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Going trough a colonoscopy and living with inflammatory bowel disease: children's and parents' experiences and evaluation of the bowel cleansing quality prior to colonoscopy
Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).ORCID iD: 0000-0003-0690-3940
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis focuses on children aged 10-18 years with symptoms of, ordiagnosed with, inflammatory bowel disease (henceforth referred to as IBD).Before the disease can be diagnosed, a child must undergo several procedures,with colonoscopy as an established investigation, including bowel cleansing,which is crucial for the safe examination of the intestine. The prevalence ofpaediatric IBD is increasing worldwide, which will augment the number ofpaediatric colonoscopies. When the recommended laxative polyethylene glycol(PEG) was used for bowel cleansing, the children and their accompanyingparents experienced the procedure as difficult due to the large volume of badtastingPEG. Once IBD is diagnosed, the children must undergo lifelongmedical treatment, which entails several follow-up colonoscopies.Furthermore, IBD is a chronic illness with an unpredictable activity patternthat can have a negative impact on the children’s quality of life. One of theaims of this thesis was to explore a child/child’s perspective of going through acolonoscopy and child’s perspective of living with IBD. A further aim was toinvestigate whether sodium picosulphate (NaPico) can be used as an adequatealternative when the bowel is cleansed prior to colonoscopy in children.Three of the studies were interview studies (Papers I, II, & IV) with childrenand parents as participants. The data from 17 children and 12 parents (PapersI & II) was analysed using content analysis, and a phenomenologicalhermeneutic method was used when 7 children (Paper IV) were interviewed.The children’s experiences prior to colonoscopy (Paper I) were identified asbelonging to an overall theme, A private affair, which could be divided intofour categories: Preparing yourself, Mastering the situation, Reluctantlyparticipating, and Feeling emotional support. The result from the parents’ experiences when their child is undergoing an elective colonoscopy wasstructured into one theme, Charged with conflicting emotions, with threecategories: Being forced to force, Losing one’s sense of being a parent, andStanding without guidance (Paper II). The initial findings from these empirical studies undertaken served as apreparation for another study, aimed at comparing the quality of bowelcleansing using either PEG or sodium picosulphate (NaPico) in relation to thetolerability and acceptance of the laxatives among children and theiraccompanying parents (Paper III). This study was a randomised controlledtrial (RCT) that was conducted as an investigator-blinded study within theDepartment of Paediatrics at a university hospital in Sweden(www.clinicaltrials.gov, identifier NCT02009202). A total of 72 children wererandomly placed into one of two groups (PEG or NaPico). The Ottawa BowelPreparation Quality Scale (OBPQS) was used to evaluate the quality of thebowel cleansing. Two different questionnaires were used to evaluate both theacceptability and the tolerability of the laxatives. In total, 67 protocols wereanalysed according to the OBPQS. No significant difference in bowelcleansingquality was detected between the two groups. However, rates ofacceptability and tolerability were significantly higher in the NaPico group than in the PEG group, according to both the children and the parents. Finally, in order to illuminate the meaning of children’s lived experience ofIBD, an interview study with seven children was conducted. The meaning oftheir lived experience of IBD was interpreted as A daily struggle to adapt andto be perceived as normal. This interpretation was discussed in relation toIngmar Pörn’s theory of adaptedness (Paper IV). The findings point to the conclusion that both children’s and parents’perspectives are important, in order to improve the paediatric colonoscopy.The children (10-18 years) with symptoms of, or diagnosed with, IBD werereluctant to talk about their problems, including colonoscopy. However, theywere willing to share their experiences in order to help other children withsimilar problems, or in order to influence and improve paediatric care. Itemerged that both children and parents need to feel confident in their dealingswith healthcare professionals and to feel that healthcare professionals taketheir opinions seriously when preparing the child for colonoscopy. It is also important that the children have the opportunity to choose thebowel-cleansing protocol. NaPico can be recommended as the option forbowel cleansing in children aged 10 years and older. The meaning that can beextracted from the children’s experience of IBD is that they are struggling toadapt and to be perceived as normal. This is a conscious process entailing aconfrontation with various problems, such as ambitions and goals that arehard to achieve, due to reduced abilities resulting from the illness or from aninsufficiently adapted environment.

