Rhodes Erinn T, Boles Richard E, Chin Kimberly, Christison Amy, Testa Elizabeth Getzoff, Guion Kimberly, Hawkins Mary Jane, Petty Carter R, Sallinen Gaffka Bethany, Santos Melissa, Shaffer Laura, Tucker Jared, Hampl Sarah E
1 Division of Endocrinology, Boston Children's Hospital , Boston, MA.
2 Children's Hospital Colorado , Aurora, CO.
Child Obes. 2017 Apr;13(2):120-127. doi: 10.1089/chi.2016.0215. Epub 2017 Jan 16.
Attrition in pediatric weight management negatively impacts treatment outcomes. A potentially modifiable contributor to attrition is unmet family expectations. This study aimed to evaluate the association between adolescent and parent/guardian treatment expectations and attrition.
A prospective, nonrandomized, uncontrolled, single-arm pilot trial was conducted among 12 pediatric weight management programs in the Children's Hospital Association's FOCUS on a Fitter Future collaborative. Parents/guardians and adolescents completed an expectations/goals survey at their initial visit, with categories including healthier food/drinks, physical activity/exercise, family support/behavior, and weight management goals. Attrition was assessed at 3 months.
From January to August 2013, 405 parents/guardians were recruited and reported about their children (203 adolescents, 202 children <12 years). Of the 203 adolescents, 160 also self-reported. Attrition rate was 42.2% at 3 months. For adolescents, greater interest in family support/behavior skills was associated with decreased odds of attrition at 3 months [odds ratio (OR) 0.75, 95% confidence interval (CI) 0.57-0.98, p = 0.04]. The more discordant the parent/adolescent dyad responses in this category, the higher the odds of attrition at 3 months (OR 1.36, 95% CI 1.04-1.78, p = 0.02). Weight loss was an important weight management goal for both adolescents and parents. For adolescents with this goal, the median weight-loss goal was 50 pounds. Attrition was associated with adolescent weight-loss goals above the desired median (50% above the median vs. 28% below the median, p = 0.02).
Assessing initial expectations may help tailor treatment to meet families' needs, especially through focus on family-based change and realistic goal setting.
Clinicaltrials.gov NCT01753063.
儿科体重管理中的患者流失对治疗结果产生负面影响。导致患者流失的一个可能可改变的因素是家庭期望未得到满足。本研究旨在评估青少年与家长/监护人的治疗期望与患者流失之间的关联。
在儿童医院协会“关注更健康未来”合作项目中的12个儿科体重管理项目中进行了一项前瞻性、非随机、无对照、单臂试点试验。家长/监护人和青少年在初次就诊时完成了一项期望/目标调查，类别包括更健康的食物/饮料、体育活动/锻炼、家庭支持/行为以及体重管理目标。在3个月时评估患者流失情况。
2013年1月至8月，招募了405名家长/监护人并报告了他们孩子的情况（203名青少年，202名12岁以下儿童）。在203名青少年中，160名也进行了自我报告。3个月时的患者流失率为42.2%。对于青少年而言，对家庭支持/行为技能的更大兴趣与3个月时较低的流失几率相关[优势比（OR）0.75，95%置信区间（CI）0.57 - 0.98，p = 0.04]。在这一类别中，家长/青少年二元组反应的不一致性越高，3个月时的流失几率越高（OR 1.36，95% CI 1.04 - 1.78，p = 0.02）。减肥是青少年和家长重要的体重管理目标。对于有此目标的青少年，体重减轻目标中位数为50磅。患者流失与高于期望中位数的青少年减肥目标相关（高于中位数的50%与低于中位数的28%相比，p = 0.02）。
评估初始期望可能有助于调整治疗以满足家庭需求，特别是通过关注基于家庭的改变和设定现实的目标。
Clinicaltrials.gov NCT01753063
