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Erschienen in: The Patient - Patient-Centered Outcomes Research 1/2015

01.02.2015 | Original Research Article

Adopting a Sustainable Community of Practice Model when Developing a Service to Support Patients with Epidermolysis Bullosa (EB): A Stakeholder-Centered Approach

verfasst von: Rosemary Joan Gowran, Avril Kennan, Siobhán Marshall, Irene Mulcahy, Sile Ní Mhaille, Sarah Beasley, Mark Devlin

Erschienen in: The Patient - Patient-Centered Outcomes Research | Ausgabe 1/2015

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Abstract

Objectives

Epidermolysis bullosa (EB) is a rare, genetic skin condition that is complicated, distressing, and painful and permeates every aspect of patients’ lives. Support services are essential for meeting the primary needs of patients and families living with EB; however, provision is challenged by many complex issues. In collaboration with the patient organization DEBRA Ireland, this research conducted an in-depth analysis of Irish healthcare support services for EB, with a view to moving towards an improved and sustainable care pathway.

Methods

A sustainable community of practice model (SCOP), as a core construct provided a simplified framework when studying this complex system. The research utilized mixed methods, comprising individual interviews, questionnaires, and a participatory action research workshop based on a soft systems approach. The study engaged patients, family members, service providers, and policy developers.

Results

Findings emphasized that the complexities of life with EB are more than ‘skin deep’. The lived experience of stakeholders revealed many levels of emotion, both positive and heart-rending. Despite the positive efforts of specialists in this field, inadequacies to meet the primary needs of people with EB, such as bandages—fundamental for survival—were highlighted. Participants reported challenges relating to understanding patients’ needs, access to consistent services within hospitals and the community, time constraints, and the strong emotions evoked by this severe and rare disease.

