Caregiving and Confidence to Avoid Hospitalization for Children with Medical Complexity
To test associations between parent-reported confidence to avoid hospitalization and caregiving strain, activation, and health-related quality of life (HRQOL). In this prospective cohort study, enrolled parents of children with medical complexity (n = 75) from 3 complex care programs received text m...
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| Veröffentlicht in: | The Journal of pediatrics 2022-08, Vol.247, p.109-115.e2 |
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| container_end_page | 115.e2 |
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| container_title | The Journal of pediatrics |
| container_volume | 247 |
| creator | Coller, Ryan J. Lerner, Carlos F. Chung, Paul J. Klitzner, Thomas S. Cushing, Christopher C. Warner, Gemma Nacht, Carrie L. Thompson, Lindsey R. Eickhoff, Jens Ehlenbach, Mary L. Garrity, Brigid M. Bowe, Terah Berry, Jay G. |
| description | To test associations between parent-reported confidence to avoid hospitalization and caregiving strain, activation, and health-related quality of life (HRQOL).
In this prospective cohort study, enrolled parents of children with medical complexity (n = 75) from 3 complex care programs received text messages (at random times every 2 weeks for 3 months) asking them to rate their confidence to avoid hospitalization in the next month. Low confidence, as measured on a 10-point Likert scale (1 = not confident; 10 = fully confident), was defined as a mean rating |
| doi_str_mv | 10.1016/j.jpeds.2022.05.011 |
| format | Article |
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In this prospective cohort study, enrolled parents of children with medical complexity (n = 75) from 3 complex care programs received text messages (at random times every 2 weeks for 3 months) asking them to rate their confidence to avoid hospitalization in the next month. Low confidence, as measured on a 10-point Likert scale (1 = not confident; 10 = fully confident), was defined as a mean rating <5. Caregiving measures included the Caregiver Strain Questionnaire, Family Caregiver Activation in Transition (FCAT), and caregiver HRQOL (Medical Outcomes Study Short Form 12 [SF12]). Relationships between caregiving and confidence were assessed with a hierarchical logistic regression and classification and regression trees (CART) model.
The parents were mostly mothers (77%) and were linguistically diverse (20% spoke Spanish as their primary language), and 18% had low confidence on average. Demographic and clinical variables had weaker associations with confidence. In regression models, low confidence was associated with higher caregiver strain (aOR, 3.52; 95% CI, 1.45-8.54). Better mental HRQOL was associated with lower likelihood of low confidence (aOR, 0.89; 95% CI, 0.80-0.97). In the CART model, higher strain similarly identified parents with lower confidence. In all models, low confidence was not associated with caregiver activation (FCAT) or physical HRQOL (SF12) scores.
Parents of children with medical complexity with high strain and low mental HRQOL had low confidence in the range in which intervention to avoid hospitalization would be warranted. Future work could determine how adaptive interventions to improve confidence and prevent hospitalizations should account for strain and low mental HRQOL.</description><identifier>ISSN: 0022-3476</identifier><identifier>EISSN: 1097-6833</identifier><identifier>DOI: 10.1016/j.jpeds.2022.05.011</identifier><identifier>PMID: 35569522</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Caregivers ; caregiving ; Child ; confidence ; Hospitalization ; Humans ; medical complexity ; mHealth ; mixed methods ; Prospective Studies ; Quality of Life ; Surveys and Questionnaires</subject><ispartof>The Journal of pediatrics, 2022-08, Vol.247, p.109-115.e2</ispartof><rights>2022 Elsevier Inc.</rights><rights>Copyright © 2022 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c459t-82ee5c333660b90872f64ff0c4a41bc7bf3260d605a67690c16ec98d925241fa3</citedby><cites>FETCH-LOGICAL-c459t-82ee5c333660b90872f64ff0c4a41bc7bf3260d605a67690c16ec98d925241fa3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jpeds.2022.05.011$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,780,784,885,3548,27923,27924,45994</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35569522$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Coller, Ryan J.</creatorcontrib><creatorcontrib>Lerner, Carlos F.</creatorcontrib><creatorcontrib>Chung, Paul J.</creatorcontrib><creatorcontrib>Klitzner, Thomas S.</creatorcontrib><creatorcontrib>Cushing, Christopher C.</creatorcontrib><creatorcontrib>Warner, Gemma</creatorcontrib><creatorcontrib>Nacht, Carrie L.</creatorcontrib><creatorcontrib>Thompson, Lindsey R.</creatorcontrib><creatorcontrib>Eickhoff, Jens</creatorcontrib><creatorcontrib>Ehlenbach, Mary L.</creatorcontrib><creatorcontrib>Garrity, Brigid M.</creatorcontrib><creatorcontrib>Bowe, Terah</creatorcontrib><creatorcontrib>Berry, Jay G.</creatorcontrib><title>Caregiving and Confidence to Avoid Hospitalization for Children with Medical Complexity</title><title>The Journal of pediatrics</title><addtitle>J Pediatr</addtitle><description>To test associations between parent-reported confidence to avoid hospitalization and caregiving strain, activation, and health-related quality of life (HRQOL).
