P and 1 (8%) before the interview. Feedback was highly positive, with 100% willing to recommend PRISM-P. Perceived barriers to resilience included uncertainty about their child's health; facilitators included social support, parental identity, knowledge, and control. CONCLUSIONS PRISM-P was acceptable among caregivers of children with craniofacial conditions but not feasible based on program completion rates. Barriers and facilitators of resilience support the appropriateness of PRISM-P for this population and inform adaptation.
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Affiliation(s)
- Kaitlyn M Fladeboe
- Department of Pediatrics. 7284University of Washington School of Medicine, Seattle, WA, USA
- 145793Seattle Children's Research Institute, Center for Clinical & Translational Research, Seattle, WA, USA
| | - Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Carrie L Heike
- Department of Pediatrics. 7284University of Washington School of Medicine, Seattle, WA, USA
- 145793Seattle Children's Research Institute, Center for Clinical & Translational Research, Seattle, WA, USA
| | - Kelly N Evans
- Department of Pediatrics. 7284University of Washington School of Medicine, Seattle, WA, USA
- 145793Seattle Children's Research Institute, Center for Clinical & Translational Research, Seattle, WA, USA
| | - Courtney Junkins
- 145793Seattle Children's Research Institute, Center for Clinical & Translational Research, Seattle, WA, USA
| | - Laura Stueckle
- 145793Seattle Children's Research Institute, Center for Clinical & Translational Research, Seattle, WA, USA
| | - Alison O'Daffer
- 145793Seattle Children's Research Institute, Center for Clinical & Translational Research, Seattle, WA, USA
| | - Abby R Rosenberg
- Department of Psychosocial Oncology and Palliative Care, 1855Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Palliative Care, 1862Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, 1811Harvard Medical School, Boston, MA, USA
| | - Joyce P Yi-Frazier
- 145793Seattle Children's Research Institute, Center for Clinical & Translational Research, Seattle, WA, USA
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Costa B, McWilliams D, Blighe S, Hudson N, Hotton M, Swan MC, Stock NM. Isolation, Uncertainty and Treatment Delays: Parents' Experiences of Having a Baby with Cleft Lip/Palate During the Covid-19 Pandemic. Cleft Palate Craniofac J 2023; 60:82-92. [PMID: 34841909 PMCID: PMC9218610 DOI: 10.1177/10556656211055006] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES Previous literature finds that having a child with a cleft lip and/or palate (CL/P) may pose social and emotional challenges for parents. For parents of children born during the Covid-19 pandemic, such challenges may be heightened. Further, novel demands brought about by the pandemic could have caused additional hardships. The aim of this study was to describe the impact of the pandemic on new parents through qualitative exploration of their experiences. DESIGN Semi-structured interviews were conducted with 14 parents of children born in the United Kingdom with CL/P between January and June 2020, around the start of the pandemic. Data were analysed using inductive thematic analysis. RESULTS Three themes, with sub-themes, were identified. The first theme, "Changes to Healthcare: The Impact of Restrictions and Reduced Contact", discussed the impact of the pandemic on perinatal care, the care received from the specialist CL/P teams, and parents' experiences of virtual consultations. The second theme, "Family Functioning During the Pandemic", covered parental anxiety, fathers' experiences, and social support. The third theme, "Surgical Prioritisation: Delays and Uncertainty", addressed changes to surgical protocols, coping with uncertainty, complications associated with delayed surgery, and how parents created positive meaning from this period. CONCLUSIONS A range of increased and additional psychosocial impacts for parents were identified, along with several coping strategies, utilization of social support, and the positive aspects of their experiences. As the pandemic continues, close monitoring of families affected by CL/P remains imperative, particularly for those at risk of emotional distress.
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Affiliation(s)
- Bruna Costa
- Centre for Appearance Research, University of the West of
England, Bristol, UK,Nicola Marie Stock, Associate Professor in
Psychology, Centre for Appearance Research, University of the West of England,
Bristol, United Kingdom.
| | - Danielle McWilliams
- Centre for Appearance Research, University of the West of
England, Bristol, UK
| | - Sabrina Blighe
- Spires Cleft Centre, Level 2 Children's
Hospital, John Radcliffe Hospital, Oxford, UK
| | - Nichola Hudson
- Spires Cleft Centre, Salisbury District
Hospital, Salisbury, UK
| | - Matthew Hotton
- Spires Cleft Centre, Level 2 Children's
Hospital, John Radcliffe Hospital, Oxford, UK
| | - Marc C Swan
- Spires Cleft Centre, Children's
Hospital, John Radcliffe Hospital, Oxford, UK
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McWilliams D, Costa B, Blighe S, Swan MC, Hotton M, Hudson N, Stock NM. The Impact of the Covid-19 Pandemic on Cleft Lip and Palate Service Delivery for New Families in the United Kingdom: Medical and Community Service Provider Perspectives. Cleft Palate Craniofac J 2022; 60:551-561. [PMID: 35195455 PMCID: PMC9218609 DOI: 10.1177/10556656221074870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Professionals in the United Kingdom providing care to new families affected by cleft lip and/or palate (CL/P) had to adapt to ensure families' needs were met during a time of uncertainty due to Covid-19. The aims of this study were to explore the impacts of the pandemic on CL/P care provision for new families from the perspectives of professionals working in medical and community settings along with any personal impact on professionals and their reflections on the future of CL/P care. DESIGN Semistructured interviews (n = 27) were completed about experiences from March 2020 to October 2020 with consultant cleft surgeons (n = 15), lead clinical nurse specialists (n = 8), and staff working at the Cleft Lip and Palate Association (n = 4). Transcripts were analyzed using inductive thematic analysis. RESULTS Three themes were identified: (1) the impact of Covid-19 on the provision of cleft care in the United Kingdom, including working conditions, delays to treatment, and Covid-19 policies; (2) the impact of the pandemic on professionals' mental health, including personal distress and concerns about Covid-19 exposure; and (3) reflections on the future of CL/P care, whereby professionals expressed both hope and concern about the Covid-19 recovery effort. CONCLUSIONS The ongoing Covid-19 pandemic has impacted CL/P service delivery for new families significantly, warranting recommendations for cohesive psychological support for families in addition to a safe and resourced recovery effort. Support for professionals is also suggested, following existing evidence-based models for providers' needs that address the difficulties of working throughout challenging times.
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Affiliation(s)
- Danielle McWilliams
- Centre for Appearance Research, 1981University of the West of England, Bristol, United Kingdom
| | - Bruna Costa
- Centre for Appearance Research, 1981University of the West of England, Bristol, United Kingdom
| | - Sabrina Blighe
- Spires Cleft Centre, 11269John Radcliffe Hospital, Headley Way, Headington, Oxford, United Kingdom
| | - Marc C Swan
- Spires Cleft Centre, 11269John Radcliffe Hospital, Headley Way, Headington, Oxford, United Kingdom
| | - Matthew Hotton
- Spires Cleft Centre, 11269John Radcliffe Hospital, Headley Way, Headington, Oxford, United Kingdom
| | - Nichola Hudson
- Spires Cleft Centre, 11269John Radcliffe Hospital, Headley Way, Headington, Oxford, United Kingdom
| | - Nicola Marie Stock
- Centre for Appearance Research, 1981University of the West of England, Bristol, United Kingdom
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Feragen KJB, Myhre A, Stock NM. "Will You Still Feel Beautiful When You Find Out You Are Different?": Parents' Experiences, Reflections, and Appearance-Focused Conversations About Their Child's Visible Difference. Qual Health Res 2022; 32:3-15. [PMID: 34596475 PMCID: PMC8739583 DOI: 10.1177/10497323211039205] [Citation(s) in RCA: 2] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
To investigate parents' reflections and experiences of having a child born with an appearance-altering condition, interviews with 33 parents of children born with rare craniofacial conditions were analyzed using inductive thematic analysis. Three themes emerged: "Managing emotions: A dynamic process," "Through another lens: External reminders of difference," and "Awareness of difference: Approaching the child." Findings suggest that although parents learned to accept and love their child's visible difference, external factors such as appearance-altering surgery and other people's reactions activated difficult emotions in parents. Parents struggled to decipher whether and when to raise appearance-related issues with their child, and how this could be done without distressing the child. Anticipatory guidance that facilitates positive appearance-focused conversations both within and outside the home seems to be needed. Parenting skills could also be strengthened by preparing parents for social reactions to the child's visible difference, and their child's changed appearance following surgery.
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Tollow P, Marie Stock N, Harcourt D. Exploring parents' attitudes towards a multicentre cohort study of children with burns injuries: A qualitative interview study. Scars Burn Heal 2022; 8:20595131221098526. [PMID: 35800295 PMCID: PMC9253984 DOI: 10.1177/20595131221098526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Burn injuries affect more than 60,000 children every year in the UK, with
many experiencing scarring as a result. Scarring can be highly variable, and
research is required to explore the factors that may influence variability,
as well as the psychosocial impact of these injuries on children and their
caregivers. A multicentre burns cohort study is being planned to investigate
genetic determinants of scarring and long-term psychosocial outcomes. Public
involvement (PI) is an essential element of the design and feasibility
stages of this planning. As part of this work, this study aimed to gain an
in-depth understanding of parents’ attitudes towards participation in burns
research, specifically a longitudinal cohort study of children with small
burns (<10% total body surface area [TBSA]). Methods In total, 16 parents of children with burns took part in semi-structured
interviews regarding their experiences of taking part in research and their
attitudes towards the potential future cohort study. Interviews were
audio-recorded, transcribed verbatim and analysed using Reflexive Thematic
Analysis. Results Four themes were identified: ‘Acknowledging trauma’; ‘Aligning research with
experience’; ‘Research as a reciprocal relationship’; and ‘Contributing to
change’. Discussion These four themes represent factors that parents suggested were important for
acceptability, relevance, recruitment and retention of participants into a
longitudinal multicentre cohort study of children with a burn injury and
their caregivers. Conclusion The findings of this study will be incorporated into the design of such a
study, as well as having wide reaching relevance for research in the field
of paediatric burn injuries. Lay Summary Background to this subject More than 60,000 children experience a burn injury every year in the UK and
many of these injuries lead to scarring. We know that the extent of this
scarring can vary, and we know that some children and their
parents/caregivers manage well but others struggle with the challenges they
face after having a burn. Researchers would like to carry out research on
these topics, including asking participants to take part in research over
several years to find out how genetics might influence scarring, as well as
their psychological experiences over this time. Before they conduct this
study, it is very important that researchers understand parents' attitudes
towards this kind of research. The current study aimed to find out parents'
opinions and ask what issues were important to them when taking part in
burns research. Details of how the work was conducted Parents of children who had experienced a scald (a type of burn injury) were
asked to take part in a research interview. In total, 16 parents took part
in this study. We recorded these interviews and analysed them, looking for
patterns and shared experiences in participants' interviews. What we did and did not learn from this study We found four themes in the interview data: ‘Acknowledging trauma', ‘Aligning
research with experience', ‘Research as a reciprocal relationship', and
‘Contributing to change'. Overall, these themes suggest that parents were
mostly supportive of a ‘burns cohort study’, but they have also highlighted
some important considerations for this research and other future burns
research studies.
