scholarly journals Utility of cognitive behavioral therapy to reduce pain in children with sickle cell disease

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Abigail Radomsky
Keyword(s):  
Sickle Cell Disease ◽  
Cognitive Behavioral Therapy ◽  
Sickle Cell ◽  
Behavioral Therapy ◽  
Clinical Decision ◽  
Cognitive Behavioral ◽  
Cell Disease ◽  
Behavioral Training ◽  
Clinical Journal

A clinical decision report appraising: Schatz J, Schlenz AM, McClellan CB, et al. Changes in coping, pain, and activity after cognitive-behavioral training. The Clinical Journal of Pain 2015;31(6):536-47 https://doi.org/10.1097/ajp.0000000000000183 for a child with sickle cell disease.

scholarly journals Patient-Centered eHealth Interventions for Children, Adolescents, and Adults With Sickle Cell Disease: Systematic Review (Preprint)

2018 ◽  
Author(s):  
Sherif M Badawy ◽  
Robert M Cronin ◽  
Jane Hankins ◽  
Lori Crosby ◽  
Michael DeBaun ◽  
...  
Keyword(s):  
Systematic Review ◽  
Sickle Cell Disease ◽  
Cognitive Behavioral Therapy ◽  
Sickle Cell ◽  
Behavioral Therapy ◽  
Cognitive Behavioral ◽  
Self Management ◽  
Original Research ◽  
Cell Disease ◽  
Blood Disorder

BACKGROUND Sickle cell disease is an inherited blood disorder that affects over 100,000 Americans. Sickle cell disease–related complications lead to significant morbidity and early death. Evidence supporting the feasibility, acceptability, and efficacy of self-management electronic health (eHealth) interventions in chronic diseases is growing; however, the evidence is unclear in sickle cell disease. OBJECTIVE We systematically evaluated the most recent evidence in the literature to (1) review the different types of technological tools used for self-management of sickle cell disease, (2) discover and describe what self-management activities these tools were used for, and (3) assess the efficacy of these technologies in self-management. METHODS We reviewed literature published between 1995 and 2016 with no language limits. We searched MEDLINE, EMBASE, CINAHL, PsycINFO, and other sources. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Two independent reviewers screened titles and abstracts, assessed full-text articles, and extracted data from articles that met inclusion criteria. Eligible studies were original research articles that included texting, mobile phone–based apps, or other eHealth interventions designed to improve self-management in pediatric and adult patients with sickle cell disease. RESULTS Of 1680 citations, 16 articles met all predefined criteria with a total of 747 study participants. Interventions were text messaging (4/16, 25%), native mobile apps (3/16, 19%), Web-based apps (5/16, 31%), mobile directly observed therapy (2/16, 13%), internet-delivered cognitive behavioral therapy (2/16, 13%), electronic pill bottle (1/16, 6%), or interactive gamification (2/16, 13%). Interventions targeted monitoring or improvement of medication adherence (5/16, 31%); self-management, pain reporting, and symptom reporting (7/16, 44%); stress, coping, sleep, and daily activities reporting (4/16, 25%); cognitive training for memory (1/16, 6%); sickle cell disease and reproductive health knowledge (5/16, 31%); cognitive behavioral therapy (2/16, 13%); and guided relaxation interventions (1/16, 6%). Most studies (11/16, 69%) included older children or adolescents (mean or median age 10-17 years; 11/16, 69%) and 5 included young adults (≥18 years old) (5/16, 31%). Sample size ranged from 11 to 236, with a median of 21 per study: <20 in 6 (38%), ≥20 to <50 in 6 (38%), and >50 participants in 4 studies (25%). Most reported improvement in self-management–related outcomes (15/16, 94%), as well as high satisfaction and acceptability of different study interventions (10/16, 63%). CONCLUSIONS Our systematic review identified eHealth interventions measuring a variety of outcomes, which showed improvement in multiple components of self-management of sickle cell disease. Despite the promising feasibility and acceptability of eHealth interventions in improving self-management of sickle cell disease, the evidence overall is modest. Future eHealth intervention studies are needed to evaluate their efficacy, effectiveness, and cost effectiveness in promoting self-management in patients with sickle cell disease using rigorous methods and theoretical frameworks with clearly defined clinical outcomes.

