PEDIATRICS Vol. 123 No. 4 April 2009, pp. e708-e715 (doi:10.1542/peds.2008-2572)
ARTICLE |
Quality-of-Life Concerns Differ Among Patients, Parents, and Medical Providers in Children and Adolescents With Congenital and Acquired Heart Disease
a Division Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine
b Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
c Division of Behavioral Medicine and Clinical Psychology and Divisions of
d Cardiology
f Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
e Division of General Internal Medicine, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
OBJECTIVES. Mortality rates in pediatric patients with heart disease have decreased dramatically in recent decades, resulting in an increasing number of survivors with morbidities that impact quality of life. The purpose of this study was to assess and compare how heart disease affects the quality of life of the pediatric cardiac patient from the perspectives of the patient, parent, and health care provider.
METHOD. Individual focus groups were conducted with children (8–12 years of age) with heart disease, adolescents (13–18 years of age) with heart disease, parents of children with heart disease, parents of adolescents with heart disease, and health care providers of pediatric patients with heart disease. A structured focus group technique was used to develop a list of potential items that might affect quality of life. Participants chose the 5 most important items from the list. These items were then categorized into preidentified dimensions (physical, psychological, social, school, and other). The percentages of the total votes for all items were calculated and distributions of responses across dimensions within group and within dimension across groups were reported and compared qualitatively.
RESULTS. Patient and parent groups identified similar items as important. Providers identified different items. The physical limitation item received the largest percentage of total votes in all groups (9%–20%). Analysis across dimension revealed that those items related to the physical dimension received the highest percentage of total votes among all groups (30.2%–51.2%). Analysis within dimension revealed that patients endorsed items in the physical dimension more frequently than parents or providers. Within the psychological dimension, the children selected the fewest items relative to all other groups (7.2% vs 21.3%–37.8%), whereas health care providers endorsed these items more frequently than patients or parents (child or parent of child groups 7.2%–21.3% vs health care provider group 28.8%; adolescent or parent of adolescent groups 29.6% vs health care provider group 37.8%). Differences were noted between the child and adolescent groups in the psychological (child versus adolescent: 7.2% vs 29.6%) and school (child versus adolescent: 11.2% vs 2.1%) dimensions.
CONCLUSIONS. Patients and parents generally agreed on how heart disease affects the quality of life of children and adolescents, whereas health care providers had a different opinion.
Key Words: children • adolescents • congenital heart disease • focus groups • medical providers • quality of life
Abbreviations: HD—heart disease • QoL—quality of life • CHOP—Children's Hospital of Philadelphia • TGA—transposition of the great arteries • S/P—Status Post
Accepted Dec 2, 2008.
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