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Affiliation(s)
- Philippa Tollow
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Diana Harcourt
- Centre for Appearance Research, University of the West of England, Bristol, UK
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Costa B, Ardouin K, Stock NM. Factors Associated With Psychological Adjustment in Adults With Cleft Lip and/or Palate: Findings From a National Survey in the United Kingdom. Cleft Palate Craniofac J 2021; 59:S7-S17. [PMID: 34235990 DOI: 10.1177/10556656211028494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Research has identified adults born with cleft lip and/or palate (CL/P) to be at risk of poorer psychological outcomes compared to the general population. This study investigated factors that may contribute to positive and negative adjustment in adults born with CL/P. DESIGN A survey was designed and distributed by the Cleft Lip and Palate Association in collaboration with the Centre for Appearance Research CAR at the University of the West of England (UWE). There were 207 eligible responses (95% completed online) received between July and October 2018. Dependent variables included the Body Esteem Scale for Adolescents and Adults, Harter's Self Perception Profile for Adults (Global Self-Worth, Social Competence, and Intimacy subscales), the Fear of Negative Appearance Evaluation Scale, and the Revised Adult Attachment Scale. Independent variables were the Revised Life Orientation Test, biodemographic data, and self-reported single-item questions. RESULTS Factors associated with positive adjustment included reports of a happy childhood, talking about CL/P with family, close friendships, comfort in public spaces, satisfaction with appearance, and a positive life orientation. Psychological distress was associated with a desire for further surgery to improve appearance and/or function. CONCLUSIONS Several factors were identified that may influence psychological adjustment in adults with CL/P. Throughout childhood, family-centered practice to support family cohesion and an open dialogue about CL/P is indicated, as is support for young people to develop social confidence. For adults returning to the cleft service, treatment options for appearance and/or functional concerns should be explored, with access to psychological support when indicated. Interventions to increase optimism, resilience, and self-acceptance may also be warranted throughout the life span.
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Affiliation(s)
- Bruna Costa
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Kenny Ardouin
- Cleft Lip and Palate Association, London, United Kingdom
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Ardouin K, Davis N, Stock NM. Expanding Support Services for Adults Born With Cleft Lip and/or Palate in the United Kingdom: An Exploratory Evaluation of the Cleft Lip and Palate Association Adult Services Programme. Cleft Palate Craniofac J 2021; 59:S48-S56. [PMID: 34184577 DOI: 10.1177/10556656211025415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The largest group of people living with repaired cleft lip and/or palate (CL/P) are adults. Previous research has identified unmet treatment and psychosocial needs, yet few interventions exist. This article outlines 3 interventions developed by the Cleft Lip and Palate Association as part of its 3-year community-based Adult Services Programme; an Adults Conference, a series of panel discussions ("Cleft Talk") streamed in podcast/video format, and a Leaver's Pack of resources for adults wishing to return to cleft care. METHODS Feedback from attendees of the Adults Conferences (2018-2019) was collected using specifically developed evaluation forms. Streaming metrics and social media interactions were extracted for Cleft Talk panel discussions (2019-2020). The Leaver's Pack was piloted in 2020, using an online evaluation form. Specialist health professionals were invited to provide feedback or participate in a one-to-one interview regarding their perceived impact of the program. RESULTS All 3 interventions across the different modalities received support from participating adults, demonstrating potential to meet adults' needs across the life span. Health professionals also offered support for the program, viewing the interventions as a valuable adjunct to formal medical CL/P services. CONCLUSIONS This exploratory evaluation indicates that peer- and community-led interventions, in combination with ongoing access to specialist medical care, can have a range of positive impacts for adults with CL/P. There is scope for similar initiatives to be developed internationally and for individuals with other craniofacial conditions. Not-for-profit organizations are encouraged to routinely evaluate their interventions to create a stronger evidence base for their valuable work.
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Affiliation(s)
- Kenny Ardouin
- Cleft Lip and Palate Association, The Green House, London, United Kingdom
| | - Nicky Davis
- Cleft Lip and Palate Association, The Green House, London, United Kingdom
| | - Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
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Stock NM, Sharratt ND, Treneman-Evans G, Montgomery K, Denman R, Harcourt D, At The Centre For Appearance Research TVTCTFRT. 'My face in someone else's hands': a qualitative study of medical tattooing in women with hair loss. PSYCHOL HEALTH MED 2021; 27:1431-1442. [PMID: 33559487 DOI: 10.1080/13548506.2021.1883688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Indexed: 10/22/2022]
Abstract
The psychological and social impact of hair loss and its ongoing treatment can be considerable. Medical treatments are not always successful, and alternative treatments, such as medical tattooing, are growing in popularity. The aims of this study were to explore adults' motivations, experiences, and self-perceived outcomes in relation to medical tattooing. Individual telephone interviews were conducted with 22 women from the United Kingdom aged 26-67 years who had undergone medical tattooing in the past 5 years related to hair loss. Interviews were transcribed and inductive thematic analysis was performed. Appearance concerns, loss of self-confidence/identity, and the practicalities of daily upkeep were cited as reasons for seeking a semi-permanent solution. Trust in the practitioner and the ongoing costs of tattoo maintenance were important considerations in participants' decision-making process and their overall satisfaction with treatment outcomes. Participants felt the emotional impact of hair loss and the subsequent need for appearance-restoring treatment remains unrecognised. This study provides insight into participants' perceptions of an under-researched and unregulated but widely accessible treatment. Implications for the decision-making process are discussed, and suggestions for health professionals are offered.
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Affiliation(s)
- Nicola Marie Stock
- Department of Health and Social Sciences, The Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Nicholas David Sharratt
- Department of Health and Social Sciences, The Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Georgia Treneman-Evans
- Department of Health and Social Sciences, The Centre for Appearance Research, University of the West of England, Bristol, UK
| | | | - Rae Denman
- Rae Denman Medical Tattooing, London, UK
| | - Diana Harcourt
- Department of Health and Social Sciences, The Centre for Appearance Research, University of the West of England, Bristol, UK
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Ardouin K, Hotton M, Stock NM. Interpersonal Relationship Experiences in Adults Born With Cleft Lip and/or Palate: A Whole of Life Survey in the United Kingdom. Cleft Palate Craniofac J 2021; 58:1412-1421. [PMID: 33535806 DOI: 10.1177/1055665620987109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Previous research has suggested that adults with a cleft lip and/or palate (CL/P) may find their familial, friend, collegial, and/or romantic relationships impacted by their condition. Building on this prior work, this study examined the self-reported interpersonal experiences of a national sample of adults born with CL/P. DESIGN An online survey was designed by the Cleft Lip and Palate Association in collaboration with the Centre for Appearance Research. Data from 181 participants were included in the present study, collected between July and October 2018. Qualitative data were analyzed using inductive content analysis, while quantitative data were analyzed using descriptive statistics and independent t tests. RESULTS Most participants reported having good relationships with family members and existing friends with similar patterns of marriage as the general population. However, some experienced difficulties initiating new friendships and romantic relationships. Participants described bullying and discrimination in adulthood, most often in public settings and the workplace. Participants reported lower satisfaction with intimate relationships and less secure attachment compared to the general population. Concerns regarding the heritability of CL/P and its impact on the decision to have a family were also reported. CONCLUSIONS Individuals with CL/P are at risk of negative social experiences, which if not appropriately addressed may impact psychological well-being in adulthood. The findings illustrate the importance of routine psychosocial support from childhood onward to help individuals with CL/P build social skills, self-esteem, and social confidence and to develop mutually fulfilling friendships and intimate relationships. Additionally, societal campaigns to raise awareness and target discrimination may be helpful.
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Affiliation(s)
- Kenny Ardouin
- Cleft Lip and Palate Association, The Green House, London, United Kingdom
| | - Matt Hotton
- The Spires Cleft Centre, 11269John Radcliffe Hospital, Oxford, United Kingdom
| | - Nicola Marie Stock
- Centre for Appearance Research, 1981University of the West of England, Bristol, United Kingdom
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Ardouin K, Drake D, Popat S, Stock NM. Treatment Experiences in Adults Born With Cleft Lip and/or Palate: A Whole of Life Survey in the United Kingdom. Cleft Palate Craniofac J 2020; 58:864-871. [PMID: 33138633 DOI: 10.1177/1055665620968342] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: Adults with cleft lip and/or palate (CL/P) may report dissatisfaction with aesthetic and/or functional outcomes and express desire for further treatment. Although medical intervention can improve quality of life, surgical procedures require complex decision-making and can invoke psychological distress. The aim of this study was to gain a better understanding of ongoing treatment-related support needs by examining self-reported treatment experiences of a sample of adults born with CL/P. Design: An online, mixed-methods survey was designed by the Cleft Lip and Palate Association in collaboration with the Centre for Appearance Research at the University of the West of England. A total of 207 eligible responses were received. Qualitative data were analyzed using inductive content analysis, while quantitative data were analyzed using descriptive statistics. Results: Although participants were satisfied with surgical and dental/orthodontic outcomes overall, many reported ongoing difficulties. Some stated they would seek further treatment while others felt conflicted about risks and benefits. Some had refused treatment, citing treatment fatigue, anxiety, and/or concerns that treatment would be unsuccessful. More than 40% of participants were unaware of their entitlement to cleft-related treatment provided by the National Health Service, and many others had experienced difficulties accessing care. Conclusions: Although advances in health care may offer opportunities for adults to improve their quality of life, treatment decisions should be weighed with the support of a clinical psychologist where available. Guidance for young adults considering future treatment is also recommended. Finally, training and resources for local practitioners may improve general awareness of CL/P services and increase access to specialist care for adults with ongoing CL/P-related concerns.