In this prospective cohort study, enrolled parents of children with medical complexity (n = 75) from 3 complex care programs received text messages (at random times every 2 weeks for 3 months) asking them to rate their confidence to avoid hospitalization in the next month. Low confidence, as measured on a 10-point Likert scale (1 = not confident; 10 = fully confident), was defined as a mean rating <5. Caregiving measures included the Caregiver Strain Questionnaire, Family Caregiver Activation in Transition (FCAT), and caregiver HRQOL (Medical Outcomes Study Short Form 12 [SF12]). Relationships between caregiving and confidence were assessed with a hierarchical logistic regression and classification and regression trees (CART) model.
The parents were mostly mothers (77%) and were linguistically diverse (20% spoke Spanish as their primary language), and 18% had low confidence on average. Demographic and clinical variables had weaker associations with confidence. In regression models, low confidence was associated with higher caregiver strain (aOR, 3.52; 95% CI, 1.45-8.54). Better mental HRQOL was associated with lower likelihood of low confidence (aOR, 0.89; 95% CI, 0.80-0.97). In the CART model, higher strain similarly identified parents with lower confidence. In all models, low confidence was not associated with caregiver activation (FCAT) or physical HRQOL (SF12) scores.
Parents of children with medical complexity with high strain and low mental HRQOL had low confidence in the range in which intervention to avoid hospitalization would be warranted. Future work could determine how adaptive interventions to improve confidence and prevent hospitalizations should account for strain and low mental HRQOL.</description><subject>Caregivers</subject><subject>caregiving</subject><subject>Child</subject><subject>confidence</subject><subject>Hospitalization</subject><subject>Humans</subject><subject>medical complexity</subject><subject>mHealth</subject><subject>mixed methods</subject><subject>Prospective Studies</subject><subject>Quality of Life</subject><subject>Surveys and Questionnaires</subject><issn>0022-3476</issn><issn>1097-6833</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU2P0zAQhi0EYsvCL0BCOXJJGNuxEx9AWkXAIi3iAuJoufaknSqNg50Wll9PSpcVXDjN4f2Y0TyMPedQceD61a7aTRhyJUCIClQFnD9gKw6mKXUr5UO2gkUpZd3oC_Yk5x0AmBrgMbuQSmmjhFixr51LuKEjjZvCjaHo4thTwNFjMcfi6hgpFNcxTzS7gX66meJY9DEV3ZaGkHAsvtO8LT5iIO-GJb2fBvxB8-1T9qh3Q8Znd_OSfXn39nN3Xd58ev-hu7opfa3MXLYCUXkppdawNtA2otd134OvXc3Xvln3UmgIGpTTjTbguUZv2mCEEjXvnbxkb86902G9x-BxnJMb7JRo79KtjY7sv8pIW7uJR2taBbUUS8HLu4IUvx0wz3ZP2eMwuBHjIVuhteLQCq0WqzxbfYo5J-zv13CwJyR2Z38jsSckFpRdkCypF39feJ_5w2AxvD4bcPnTkTDZ7OlEIFBCP9sQ6b8LfgGpU58z</recordid><startdate>20220801</startdate><enddate>20220801</enddate><creator>Coller, Ryan J.</creator><creator>Lerner, Carlos F.</creator><creator>Chung, Paul J.</creator><creator>Klitzner, Thomas S.</creator><creator>Cushing, Christopher C.</creator><creator>Warner, Gemma</creator><creator>Nacht, Carrie L.</creator><creator>Thompson, Lindsey R.</creator><creator>Eickhoff, Jens</creator><creator>Ehlenbach, Mary L.</creator><creator>Garrity, Brigid M.</creator><creator>Bowe, Terah</creator><creator>Berry, Jay G.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20220801</creationdate><title>Caregiving and Confidence to Avoid Hospitalization for Children with Medical Complexity</title><author>Coller, Ryan J. ; Lerner, Carlos F. ; Chung, Paul J. ; Klitzner, Thomas S. ; Cushing, Christopher C. ; Warner, Gemma ; Nacht, Carrie L. ; Thompson, Lindsey R. ; Eickhoff, Jens ; Ehlenbach, Mary L. ; Garrity, Brigid M. ; Bowe, Terah ; Berry, Jay G.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c459t-82ee5c333660b90872f64ff0c4a41bc7bf3260d605a67690c16ec98d925241fa3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Caregivers</topic><topic>caregiving</topic><topic>Child</topic><topic>confidence</topic><topic>Hospitalization</topic><topic>Humans</topic><topic>medical complexity</topic><topic>mHealth</topic><topic>mixed methods</topic><topic>Prospective Studies</topic><topic>Quality of Life</topic><topic>Surveys and Questionnaires</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Coller, Ryan J.