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儿童慢性疾病诊断后的常态重建:“罕见”有影响吗?

Reconstructing normality following the diagnosis of a childhood chronic disease: does "rare" make a difference?

机构信息

Health Economics and Health Technology Assessment (HEHTA), Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK.

Institute of Communication and Health (ICH), Faculty of Communication Sciences, Università della Svizzera Italiana, 6900, Lugano, Switzerland.

出版信息

Eur J Pediatr. 2018 Apr;177(4):489-495. doi: 10.1007/s00431-017-3085-7. Epub 2018 Jan 16.

Abstract

UNLABELLED

Living with a childhood chronic disease can be challenging, especially if the diagnosis involves a rare condition. This study sought to elucidate how the diagnosis of a rare disease, as compared to a common, chronic condition, may influence maternal experiences of childhood illness. We conducted face-to-face, semi-structured interviews with 26 mothers of children treated in a pediatric hospital in the province of Lecco, Italy. Half of the participants had a child diagnosed with Bartter syndrome (BS), and the rest had a child suffering from celiac disease (CD). Interviews were recorded, transcribed, and analyzed using an inductive thematic approach. We identified three main themes from the analysis of our data: (1) disrupted normality and the need to know, (2) reconstructing normality, and (3) acting "normal." Although most participants experienced the disclosure of diagnosis as a relief, processes that facilitated normality reconstruction in celiac families, notably access to appropriate information, social support, and personal contact with comparison others, were found to be important stressors for mothers living with BS.

CONCLUSION

This comparative qualitative study provides evidence on how well-known problems associated with the rarity of childhood diseases impact on families' efforts to cope with the illness and regain a sense of normality. What is Known: • Families living with a rare disease have been found to experience a range of common problems, directly linked to the rarity of these pathologies. What is New: • Maximization of both emotional and instrumental social support, through provision of appropriate information or establishment of disease-specific support groups, could greatly contribute to rare disease families' efforts to cope with childhood illness and regain a sense of normality.

摘要

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儿童期慢性疾病的生活可能具有挑战性,特别是如果诊断涉及罕见疾病。本研究旨在阐明罕见病的诊断与常见慢性疾病的诊断相比,如何影响母亲对儿童疾病的体验。我们对意大利莱科省一家儿科医院治疗的 26 名儿童的母亲进行了面对面的半结构化访谈。参与者中有一半的孩子被诊断为巴特综合征(BS),其余的孩子患有乳糜泻(CD)。采访以录音、转录和使用归纳主题方法进行分析。我们从数据分析中确定了三个主要主题:(1)常态被打破和对了解的需求,(2)重建常态,以及(3)表现“正常”。尽管大多数参与者在得知诊断时感到如释重负,但乳糜泻家庭中促进常态重建的过程,即获得适当的信息、社会支持和与比较对象的个人接触,被发现是巴特综合征母亲的重要压力源。

结论

这项比较定性研究提供了证据,说明与儿童疾病罕见性相关的已知问题如何影响家庭应对疾病和恢复常态的努力。已知的是:• 与这些病理罕见性直接相关,患有罕见疾病的家庭已经发现经历了一系列常见的问题。新的是:• 通过提供适当的信息或建立特定于疾病的支持小组,最大限度地增加情感和工具性社会支持,可以极大地帮助罕见病家庭应对儿童疾病并恢复常态。

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