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Affiliation(s)
- Kenny Ardouin
- Cleft Lip and Palate Association, London, United Kingdom
| | - David Drake
- National Cleft Surgical Service for Scotland, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Sandip Popat
- Restorative Dentistry, Spires Cleft Centre, John Radcliffe Hospital, Headley Way, Oxford, United Kingdom
| | - Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Coldharbour Lane, Bristol, United Kingdom
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15
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Stock NM. Achieving Consensus in the Measurement of Psychological Adjustment: A Reply and Reflection. Cleft Palate Craniofac J 2020; 57:1342-1343. [PMID: 32840136 DOI: 10.1177/1055665620949429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Nicola Marie Stock
- Centre for Appearance Research, 1981University of the West of England, Bristol, United Kingdom
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16
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Ardouin K, Davis S, Stock NM. Physical Health in Adults Born With Cleft Lip and/or Palate: A Whole of Life Survey in the United Kingdom. Cleft Palate Craniofac J 2020; 58:153-162. [PMID: 32734770 DOI: 10.1177/1055665620944758] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Objectives: Previous research in the field of cleft lip and/or palate (CL/P) has indicated a high prevalence of common health concerns, functional difficulties, and additional conditions known to affect long-term physical health, cognitive development, and psychological well-being. The aim of the present study was to examine the self-reported physical health of a national sample of adults born with CL/P. Design: Drawing upon previous literature, an online, mixed-methods survey was designed by the Cleft Lip and Palate Association in collaboration with the Centre for Appearance Research at the University of the West of England. A total of 207 eligible responses were received between July and October 2018. Qualitative data were analyzed using inductive content analysis, while quantitative data were analyzed using descriptive statistics. Results: A considerable proportion of participants reported one or more comorbid conditions, including common health concerns, difficulties related to language and/or learning, unresolved speech and/or hearing issues, problems with vision, breathing difficulties, and concerns related to eating and drinking. Many participants were unaware of their entitlement to specialist treatment, and some had experienced difficulties accessing specialist services through their general practitioner (GP). Conclusions: Individuals with CL/P may be at risk of physical health issues persisting into adulthood. The monitoring of physical symptoms from an early age is recommended, as is a routine physical assessment for adults returning to the CL/P service later in life. Education for both GPs and adults is warranted. Future studies could investigate the wider prevalence of comorbid conditions in CL/P, in order to better understand the longer-term health burden.
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Affiliation(s)
- Kenny Ardouin
- Cleft Lip and Palate Association, London, United Kingdom
| | - Sinéad Davis
- Welsh Centre for Cleft Lip and Palate, Morriston Hospital, Swansea, United Kingdom
| | - Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
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Stock NM, Hammond V, Hearst D, Owen T, Edwards Z, Ridley M, Rumsey N. Achieving Consensus in the Measurement of Psychological Adjustment to Cleft Lip and/or Palate at Age 8+ Years. Cleft Palate Craniofac J 2020; 57:746-752. [PMID: 31973561 DOI: 10.1177/1055665619898596] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 12/15/2022] Open
Abstract
BACKGROUND Consensus regarding optimal outcome measurement has been identified as one of the most important, yet most challenging developments for the future of cleft lip and/or palate (CL/P) services. In 2011, a process began to adopt a shared conceptual framework and to identify a set of core outcome measures for the comprehensive assessment of psychological adjustment. OBJECTIVES The aim of the current article is to outline the collaborative process used to achieve consensus in the academic and clinical measurement of psychological adjustment to CL/P from the age of 8 years onward. RESULTS A conceptual framework and corresponding parent- and self-reported outcome measures for use at ages 8, 10, 12, 15, 18, 20, and 25 years have been agreed upon by clinicians, researchers, and patient and parent representatives. All measures have been evaluated according to their psychometric properties, clinical utility, ability to produce meaningful longitudinal data, and a range of pragmatic considerations. CONCLUSIONS Although the collaborative process has been challenging and has required ongoing dedication from multiple stakeholders, consistency in data collection over time will allow for key research questions in CL/P to be addressed, both in the United Kingdom (UK) and internationally. The process has also demonstrated the clinical utility of the measures and the potential for the gradual integration of the measures into clinical practice. UK progress has sparked global interest, and the adaptation of the framework and its corresponding measures for worldwide use is now a prominent focus.
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Affiliation(s)
- Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Vanessa Hammond
- South Wales Cleft Service, Morriston Hospital, Swansea, United Kingdom
| | - Daniela Hearst
- Cleft Lip and Palate Service, Great Ormond Street Hospital, London, United Kingdom
| | - Tina Owen
- South West Cleft Service, University of Bristol Dental Hospital, Bristol, United Kingdom
| | - Zoe Edwards
- Cleft Lip and Palate Service, Alder Hey Children's Hospital, Liverpool, United Kingdom
| | - Matthew Ridley
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Nichola Rumsey
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
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Ardouin K, Hare J, Stock NM. Emotional Well-Being in Adults Born With Cleft Lip and/or Palate: A Whole of Life Survey in the United Kingdom. Cleft Palate Craniofac J 2020; 57:877-885. [PMID: 31906694 DOI: 10.1177/1055665619896681] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Objectives: Previous research with adults born with cleft lip and/or palate (CL/P) has identified a range of concerns regarding mental health and quality of life, concluding that overall emotional functioning is poorer compared to the general population. The aim of the current study was to build on this previous work by investigating the self-reported emotional well-being of adults born with CL/P in the United Kingdom. Design: An online, mixed methods survey was designed by the Cleft Lip and Palate Association in collaboration with the Centre for Appearance Research at the University of the West of England. A total of 207 eligible responses were received between July and October 2018. Qualitative data were analyzed using inductive content analysis, while quantitative data were analyzed using descriptive statistics and independent t tests. Results: Almost half of the sample reported a diagnosis of a mental health condition. Scores on standardized measures indicated significantly lower global self-worth, higher levels of fear of negative appearance evaluation, and lower self-perceived job competence compared to normative data. Scores of overall body esteem were in line with the general population. Most participants had not received psychological support from their regional CL/P team and 41% were unaware of their entitlement to treatment from the National Health Service. Conclusions: Individuals with CL/P may be at risk of emotional distress persisting into adulthood. The integration of routine psychological support from an early age is highly recommended, as is information for young adults about to complete routine treatment. Comprehensive psychological screening for adults returning to the service later in life is also strongly advised.
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Affiliation(s)
- Kenny Ardouin
- Cleft Lip and Palate Association, London, United Kingdom
| | - Jess Hare
- National Cleft Surgical Service for Scotland, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
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19
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Costa B, White P, Stock NM. Satisfaction With Health Care in Families Following a Diagnosis of Cleft Lip and/or Palate in the United Kingdom. Cleft Palate Craniofac J 2019; 57:599-605. [PMID: 31813267 DOI: 10.1177/1055665619888318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 11/16/2022] Open
Abstract
OBJECTIVE Having a child born with a cleft lip and/or palate (CL/P) poses several challenges for new parents and can have a significant psychological impact on the family as a whole. Previous research has indicated that dissatisfaction with health care is a risk factor for poor parental adjustment and family functioning. Yet, knowledge is lacking in regard to which aspects of care parents may be dissatisfied with. The current study aimed to comprehensively evaluate health-care satisfaction in families following a diagnosis of CL/P by utilizing data collected from a UK-wide birth cohort. METHODS Self-reported questionnaire data were obtained from 517 parent dyads enrolled in The Cleft Collective Birth Cohort Study. The "Pediatric Quality of Life Inventory-Healthcare Satisfaction Generic Module" was used as the primary outcome measure. RESULTS Overall, parents were satisfied with the care they had received. However, less favorable scores were identified in relation to the information parents had been given. A good degree of agreement between mothers and fathers was observed. However, marginal evidence suggested that fathers were significantly more dissatisfied than mothers regarding the "Communication" and "Inclusion of Family" subscales. CONCLUSIONS Although the findings of this large-scale study reflect overall health-care satisfaction, issues are raised in relation to the quality of information families received, particularly for fathers. In addition, fathers may feel less included in their child's treatment pathway. These findings offer practical suggestions as to which areas of care could be targeted by all health professionals to improve parents' health-care experiences and promote overall familial adjustment.
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Affiliation(s)
- Bruna Costa
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Paul White
- Applied Statistics Group, University of the West of England, Bristol, United Kingdom
| | - Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
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20
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Stock NM, Costa B. Provision of Care for Families Affected by Craniofacial Conditions: The Views of Nonspecialist Health Professionals. Cleft Palate Craniofac J 2019; 57:470-476. [PMID: 31665891 DOI: 10.1177/1055665619883151] [Citation(s) in RCA: 3] [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: 01/26/2023] Open
Abstract
OBJECTIVE A diagnosis of a congenital craniofacial condition can have a significant impact on the psychological well-being of the affected family. As the first health professionals likely to come into contact with families, nonspecialists, such as diagnostic sonographers, midwives, and health visitors play a crucial role in facilitating familial adjustment. Yet, previous research has demonstrated parental dissatisfaction with the care delivered by nonspecialists. The aim of this study was to investigate the provision of care for families affected by craniofacial conditions from the perspective of nonspecialist health professionals, with a view to informing the development of educational materials. DESIGN Individual semistructured telephone interviews (n = 14) were conducted with 3 diagnostic sonographers, 2 fetal medicine consultants, 3 midwives, 4 health visitors, and 2 children's nurses. RESULTS Participants identified a range of barriers to the delivery of optimal care, including dealing with parental reactions, time pressure, hospital protocols and resources, a lack of contact with specialist craniofacial teams, and the emotional impact of delivering a diagnosis. Most participants had received no prior training in the area of congenital craniofacial conditions, while those who had felt current training materials were insufficient. All participants expressed a desire for further training and provided guidance regarding preferred content and format. CONCLUSIONS This study provides insight into the challenges faced by nonspecialists, as well as a range of information and training needs that could improve their knowledge and confidence. Suggestions for the development of educational materials for nonspecialist health professionals are made.