Conclusions

The study identified several areas that can be targeted to bring about improvements in meeting primary needs. Education and research at public, policy, and practice levels need to be prioritized. It is imperative that citizens move beyond an awareness that EB exists and demonstrate a consciousness about the importance of advocating and enabling seamless and sustainable support services through collective action.
Literatur
1.
Zurück zum Zitat Pagliarello C, Tabolli S. Factors affecting quality of life in epidermolysisbullosa. Expert Rev Pharmacoecon Res. 2010;10(3):329–38. Pagliarello C, Tabolli S. Factors affecting quality of life in epidermolysisbullosa. Expert Rev Pharmacoecon Res. 2010;10(3):329–38.
2.
Zurück zum Zitat Fine JD. A genetic disease of altered cell adhesion and wound healing, and the possible clinical utility of topically applied thymosin. Ann NY Acad Sci. 2007;1112:396–406.7.PubMedCrossRef Fine JD. A genetic disease of altered cell adhesion and wound healing, and the possible clinical utility of topically applied thymosin. Ann NY Acad Sci. 2007;1112:396–406.7.PubMedCrossRef
4.
Zurück zum Zitat Frew JW, Martin LK, Nijsten T, Murrell DF. Quality of life evaluation in epidermolysisbullosa (EB) through the development of the QOLEB questionnaire: an EB-specific quality of life instrument. Br J Dermatol. 2009;161:1323–30.PubMedCrossRef Frew JW, Martin LK, Nijsten T, Murrell DF. Quality of life evaluation in epidermolysisbullosa (EB) through the development of the QOLEB questionnaire: an EB-specific quality of life instrument. Br J Dermatol. 2009;161:1323–30.PubMedCrossRef
5.
Zurück zum Zitat Sarkar R, Bansal S, Garg VK. EpidermolysisBullosa: where do we stand? Indian J Dermatol Venereol Leprol. 2011;77(4):431–8.PubMedCrossRef Sarkar R, Bansal S, Garg VK. EpidermolysisBullosa: where do we stand? Indian J Dermatol Venereol Leprol. 2011;77(4):431–8.PubMedCrossRef
6.
Zurück zum Zitat Pope E, Lara-Corrales I, Mellerio J, Martinez A, Schultz G, Burrell R, Goodman L, Coutts P, Wagner J, Allen U, Sibbald G. A consensus approach to wound care in epidermolysisbullosa’. J Am Acad Derm. 2012;67(5):904–17.PubMedCentralPubMedCrossRef Pope E, Lara-Corrales I, Mellerio J, Martinez A, Schultz G, Burrell R, Goodman L, Coutts P, Wagner J, Allen U, Sibbald G. A consensus approach to wound care in epidermolysisbullosa’. J Am Acad Derm. 2012;67(5):904–17.PubMedCentralPubMedCrossRef
7.
Zurück zum Zitat Mellerio J. Infection and colonization in EpidermolysisBullosa. Dermatol Clin. 2010;28(2):267.PubMedCrossRef Mellerio J. Infection and colonization in EpidermolysisBullosa. Dermatol Clin. 2010;28(2):267.PubMedCrossRef
8.
Zurück zum Zitat Murat-Sušić S, Husar K, Skerlev M, Marinović B, Babić I. Inherited epidermolysisbullosa—the spectrum of complications. Acta Dermatovenerol Croat ADC. 2011;19(4):255–63. Murat-Sušić S, Husar K, Skerlev M, Marinović B, Babić I. Inherited epidermolysisbullosa—the spectrum of complications. Acta Dermatovenerol Croat ADC. 2011;19(4):255–63.
9.
Zurück zum Zitat Fine JD. Inherited epidermolysisbullosa. Orphanet J Rare Dis. 2010;5(12):1–17. Fine JD. Inherited epidermolysisbullosa. Orphanet J Rare Dis. 2010;5(12):1–17.
10.
Zurück zum Zitat Denyer J. Management of the infant with epidermolysisbullosa. Infant. 2009;5(6):168–71. Denyer J. Management of the infant with epidermolysisbullosa. Infant. 2009;5(6):168–71.
11.
Zurück zum Zitat Ramirez MN, Murrell DF, Fine JD. Management of epidermolysisbullosa. Expert Opin Orphan Drugs. 2013;1(4):279–93.CrossRef Ramirez MN, Murrell DF, Fine JD. Management of epidermolysisbullosa. Expert Opin Orphan Drugs. 2013;1(4):279–93.CrossRef
12.
Zurück zum Zitat Dietz MJ. A day in the life of a patient with DDEB. J Am Acad Dermatol. 2004;51(1):58–9.CrossRef Dietz MJ. A day in the life of a patient with DDEB. J Am Acad Dermatol. 2004;51(1):58–9.CrossRef
13.
Zurück zum Zitat Fine JD, Johnson LB, Weiner M, Suchindran C. Assessment of mobility, activities and pain in different subtypes of epidermolysisbullosa. Clin Exp Dermatol. 2004;29:122–7.PubMedCrossRef Fine JD, Johnson LB, Weiner M, Suchindran C. Assessment of mobility, activities and pain in different subtypes of epidermolysisbullosa. Clin Exp Dermatol. 2004;29:122–7.PubMedCrossRef
14.
Zurück zum Zitat Dures E, Morris M, Gleeson K, Rumsey N. The psychosocial impact of epidermolysisbullosa. Qual Health Res. 2011;21(6):771–82.PubMedCrossRef Dures E, Morris M, Gleeson K, Rumsey N. The psychosocial impact of epidermolysisbullosa. Qual Health Res. 2011;21(6):771–82.PubMedCrossRef
15.
