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- El Malla, Hanan, et al.
(författare)
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Parental trust in health care : a prospective study from the Children's Cancer Hospital in Egypt
- 2013
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Ingår i: Psycho-Oncology. - : Wiley. - 1057-9249 .- 1099-1611. ; 22:3, s. 548-554
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Patient-physician communication and patient satisfaction are important elements of cancer care. Trust is considered to be crucial for the patient-physician relationship, yet little is to be found in the literature regarding what factors may influence trust. METHODS: We assessed predictors of trust in health-care professionals and in the medical care by administering two questionnaires, one at start of chemotherapy treatment and one at the time of the third chemotherapy cycle, to 304 parents of children with newly diagnosed cancer at the Children's Cancer Hospital in Cairo, Egypt. RESULTS: Parents' trust in the medical care at the time of the child's third chemotherapy cycle was significantly associated with the following at the start of treatment: having received at least moderate information about the disease (relative risk (RR) 13.2; 95% CI 7.8-22.3) and the treatment (RR 17.2; 95% CI 9.5-31.4), having the opportunity to communicate with the child's physicians (RR 21.3; 95% CI 11.7-38.8), being satisfied with the physicians conversation style (RR 30.6; 95% CI 14.4-64.9), having the emotional needs met (RR 22.2; 95% CI 11.8-41.9), and being met with care by the child's physicians (RR 32.0; 95% CI 15.2-67.7). After multivariable model selection, the strongest predictor of trust at the time of the third chemotherapy cycle was to be met with care at the start of treatment. CONCLUSION: Parents being met with care by the child's physicians at the beginning of the child's chemotherapy treatment develop an increased trust in the medical care. Copyright © 2012 John Wiley & Sons, Ltd.
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| 2. |
- Hanan, El Malla, et al.
(författare)
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Adherence to medication : A nation-wide study from the Children's Cancer Hospital, Egypt
- 2013
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Ingår i: World journal of psychiatry. - : Baishideng Publishing Group Inc.. - 2220-3206. ; 22, s. 62-62
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To investigate adherence to medical regimen and predictors for non-adherence among children with cancer in Egypt.METHODS: We administered two study specific questionnaires to 304 parents of children diagnosed with cancer at the Children's Cancer Hospital in Cairo, Egypt, one before the first chemotherapy treatment and the other before the third. The questionnaires were translated to colloquial Egyptian Arabic, and due, to the high illiteracy level in Egypt an interviewer read the questions in Arabic to each parent and registered the answers. Both questionnaires consisted of almost 90 questions each. In addition, a Case Report Form was filled in from the child's medical journal. The study period consisted of 7 mo (February until September 2008) and we had a participation rate of 97%. Descriptive statistics are presented and Fisher's exact test was used to check for possible differences between the adherent and non-adherent groups. A P-value below 0.05 was considered significant. Software used was SAS version 9.3 for Windows (SAS Institute Inc., Cary, NC, United States).RESULTS: Two hundred and eighty-one (90%) parents answered the second questionnaire, regarding their child's adherence behaviour. Approximately two thirds of the children admitted to their third chemotherapy treatment had received medical recommendations upon discharge from the first or second chemotherapy treatment (181/281, 64%). Sixty-eight percent (123/181) of the parents who were given medical recommendations reported that their child did not follow the recommendations. Two main predictors were found for non-adherence: child resistance (111/123, 90%) and inadequate information (100/123, 81%). In the adherent group, 20% of the parents (n = 12/58) reported trust in their child's doctor while 14 percent 8/58 reported trust in the other health-care professionals. Corresponding numbers for the non-adherent group are 8/123 (7%) for both their child's doctor and other health-care professionals. Almost all of the parents expressed a lack of optimism towards the treatment (116/121, 96%), yet they reported an intention to continue with the treatment for two main reasons, for the sake of their child's life (70%) (P = 0.005) and worry that their child would die if they discontinued the treatment (81%) (P < 0.0001).CONCLUSION: Non-adherence to medical regimen is common among children diagnosed with cancer in Egypt, the main reasons being child resistance and inadequate information.
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| 4. |
- Hanan, El Malla, et al.
(författare)
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Cancer disclosure-account from a pediatric oncology ward in Egypt
- 2017
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Ingår i: Psycho-Oncology. - Chichester : Wiley. - 1057-9249 .- 1099-1611. ; 26:5, s. 679-685
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Informing the child about his/her diagnosis and treatment plan is essential; research has shown that it is related to the patient's quality of life and adherence to medication.METHODS: For 7 months during 2008 (February to September), 2 study-specific questionnaires were constructed and administered to 304 parents of children diagnosed with cancer at the Children's Cancer Hospital Egypt.RESULTS: Among the 313 eligible parents of children diagnosed with cancer, 304 (97%) answered the first questionnaire and 281 (92%) answered the second questionnaire. We found that nearly three-quarters (72%) of the parents had their child's cancer diagnosis communicated by the physician. Among the 72%, the rate of the children present with the parent or parents during the disease disclosure conversation was 39% (n = 85/219). The majority of the children were in the age group 5-18 years (55%).CONCLUSIONS: Our findings indicate that cancer disclosure at the Children's Cancer Hospital is to a certain degree common; yet even when disclosure does take place, it is mainly in the absence of the child. Moreover, the information provided during the conversation may not be fully comprehended by the parent or the child because of the physician's misleading use of terms when disclosing the disease. Therefore, better practice should be developed for disease disclosure, and proper communication should be established between the patients and the provider; patient autonomy should also have an influence in the clinical practice.