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Affiliation(s)
- Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, England, United Kingdom
| | - Bruna Costa
- Centre for Appearance Research, University of the West of England, Bristol, England, United Kingdom
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- Centre for Appearance Research, University of the West of England, Bristol, England, United Kingdom
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Stock NM, Marik P, Magee L, Aspinall CL, Garcia L, Crerand C, Johns A. Facilitating Positive Psychosocial Outcomes in Craniofacial Team Care: Strategies for Medical Providers. Cleft Palate Craniofac J 2019; 57:333-343. [PMID: 31446785 DOI: 10.1177/1055665619868052] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: Psychosocial issues associated with craniofacial diagnoses and the ongoing burden of care can impact the quality of life of patients and families, as well as treatment adherence and outcomes. Utilizing available literature and clinical expertise across 6 centers, the present article summarizes key psychosocial issues for the benefit of nonmental health medical providers and offers suggestions as to how all members of craniofacial teams can promote positive psychosocial outcomes. Results: Family adjustment across developmental phases is outlined, with strategies to support adaptive parental coping. Teasing is a common concern in craniofacial populations and medical providers can promote coping and social skills, as well as link families to mental health services when needed. Academic issues are described, alongside suggestions for medical providers to assist families with school advocacy and ensure access to appropriate services within the school setting. Medical providers are key in preparing patients and families for surgery, including consideration of medical, social, and logistical supports and barriers. As craniofacial care spans infancy to adulthood, medical providers are instrumental in assisting patients and families to navigate treatment transition periods. In addition to ongoing clinical team assessments, medical providers may utilize screening measures to identify and track patient and family adjustment in multiple areas of team care. Conclusions: Multidisciplinary providers play an important role in supporting positive adjustment in patients affected by craniofacial conditions and their families.
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Affiliation(s)
- Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Patricia Marik
- Children’s Hospital of Wisconsin, Milwaukee, WI, USA
- Medical College of Wisconsin, Wauwatosa, WI, USA
| | - Leanne Magee
- The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Laura Garcia
- Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - Canice Crerand
- Departments of Pediatrics and Plastic Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
- Center for Biobehavioral Health, The Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
- Cleft Lip and Palate Center and Center for Complex Craniofacial Disorders, Section of Plastic and Reconstructive Surgery, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Alexis Johns
- Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles, Los Angeles, CA, USA
- Keck School of Medicine, University of South California, Los Angeles, CA, USA
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Feragen KB, Stock NM, Myhre A, Due-Tønnessen BJ. Medical Stress Reactions and Personal Growth in Parents of Children With a Rare Craniofacial Condition. Cleft Palate Craniofac J 2019; 57:228-237. [PMID: 31426676 DOI: 10.1177/1055665619869146] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 11/15/2022] Open
Abstract
BACKGROUND The birth of a child with a congenital craniofacial anomaly (CFA) can have a profound psychological impact on the family. Despite the complexity and variability in treatment for these rare conditions, few studies have been conducted into parents' emotional responses to health-care experiences. The aim of the present study was to investigate parents' subjective experiences of their child's condition and treatment using an in-depth qualitative approach. METHODS Individual semistructured interviews were conducted in person or over the telephone with 48 parents of children with a range of rare CFAs. Interviews were transcribed verbatim, translated into English, and analyzed using inductive thematic analysis. RESULTS Participants reported physical and psychological symptoms that could be indicative of medical traumatic stress in relation to their child's diagnosis and treatment. Participants described feelings of powerlessness and the weight of being responsible for their child's care. Yet, participants also reported that as a result of their experiences, their perspective on life had changed and they had grown in self-confidence. CONCLUSIONS The findings provide insight into the complex physical and psychological effects experienced by parents in response to their child's diagnosis and medical treatment, as well as an understanding of how these experiences may also result in personal growth over time. Implementation of trauma-informed evidence-based resources should be considered in craniofacial care and future research, particularly in regard to prevention and treatment of psychological distress.
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Affiliation(s)
| | - Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, England
| | - Anita Myhre
- Centre for Rare Disorders, Oslo University Hospital (Rikshospitalet), Oslo, Norway
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Stock NM, Zucchelli F, Hudson N, Kiff JD, Hammond V. Promoting Psychosocial Adjustment in Individuals Born With Cleft Lip and/or Palate and Their Families: Current Clinical Practice in the United Kingdom. Cleft Palate Craniofac J 2019; 57:186-197. [PMID: 31431061 DOI: 10.1177/1055665619868331] [Citation(s) in RCA: 10] [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] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Objectives: The importance of psychosocial aspects of care has received growing recognition in recent years. However, the evidence base for psychosocial intervention remains limited. Specialist clinicians working in cleft lip and/or palate (CL/P) services hold a wealth of knowledge and experience yet to be elicited. The aims of this study were to identify common psychosocial challenges and potential risk and/or protective factors for psychosocial distress from the perspective of specialist clinicians and to establish the types of interventions currently being delivered in practice. Design: Individual interviews with 17 clinical nurse specialists and 19 specialist clinical psychologists, representing all 16 UK CL/P surgical sites. Data were analyzed using inductive content analysis. Results: Numerous psychosocial challenges affecting individuals with CL/P and their families were identified across the life span. Risk factors were predominantly contextual in nature, while protective factors appeared amenable to intervention. Participants drew upon a range of therapeutic models and approaches to guide formulation and intervention, while acknowledging the lack of evidence to support these approaches in CL/P populations specifically. Conclusions: Findings have important implications for the way in which psychosocial support for CL/P and related conditions is delivered and evaluated. A framework for the standardized assessment of holistic individual and familial well-being is proposed. Suggestions for increasing the evidence base for specific psychosocial interventions are made, including enhanced family functioning; social, emotional, and appearance concerns; treatment decision-making; and screening for psychosocial and developmental issues.
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Affiliation(s)
- Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Coldharbour Lane, Bristol, United Kingdom
| | - Fabio Zucchelli
- Centre for Appearance Research, University of the West of England, Coldharbour Lane, Bristol, United Kingdom
| | | | - James D. Kiff
- Centre for Appearance Research, University of the West of England, Coldharbour Lane, Bristol, United Kingdom
| | - Vanessa Hammond
- Welsh Centre for Cleft Lip and Palate, Swansea, United Kingdom
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Stock NM, Costa B, White P, Rumsey N. Risk and Protective Factors for Psychological Distress in Families Following a Diagnosis of Cleft Lip and/or Palate. Cleft Palate Craniofac J 2019; 57:88-98. [PMID: 31378083 DOI: 10.1177/1055665619862457] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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: 11/17/2022] Open
Abstract
OBJECTIVES Despite the potential psychological impact of a diagnosis of cleft lip and/or palate (CL/P) on parents, few large-scale studies currently exist. Utilizing data extracted from The Cleft Collective Birth Cohort Study, the current study aimed to examine the psychological impact of the diagnosis on parent and family functioning and to identify risk and/or protective factors contributing to parental adjustment in order to inform future psychological intervention. METHODS Parent-reported questionnaire data were extracted for 1163 parents (644 mothers and 519 fathers). Outcome measures included the PedsQL-Family Impact Module, the Perceived Stress Scale, the Hospital Anxiety and Depression Scale, and a condition-specific tool designed by the Psychology Clinical Excellence Network. RESULTS Overall, findings suggest that parents adjust well to the diagnosis. Factors found to be protective against psychological distress for both mothers and fathers included a positive life orientation, satisfaction with health care, and relationship satisfaction. Close friendships were also protective against depression in mothers. Risk factors for mothers included the presence of a prior mental health condition, and stressful life events during pregnancy. Risk factors for fathers included being older at the time of conception, and recently being absent from work. CONCLUSIONS Findings suggest a need for appropriate psychological screening of both parents following a diagnosis of CL/P and emphasize the importance of coordinated multidisciplinary care for psychological health. Preventative models of intervention to strengthen familial relationships and build resilience require further investigation.
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Affiliation(s)
- Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Bruna Costa
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Paul White
- Applied Statistics Group, University of the West of England, Bristol, United Kingdom
| | - Nichola Rumsey
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
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Stock NM, Guest E, Stoneman K, Ridley M, Evans C, LeRoy C, Anwar H, McCarthy G, Cunniffe C, Rumsey N. The Contribution of a Charitable Organization to Regional Cleft Lip and Palate Services in England and Scotland. Cleft Palate Craniofac J 2019; 57:14-20. [PMID: 31307213 DOI: 10.1177/1055665619862727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND From diagnosis through to adulthood, a cleft lip and/or palate (CL/P) poses a number of challenges for those affected. Alongside the care provided by clinical teams, complementary information and support is offered by charitable organizations. In 2011, the Cleft Lip and Palate Association received funding to implement a new regional service across England and Scotland, with the aim of increasing support at a local level. The Centre for Appearance Research at the University of the West of England were commissioned to conduct an independent evaluation of the service over 7 years. METHODS A pragmatic, mixed-methods approach was utilized to assess the impact of the service from the perspective of charity volunteers; children, young people, and adults with CL/P; caregivers; and clinicians. Feedback forms were distributed to stakeholders at a variety of events, and qualitative feedback was collected via focus groups and an online survey. RESULTS The majority of participants indicated they had gained access to a local support network, felt more able to cope with CL/P-related challenges, and felt more confident in themselves. Qualitative investigation provided further support for these findings and highlighted additional benefits of the regional service for clinical teams. CONCLUSIONS The evaluation provides encouraging evidence toward the contribution of a relatively small charitable organization in the context of cleft care. The importance of a pragmatic approach to community-based evaluation and the benefits of collaborative working between researchers and the charitable sector were also highlighted.