Cognitive Behavioral Therapy in Patients With Sickle Cell Disease

2015 ◽  
Vol 21 (1) ◽  
pp. 38-46 ◽  
Author(s):  
Sheena Daniels
Keyword(s):  
Quality Of Life ◽  
Sickle Cell Disease ◽  
Cognitive Behavioral Therapy ◽  
Sickle Cell ◽  
Behavioral Therapy ◽  
The United States ◽  
Cognitive Behavioral ◽  
Psychological Interventions ◽  
Cell Disease

Introduction: Sickle cell disease (SCD) is an inherited autosomal recessive disorder. In the United States, most individuals with SCD are African Americans, with an incidence of 1 in 400 to 1 in 500 live births. SCD is a lifelong disorder with no known cure.Background: SCD causes anemia, frequent painful episodes, and reduced life expectancy. The most disturbing clinical problem associated with SCD is severe pain episodes, the most common reason for hospitalization. Pharmacological interventions have been the mainstream for treatment; however, psychological interventions such as cognitive behavioral therapy (CBT) may complement current medical treatment, leading to better coping and overall improved quality of life.Methods: In a quasi-experimental one-group pretest–posttest study, 9 African American individuals with SCD completed 3 weekly educational sessions learning CBT methods.Results: Participants demonstrated increased frequency of use of CBT methods post-intervention, including diverting attention, coping self-statements, and behavioral activities, leading to better pain control. However, quality of life and role limitation did not show significant improvement.Discussion: CBT may be beneficial to those suffering from SCD when combined with conventional treatment options; however, there are still barriers to incorporating psychological interventions into practice.Conclusions: CBT shows promise for individuals with chronic conditions such as SCD, but more investigation into its efficacy is needed with larger sample sizes over longer periods of time.

scholarly journals The Role of Cognitive Behavioral Therapy in Opioid Use Reduction in Pediatric Sickle Cell Disease: Protocol for a Systematic Review (Preprint)

2018 ◽  
Author(s):  
Ashaunta T Anderson ◽  
Nhu Tran ◽  
Kathryn Smith ◽  
Lorraine I Kelley-Quon
Keyword(s):  
Systematic Review ◽  
Pain Management ◽  
Sickle Cell Disease ◽  
Cognitive Behavioral Therapy ◽  
Sickle Cell ◽  
Behavioral Therapy ◽  
Cognitive Behavioral ◽  
Cell Disease ◽  
Opioid Use ◽  
Eligibility Criteria

BACKGROUND Sickle cell disease (SCD) is a genetic disorder of red blood cells that results in acute and chronic health problems, including painful syndromes. Opioid analgesia is the mainstay of moderate to severe pain management in SCD, although adjunctive psychosocial approaches such as cognitive behavioral therapy (CBT) are increasingly incorporated. CBT has been used in populations of various ages to address a wide range of issues, such as mood disorders and chronic pain. It is unclear if effective CBT reduces the use of opioids to manage pain in pediatric SCD. OBJECTIVE The aim of this study is to evaluate the association between CBT and decreased opioid use in children with SCD. METHODS In this systematic review protocol, we describe our approach to applying predetermined eligibility criteria to searches of PubMed (including Medline), Embase, Cochrane, Web of Science, and PsycINFO databases, as well as Google Scholar and grey literature. In particular, we will use keywords to search for English-language studies of individuals with SCD aged 21 years old and younger published before November 2018. Keywords will allow us to assess for the primary outcome—total use of opioid medications—and the secondary outcomes—pain intensity and emotional functioning—during pain management using a combined opioid and CBT approach, opioids alone, or CBT alone. The review team will use standardized abstraction forms to review articles at the title, abstract, and full-text levels. Finally, reviewers will assess the risk for bias, quality of evidence, and adequacy of data for quantitative versus qualitative synthesis. If meta-analysis is deemed inappropriate, a narrative review will be conducted. RESULTS We will report a summary of findings across studies that meet eligibility criteria to compare the extent to which adjunctive CBT is associated with decreased opioid use among children with SCD. CONCLUSIONS This systematic review will present the current state of the evidence on CBT and opioid use in pediatric SCD, which may inform clinical practice and health policy to support optimized pain management. INTERNATIONAL REGISTERED REPOR PRR1-10.2196/13211

scholarly journals Attitudes toward Management of Sickle Cell Disease and Its Complications: A National Survey of Academic Family Physicians

Anemia ◽  
2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Arch G. Mainous ◽  
Rebecca J. Tanner ◽  
Christopher A. Harle ◽  
Richard Baker ◽  
Navkiran K. Shokar ◽  
...  
Keyword(s):  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Family Physicians ◽  
Clinical Decision ◽  
The United States ◽  
Significant Degree ◽  
Medical Intervention ◽  
Comfort Level ◽  
Cell Disease ◽  
Research Alliance