Place, publisher, year, edition, pages
Malmö university, Faculty of Health and Society , 2016. , p. 89
Series
Malmö University Health and Society Dissertations, ISSN 1653-5383 ; 5
Keywords [en]
Colonoscopy, Inflammatory bowel diseases, Randomised control trial, Content analysis, Phenomenological hermeneutics
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:mau:diva-7331Local ID: 20697ISBN: 9789171046819 (print)OAI: oai:DiVA.org:mau-7331DiVA, id: diva2:1404245
Note

Paper III and IV not included in the fulltext online.

Paper IV in dissertation as manuscript.

Available from: 2020-02-28 Created: 2020-02-28 Last updated: 2024-03-16Bibliographically approved
List of papers
1. A private affair: children’s experiences prior to colonoscopy
Open this publication in new window or tab >>A private affair: children’s experiences prior to colonoscopy
2015 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 24, no 7-8, p. 1038-1047Article in journal (Refereed)
Abstract [en]

Aims and objectives. To illuminate children’s experiences prior to colonoscopy. Background. It is well known that children need to be well prepared before undergoing stressful medical procedures, and the goal of such preparations should focus on minimising their level of anxiety. The clinical investigation of children with suspected inflammatory bowel disease involves several steps, with colonoscopy being routinely used to investigate the colon and the lower part of the small intestine. To minimise children’s anxiety during various medical procedures, it is important that information about their experiences is obtained directly from the children themselves. Design. A qualitative study. Method. The study was designed as a qualitative interview study involving 17 children aged 10–17 years undergoing colonoscopy at a children’s university hospital in Sweden. Verbatim transcripts were analysed using content analysis. Results. The children’s experiences prior to colonoscopy were identified as belonging to an overall theme, a private affair, and to four categories: preparing yourself, mastering the situation, reluctantly participating and feeling emotional support. Conclusion. This study shows that children’s experiences prior to colonoscopy are a private affair and that the preparation needs to be individually adapted for the ‘preprocedural’ preparation to be comprehended. Relevance to clinical practice. The children’s experiences ascertained in this study can contribute to a greater understanding of children’s needs prior to a colonoscopy and may provide professional care staff with the basis for future nursing assessments.

Place, publisher, year, edition, pages
John Wiley & Sons, 2015
Keywords
children, children’s nurses, colonoscopy, paediatric nursing, patient’s experience, preparation, qualitative study
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:mau:diva-14864 (URN)10.1111/jocn.12661 (DOI)000351633800015 ()25060547 (PubMedID)2-s2.0-84925300779 (Scopus ID)18033 (Local ID)18033 (Archive number)18033 (OAI)
Available from: 2020-03-30 Created: 2020-03-30 Last updated: 2024-02-05Bibliographically approved
2. Parents’ experiences when their child is undergoing an elective colonoscopy
Open this publication in new window or tab >>Parents’ experiences when their child is undergoing an elective colonoscopy
2015 (English)In: Journal for Specialist sin Pediatric Nursing, ISSN 1744-6155, Vol. 20, no 2, p. 123-130Article in journal (Refereed)
Abstract [en]

Purpose. The purpose was to illuminate parents’ experiences when their children are undergoing an elective colonoscopy performed using polyethylene glycol-based regimes for bowel preparation. Design and Methods. Individual interviews with 12 parents were performed and analysed using content analysis. Results. The parents’ experiences were structured into one theme: “Charged with conflicting emotions” with three categories: “Being forced to force,” “Losing one’s sense of being a parent” and “Standing without guidance.” Practice Implications. Understanding parents’ experiences can help healthcare staff guide parents in helping their children undergo a colonoscopy

Place, publisher, year, edition, pages
John Wiley & Sons, 2015
Keywords
Colonoscopy, qualitative research, parents, pediatric nursing
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:mau:diva-15175 (URN)10.1111/jspn.12109 (DOI)000352567000005 ()25845734 (PubMedID)2-s2.0-84926677990 (Scopus ID)19782 (Local ID)19782 (Archive number)19782 (OAI)
Available from: 2020-03-30 Created: 2020-03-30 Last updated: 2024-02-05Bibliographically approved
3. Polyethylene Glycol- or Sodium Picosulphate-Based Laxatives Before Colonoscopy in Children
Open this publication in new window or tab >>Polyethylene Glycol- or Sodium Picosulphate-Based Laxatives Before Colonoscopy in Children
Show others...
2016 (English)In: Journal of Pediatric Gastroenterology and Nutrition - JPGN, ISSN 0277-2116, E-ISSN 1536-4801, Vol. 62, no 3, p. 414-419Article in journal (Refereed)
Abstract [en]