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Affiliation(s)
- Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Ella Guest
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Kate Stoneman
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Matthew Ridley
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Claire Evans
- The Cleft Lip and Palate Association, London, United Kingdom
| | - Cherry LeRoy
- The Cleft Lip and Palate Association, London, United Kingdom
| | - Hamza Anwar
- The Cleft Lip and Palate Association, London, United Kingdom
| | | | - Claire Cunniffe
- The Cleft Lip and Palate Association, London, United Kingdom
| | - Nichola Rumsey
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
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Guest E, Costa B, McCarthy G, Cunniffe C, Stock NM. The Experiences and Support Needs of Grandparents of Children Born With Cleft Lip and/or Palate. Cleft Palate Craniofac J 2019; 56:1181-1186. [PMID: 31142132 DOI: 10.1177/1055665619850709] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The birth of a child with a cleft lip and/or palate (CL/P) can have a significant emotional and social impact on parents. Yet, the impact on the wider family is rarely investigated. Grandparents are becoming increasingly involved in the care of their grandchildren and may therefore have support needs of their own. The aim of the current study was to explore the experiences and support needs of grandparents of children born with CL/P. DESIGN Individual semistructured telephone interviews were carried out with 12 grandparents of children born with CL/P and were analyzed using inductive thematic analysis. RESULTS Five themes were identified (1) emotional impact of CL/P on grandparents, (2) grandparents' social experiences, (3) grandparents' involvement, (4) grandparents' information needs, and (5) grandparents' support needs. Participants experienced difficult emotions around the time of diagnosis and were concerned about the child's treatment and future experiences. Participants played a significant role in supporting the whole family, but received little information or support themselves. CONCLUSIONS Grandparents reported experiences comparable to published literature on parents. Clinicians and charitable organizations could consider how existing resources could be made more accessible to and/or adapted for wider family members, including grandparents.
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Affiliation(s)
- Ella Guest
- 1 Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Bruna Costa
- 1 Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | | | | | - Nicola Marie Stock
- 1 Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
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Billaud Feragen K, Myhre A, Stock NM. “Exposed and Vulnerable”: Parent Reports of Their Child’s Experience of Multidisciplinary Craniofacial Consultations. Cleft Palate Craniofac J 2019; 56:1230-1238. [PMID: 31142141 DOI: 10.1177/1055665619851650] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: Childhood is a period of extensive socioemotional development, which can be impacted by the presence of a congenital craniofacial anomaly (CFA). Complex multidisciplinary treatment and long-term follow-up are normally required, yet understanding of children’s treatment experiences is limited. The objective of this study was to investigate children’s experiences of multidisciplinary team (MDT) consultations from the perspective of their parents. Design: Thirty-eight parents of children with a rare CFA were interviewed in person or over the telephone. Interviews were transcribed verbatim, translated into English, and explored using thematic analysis. Results: Background factors influencing the child’s experience of the consultation included age, developmental stage, personality, and prior treatment experiences. Participants tried to prepare their child for meeting the MDT, but did not fully understand what to expect themselves. During consultations, participants were acutely focused on their child’s emotional state, making it difficult to balance their desire to protect the child from potentially negative experiences, and the need to engage in a constructive dialogue with health professionals. Participants believed that health professionals’ conduct could considerably influence the child’s well-being and subsequent treatment decisions. Finally, participants highlighted the need to debrief their child to help them adjust positively. Conclusions: The ultimate goal of craniofacial care is to help children develop into confident adults who are able to cope with the challenges associated with their condition. Multidisciplinary teams play a vital role in creating a safe and supportive environment in which children feel genuinely informed and involved in key aspects of their care.
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Affiliation(s)
| | - Anita Myhre
- Centre for Rare Disorders, Oslo University Hospital (Rikshospitalet), Oslo, Norway
| | - Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
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Stock NM, Costa B, Williams JR, Martindale A. Breaking the News: Parents’ Experiences of Receiving an Antenatal Diagnosis of Cleft Lip. Cleft Palate Craniofac J 2019; 56:1149-1156. [DOI: 10.1177/1055665619830884] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective:In high-income countries, many cases of cleft lip are now identified at the 18- to 21-week pregnancy scan. The manner in which a diagnosis is communicated is vital for long-term parental well-being, yet previous studies have been indicative of parental dissatisfaction. The aims of the present study were to examine the experiences of parents who received an antenatal diagnosis of cleft lip in their unborn child and to offer pragmatic suggestions for improving the diagnostic experience in practice.Design:An online, mixed-methods survey was designed and distributed by the Cleft Lip and Palate Association. Data from 574 eligible parents were analyzed using descriptive statistics and inductive content analysis.Results:Although survey responses indicated positive diagnostic experiences overall, respondents perceived a lack of sensitivity among sonographers, long waiting times between referrals, and a lack of appropriate and reliable information. Respondents also reported a number of misconceptions about cleft lip and/or palate and its prognosis, as well as a variety of initial concerns about their own ability to cope with the anticipated challenges.Conclusion:Findings emphasize the importance of providing accurate and individualized information to prospective parents, in a sensitive manner, so they can adjust to their child’s diagnosis and prepare for the birth appropriately. Given that antenatal screening for cleft lip is becoming more fully integrated into routine practice, more training for health-care professionals, improved access to reliable information in a variety of formats, and stronger links between local hospitals and specialist cleft services may be needed.
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Affiliation(s)
- Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Bruna Costa
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
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Kappen IFPM, Bittermann GKP, Stock NM, Mink van der Molen AB, Breugem CC, Swanenburg de Veye HFN. Quality of Life and Patient Satisfaction in Adults Treated for a Cleft Lip and Palate: A Qualitative Analysis. Cleft Palate Craniofac J 2019; 56:1171-1180. [DOI: 10.1177/1055665619843410] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Objective: Long-term outcomes of patients born with a cleft lip and palate (CLP) are scarcely investigated. Yet, this patient group is of particular interest, as they can provide a valuable retrospective view upon their treatment experiences and psychological adjustment. Qualitative accounts may be especially useful in understanding the patient journey. Design: The present study set out to evaluate quality of life and satisfaction with treatment in adult patients previously treated for CLP at the Wilhelmina Children’s Hospital. Semistructured interviews were performed. Patients: A total of 22 patients aged 17 to 35 years (mean: 25 years) were interviewed about their experiences of growing up with CLP and of the treatment they received. Interviews were audio-recorded and factors thought to influence psychological adjustment were identified. Results: Four main themes were identified: background factors, support systems, treatment factors, and coping/internal factors. Each theme was described with illustrative quotes. Conclusion: This study underlines that psychological adjustment can fluctuate over time and greatly differs between individuals, even during adulthood. Psychological support should therefore be available beyond the finalization of the treatment course. Furthermore, the majority of participants stated they had wanted more psychological support as a child to facilitate resilience and to help them cope with challenges.
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Affiliation(s)
- Isabelle F. P. M. Kappen
- Department of Plastic Surgery, Wilhelmina Children’s Hospital, University of Utrecht, Utrecht, the Netherlands
| | - Gerhard K. P. Bittermann
- Department of Maxillofacial Surgery, Wilhelmina Children’s Hospital, University of Utrecht, Utrecht, the Netherlands
| | - Nicola Marie Stock
- Centre for Academic Child Health, University of Bristol, Bristol, United Kingdom
| | | | - Corstiaan C. Breugem
- Department of Plastic Surgery, Wilhelmina Children’s Hospital, University of Utrecht, Utrecht, the Netherlands
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Stock NM, Costa B, Williams J, Martindale A, At The Centre For Appearance Research TVFRT. Parental views of antenatal testing and termination following a diagnosis of cleft lip. PSYCHOL HEALTH MED 2018; 24:456-469. [PMID: 30280914 DOI: 10.1080/13548506.2018.1529328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Indexed: 10/28/2022]
Abstract
Fetal anomaly screening at 18-21 weeks now routinely includes cleft lip. If detected, the manner in which the diagnosis is communicated can considerably influence prospective parents' decision-making in regard to further testing and termination of pregnancy (TOP). Given the known psychological impact of an antenatal diagnosis of cleft lip on prospective parents, this study aimed to explore the decision-making process from the parents' perspective, in order to evaluate how well current practice is meeting guidelines. Data from 217 parents of children born with cleft lip (with or without cleft palate) were collected using a mixed-methods online survey. Respondents reported feeling upset, offended and/or anxious following the diagnosis, due to unsatisfactory information and a perceived lack of empathy from health professionals. Some respondents had felt under pressure to make a decision quickly, with a minority having regretted undergoing amniocentesis, and/or experiencing significant distress at having come close to TOP unnecessarily. A number of suggestions are made as to how the discussion between parents and health professionals could be improved, to ensure that the information and support needs of families affected by cleft lip are fully addressed.
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Affiliation(s)
- Nicola Marie Stock
- a Centre for Appearance Research , University of the West of England , Bristol , UK
| | - Bruna Costa
- a Centre for Appearance Research , University of the West of England , Bristol , UK
| | - Jenny Williams
- b South Thames Cleft Service, St Thomas' Hospital , London , UK
| | - Anna Martindale
- c Communications and Information , Cleft Lip and Palate Association , London , UK
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Stock NM, Sharratt ND, Heath J, Nankivell D, Martindale A, Ridley M, Ahmed A, McMullin A, Cunniffe C. Falling through the gap: Dental treatment experiences of patients affected by cleft lip and/or palate. Br Dent J 2018; 225:218-222. [PMID: 30072784 DOI: 10.1038/sj.bdj.2018.542] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2018] [Indexed: 11/09/2022]
Abstract
Introduction In the UK, one in 600–700 infants is born with a cleft lip and/or palate (CL/P). Previous research has identified patients with CL/P to be at high risk of long-term oral health issues. Yet, few of these patients are currently accessing community dental care. Aims To assess patients' dental treatment experiences and their suggestions for improving services. Materials and methods Five focus groups were conducted with 24 adults with CL/P. Thematic analysis was performed on the data. Results Participants perceived local dental practitioners to lack knowledge about CL/P and its treatment. Consequently, some participants had stopped visiting a dental practice altogether. Participants were also largely unaware of the specialist CL/P services they are entitled to. Discussion Suggestions are made for the integration of improved training and resources for local dental practitioners. Closer communication between specialist cleft teams and local dental practitioners could also help to bridge the gap in knowledge and improve patients' engagement with dental services. The tertiary sector has a crucial role to play in empowering patients to take more control of their oral health and dental treatment.
