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Exploring the impact of paediatric localized scleroderma on health‐related quality of life: focus groups with youth and caregivers
Author(s) -
Zigler C.K.,
Ardalan K.,
Hernandez A.,
Caliendo A.E.,
Magee K.E.,
Terry M.A.,
Mann C.M.,
Torok K.S.
Publication year - 2020
Publication title -
british journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.304
H-Index - 179
eISSN - 1365-2133
pISSN - 0007-0963
DOI - 10.1111/bjd.18879
Subject(s) - disfigurement , focus group , medicine , quality of life (healthcare) , qualitative research , physical therapy , clinical psychology , gerontology , pediatrics , surgery , nursing , sociology , social science , marketing , business
Summary Background Paediatric localized scleroderma ( LS ) can negatively impact health‐related quality of life ( HRQ oL) by causing skin fibrosis, abnormal limb development, disfigurement, and side‐effects from immunosuppressive treatment. Studies to date have rarely included qualitative data gathered directly from paediatric patients with LS . Objectives To assess the impact of LS on HRQ oL among affected youth and their caregivers using qualitative description. Methods Youth with all subtypes of LS and their caregivers were purposively sampled to participate in age‐appropriate focus groups (younger children, early adolescents, adolescents). Each group started with a drawing exercise followed by in‐depth discussion of topics including skin symptoms (e.g. itch, pain, tightness), functional impairment, physical appearance, family and peer relationships, and treatment burden. Focus groups were transcribed verbatim and co‐coded, with adjudication of differentially applied codes. The study findings were triangulated via comparison with adult reports and published literature. Results Eleven youth aged 9–16 years and 16 caregivers participated in three focus groups each. Major identified areas of impact included uncomfortable skin symptoms, physical functioning limitations, extracutaneous manifestations, body image, bullying and teasing, unwanted questioning from others, and treatment side‐effects and burden. Conclusions This is the first qualitative study of HRQ oL in LS to include all major LS subtypes. We identified domains of HRQ oL impacted by LS , some of which replicate earlier findings and some of which were novel. As impact also changed with developmental stage, our findings support the need for ongoing, formal evaluation of HRQ oL in children and adolescents with LS .What is already known about this topic? Paediatric localized scleroderma (LS) negatively impacts health‐related quality of life (HRQoL) via skin fibrosis, musculoskeletal and other extracutaneous manifestations from the disease process, and side‐effects of systemic immunosuppression. The full impact of LS and its treatment on HRQoL is incompletely understood, with only one published qualitative study of youth with LS, which was limited to facial involvement. There are no qualitative studies of HRQoL in other LS subtypes to date.What does this study add? This is the first qualitative evaluation of HRQoL in youth with LS inclusive of all disease subtypes. Our study confirms that LS affects HRQoL across multiple distinct domains, including uncomfortable skin sensations, impacts on body image, bullying and teasing from peers, unwanted intrusive questioning, physical limitations, extracutaneous manifestations and high treatment burden. These results indicate the need for ongoing clinical assessment of paediatric patients in these domains.What are the clinical implications of the work? These results support the need to care for patients with LS holistically by synthesizing cutaneous, musculoskeletal and extracutaneous disease assessments with multidimensional evaluation of psychosocial impact and adverse effects of treatments. The development of an LS‐specific HRQoL measure would advance such efforts.