Objectives: The purpose of this randomised study was to compare the quality of bowel cleansing using either polyethylene glycol (PEG) or sodium picosulphate (NaPico) (primary outcome) in relation to the tolerability and acceptance of these laxatives among children and their caregivers (secondary outcome). Methods: The study was a randomised controlled trial that was conducted as an investigator-blinded study within the Department of Paediatrics of Ska°ne University Hospital in Malmo¨ , Sweden. A total of 72 children (10–18 years of age) were randomly placed into 1 of 2 groups (PEG or NaPico). The Ottawa Bowel Preparation Quality Score was used to evaluate the quality of bowel cleansing. A total of 2 different questionnaires were used to evaluate both the acceptability and tolerability of the laxatives. Results: In total, 71 children completed the bowel cleansing. Of these 71 cleanses, 67 protocols were analysed according to the Ottawa Bowel Preparation Quality Score. No significant difference in bowel cleansing quality was detected between the 2 groups. Rates of acceptability and tolerability were significantly higher in the NaPico group than in the PEG group. Conclusions: In the present study, both laxatives were found to be satisfactory in terms of aiding the performance of an uncomplicated and successful colonoscopy. NaPico was, however, more tolerable to the children than PEG, and both, the children and their caregivers, were more accepting of NaPico than of PEG. Consequently, NaPico can be recommended as the option for bowel cleansing in children ages 10 years and older. Key Words: bowel cleansing, children, colonoscopy, randomised controlled trial

Place, publisher, year, edition, pages
Lamy, Wolters Kluwer, 2016
Keywords
bowel cleansing, children, colonoscopy, randomised controlled trial
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:mau:diva-14897 (URN)10.1097/MPG.0000000000000978 (DOI)000371304000015 ()26360658 (PubMedID)2-s2.0-84959876546 (Scopus ID)21901 (Local ID)21901 (Archive number)21901 (OAI)
Available from: 2020-03-30 Created: 2020-03-30 Last updated: 2024-06-17Bibliographically approved
4. Swedish Children's Lived Experience of Ulcerative Colitis
Open this publication in new window or tab >>Swedish Children's Lived Experience of Ulcerative Colitis
2018 (English)In: Gastroenterology Nursing, ISSN 1042-895X, E-ISSN 1538-9766, Vol. 41, p. 333-340Article in journal (Refereed) Published
Abstract [en]

Inflammatory bowel disease (IBD) is increasing in children. When this lifelong illness is diagnosed in childhood, especially during adolescence, it may have a negative impact on children's quality of life. The aim of the present study was to illuminate the meaning of children's lived experience of ulcerative colitis. Seven children aged between 10 and 18 years were recruited from University Hospital South Sweden and interviewed about the phenomenon under scrutiny. Data were analyzed by means of a phenomenological hermeneutical method. The meaning of the children's lived experience of ulcerative colitis was summed up as a main theme. A daily struggle to adapt and be perceived as normal consisted of 4 subthemes: being healthy despite the symptoms, being healthy despite being afraid, being healthy despite a sense of being different, and being healthy despite needing support. The children strove to perceive themselves as healthy, and they needed to be perceived as healthy, especially when experiencing symptoms of inflammatory bowel disease. Children with inflammatory bowel disease confront various problems, such as ambitions and goals that are hard to achieve, due to reduced abilities as a result of the illness or an insufficiently adapted environment.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2018
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:mau:diva-14621 (URN)10.1097/SGA.0000000000000295 (DOI)000442742900007 ()28759516 (PubMedID)2-s2.0-85052660494 (Scopus ID)24218 (Local ID)24218 (Archive number)24218 (OAI)
Available from: 2020-03-30 Created: 2020-03-30 Last updated: 2024-06-17Bibliographically approved

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Vejzovic, Vedrana

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