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Affiliation(s)
- N M Stock
- University of the West of England, Centre for Appearance Research, Coldharbour Lane, Bristol, BS16 1QY, United Kingdom
| | - N D Sharratt
- University of the West of England, Centre for Appearance Research, Coldharbour Lane, Bristol, BS16 1QY, United Kingdom
| | - J Heath
- University of the West of England, Centre for Appearance Research, Coldharbour Lane, Bristol, BS16 1QY, United Kingdom
| | - D Nankivell
- Cleft Lip and Palate Association, London, EC1V 7LQ, United Kingdom
| | - A Martindale
- Cleft Lip and Palate Association, London, EC1V 7LQ, United Kingdom
| | - M Ridley
- University of the West of England, Centre for Appearance Research, Coldharbour Lane, Bristol, BS16 1QY, United Kingdom
| | - A Ahmed
- University of Liverpool School of Dentistry, Liverpool, L69 7ZX, United Kingdom
| | - A McMullin
- Cleft Lip & Palate Orthodontics, Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, United Kingdom
| | - C Cunniffe
- Cleft Lip and Palate Association, London, EC1V 7LQ, United Kingdom
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Sainsbury DCG, Davies A, Wren Y, Southby L, Chadha A, Slator R, Stock NM. The Cleft Multidisciplinary Collaborative: Establishing a Network to Support Cleft Lip and Palate Research in the United Kingdom. Cleft Palate Craniofac J 2018; 56:502-507. [DOI: 10.1177/1055665618790174] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- David C. G. Sainsbury
- Northern & Yorkshire Cleft Lip and Palate Service, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Amy Davies
- The Cleft Collective, University of Bristol, Bristol, United Kingdom
| | - Yvonne Wren
- The Cleft Collective, University of Bristol, Bristol, United Kingdom
- Bristol Speech and Language Therapy Research Unit, North Bristol NHS Trust, Bristol, United Kingdom
| | - Lucy Southby
- Cleft.NET.East, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Bristol Speech and Language Therapy Research Unit, North Bristol NHS Trust, Bristol, United Kingdom
- Centre for Academic Child Health, University of Bristol, Bristol, United Kingdom
| | - Ambika Chadha
- South Thames Cleft Service, Evelina Children’s Hospital, London, United Kingdom
| | - Rona Slator
- Birmingham Children’s Hospital, Birmingham, United Kingdom
| | - Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
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Harcourt D, Hamlet C, Feragen KB, Garcia-Lopez LJ, Masnari O, Mendes J, Nobile F, Okkerse J, Pittermann A, Spillekom-van Koulil S, Stock NM, Williamson H. The provision of specialist psychosocial support for people with visible differences: A European survey. Body Image 2018; 25:35-39. [PMID: 29454284 DOI: 10.1016/j.bodyim.2018.02.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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: 07/30/2017] [Revised: 02/05/2018] [Accepted: 02/05/2018] [Indexed: 10/18/2022]
Abstract
A substantial body of research has demonstrated the challenges commonly facing people with visible differences (disfigurements) and explored the potential benefits offered by specialist psychosocial support and intervention for those who are negatively affected. However, little is known about the availability of such support in Europe for people whose appearance is in any way different to 'the norm'. This survey of 116 psychosocial specialists from 15 European countries, working with a range of patient groups, has shown a tendency for specialists to prioritise Cognitive-behavioural-based approaches, amongst a wide range of other approaches and interventional techniques. It indicates variations in the availability of support, and a perceived need for improved access to interventions, additional training, and greater awareness of the psychosocial issues associated with visible differences.
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Affiliation(s)
- Diana Harcourt
- Centre for Appearance Research, University of the West of England, Bristol, BS16 1QY, UK.
| | - Claire Hamlet
- Centre for Appearance Research, University of the West of England, Bristol, BS16 1QY, UK
| | | | - Luis-Joaquin Garcia-Lopez
- Department of Psychology, Division of Clinical Psychology, University of Jaen, Building C5, 23071, Jaen, Spain
| | - Ornella Masnari
- Department of Psychosomatics and Psychiatry, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
| | - Jose Mendes
- INTELECTO - Psychology & Research, Rua do Monte, 52B, R/C Esquerdo Nascente, 9500-451, Ponta Delgada, Açores, Portugal
| | | | - Jolanda Okkerse
- Department of Child and Adolescent Psychiatry, Sophia Children's Hospital, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Anna Pittermann
- General Hospital of Vienna, Medical University, Department of Plastic and Reconstructive Surgery, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | | | - Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, BS16 1QY, UK; Cleft Collective, University of the West of England, Bristol, UK
| | - Heidi Williamson
- Centre for Appearance Research, University of the West of England, Bristol, BS16 1QY, UK
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Wren Y, Humphries K, Stock NM, Rumsey N, Lewis S, Davies A, Bennett R, Sandy J. Setting up a cohort study in speech and language therapy: lessons from The UK Cleft Collective Speech and Language (CC-SL) study. Int J Lang Commun Disord 2018; 53:421-430. [PMID: 29265580 DOI: 10.1111/1460-6984.12364] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 08/01/2017] [Accepted: 09/29/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Efforts to increase the evidence base in speech and language therapy are often limited by methodological factors that have restricted the strength of the evidence to the lower levels of the evidence hierarchy. Where higher graded studies, such as randomized controlled trials, have been carried out, it has sometimes been difficult to obtain sufficient power to detect a potential effect of intervention owing to small sample sizes or heterogeneity in the participants. With certain clinical groups such as cleft lip and palate, systematic reviews of intervention studies have shown that there is no robust evidence to support the efficacy of any one intervention protocol over another. AIMS To describe the setting up of an observational clinical cohort study and to present this as an alternative design for answering research questions relating to prevalence, risk factors and outcomes from intervention. METHODS The Cleft Collective Speech and Language (CC-SL) study is a national cohort study of children born with cleft palate. Working in partnership with regional clinical cleft centres, a sample size of over 600 children and 600 parents is being recruited and followed up from birth to age 5 years. Variables being collected include demographic, psychological, surgical, hearing, and speech and language data. MAIN CONTRIBUTION The process of setting up the study has led to the creation of a unique, large-scale data set which is available for researchers to access now and in future. As well as exploring predictive factors, the data can be used to explore the impact of interventions in relation to individual differences. Findings from these investigations can be used to provide information on sample criteria and definitions of intervention and dosage which can be used in future trials. CONCLUSIONS The observational cohort study is a useful alternative design to explore questions around prevalence, risk factors and intervention for clinical groups where robust research data are not yet available. Findings from such a study can be used to guide service-delivery decisions and to determine power for future clinical trials.
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Affiliation(s)
- Yvonne Wren
- Faculty of Health Sciences, University of Bristol /Bristol Speech and Language Therapy Research Unit, North Bristol NHS Trust
| | | | | | - Nichola Rumsey
- Centre for Appearance Research, University of the West of England
| | - Sarah Lewis
- Faculty of Health Sciences, University of Bristol
| | - Amy Davies
- Faculty of Health Sciences, University of Bristol
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Stock NM, Feragen KB. Assessing Psychological Adjustment to Congenital Craniofacial Anomalies: An Illustration of Methodological Challenges. Cleft Palate Craniofac J 2018; 56:64-73. [DOI: 10.1177/1055665618769661] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Recognition of the challenges inherent in psychology research related to cleft lip and/or palate (CL/P) and other craniofacial anomalies (CFAs) is far from novel; yet these challenges continue to limit progress within the field. The aim of the present article was to illustrate these challenges by utilizing data extracted from 2 recent literature reviews pertaining to psychological adjustment within CL/P and CFA research. Design: Data relating to 148 CL/P and 41 CFA studies were extracted, summarized, and compared, using percentages, figures, and χ2 calculations. Results: Comparable patterns were observed in both populations in relation to small sample sizes, wide age ranges, a reliance on data collection from single sites, and limited global coverage. Similarly, only one-third of all studies had used a comparison group, 42% of studies did not include the patient perspective, and fewer than 10% of studies had collected data longitudinally. Qualitative research was lacking across both populations, but particularly in relation to CFA. A higher proportion of CFA studies utilized validated measures and were less likely to exclude patients with additional anomalies. CFA studies most frequently focused on behavior and overall quality of life, while CL/P studies tended to investigate emotional well-being and social experiences. Conclusions: Findings illustrate the variability in research approaches, sampling, measurement, and analysis across both populations. There is a pressing need to address key methodological issues within craniofacial research and to examine the possible similarities and condition-specific differences between CL/P and other congenital craniofacial anomalies.
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Affiliation(s)
- Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
- University of Bristol, Bristol, United Kingdom
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Stock NM, Feragen KB. Comparing Psychological Adjustment Across Cleft and Other Craniofacial Conditions: Implications for Outcome Measurement and Intervention. Cleft Palate Craniofac J 2018; 56:766-772. [PMID: 29652532 DOI: 10.1177/1055665618770183] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
- University of Bristol, Bristol, United Kingdom
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Abstract
Background: Cleft lip and/or palate (CL/P) poses many challenges for those affected throughout the school years, with recent studies pointing to a trend in poor educational outcomes. Previous research has highlighted the important role that teachers play in supporting young people with chronic health conditions yet studies in the field of CL/P suggest that teachers may lack knowledge of the condition, and underestimate pupils’ academic ability. Qualitative investigation of the impact of CL/P from the teacher’s perspective may provide additional insight as well as potential suggestions for improving the school experience for affected pupils. Methods: Twenty UK preschool, primary, and secondary school teachers with experience of teaching pupils with CL/P completed an open-ended survey, eliciting qualitative data. Results: Qualitative content analysis was performed. Data were presented under 5 key headings: Knowledge of CL/P and its effects, perceived impact of CL/P on education, teachers’ training needs, delivery of training, and impact of CL/P on teachers. Teachers were able to identify a number of potential social, emotional, and treatment-related challenges within the school setting, yet did not believe that CL/P would have a long-term impact on pupils’ educational achievement. Participating teachers reported that cleft-specific training and access to relevant resources would be highly beneficial. Conclusions: Acting as a platform for future research, this exploratory study provides insight into the challenges faced by teachers and offers suggestions for how to improve teachers’ understanding of CL/P, and their confidence in dealing with cleft-related issues.