Objective. Sickle cell disease (SCD) is a disease that requires a significant degree of medical intervention, and family physicians are one potential provider of care for patients who do not have access to specialists. The extent to which family physicians are comfortable with the treatment of and concerned about potential complications of SCD among their patients is unclear. Our purpose was to examine family physician’s attitudes toward SCD management.Methods. Data was collected as part of the Council of Academic Family Medicine Educational Research Alliance (CERA) survey in the United States and Canada that targeted family physicians who were members of CERA-affiliated organizations. We examined attitudes regarding management of SCD.Results. Overall, 20.4% of respondents felt comfortable with treatment of SCD. There were significant differences in comfort level for treatment of SCD patients depending on whether or not physicians had patients who had SCD, as well as physicians who had more than 10% African American patients. Physicians also felt that clinical decision support (CDS) tools would be useful for treatment (69.4%) and avoiding complications (72.6%) in managing SCD patients.Conclusions. Family physicians are generally uncomfortable with managing SCD patients and recognize the utility of CDS tools in managing patients.

scholarly journals Addressing Sickle Cell Disease Implicit Bias in Internal Medicine Residents

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 2965-2965
Author(s):  
Nabil Abou Baker ◽  
Daniela Anderson ◽  
Byron Brooks
Keyword(s):  
Internal Medicine ◽  
Sickle Cell Disease ◽  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Automatic Thoughts ◽  
Cell Disease ◽  
Individual Level ◽  
Implicit Biases ◽  
Internal Medicine Residents

Abstract Introduction: Throughout the years, patients with sickle cell disease (SCD) have been subjected to biases and stigmas that have affected their care, which then leads to them experiencing greater pain and a lower quality of life. Literature continues to show that patients suffer from their pain being discounted during hospitalizations. In the previous year, our group showed that our internal medicine residents had negative implicit biases (IB) toward patients with SCD. Frameworks and trainings exist for addressing different aspects of IB; however, none exists to address implicit biases on the individual level. We developed an implicit bias module (SOAR) for residents to complete to help address negative IB toward patients with SCD. Methods: Twenty-three 2 nd and 3 rd year internal medicine residents went through the SOAR module for addressing IB twice. The SOAR framework assisted the residents in self-identification of the IB, observing when the IB occurs, creating an action plan to address the IB, and repeating the steps for maintenance. SOAR framework is heavily based on methods from cognitive behavioral therapy. The SOAR sample case for residents involved a patient with SCD requiring pain medication. Residents were surveyed on their initial forming thoughts, in this case the IB, emotions, and intensity of the IB or emotion before and after going through the module. A 10-point Likert scale (10 = high/1=low) was used to judge intensity of the IB or emotion. Results: Residents had a range of initial thoughts such as: failure, suspicion and opioids, pity and boring admission, chronic pain and dread of confrontation, and frustration, with an average belief of 7/10 in that thought. Their emotions initially included: frustration, sadness, shame, guilt, worry, and pessimism with an average belief of 5.5/10 in that emotion. After completing SOAR, the average belief in the initial IB decreased to 4.3/10. Emotions changed to feelings of regret and sadness with an average intensity of 6/10. 75% of the residents found the lecture helpful, 92% stated they believed it is important to address implicit biases, and 100% stated that they would use SOAR framework to address their own negative implicit biases. Discussion: The IB module is based on cognitive behavioral therapy techniques and uses concepts typically reserved for automatic thoughts such as in patients with depression or anxiety. We substituted automatic thoughts for IB. It is important to address negative IB that affect our patients and their care. We have attempted in this module to address IB on a personal or individual level for residents. The SOAR criteria helped focus on improving conscious efforts to overcome IB. This training is not enough for addressing all the faults in the medical system that perpetuates biases and health inequities toward patients with SCD or any other medical condition. It can be used to supplement other methods such as education about influences and patient outcomes, increasing awareness, and making systemic changes. Limitations in this study include voluntary participation in the survey during the module leading to a different number of respondents answering each question as well as being underpowered. Conclusion: Individual or personal strategies can be used to effectively address implicit biases we hold. Addressing implicit biases may help decrease the negative impact these biases have on patients and improve quality of care for patients with SCD. Disclosures No relevant conflicts of interest to declare.

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