Department of Pediatrics, Pediatric Hematology/Oncology, University of Michigan, 1500 E. Medical Center Drive, D4202 Medical Professional Building, Ann Arbor, MI, 48109-5718, USA.
Department of Internal Medicine, Brigham & Women's Hospital, Boston, MA, USA.
J Clin Immunol. 2019 Nov;39(8):805-813. doi: 10.1007/s10875-019-00703-7. Epub 2019 Oct 26.
Both pediatric and adult patients with a primary immunodeficiency/immune dysregulation (PID/PIDR) diagnosis report inferior quality of life (QOL) and patient-reported outcomes (PROs) as compared with their healthy peers. Recognition of the negative impact on QOL and PROs provides an opportunity for clinicians to intervene with supportive measures. However, provider perceptions of PID/PIDR patients' quality of life, physical well-being, psychosocial health and neurocognition, and access to supportive resources have yet to be systematically evaluated.
We report specialty providers' perception of the QOL and psychosocial and physical well-being of their pediatric and adult patients with PID/PIDR through the utilization of an online survey assessing QOL and the impact of disease or its associated treatment on their physical well-being, mental health, social relationships, neurocognition, and work/school performance.
Clinicians trended towards believing adult PID/PIDR patients had worse overall QOL than children with PID/PIDR. Providers additionally identified their adult patients' QOL to be more deleteriously affected by co-morbidities than their pediatric patients. Clinicians distinguished anxiety and social relationships as the psychosocial aspects most often affected by a complex immunological diagnosis in all patients. Of physical health considerations, energy, rather than mobility or pain, was perceived to be more negatively influenced by PID/PIDR in both adult and pediatric patients.
Knowledge of these clinician perceptions can affect communication of findings with patients, as well as ongoing management, and thus, it is important to understand these fully to improve healthcare delivery to, and clinical management of, these patients.
与健康同龄人相比,患有原发性免疫缺陷/免疫调节紊乱(PID/PIDR)的儿科和成年患者报告生活质量(QOL)和患者报告的结果(PROs)较差。认识到对 QOL 和 PROs 的负面影响为临床医生提供了通过支持措施进行干预的机会。然而,提供者对 PID/PIDR 患者的生活质量、身体健康、心理社会健康和神经认知以及获得支持性资源的看法尚未得到系统评估。
我们通过使用在线调查来评估 QOL 以及疾病或其相关治疗对其身体健康、心理健康、社会关系、神经认知和工作/学校表现的影响,报告了专科医生对儿科和成年 PID/PIDR 患者的 QOL 和心理社会及身体健康的看法。
临床医生倾向于认为成年 PID/PIDR 患者的总体 QOL 比患有 PID/PIDR 的儿童差。提供者还确定他们的成年患者的 QOL 比他们的儿科患者更容易受到合并症的影响。临床医生将焦虑和社会关系作为所有患者中最常受复杂免疫诊断影响的心理社会方面进行了区分。在考虑身体健康时,与行动不便或疼痛相比,PID/PIDR 对成年和儿科患者的能量的负面影响更大。
了解这些临床医生的看法会影响与患者的沟通结果以及正在进行的管理,因此,全面了解这些看法对于改善这些患者的医疗保健服务和临床管理非常重要。