Facilitating Positive Psychosocial Outcomes in Craniofacial Team Care: Strategies for Medical Providers

Objective: To investigate the influence of gender, dispositional optimism, and coping strategies on appearance-related distress among individuals with unilateral cleft lip and palate (UCLP). Design: Cross-sectional design with self-report questionnaires analyzed primarily with Spearman correlations ( r s) and multivariate regression analyses. Setting: A tertiary cleft center in Sweden. Participants: Eighty individuals with UCLP born 1966 to 1986. The mean age for men (n = 50) and women (n = 30) was 38.8 and 37.4 years, respectively. Main Outcome Measures: The Derriford Appearance Scale 24 measured appearance-related distress, the Life Orientation Test–Revised, short version measured dispositional optimism and pessimism, and the Coping Orientation to Problems Experienced, short version included 14 coping strategies. Results: Women had higher appearance-related distress than men, which was significantly ( P < .05) related to self-blame ( r s = 0.59), pessimism ( r s = 0.59), and low optimism ( r s = −0.56). Men’s appearance-related distress was significantly associated with low active coping ( r s = 0.35), low use of emotional support ( r s = 0.29), denial ( r s = 0.39), behavioral disengagement ( r s = 0.41), and pessimism ( r s = 0.28). The only significant gender interaction reflected greater impact of optimism in reducing appearance-related distress for women (β = −0.06). Conclusions: This study showed that high levels of dispositional optimism decrease appearance-related distress, particularly for women. The coping strategies used differed between men and women, and the results suggest that both gender and psychosocial facto r s need to be considered in regard to appearance-related distress among individuals with UCLP in both clinical and research settings. A possible way to decrease distress is to strengthen positive coping strategies and dispositional optimism.

Section: Discussionmentioning

confidence: 93%

Influence of Gender, Dispositional Optimism, and Coping Strategies on Appearance-Related Distress Among Swedish Adults With Cleft Lip and Palate

Paganini

Persson

Mark

2021

“…Despite these standards, multiple barriers to care can impede timely CL/P diagnosis, surgical repair, follow-up, and further interventions. Availability of surgeons can serve as a significant obstacle (Carlson et al, 2016b), and challenges such as financial cost, geographic accessibility, education, or cultural understanding of surgical need also may delay care (Adetayo et al, 2012; Cassell et al, 2013; Cassell et al, 2014; Massenburg et al, 2016; Yao et al, 2016; Carlson et al, 2016b; Swanson et al, 2017; Bennett et al, 2018; Dean et al, 2019; Ise et al, 2019; Kantar et al, 2019; Stock et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

Factors Associated With Delay in Cleft Surgery at a Tertiary Children’s Hospital in a Major US Metropolitan City

Stoneburner

Munabi

Nagengast

et al. 2021

Objective: To identify factors associated with late cleft repair at a US tertiary children’s hospital. Design: Retrospective study of children with CL/P using Children’s Hospital Los Angeles (CHLA) records. Setting: US tertiary children’s hospital. Patients/Participants: Patients undergoing primary CL or CP repair at CHLA from 2009 to 2018. Main Outcome Measures: Proportion of children who had delayed primary CL repair or CP repair using CHLA and American Cleft Palate-Craniofacial Association (ACPA) guidelines and factors associated with late surgery. Results: In total, 805 patients—503 (62.5%) who had CL repair, 302 (37.5%) CP repair—were included. Using CHLA protocol, 14.3% of patients seeking CL repair had delayed surgery. Delay was significantly associated with female gender, non-Hispanic ethnicity, Spanish primary language, government insurance, bilateral cleft, cleft lip and palate (CLP), and syndromic diagnosis. Using ACPA guidelines, 5.4% had delayed surgery. Female gender and syndromic diagnosis were significantly associated with delay and remained significant after adjustment for confounders in multivariate models. For CP repair, 60.3% of patients had delayed surgery using CHLA protocol. Cleft lip and palate diagnosis, complete cleft, syndromic diagnosis, and longer travel distance were significantly associated with delay. Using ACPA guidelines, 28.5% had delayed surgery; however, significant association with patient variables was not consistently observed. Conclusions: Delay in cleft surgery occurs most often for patients seeking CP repair and is associated with female gender, non-Hispanic ethnicity, Spanish language, government insurance, and bilateral CL, CLP, or syndromic diagnoses. Initiatives should aim to optimize cleft surgery delivery for these subpopulations.

“…Our findings also highlight the importance of visit flow logistics and maximizing team member roles as one of our most important interventions, such as designating a single person as responsible for monitoring the PAT-CV (from administration to scoring) during the clinic. In recent years, several instruments have been recommended to facilitate screening, audit, and outcomes assessments in craniofacial populations, many of which measure either general psychosocial functioning (e.g., Strengths and Difficulties Questionnaire) or craniofacial-specific concerns, such as the CLEFT-Q, which measures cleft-related healthrelated quality of life and satisfaction with speech and appearance (see Stock et al, 2020 for an overview of these instruments). The PAT-CV provides a means of screening for both general and craniofacial-specific problems and can be used to identify families in need of psychosocial interventions to support adaptive functioning.…”

Section: Discussionmentioning

confidence: 99%

Improving Psychosocial Risk Assessment and Service Provision for Craniofacial Team Patients: A Quality Improvement Project

Crerand

O’Brien

Kapa

et al. 2021

To improve psychosocial risk assessment and service provision for children with craniofacial conditions presenting for annual interdisciplinary team visits. Institute for Healthcare quality improvement model. U.S. pediatric academic medical center. Caregivers of children ages 0-17 years with craniofacial conditions presenting for 1692 team visits between August 2017 and July 2019. Key drivers included: (1) standardizing pre-visit triage processes; (2) administering the Psychosocial Assessment Tool-Craniofacial Version (PAT-CV); (3) utilizing PAT-CV scores in real time to add patients to psychosocial provider schedules; and (4) family education. Interventions included improving patient screening, increasing PAT-CV completion rate, altering clinic flow, providing patient and parent education about psychosocial services, and altering team member roles to fully integrate PAT-CV administration and scoring in the clinic. The primary outcome was the percentage of patients identified for psychosocial consultations via nurse triage, PAT-CV score, family or provider request who completed consultations. The secondary outcome was the percentage of patients completing needed psychosocial consultations based on elevated PAT-CV scores. Use of the PAT-CV resulted in an increase in the percentage of patients with elevated psychosocial risk who received a psychosocial consultation from 86.7% to 93.4%. The percentage of children receiving psychosocial consultation at their annual team visit due to elevated PAT-CV scores increased from 72% to 90%. Integrating a validated psychosocial risk screening instrument can improve risk identification and psychosocial consultation completion. A combination of risk screening approaches may be indicated to identify patients in need of psychosocial services.