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Coping and health service utilisation in a UK study of paediatric sickle cell pain
1Brent Sickle Cell and Thalassaemia Centre, Department of Haematology, Central Middlesex Hospital, London, UK. kofi@sickle-psychology.com
Insights
Children with sickle cell disease experience severe pain, influencing their health service use. Psychological coping strategies significantly impact pain severity and healthcare utilization, suggesting a need for integrated interventions.
Area of Science:
- Pediatric Hematology
- Psychology
- Health Services Research
Background:
- Sickle cell disease (SCD) is a genetic blood disorder characterized by severe, recurrent pain episodes.
- Understanding pain management and coping mechanisms in pediatric SCD patients is crucial for effective healthcare.
- The relationship between coping strategies, pain experience, and health service utilization in children with SCD requires further investigation.
Purpose of the Study:
- To evaluate pain and coping strategies in children diagnosed with sickle cell disease.
- To investigate the correlation between pain, coping mechanisms, and the utilization of health services among these children.
- To identify psychological factors influencing pain severity and healthcare access in pediatric SCD.
Main Methods:
- A cross-sectional study was conducted with 67 children suffering from sickle cell disease across three London hospitals.
- Data collection involved interviews and questionnaires assessing pain, health service use, and coping responses using a revised Coping Strategies Questionnaire (CSQ).
- Relevant medical data, including SCD complications, hemoglobin (Hb) levels, and fetal hemoglobin (HbF) percentages, were also gathered.
Main Results:
- Pain was a significant factor, accounting for approximately 24% of hospital service utilization, irrespective of demographic or clinical variables.
- A notable proportion (42%) of patients had not utilized hospital services within the preceding 12 months.
- Factor analysis of the CSQ identified three coping patterns: active coping, affective coping, and passive adherence coping. Passive adherence coping predicted pain severity, while active coping predicted hospital service utilization.
Conclusions:
- Pediatric sickle cell disease frequently involves severe, recurring pain, sometimes necessitating hospitalization.
- Psychological coping patterns are intrinsically linked to both the experience of pain and the use of acute hospital services.
- Community-based interventions integrating medical and psychological assessments are likely to benefit children with SCD.
Aims:
To assess sickle cell pain and coping in children and to examine the relation between these factors and the utilisation of health services.
Methods:
Cross sectional study involving 67 children with sickle cell disease attending three London hospitals. Interviews and questionnaires involved measures of pain, health service utilisation, and coping responses (measured with the Coping Strategies Questionnaire (CSQ), revised for children with sickle cell disease). Medical data on complications, haemoglobin (Hb) levels, and foetal haemoglobin (HbF) percentage were also collected.
Results:
Pain accounted for about 24% of hospital service use, independent of age, sex, number of with sickle cell disease complications, and Hb levels. However, 42% of patients had not utilised hospital services in the past 12 months. Three higher order factors emerged from analysis of the CSQ (active coping, affective coping, passive adherence coping). Pain severity was predicted by passive adherence coping, while utilisation of hospital services was predicted by active coping.
Conclusions:
Sickle cell disease in children involves severe recurrent pain leading to hospitalisation in some cases. Psychological coping patterns are relevant to both pain experience, and the use of acute hospital services. It is likely that children would benefit from community based interventions that incorporate both medical and psychological assessments.