Department of Pediatric Endocrinology and Diabetes, Children's National Hospital, Washington, District of Columbia, USA.
Department of Psychology and Behavioral Health, Children's National Hospital, Washington, District of Columbia, USA.
Diabet Med. 2024 Dec;41(12):e15416. doi: 10.1111/dme.15416. Epub 2024 Aug 7.
Caregiver diabetes distress (DD) consists of feeling overwhelmed, sad, and/or concerned; one-third of parents of youth with type 1 diabetes (T1D) report severe distress up to 4 years after T1D diagnosis. PAID-PR (Problem Areas in Diabetes Survey-Parent Revised) assesses DD primarily in research settings; however, less is known about its clinical utility. We aimed to identify the feasibility of implementing PAID-PR screening at a diverse, academic US paediatric diabetes center during routine clinic follow-up visits through quality improvement methodologies.
The PAID-PR was intended to be offered in English to caregivers at all paediatric T1D appointments, by the front desk during appointment check-in, or through REDCap prior to telehealth appointments or at local sites to all eligible caregivers. Adult psychosocial resources were provided to all, regardless of score. Forms were scored after appointments; scores ≥80 were referred to Diabetes Psychology providers for follow-up.
A total of 391 caregivers completed the PAID-PR, though only half of eligible caregivers received it in person. Response rates were highest in person (90%), compared to REDCap (25%). In total, 27% (n = 107) scored ≥56 (DD). Of those with DD, 21% (n = 23) scored ≥80 and were referred to psychology. Demographics are reported in Table 1. PAID-PR score was positively correlated to A1c (p = 0.038) and inversely to child age (p = 0.014).
Clinic caregiver DD screening was implemented with higher response rates in person; however, expanding in-person screening to all eligible caregivers is necessary. Furthermore, since the PAID-PR was in English, some caregivers with DD were likely missed. Future directions include screening in additional languages.
照顾者糖尿病困扰（DD）包括感到不知所措、悲伤和/或担忧；三分之一的 1 型糖尿病（T1D）患儿的父母在 T1D 诊断后长达 4 年报告严重困扰。PAID-PR（糖尿病调查-父母修订版）主要在研究环境中评估 DD；然而，其临床效用知之甚少。我们旨在通过质量改进方法确定在一个多样化的美国儿科糖尿病中心在常规诊所随访期间实施 PAID-PR 筛查的可行性。
PAID-PR 打算在所有儿科 T1D 预约时以英语提供给照顾者，在预约登记时由前台提供，或在远程医疗预约前通过 REDCap 或在当地地点提供给所有符合条件的照顾者。所有符合条件的照顾者都可以获得成人心理社会资源，无论得分如何。预约后对表格进行评分；得分≥80 分的将转介给糖尿病心理学提供者进行随访。
共有 391 名照顾者完成了 PAID-PR，尽管只有一半符合条件的照顾者亲自收到了它。面对面的回复率最高（90%），相比之下 REDCap 为 25%。共有 27%（n=107）的人得分≥56（DD）。在有 DD 的人中，21%（n=23）的人得分≥80 分并被转介到心理学。表 1 报告了人口统计学特征。PAID-PR 评分与 A1c 呈正相关（p=0.038），与儿童年龄呈负相关（p=0.014）。
在现场实施了诊所照顾者 DD 筛查，现场的回复率较高；然而，有必要将现场筛查扩大到所有符合条件的照顾者。此外，由于 PAID-PR 是英文的，因此可能会错过一些有 DD 的照顾者。未来的方向包括用其他语言进行筛查。