Zurück zum Zitat Moss K. Contact at the borderline: psychoanalytic psychotherapy with EB patients. Br J Nurs (BJN). 2008;17(7):449–55.CrossRef Moss K. Contact at the borderline: psychoanalytic psychotherapy with EB patients. Br J Nurs (BJN). 2008;17(7):449–55.CrossRef
16.
Zurück zum Zitat Tabolli S, Sampogna F, Di Pietro C, Paradisi A, Uras C, Zotti P, Castiglia D, Zambruno G, Abeni D. Quality of life in patients with epidermolysisbullosa. Br J Dermatol. 2009;161(5):869–77.PubMedCrossRef Tabolli S, Sampogna F, Di Pietro C, Paradisi A, Uras C, Zotti P, Castiglia D, Zambruno G, Abeni D. Quality of life in patients with epidermolysisbullosa. Br J Dermatol. 2009;161(5):869–77.PubMedCrossRef
17.
Zurück zum Zitat Andreoli E, Mozzetta A, Angelo C, Paradisi M, Foglio-Bonda G. Epidermolysisbullosa: psychological and psychosocial aspects. Dermatol Psychosom. 2002;3(2):77–81.CrossRef Andreoli E, Mozzetta A, Angelo C, Paradisi M, Foglio-Bonda G. Epidermolysisbullosa: psychological and psychosocial aspects. Dermatol Psychosom. 2002;3(2):77–81.CrossRef
18.
Zurück zum Zitat Margari F, Lecce PA, Santamato W, Ventura P, Sportelli N, Annicchiarico G, Bonifazi E. Psychiatric symptoms and quality of life in patients affected by epidermolysisbullosa. J Clin Psychol Med Settings. 2010;17:333–9.PubMedCrossRef Margari F, Lecce PA, Santamato W, Ventura P, Sportelli N, Annicchiarico G, Bonifazi E. Psychiatric symptoms and quality of life in patients affected by epidermolysisbullosa. J Clin Psychol Med Settings. 2010;17:333–9.PubMedCrossRef
19.
Zurück zum Zitat Tabolli S, Pagliarello C, Uras C, Di Pietro C, Zambruno G, Castiglia D, Sampogna F, Abeni D. Family burden in epidermolysisbullosa is high independent of disease type / subtype. Acta Derm Venereol. 2010;90:607–11.PubMedCrossRef Tabolli S, Pagliarello C, Uras C, Di Pietro C, Zambruno G, Castiglia D, Sampogna F, Abeni D. Family burden in epidermolysisbullosa is high independent of disease type / subtype. Acta Derm Venereol. 2010;90:607–11.PubMedCrossRef
20.
Zurück zum Zitat Fine JD, Johnson LB, Weiner M, Suchindran C. Impact of inherited epidermolysisbullosa on parental interpersonal relationships, marital status and family size. Br J Dermatol. 2005;152:1009–14.PubMedCrossRef Fine JD, Johnson LB, Weiner M, Suchindran C. Impact of inherited epidermolysisbullosa on parental interpersonal relationships, marital status and family size. Br J Dermatol. 2005;152:1009–14.PubMedCrossRef
21.
Zurück zum Zitat Williams FE, Gannon K, Soon K. The experiences of young people with epidermolysisbullosa simplex: a qualitative study’. J Health Psychol. 2011;16:701.PubMedCrossRef Williams FE, Gannon K, Soon K. The experiences of young people with epidermolysisbullosa simplex: a qualitative study’. J Health Psychol. 2011;16:701.PubMedCrossRef
22.
Zurück zum Zitat van Scheppingen C, Lettinga AT, Duipmans JC, Maathuis CGB, Jonkman MF. Main problems experienced by children with epidermolysisbullosa: a qualitative study with semi-structured interviews. Acta Derm Venereologica. 2008;88(2):143–50.CrossRef van Scheppingen C, Lettinga AT, Duipmans JC, Maathuis CGB, Jonkman MF. Main problems experienced by children with epidermolysisbullosa: a qualitative study with semi-structured interviews. Acta Derm Venereologica. 2008;88(2):143–50.CrossRef
23.
Zurück zum Zitat Horn HM, Tidman MJ. Quality of life in epidermolysisbullosa. Clinical Exp Dermatol. 2002;27(6):707–10.CrossRef Horn HM, Tidman MJ. Quality of life in epidermolysisbullosa. Clinical Exp Dermatol. 2002;27(6):707–10.CrossRef
24.
Zurück zum Zitat Dures E, Morris M, Gleeson K, Rumsey N. “You’re whatever the patient needs at the time”. The impact on health and social care professionals of supporting people with epidermolysisbullosa. Chronic Illn. 2010;6(3):215–27.PubMedCrossRef Dures E, Morris M, Gleeson K, Rumsey N. “You’re whatever the patient needs at the time”. The impact on health and social care professionals of supporting people with epidermolysisbullosa. Chronic Illn. 2010;6(3):215–27.PubMedCrossRef
27.
Zurück zum Zitat Gowran RJ. Building a sustainable wheelchair and seating provision community—meeting peoples’ primary needs now and in the future. Unpublished thesis (PhD). University of Limerick. 2012. Gowran RJ. Building a sustainable wheelchair and seating provision community—meeting peoples’ primary needs now and in the future. Unpublished thesis (PhD). University of Limerick. 2012.
28.
Zurück zum Zitat Checkland P, Scholes J. Soft systems methodology in action. Chichester: Wiley; 1999. Checkland P, Scholes J. Soft systems methodology in action. Chichester: Wiley; 1999.
29.
Zurück zum Zitat Kronenberg F, Algado SS, Pollard N. Occupational therapy without borders—learning from the spirit of survivors. London: Elsevier Limited; 2005. Kronenberg F, Algado SS, Pollard N. Occupational therapy without borders—learning from the spirit of survivors. London: Elsevier Limited; 2005.
