Thomas I Mackie1, Lisa L Tse2, Sarah D de Ferranti3, Heather R Ryan4, Laurel K Leslie5. 1. Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA. Electronic address: tmackie@tuftsmedicalcenter.org. 2. Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA. 3. Department of Cardiology, Boston Children's Hospital Harvard Medical School, Boston, MA, USA. 4. Department of Cardiology, Boston Children's Hospital, Boston, MA, USA. 5. Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Tufts Clinical and Translational Science Institute, Tufts University School of Medicine, Boston, MA, USA.
Abstract
BACKGROUND: Adolescents and young adults (AYAs) with familial hypercholesterolemia (FH) are at high risk for underdiagnosis and inadequate treatment. Yet, little is known about the factors that influence the medical decision making of AYAs with FH and their families. OBJECTIVE: This study explores how family medical history, family narratives of medical experiences, and AYA medical experiences together function as "experiential evidence" and influence screening and treatment decisions. METHODS: Twenty-four parents and AYAs affected by FH from a pediatric preventive cardiology practice responded to a survey and a semistructured qualitative interview. Transcribed interviews were analyzed using a modified grounded theory approach. Study design, instruments, and interpretation of results were informed by a 20-member stakeholder panel. RESULTS: AYAs and parents reported extensive personal and family experiences with cholesterol and cardiovascular conditions and treatments, sometimes distinct from FH, which were used as evidence to inform their own perceptions of FH risk and treatment. This experiential evidence impacted perceptions of: (1) hereditary risk for FH diagnoses, (2) risk for future cardiovascular disease, (3) risks associated with treatments, and (4) capacity to comply with recommended treatments. Although experiences of family members initially informed screening and treatment decisions, the subsequent personal experiences of AYAs led to new experiential evidence that informed future decisions. CONCLUSIONS: Family cardiovascular history related to and distinct from FH influenced screening and treatment decisions of AYAs and parents affected by FH. Additional clinical assessment of personal and family medical experiences may enhance understanding of the decision-making processes among AYAs and ultimately improve adherence to screening and treatment recommendations.
BACKGROUND: Adolescents and young adults (AYAs) with familial hypercholesterolemia (FH) are at high risk for underdiagnosis and inadequate treatment. Yet, little is known about the factors that influence the medical decision making of AYAs with FH and their families. OBJECTIVE: This study explores how family medical history, family narratives of medical experiences, and AYA medical experiences together function as "experiential evidence" and influence screening and treatment decisions. METHODS: Twenty-four parents and AYAs affected by FH from a pediatric preventive cardiology practice responded to a survey and a semistructured qualitative interview. Transcribed interviews were analyzed using a modified grounded theory approach. Study design, instruments, and interpretation of results were informed by a 20-member stakeholder panel. RESULTS: AYAs and parents reported extensive personal and family experiences with cholesterol and cardiovascular conditions and treatments, sometimes distinct from FH, which were used as evidence to inform their own perceptions of FH risk and treatment. This experiential evidence impacted perceptions of: (1) hereditary risk for FH diagnoses, (2) risk for future cardiovascular disease, (3) risks associated with treatments, and (4) capacity to comply with recommended treatments. Although experiences of family members initially informed screening and treatment decisions, the subsequent personal experiences of AYAs led to new experiential evidence that informed future decisions. CONCLUSIONS: Family cardiovascular history related to and distinct from FH influenced screening and treatment decisions of AYAs and parents affected by FH. Additional clinical assessment of personal and family medical experiences may enhance understanding of the decision-making processes among AYAs and ultimately improve adherence to screening and treatment recommendations.
Authors: Elizabeth M Haney; Laurie Hoyt Huffman; Christina Bougatsos; Michele Freeman; Robert D Steiner; Heidi D Nelson Journal: Pediatrics Date: 2007-07 Impact factor: 7.124
Authors: Holly C Gooding; R Christopher Sheldrick; Laurel K Leslie; Supriya Shah; Sarah D de Ferranti; Thomas I Mackie Journal: J Adolesc Health Date: 2016-05-05 Impact factor: 5.012
Authors: Samantha K Sliwinski; Holly Gooding; Sarah de Ferranti; Thomas I Mackie; Supriya Shah; Tully Saunders; Laurel K Leslie Journal: J Clin Lipidol Date: 2016-11-09 Impact factor: 4.766
Authors: Karen Forrest Keenan; Robert M Finnie; William G Simpson; Lorna McKee; John Dean; Zosia Miedzybrodzka Journal: J Community Genet Date: 2018-06-14