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Affiliation(s)
- Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
- The Cleft Collective Bristol, University of Bristol, Bristol, United Kingdom
| | - Matthew Ridley
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
- The Cleft Collective Bristol, University of Bristol, Bristol, United Kingdom
| | - Ella Guest
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
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Feragen KB, Stock NM. Factors affecting subjective appearance evaluations among patients with congenital craniofacial conditions: An application of Cash's cognitive-behavioural model of body image development. Body Image 2018; 24:124-136. [PMID: 29414145 DOI: 10.1016/j.bodyim.2017.12.005] [Citation(s) in RCA: 5] [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] [Received: 07/14/2017] [Revised: 11/16/2017] [Accepted: 12/19/2017] [Indexed: 12/11/2022]
Abstract
Satisfaction with appearance is of central importance for psychological well-being and health. For individuals with an unusual appearance, such as congenital craniofacial anomalies (CFA), appearance evaluations could be especially important. However, few, if any papers have presented a comprehensive synthesis of the factors found to affect subjective satisfaction with appearance among children, adolescents, and adults born with a CFA. Further, only a handful of craniofacial studies have applied psychological theories or models to their findings, resulting in an overall lack of guidance for researchers in the field. This paper summarises the literature pertaining to satisfaction with appearance among those affected by CFAs, and examines the extent to which Cash's cognitive-behavioural model of body image development (2012) fits with this literature. Given the overlap between factors of interest in the field of CFAs, and in the area of body image more broadly, a closer collaboration between the two research fields is suggested.
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Affiliation(s)
| | - Nicola Marie Stock
- 'Scar Free Foundation Research Fellow' at the 'Centre for Appearance Research and The Cleft Collective', University of the West of England, Frenchay Campus, Coldharbour Lane, Bristol, BS16 1QY, United Kingdom.
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Abstract
Background: Since the implementation of centralized services in the United Kingdom for those affected by cleft lip and/or palate (CL/P), several studies have investigated the impact of service rationalization on the delivery of care. While large-scale quantitative studies have demonstrated improvements in a range of patient outcomes, and smaller studies have reported on the benefits and challenges of centralization from the views of health professionals, little research has attempted to capture the patient perspective. Furthermore, few studies have investigated the views of adult “returners” who have undergone treatment both pre- and postcentralization. Methods: Qualitative data relevant to the subject of this article were extracted from 2 previous larger studies carried out between January 2013 and March 2014. A total of 16 adults born with CL/P contributed data to the current study. These data were subjected to inductive thematic analysis. Results: The findings suggest that centralization of CL/P services has considerably enhanced the patient experience. Specifically, the overall standard and coordination of care has improved, service delivery has become more patient centered, and access to professional psychological support and peer support has greatly improved patients’ capacity to cope with the associated emotional challenges. Conclusions: The data collected provide additional insight into the impact of centralization from the perspective of a largely unexplored patient population. In combination with other literature, these findings are also relevant to future efforts to centralize other specialist services around the world.
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Affiliation(s)
- Nicola Marie Stock
- Centre for Appearance Research and The Cleft Collective, University of the West of England, Bristol, UK
| | - Hamza Anwar
- Regional Coordinator for the East of England, Cleft Lip and Palate Association, London, UK
| | - Jonathan R. Sandy
- Dean of the Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Nichola Rumsey
- Centre for Appearance Research, University of the West of England, Bristol, UK
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Zucchelli F, Rumsey N, Humphries K, Bennett R, Davies A, Sandy J, Stock NM. Recruiting to cohort studies in specialist healthcare services: Lessons learned from clinical research nurses in UK cleft services. J Clin Nurs 2018; 27:e787-e797. [DOI: 10.1111/jocn.14188] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Fabio Zucchelli
- Centre for Appearance Research; University of the West of England (UWE); Bristol UK
| | - Nichola Rumsey
- Centre for Appearance Research; University of the West of England (UWE); Bristol UK
- The Cleft Collective; School of Oral and Dental Sciences; University of Bristol; Bristol UK
| | - Kerry Humphries
- The Cleft Collective; School of Oral and Dental Sciences; University of Bristol; Bristol UK
| | - Rhiannon Bennett
- The Cleft Collective; School of Oral and Dental Sciences; University of Bristol; Bristol UK
| | - Amy Davies
- The Cleft Collective; School of Oral and Dental Sciences; University of Bristol; Bristol UK
| | - Jonathan Sandy
- The Cleft Collective; School of Oral and Dental Sciences; University of Bristol; Bristol UK
| | - Nicola Marie Stock
- Centre for Appearance Research; University of the West of England (UWE); Bristol UK
- The Cleft Collective; School of Oral and Dental Sciences; University of Bristol; Bristol UK
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Stock NM, Feragen KB, Rumsey N. Adults’ Narratives of Growing up with a Cleft Lip and/or Palate: Factors Associated with Psychological Adjustment. Cleft Palate Craniofac J 2018; 53:222-39. [DOI: 10.1597/14-269] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Growing up with a cleft lip and/or palate presents a number of challenges for those affected and their families. Understanding why some individuals cope well while others struggle is key to psychological research in this field. A better appreciation of the factors and processes that contribute to psychological adjustment to cleft lip and/or palate (CL/P) from the patient perspective would be of value to both researchers and clinicians. Design Qualitative data elicited from individual interviews with 52 adults born with CL/P. Result Inductive thematic analysis identified three main themes: “background” factors (age, gender, sexual orientation, culture, additional conditions, socioeconomic status, and adoption), “external” factors (treatment autonomy, familial coping and support, salience, public understanding, psychological input, and peer support), and “internal” psychological factors (perceptions of difference, noticeability and teasing, social confidence, internalization of beauty ideals, valence, expectations of treatment, responding to challenges, social comparisons, acceptance, faith, dispositional style, and recognition of strengths and positive growth). Conclusions The number and breadth of factors identified in this study are testament to the importance of psychology in the field of CL/P and may offer guidance in relation to developing and assessing the value of psychological interventions. There is a clear role for psychologists in tackling appearance-related concerns, designing materials, supporting patient decision making, and improving social interaction, as well as providing specialist psychological support. The findings illustrate the potential degree of individual variation in perspectives and offer insight into the conflicting results found within current literature.
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Affiliation(s)
- Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | | | - Nichola Rumsey
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
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Feragen KB, Stock NM. Risk and Protective Factors at Age 10: Psychological Adjustment in Children with a Cleft Lip and/or Palate. Cleft Palate Craniofac J 2018; 53:161-79. [DOI: 10.1597/14-062] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To explore psychological functioning in children with a cleft at age 10 from a broad perspective, including cognitive, emotional, behavioral, appearance-related, and social adjustment. High-risk groups were identified within each area of adjustment to investigate whether vulnerable children were found across domains or whether risk was limited to specific areas of adjustment. Methods Retrospective chart review from psychological assessments at age 10 (N – 845). The effects of gender, cleft visibility, and the presence of an additional condition were investigated. Results were compared with large national samples. Measures Personality Inventory for Children, Child Experience Questionnaire, Strengths and Difficulties Questionnaire, Satisfaction With Appearance scale. Result The factor affecting psychological adjustment on most domains was the presence of an associated condition in addition to the cleft. As expected, no support was found for cleft visibility as a risk factor, while there were some gender differences related to emotional difficulties and attention. Correlation analyses of risk groups pointed to an association between social experiences and emotional adjustment and between social and behavioral adjustment; whereas, dissatisfaction with appearance was not related to any other domains of risk at age 10. Conclusions The results point to the importance of early screening and assessment of children born with a cleft to identify possible associated conditions and offer adapted and appropriate treatment and care. Future research should investigate how protective factors could counteract potential risk in children with a cleft.
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Affiliation(s)
- Kristin Billaud Feragen
- Department of Speech and Language Disorders, Bredtvet Resource Centre, Statped sørøst, Oslo, Norway
| | - Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
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Stock NM, Ridley M. Young Person and Parent Perspectives on the Impact of Cleft Lip and/or Palate Within an Educational Setting. Cleft Palate Craniofac J 2017; 55:607-614. [PMID: 29554456 DOI: 10.1177/1055665617734991] [Citation(s) in RCA: 14] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: During the school years, a cleft of the lip and/or palate (CL/P) may pose a risk to educational achievement. To further understand this multifaceted association, and to offer suggestions as to how young people’s educational experiences might be improved, qualitative investigation is warranted. Design: Semi-structured telephone interviews were conducted with young people born with CL/P (n = 10; aged 10-16 years) and their parents (n = 10). The resulting data were subjected to inductive thematic analysis. Results: Negative social interactions, cleft-related treatment, the presence of an additional condition, and a lack of appropriate support from teachers was found to influence young people’s educational experience. Methods for promoting diversity, support from clinical teams, facilitation of positive school transitions, implementation of training for teachers, and a holistic approach to the measurement of “success” were suggested by participants as potential ways of improving this experience. Conclusions: The findings of this study point to a need for a range of school-focused interventions, as well as the inclusion of a number of potentially impactful variables within future quantitative research.
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Affiliation(s)
- Nicola Marie Stock
- Centre for Appearance Research and The Cleft Collective, University of the West of England, Bristol, United Kingdom
| | - Matthew Ridley
- Centre for Appearance Research and The Cleft Collective, University of the West of England, Bristol, United Kingdom
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Abstract
Objective: To date, research investigating the psychological impact of craniofacial conditions has produced variability across outcomes. The aims of this article were to summarize the challenges that may contribute to this variability, and to offer alternative perspectives and approaches to guide future research and practice. Design: A comprehensive evaluation of papers exploring adjustment to congenital craniofacial conditions was conducted. Methodological approaches and underlying conceptual issues were identified and summarized. Results: The conceptual limitations identified include inherent challenges pertaining to the multifactorial and fluctuating nature of adjustment, a lack of consensus regarding the primary constituents of a positive outcome, scant use of appropriate models and theories, and a predominant focus on “deficits” over “strengths.” The methodological shortcomings identified include a lack of representative samples, biomedical inclusion/exclusion criteria, inconsistency in measurement, a relative absence of the patient perspective, variability in approaches to data analysis and interpretation, and the failure to draw on knowledge from other disciplines and related fields of health research. Findings are believed to be relevant to all disciplines involved in craniofacial research and practice. Conclusions: Existing literature remains markedly affected by a range of conceptual and methodological challenges, despite these challenges being identified 25 years ago. The present article proposes that a shift in the way we conceptualize and study craniofacial conditions is needed, in order to construct a comprehensive understanding of adjustment to craniofacial conditions, and to address the key unanswered questions important to all stakeholders.
