Kathy L. Bradley-Klug

Who Decides? Decision Making and Fertility Preservation in Teens With Cancer: A Review of the Literature

PURPOSE The knowledge that cancer treatment may impair fertility in pediatric populations is an emerging aspect of quality of life in this population. However, decision making and use of fertility preservation (FP) among adolescent cancer patients and their families has not been well studied. This review summarizes the available published data on aspects of decision making and FP in adolescent cancer patients. METHODS An electronic search was performed to identify peer-reviewed studies published between 1999 and 2009 using key Medical Subject Heading terms and inclusion criteria. Inclusion criteria limited eligible studies to those that focused on adolescent decision making in cancer treatment or FP, fertility concerns in pediatric oncology, capacity for decision making, and health decision making in pediatrics. Studies that did not meet at least one of these criteria were excluded. RESULTS A total of 29 articles were reviewed and summarized. Three categories of results were seen: a focus on adolescent decision making in oncology, decision making in chronic illness, and decision making in cancer-related infertility and preservation. CONCLUSION Most of the studies showed that adolescents have a strong desire to participate in decisions related to their cancer treatment and many have concerns regarding their future fertility, although barriers often prevented these discussions. More research is needed to explore the role of teenagers and parents in decisions about fertility in relation to cancer treatment.

Using Multiple Measures to Evaluate Positive Behavior Support A Case Example

In recent years, calls to expand the criteria by which behavior support efforts are evaluated have increased. Success is now said to depend on outcomes that transcend a reduction in the occurrence of problem behaviors and include the achievement of new competencies and improvements in ones quality of life. This single-case investigation was conducted as an effort to evaluate the effects of a positive behavior support intervention with multiple measures that included experimental analyses of the participants problem behavior, engagement, happiness, and efficiency in completing transitions, as well as adult and peer perceptions of aspects of the participants quality of life. Multiple baseline analyses indicated that the assessment-based intervention was effective in producing durable improvements in all of the measured variables and that the procedures were socially valid. The results are discussed in the context of the growing number of empirical case studies in positive behavior support, and the need to develop more efficient strategies for evaluating the essential outcomes of intervention.

Communication and Collaboration With Schools: Pediatricians’ Perspectives

The multifaceted effect of chronic illness in children has created a need for pediatricians and school personnel, specifically school psychologists, to engage in collaborative problem solving. However, the extent to which this collaboration actually occurs in practice is unknown. A survey was developed and administered to a national sample of members of the American Academy of Pediatrics to assess their type and frequency of communication and collaboration with school personnel, preferred methods of communication, primary school contact person, and their perceptions of the barriers to and benefits of collaborating with school personnel. Results of this survey yield strategies for school psychologists to facilitate communication and collaboration with pediatricians to assist in meeting the needs of children with pediatric health issues.

Collaborative Consultation to Support Children With Pediatric Health Issues: A Review of the Biopsychoeducational Model

Medical technology continues to improve, increasing life expectancies and capabilities of children with chronic illnesses and disabilities. Pediatric health issues have an impact on childrens academic, emotional, behavioral, and social functioning. This article reviews a consultative Biopsychoeducational Model, based on a problem-solving process, for working with children affected by health issues within the school setting. Facilitated by the school psychologist, this model promotes communication and collaboration among family members, educators, and medical professionals. The goal is to aid in the often complex assessment of strengths and weaknesses of children with health issues and to help design and evaluate effective interventions for these children. Potential roadblocks in implementation and possible solutions are discussed.

Student and resident perspectives on professionalism: beliefs, challenges, and suggested teaching strategies

Objectives The purpose of this study was to investigate the views of medical students and residents regarding the practice of professionalism, their perceived challenges, and ideas for the development of a new curriculum in medical professionalism. Methods Data were collected from four focus groups comprised of 27 residents and medical students recruited from the University of South Florida Morsani School of Medicine and Residency Programs between January and March 2012. A questioning protocol was used to guide the focus group discussion. Data were transcribed for thematic analysis. Results Learners expressed beliefs regarding key attributes of professional behaviors, factors perceived to be associated with lapses of professional behavior, skills that need to be taught, and strategies to teach professionalism from the learners’ perspective. Learners perceived that the values of professionalism are often disconnected from the reality evidenced in clinical training due to a myriad of personal and contextual challenges. Conclusions Residents and students need help in negotiating some of the challenges to medical professionalism that are encountered in clinical settings. We recommend a learner’s centered model of curriculum development in medical professionalism that takes into consideration perceived challenges and strategies for modeling and reinforcing medical professionalism.