30.
Zurück zum Zitat Seghezzo L. The five dimensions of sustainability. Environ Polit. 2009;18(4):539–56.CrossRef Seghezzo L. The five dimensions of sustainability. Environ Polit. 2009;18(4):539–56.CrossRef
31.
Zurück zum Zitat Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77–101.CrossRef Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77–101.CrossRef
32.
Zurück zum Zitat Gowran RJ. Sustainable solutions for wheelchair and seating assistive technology provision: presenting a cosmopolitan narrative with rich pictures. Assistive Technology Research Series; vol. 33. Amsterdam: IOS Press; 2013:290-297. Gowran RJ. Sustainable solutions for wheelchair and seating assistive technology provision: presenting a cosmopolitan narrative with rich pictures. Assistive Technology Research Series; vol. 33. Amsterdam: IOS Press; 2013:290-297.
33.
Zurück zum Zitat Palazzo G. Post-national constellations of innovativeness: a cosmopolitan approach. Technol Anal Strateg Manag. 2005;17(1):55–72.CrossRef Palazzo G. Post-national constellations of innovativeness: a cosmopolitan approach. Technol Anal Strateg Manag. 2005;17(1):55–72.CrossRef
34.
Zurück zum Zitat Pollard N, Sakellariou D, Kronenberg, F. A political practice of occupational therapy. Edinburgh: Elsevier; 2009. Pollard N, Sakellariou D, Kronenberg, F. A political practice of occupational therapy. Edinburgh: Elsevier; 2009.
35.
Zurück zum Zitat Yuen WY, Duipmans JC, Jonkman MF. The needs of parents of children suffering with lethal epidermolysisbullosa. Br J Dermatol. 2012;167(3):613–8.PubMedCrossRef Yuen WY, Duipmans JC, Jonkman MF. The needs of parents of children suffering with lethal epidermolysisbullosa. Br J Dermatol. 2012;167(3):613–8.PubMedCrossRef
36.
38.
Zurück zum Zitat Dziopa F, Ahern K. What make a quality therapeutic relationship in psychiatric/mental health nursing: a review of the literature. Internet J Adv Nurs Pract. 2008;10:1. Dziopa F, Ahern K. What make a quality therapeutic relationship in psychiatric/mental health nursing: a review of the literature. Internet J Adv Nurs Pract. 2008;10:1.
39.
Zurück zum Zitat Moyle W. Nursing-patient relationship: a dichotomy of expectations. Int J Ment Health Nurs. 2003;12:103–9.PubMedCrossRef Moyle W. Nursing-patient relationship: a dichotomy of expectations. Int J Ment Health Nurs. 2003;12:103–9.PubMedCrossRef
40.
Zurück zum Zitat Sumsion T. Client-centred practice in occupational therapy a guide to implementation. 2nd ed. London: Churchill Livingston, Elsevier Science; 2006. Sumsion T. Client-centred practice in occupational therapy a guide to implementation. 2nd ed. London: Churchill Livingston, Elsevier Science; 2006.
41.
Zurück zum Zitat Abelenda J, Keilhofner G, Yolanda SB, Keilhofner K. The model of human occupation as a conceptual tool for understanding and addressing occupational apartheid. In Kronenberg F, Algado SS, Pollard N. Occupational therapy without borders—learning from the spirit of survivors. London: Elsevier Limited; 2005. Abelenda J, Keilhofner G, Yolanda SB, Keilhofner K. The model of human occupation as a conceptual tool for understanding and addressing occupational apartheid. In Kronenberg F, Algado SS, Pollard N. Occupational therapy without borders—learning from the spirit of survivors. London: Elsevier Limited; 2005.
43.
Zurück zum Zitat Leung KK, Silvius JL, Pimlott N, Dalziel W, Drummond N. Why health expectations and hopes are different: the development of a conceptual model. Health Expect. 2009;12:347–60.PubMedCrossRef Leung KK, Silvius JL, Pimlott N, Dalziel W, Drummond N. Why health expectations and hopes are different: the development of a conceptual model. Health Expect. 2009;12:347–60.PubMedCrossRef
44.
Zurück zum Zitat Maden S, Pakenham KI. The stress-buffering effects of hope on adjustment to mulitiple sclerosis. Int J Behav Med. Epub 17 Jan 2014. Maden S, Pakenham KI. The stress-buffering effects of hope on adjustment to mulitiple sclerosis. Int J Behav Med. Epub 17 Jan 2014.
Metadaten
Titel
Adopting a Sustainable Community of Practice Model when Developing a Service to Support Patients with Epidermolysis Bullosa (EB): A Stakeholder-Centered Approach
verfasst von
Rosemary Joan Gowran
Avril Kennan
Siobhán Marshall
Irene Mulcahy
Sile Ní Mhaille
Sarah Beasley
Mark Devlin
Publikationsdatum
01.02.2015
Verlag
Springer International Publishing
Erschienen in
The Patient - Patient-Centered Outcomes Research / Ausgabe 1/2015
Print ISSN: 1178-1653
Elektronische ISSN: 1178-1661
DOI
https://doi.org/10.1007/s40271-014-0097-5

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