</creatorcontrib><creatorcontrib>Lerner, Carlos F.</creatorcontrib><creatorcontrib>Chung, Paul J.</creatorcontrib><creatorcontrib>Klitzner, Thomas S.</creatorcontrib><creatorcontrib>Cushing, Christopher C.</creatorcontrib><creatorcontrib>Warner, Gemma</creatorcontrib><creatorcontrib>Nacht, Carrie L.</creatorcontrib><creatorcontrib>Thompson, Lindsey R.</creatorcontrib><creatorcontrib>Eickhoff, Jens</creatorcontrib><creatorcontrib>Ehlenbach, Mary L.</creatorcontrib><creatorcontrib>Garrity, Brigid M.</creatorcontrib><creatorcontrib>Bowe, Terah</creatorcontrib><creatorcontrib>Berry, Jay G.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>The Journal of pediatrics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Coller, Ryan J.</au><au>Lerner, Carlos F.</au><au>Chung, Paul J.</au><au>Klitzner, Thomas S.</au><au>Cushing, Christopher C.</au><au>Warner, Gemma</au><au>Nacht, Carrie L.</au><au>Thompson, Lindsey R.</au><au>Eickhoff, Jens</au><au>Ehlenbach, Mary L.</au><au>Garrity, Brigid M.</au><au>Bowe, Terah</au><au>Berry, Jay G.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Caregiving and Confidence to Avoid Hospitalization for Children with Medical Complexity</atitle><jtitle>The Journal of pediatrics</jtitle><addtitle>J Pediatr</addtitle><date>2022-08-01</date><risdate>2022</risdate><volume>247</volume><spage>109</spage><epage>115.e2</epage><pages>109-115.e2</pages><issn>0022-3476</issn><eissn>1097-6833</eissn><abstract>To test associations between parent-reported confidence to avoid hospitalization and caregiving strain, activation, and health-related quality of life (HRQOL).
In this prospective cohort study, enrolled parents of children with medical complexity (n = 75) from 3 complex care programs received text messages (at random times every 2 weeks for 3 months) asking them to rate their confidence to avoid hospitalization in the next month. Low confidence, as measured on a 10-point Likert scale (1 = not confident; 10 = fully confident), was defined as a mean rating <5. Caregiving measures included the Caregiver Strain Questionnaire, Family Caregiver Activation in Transition (FCAT), and caregiver HRQOL (Medical Outcomes Study Short Form 12 [SF12]). Relationships between caregiving and confidence were assessed with a hierarchical logistic regression and classification and regression trees (CART) model.
The parents were mostly mothers (77%) and were linguistically diverse (20% spoke Spanish as their primary language), and 18% had low confidence on average. Demographic and clinical variables had weaker associations with confidence. In regression models, low confidence was associated with higher caregiver strain (aOR, 3.52; 95% CI, 1.45-8.54). Better mental HRQOL was associated with lower likelihood of low confidence (aOR, 0.89; 95% CI, 0.80-0.97). In the CART model, higher strain similarly identified parents with lower confidence. In all models, low confidence was not associated with caregiver activation (FCAT) or physical HRQOL (SF12) scores.
Parents of children with medical complexity with high strain and low mental HRQOL had low confidence in the range in which intervention to avoid hospitalization would be warranted. Future work could determine how adaptive interventions to improve confidence and prevent hospitalizations should account for strain and low mental HRQOL.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>35569522</pmid><doi>10.1016/j.jpeds.2022.05.011</doi><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; ScienceDirect Journals (5 years ago - present) |
| subjects | Caregivers caregiving Child confidence Hospitalization Humans medical complexity mHealth mixed methods Prospective Studies Quality of Life Surveys and Questionnaires |
| title | Caregiving and Confidence to Avoid Hospitalization for Children with Medical Complexity |
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