Health-related quality of life and mental health indicators in adolescents with HIV compared to a community sample in the Southeastern US

ABSTRACT Although many studies have investigated the impact of HIV on cognitive, physical, academic, and psychosocial functioning, little is known about the self-perception of health-related quality of life (HRQOL), subjective well-being (SWB), social-emotional well-being, and psychopathology risks of adolescents with HIV. This study aimed to address gaps in the literature by exploring the psychosocial outcomes of adolescents with HIV from a strength-based assessment approach, as opposed to a traditional deficit-based approach. Specifically, we explored the relationship between HRQOL, SWB, social-emotional strengths, and psychopathology symptoms to develop a more comprehensive understanding of the physical and psychological well-being of adolescents with HIV (n = 42) compared to a community-based sample (n = 42) in the Southeastern US. Participants completed self-report measures, and data were analyzed for significant correlations, group differences between adolescents with HIV and a community-based sample, and social-emotional predictors of physical functioning and SWB. For adolescents with HIV, several HRQOL indicators were positively correlated with life satisfaction and social-emotional strengths indicators and negatively correlated with negative affect and psychopathology symptoms. Additionally, there was a significant main effect of parents’ marital status on participants’ perceptions of their social functioning and psychopathology symptoms. When differences in parents’ marital status were controlled for, the overall mean ratings of participants’ HRQOL, SWB, social-emotional strengths, and psychopathology risks did not significantly differ between groups. Furthermore, parents’ marital status and self-rated empathy skills significantly predicted physical functioning of adolescents with HIV, but no significant or meaningful variables were found to predict their SWB. These findings highlight the need for further research on the use of a comprehensive assessment framework to enhance our understanding of the overall well-being of adolescents with HIV.

Mental health screening in integrated care settings: Identifying rates of depression, anxiety, and posttraumatic stress among youth with HIV

ABSTRACT Rates of depression, anxiety, and posttraumatic stress disorder (PTSD) are greater in youth living with HIV (YLWH) than in the general population. Currently, depression screening guidelines exist for YLWH but not anxiety and PTSD. This study examined data from comprehensive mental health screenings conducted with YLWH, which included measures of depression, anxiety, and PTSD. Percentages of positive screeners were 35%, 25.7%, and 20.6% for depression, anxiety, and PTSD, respectively. Older participants reported more depression and anxiety symptoms. Participants with less education reported more PTSD symptoms. These findings support the need for universal and comprehensive mental health screenings for YLWH.

Initial development of the Health Literacy and Resiliency Scale: Youth version

Background: Health literacy and resiliency are empirically linked to better adaptation and the ability to thrive in the face of living with a chronic disease. To date, there are limited tools to assess these constructs among youth. The purpose of this study was to develop and validate the Health Literacy and Resiliency Scale: Youth Version (HLRS-Y), a questionnaire designed to tap the current health knowledge and resiliency factors for youth and young adults with chronic health conditions. Method: A multi-step process was used to create and validate the scale. A thorough review of the literature along with findings from focus groups guided initial item development. Items were refined through an expert review process and a pilot study (n = 25). All remaining items were administered to a national sample (n = 204) and responses were analyzed using exploratory factor analysis (EFA). Results: The EFA revealed a three-factor structure: Knowledge, Self-Advocacy/Support, and Resiliency. The finalized scale contained 37 items; 10 items loaded on Knowledge (α = 0.88), 14 items on Self Advocacy/Support (α = 0.94), and 13 items on Resiliency (α = 0.93). Conclusions: The HLRS-Y is the first general measure of health literacy and resiliency for youth and young adults with chronic health conditions. The information gleaned from the scale can be used to empower these individuals to develop health literacy skills, promote social connectedness and optimism, and adapt to living with their condition.

Student perceptions of a patient- centered medical training curriculum.

Objectives To evaluate a patient-centered medical training curriculum, the SELECT program, through perceptions of the inaugural student cohort. Methods Data were collected from two focus groups conducted in the university setting, comprised of fifteen first-year medical students who participated in the SELECT program during its inaugural year. A questioning protocol was used to guide the focus group discussion, which was transcribed and hand-coded through thematic analyses. Results Various themes related to patient-centered care were identified. Students noted changes in their attitudes towards interacting with patients in an empowering and educative manner as a result of communication and motivational interviewing exercises. Additionally, they recognized certain external, structural barriers as well as internal conflict between pragmatism and emotional intelligence that could potentially hinder patient-centered care. The impact of family dynamics and social support on quality of life and health outcomes was acknowledged. Students also emphasized the value of collaborating with multiple health professionals. Lastly, students provided suggestions for program improvement, namely additional simulations, more education regarding other healthcare professionals’ roles, more standardized experiences, and application of principles to acute and primary care. Conclusions Upon completion of the first year of the SELECT program, students gained an appreciation for patient-centered care and various factors and skills that facilitate such care. Additionally, they experienced a dissonance between didactic concepts from the curriculum and observed medical practices. This study highlights the educational benefits of a patient-centered medical curriculum and provides suggestions for future improvement.

School Psychological Practice for Students with Medical Issues

Students with medical issues often require a complex array of services in the educational setting to support their academic, social, and emotional needs. School psychologists can play a critical role in the development of prevention and intervention strategies to assist these students. This section focuses on the role of the school psychologist and identifies critical themes for best practice to be considered in the provision of services to students with medical issues within the context of the educational system in Australia. A review of relevant ethical and legal issues is presented for guidance to practitioners. Additionally, this session offers future directions for practice and research including the incorporation of new digital technologies to promote social connectedness and access to education for students with chronic health issues. The section concludes with a discussion of the importance of interdisciplinary communication and collaboration and the need to develop interventions to promote health literacy in youth.