A
mahtab rabiee; Fariba Zarani
Abstract
Objective: Multiple sclerosis (MS) is a chronic and unpredictable inflammatory disease impacting the central nervous system. Compared to adults, children with MS are known to have more relapses in the first six years after disease onset but show a better recovery. MS leads to different symptoms, such ...
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Objective: Multiple sclerosis (MS) is a chronic and unpredictable inflammatory disease impacting the central nervous system. Compared to adults, children with MS are known to have more relapses in the first six years after disease onset but show a better recovery. MS leads to different symptoms, such as sensory disturbances, mobility issues, and vision problems. The disabling nature of the disease cannot be reduced only to physical symptoms. Several symptoms such as cognitive impairment, fatigue, and psychological symptoms are common features of MS . The reviewed literature suggests that, despite the lower physical disability, children and adolescents diagnosed with MS are vulnerable to cognitive impairment even in the early stage of the disease. It has been hypothesized that, in pediatric age, cognitive decline may be considered a sensitive measure of MS severity. Overall, these manifestations may cause considerable functional impairment on daily and social activities, academic achievement, and quality of life that may require individualized rehabilitative treatment and extensive psychosocial care. Given the unpredictability of the disease course and its heterogeneous features, MS has a potential impact not only on patients’ cognitive and psychological development, but it may also lead to longstanding adaptive problems involving the entire family functioning. Considering that childhood and adolescence are critical periods for appropriate educational attainment, social and personal growth, an analysis of the impact of the disease on patients is essential for an appropriate management. Pediatric-Onset Multiple Sclerosis (POMS) is a chronic, autoimmune, inflammatory condition of the central nervous system that typically begins before the age of 16, sometimes even before 10. Despite more frequent relapses in children, recovery tends to be better, and progression is slower. Nevertheless, due to earlier onset, the risk of disability accumulates at a younger age, impacting the child's development and life trajectory. Method: This study presents a systematic review of the psychological and lifestyle-related effects of POMS on children and adolescents. The aim is to synthesize findings from existing literature over the past 20 years (2003–2023) to highlight critical psychological areas affected by the disease and inform future interventions. The review also identifies the need for multidimensional, interdisciplinary approaches to improve mental health, quality of life, and disease management in young patients. A systematic literature review was conducted using both Persian and English databases and Keywords such as “Pediatric MS,” “POMS,” “Children with MS,” and “Psychological Factors in POMS” were used. Inclusion criteria required articles to be published between 2003 and 2023, written in Persian or English, and accessible in full text. Out of 88 initially identified studies, 30 were selected based on relevance and quality. Results: Analysis of the selected studies revealed that POMS significantly affects seven main psychological and behavioral domains such as cognitive functioning, academic performance, mood and qualitiy of life, fatigue and sleep, life style and physical activity, family dynamics and adherence to treatment. Children with POMS often display deficits in attention, memory, and executive functioning. Early cognitive reserve plays a crucial role in preserving long-term cognitive abilities. The disease correlates with declining academic outcomes, partly due to cognitive impairments and absences from school. High rates of depression and anxiety were observed. The psychological burden of POMS extends to families. Emotional support from families is crucial, yet overprotection or high parental involvement may negatively impact autonomy and psychosocial development. Successful disease management requires strong adherence to medical protocols, which is influenced by cognitive function, family support, and psychological state. Conclusion: POMS is a multifaceted condition that imposes psychological, cognitive, and social challenges on children and adolescents. Given the chronic nature of the disease and its developmental timing, early diagnosis, psychological screening, and comprehensive interventions are critical. The review underscores the necessity of multidisciplinary support systems, including psychological counseling, educational interventions, and family support programs. Future research should aim to design and evaluate tailored tools and therapies that address the unique psychological needs of pediatric MS patients and improve their quality of life.
A
sepideh Tamrchi; Mona Farkhondehfal; Mohadese Kheradmand; Mahtab Rabiee; Fariba Zarani
Abstract
Objective: Breaking bad news to the patients and their family is an important and difficult stage in disease process requiring both verbal and non-verbal skills. Thus, studies in the field of health psychology have provided protocols to explain step by step how to break bad news. These protocols have ...
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Objective: Breaking bad news to the patients and their family is an important and difficult stage in disease process requiring both verbal and non-verbal skills. Thus, studies in the field of health psychology have provided protocols to explain step by step how to break bad news. These protocols have focused on how to break bad news in various therapeutic fields and different approaches. The diversity of these models can make health professionals hesitate in choosing the right model. The purpose of this review study was to identify the most widely used protocols for breaking bad news, their similarities and differences, and to provide a structure to compare these protocols.Methods: The search for breaking bad news protocols was conducted in Google Scholar and Science Direct databases. Then, the most widely used protocols that were mostly referred to by other studies were identified. Finally, 13 protocols were selected for detailed investigation. Results: As a result of comparing these protocols, 9 common concepts were find, including: 1- preparation before the session, 2- setting up the proper communicational space, 3- personal evaluation of the patient, 4- evaluation of the patient's environment, 5- approaching the news, 6- exploring the emotions and providing empathic response, 7-talking about treatment plans, 8- investigating support systems, 9- summarizing and concluding the session. Along with these common steps, 47 sub-steps were identified. All these findings were classified altogether in both summarized and extended model. In summarized model the one look table consisting of 9 common concepts and 47 sub-steps was provided. While in an extended table, the contribution of each of 13 investigated protocols in each of the concepts and sub-steps was clarified by detail. Conclusion: The extended table also highlights the unique features of each protocol, allowing health professionals to choose the most appropriate approach based on the specific needs of the patients and their families. In general, this study reviews and compares the most important protocols of breaking bad news to patients to provide a relatively comprehensive picture of what has been considered in different studies for breaking bad news. Therefore, it provided the summarized and extended models of breaking bad news to health professionals as a practical tool containing common concepts and different sub-steps of the most important protocols. This study emphasizes the importance of a structured and empathetic approach to breaking bad news, which can improve patient satisfaction, trust, and coping strategies.