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Affiliation(s)
- Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | | | - Tim P. Moss
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
- University of the West of England, Bristol, United Kingdom
| | - Nichola Rumsey
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
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Feragen KB, Særvold TK, Aukner R, Stock NM. Speech, Language, and Reading in 10-Year-Olds with Cleft: Associations with Teasing, Satisfaction with Speech, and Psychological Adjustment. Cleft Palate Craniofac J 2017; 54:153-165. [DOI: 10.1597/14-242] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Despite the use of multidisciplinary services, little research has addressed issues involved in the care of those with cleft lip and/or palate across disciplines. The aim was to investigate associations between speech, language, reading, and reports of teasing, subjective satisfaction with speech, and psychological adjustment. Design Cross-sectional data collected during routine, multidisciplinary assessments in a centralized treatment setting, including speech and language therapists and clinical psychologists. Participants Children with cleft with palatal involvement aged 10 years from three birth cohorts (N = 170) and their parents. Outcome Measures Speech: SVANTE-N. Language: Language 6-16 (sentence recall, serial recall, vocabulary, and phonological awareness). Reading: Word Chain Test and Reading Comprehension Test. Psychological measures: Strengths and Difficulties Questionnaire and extracts from the Satisfaction With Appearance Scale and Child Experience Questionnaire. Results Reading skills were associated with self- and parent-reported psychological adjustment in the child. Subjective satisfaction with speech was associated with psychological adjustment, while not being consistently associated with speech therapists’ assessments. Parent-reported teasing was found to be associated with lower levels of reading skills. Having a medical and/or psychological condition in addition to the cleft was found to affect speech, language, and reading significantly. Conclusions Cleft teams need to be aware of speech, language, and/or reading problems as potential indicators of psychological risk in children with cleft. This study highlights the importance of multiple reports (self, parent, and specialist) and a multidisciplinary approach to cleft care and research.
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Affiliation(s)
| | | | | | - Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
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Abstract
OBJECTIVE A congenital craniofacial anomaly (CFA) is expected to impact upon several domains of psychological, emotional and social functioning, yet no recent reviews have comprehensively summarised the available literature. Further, existing reviews tend to draw upon literature in the field of cleft lip and palate, and do not give substantive attention to other types of CFAs. DESIGN A review of 41 papers published between January 2000 and March 2016 pertaining to psychological adjustment to CFAs. MAIN OUTCOME MEASURES Findings are presented according to key psychological domains: General Psychological Well-being, Quality of Life, Behaviour, Emotional Well-being, Social Experiences, Appearance, and Treatment-Related Experiences. RESULTS Current literature offers a contradictory picture of adjustment to CFAs. Psychological adjustment appeared to be comparable to norms and reference groups in approximately half of the papers related to non-syndromic CFAs, while more variation was found across domains among samples with syndromic CFAs. Associations were found between adjustment, physical health and cognitive function in several papers. The review identified a number of gaps in the literature, such as the inclusion of a wide range of diagnoses within research samples. CONCLUSIONS This review demonstrates the complexity of findings, both within and across domains, and highlights a number of methodological challenges.
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Affiliation(s)
| | - Nicola Marie Stock
- b Centre for Appearance Research , University of the West of England , Bristol , UK
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Stock NM, Stoneman K, Cunniffe C, Rumsey N. The Psychosocial Impact of Cleft Lip and/or Palate on Unaffected Siblings. Cleft Palate Craniofac J 2016; 53:670-682. [PMID: 26437082 DOI: 10.1597/15-148] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Sibling relationships are among the most unique social connections, significantly affecting psychosocial adjustment. Previous reviews in the fields of chronic illness and disability have concluded that unaffected siblings of children with long-term conditions are at risk of poorer psychological functioning as a consequence. Much research has investigated the psychosocial impact of CL/P on affected individuals and their parents, yet comparatively little is known about the impact on other close family members. Objective To gain a better understanding of the experience of unaffected siblings of children born with CL/P, with a view to informing service provision and support. Design Individual qualitative interviews conducted over the telephone/Internet with five siblings and eight parents, including five sibling-parent pairs from the same family. Results Thematic analysis identified three key themes applicable across both parent and sibling interviews: perceptions of positive and negative impacts, factors affecting the degree of impact, and support for families. Conclusions This study provides insight into a population that is often overlooked in the context of cleft care. The analysis identified a number of sibling support and information needs, along with suggestions of how to incorporate support for siblings in practice. The findings suggest that an inclusive approach to health care encompassing all members of the family is essential for optimal familial adjustment.
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Affiliation(s)
- Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Katie Stoneman
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | | | - Nichola Rumsey
- Appearance Psychology and Co-Director, Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
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Feragen KB, Stock NM, Sharratt ND, Kvalem IL. Self-perceptions of romantic appeal in adolescents with a cleft lip and/or palate. Body Image 2016; 18:143-52. [PMID: 27459395 DOI: 10.1016/j.bodyim.2016.06.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 02/09/2016] [Accepted: 06/27/2016] [Indexed: 10/21/2022]
Abstract
During adolescence, romantic relationships are a key developmental milestone. Coupled with the increasing salience of appearance and social acceptance, adolescents with an appearance-altering condition may feel particularly vulnerable when it comes to romantic relationships. This study aimed to explore the prevalence of romantic experiences among adolescents with a cleft lip and/or palate (CL/P), and to investigate how these experiences could be related to depressive symptoms and global self-worth. The study included 661 Norwegian adolescents with CL/P, who were compared to a large national sample. The prevalence of romantic relationships was lower among adolescents with CL/P compared to the reference group, although the overall impact on depressive symptoms and global self-worth appeared to be low. This study is one of few to explore the impact of a congenital visible condition on experiences of romantic relationships and provides preliminary insight into a significant, yet complex topic.
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Affiliation(s)
- Kristin Billaud Feragen
- Statped sørøst, Oslo, Norway; Centre for Rare Disorders, Oslo University Hospital, Oslo, Norway.
| | - Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, UK.
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Stock NM, Hammond V, Owen T, Kiff J, Shanly A, Rumsey N. Achieving Consensus in the Measurement of Psychological Adjustment to Cleft Lip and/or Palate. Cleft Palate Craniofac J 2016; 53:421-6. [PMID: 26247710 DOI: 10.1597/15-071] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Psychological adjustment to cleft lip/palate is multifaceted and can fluctuate over time and across different situations. Consequently, a comprehensive understanding of adjustment is difficult to capture, and the challenge of achieving consensus among researchers and clinicians regarding key constructs and processes is considerable. Numerous measures have been used in research and clinical audit, resulting in conflicting findings and difficulties in evidencing the value of psychological intervention. The launch of the world's largest cleft lip/palate cohort study has provided an opportunity to standardize data collection across the United Kingdom. Objective To describe the collaborative process used to achieve consensus in the academic and clinical measurement of psychological adjustment to cleft lip/palate. Results Extensive work based on existing literature and clinical experience has resulted in a conceptual framework comprising six domains of adjustment and corresponding risk/protective factors that are measureable across key developmental time points. Driven by this framework, a core pack of standardized measures has been selected according to psychometric properties, clinical utility, and pragmatic considerations. Conclusions To date, these measures have been implemented within a UK-wide longitudinal cohort study (at diagnosis, 18 months, 3 years, 5 years, and 8 years) and adopted into the national routine clinical audit protocol for cleft lip/palate at age 5. Further data collection points will follow as the cohorts age. Over time, consistency in data collection will allow researchers to address some of the key unanswered questions in relation to psychological adjustment to cleft lip/palate.
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Affiliation(s)
- Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Vanessa Hammond
- South Wales & South West Managed Clinical Network, Cleft Lip and Palate, Swansea, United Kingdom
| | - Tina Owen
- South Wales & South West Managed Clinical Network, Cleft Lip and Palate, Bristol, United Kingdom
| | - James Kiff
- East of England Cleft Network, Cambridge, United Kingdom
| | | | - Nichola Rumsey
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
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Stock NM, Humphries K, Pourcain BS, Bailey M, Persson M, Ho KM, Ring S, Marsh C, Albery L, Rumsey N, Sandy J. Opportunities and Challenges in Establishing a Cohort Study: An Example from Cleft Lip/Palate Research in the United Kingdom. Cleft Palate Craniofac J 2016; 53:317-25. [DOI: 10.1597/14-306] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Cleft lip and/or palate (CL/P) is one of the most common birth conditions in the world, but little is known about its causes. Professional opinion remains divided as to which treatments may be the most beneficial for patients with CL/P, and the factors that contribute to psychological adjustment are poorly understood. The use of different methodological approaches and tools plays a key role in hampering efforts to address discrepancies within the evidence base. A new UK-wide program of research, The Cleft Collective, was established to combat many of these methodological challenges and to address some of the key research questions important to all CL/P stakeholders. Objective To describe the establishment of CL/P cohort studies in the United Kingdom and to consider the many opportunities this resource will generate. Results To date, protocols have been developed and implemented within most UK cleft teams. Biological samples, environmental information, and data pertaining to parental psychological well-being and child development are being collected successfully. Recruitment is currently on track to meet the ambitious target of approximately 9800 individuals from just more than 3000 families. Conclusions The Cleft Collective cohort studies represent a significant step forward for research in the field of CL/P. The data collected will form a comprehensive resource of information about individuals with CL/P and their families. This resource will provide the basis for many future projects and collaborations, both in the United Kingdom and around the world.
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Affiliation(s)
- Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Kerry Humphries
- Faculty of Medicine and Dentistry, University of Bristol, United Kingdom
| | - Beate St Pourcain
- Faculty of Medicine and Dentistry, University of Bristol, United Kingdom
| | - Maggie Bailey
- Faculty of Medicine and Dentistry, University of Bristol, United Kingdom
| | - Martin Persson
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Karen M. Ho
- Faculty of Medicine and Dentistry, University of Bristol, United Kingdom
| | - Susan Ring
- Faculty of Medicine and Dentistry, University of Bristol, United Kingdom
| | - Cathy Marsh
- Lead Speech and Language Therapist, South West Cleft Service, University Hospitals Bristol NHS Foundation Trust, United Kingdom
| | - Liz Albery
- Lead Speech and Language Therapist, South West Cleft Service, University Hospitals Bristol NHS Foundation Trust, United Kingdom
| | - Nichola Rumsey
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Jonathan Sandy
- Faculty of Medicine and Dentistry, University of Bristol, United Kingdom
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