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| 5. |
- Hanan, El Malla
(författare)
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Improving care of children with cancer in Egypt
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aims: More than 70 percent of the children diagnosed with cancer in Egypt die every year. In Sweden the corresponding figure is close to 20 percent. The aims of this study was to investigate psycho-oncological predictors of mortality, parental perception of the care their child received as well as of the health care professionals, in order to improve care of children with cancer. The main hypothesis was that parental degree of trust affects a child’s adherence to treatment, dose intensity and therefore survival. Methods: During an 18-month preparatory phase, we carried out in-depth interviews, participant observations at the hospital, construction of two study- specific questionnaires, face-to-face validation of the questionnaires, and thereafter, a pilot study testing the logistics. Following that, the main data collection was carried out during the recruitment period of February to September in 2008. The eligible study population was parents of children newly diagnosed with a malignancy and admitted to receive a first chemotherapy cycle at the Children’s Cancer Hospital in Cairo, Egypt. The parents were approached twice, first prior to their child’s first chemotherapy cycle and then again before the third. Among the 313 eligible parents, 304 (97%) answered the first questionnaire, and 281 (92%) the second one. ! ! Results: We found that parents reported a higher degree of trust in the medical care provided (RR 32.0; 95% CI 15.2-67.7) when they were met with care by their child’s physician. Having received information concerning the disease (RR 13.2; 95% CI 7.8-22.3) and treatment (RR 17.2; 95% CI 9.5-31.4) resulted in higher trust in the health care and the physicians. Also, we found that 72 percent (n=219/304) of the parents had their child’s disease disclosed by the physician. Among those, 39 percent (n=85/219) of the children were present during the conversation. Less than half of those children (45%) were below the age of 5. Also, 68 percent (n=123/181) of the parents reported that their child did not take the prescribed medication while at home and the two main predictors reported by the parents were child’s resistance (90%, n=111/123) and inadequate information provided (81%, n=100/123). Finally, five years after the study was conducted, we observed a survival rate of 58 percent (n=176/304) with a 10 percent lost to follow-up. Among the studied children, we could, however, not relate the mortality to any of the psychosocial predictors addressed in this thesis. Conclusion: Our main hypothesis that the degree of parental trust in the health care system and physicians affects the child’s adherence to treatment, dose intensity, and thereby the survival rate, was not confirmed. We found an association between information provision and how it is provided with trust and adherence, yet none of these predictors were associated with the obtained survival rates. The observed survival rate of the children in our group is 58 percent, with an addition of 10 percent lost to follow-up. This is an increase as compared to official statistics of earlier years. Adherence to medication while at home was associated with parental degree of trust in physicians and health care professionals, but not with survival rate. We found an association between whether before the child’s first chemotherapy cycle 1) information to parents was provided or not, and 2) how it was provided, with the degree of trust reported by the parents before the child’s third chemotherapy cycle.
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| 6. |
- Hedenrud, Tove, 1967, et al.
(författare)
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"I did not know it was so important to take it the whole time"-self-reported barriers to medical treatment among individuals with asthma
- 2019
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Ingår i: BMC Pulm Med. - : Springer Science and Business Media LLC. - 1471-2466. ; 19:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Asthma is an extensive public health problem and inadequate disease control is not uncommon. Individuals' self-perceived barriers to medical treatment for the entire treatment chain (from seeking care for symptoms to using a medicine) have seldom been studied for chronic diseases such as asthma. The aim of this study was to explore self-perceived barriers to medical treatment among individuals with asthma within the framework of AAAQ (availability, accessibility, acceptability and quality). Methods: Individuals with asthma visiting the asthma nurse at a primary health care centre, and who currently had a prescription for anti-asthmatic medicines, were informed about the study. The nurse asked the persons for their consent to be contacted by an interviewer. The interview guide was constructed from the elements of AAAQ exploring self-perceived barriers to asthma treatment. Interviews were conducted in Swedish, English, Arabic and Persian. They were transcribed verbatim and a manifest content analysis was conducted. Results: Fourteen interviews were conducted. There was a large variation in both age and reported number of years with asthma. Self-perceived barriers to asthma treatment were experienced throughout the whole treatment chain. Barriers that emerged were health care accessibility, perceived quality of care, beliefs about medicines, life circumstances, knowledge gap about asthma and medicines, practical obstacles to using medicines, and experiences with treatment. The self-perceived barriers cover all four elements of AAAQ, but there are also some barriers that go beyond those elements (life circumstances and practical obstacles to using medicines). Conclusions: Self-perceived barriers among individuals with asthma cover the whole treatment chain. We want to highlight the inadequate information/education of patients leading to knowledge gaps about both disease and the effect of medicines, and also the perceived unsatisfactory treatment at the PHCC, which could partly be counteracted if patients know what to expect from health care visits. © 2019 The Author(s).
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