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

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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

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Publication Doctoral Thesis
Title 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
Author(s) Vejzovic, Vedrana
Date 2016
English abstract
This thesis focuses on children aged 10-18 years with symptoms of, or diagnosed 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 of paediatric IBD is increasing worldwide, which will augment the number of paediatric colonoscopies. When the recommended laxative polyethylene glycol (PEG) was used for bowel cleansing, the children and their accompanying parents experienced the procedure as difficult due to the large volume of badtasting PEG. Once IBD is diagnosed, the children must undergo lifelong medical treatment, which entails several follow-up colonoscopies. Furthermore, IBD is a chronic illness with an unpredictable activity pattern that can have a negative impact on the children’s quality of life. One of the aims of this thesis was to explore a child/child’s perspective of going through a colonoscopy and child’s perspective of living with IBD. A further aim was to investigate whether sodium picosulphate (NaPico) can be used as an adequate alternative when the bowel is cleansed prior to colonoscopy in children. Three of the studies were interview studies (Papers I, II, & IV) with children and parents as participants. The data from 17 children and 12 parents (Papers I & II) was analysed using content analysis, and a phenomenological hermeneutic method was used when 7 children (Paper IV) were interviewed. The children’s experiences prior to colonoscopy (Paper I) were identified as belonging to an overall theme, A private affair, which could be divided into four categories: Preparing yourself, Mastering the situation, Reluctantly participating, and Feeling emotional support. The result from the parents’ experiences when their child is undergoing an elective colonoscopy was 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 (Paper II). The initial findings from these empirical studies undertaken served as a preparation for another study, aimed at comparing the quality of bowel cleansing using either PEG or sodium picosulphate (NaPico) in relation to the tolerability and acceptance of the laxatives among children and their accompanying parents (Paper III). This study was a randomised controlled trial (RCT) that was conducted as an investigator-blinded study within the Department of Paediatrics at a university hospital in Sweden (www.clinicaltrials.gov, identifier NCT02009202). A total of 72 children were randomly placed into one of two groups (PEG or NaPico). The Ottawa Bowel Preparation Quality Scale (OBPQS) was used to evaluate the quality of the bowel cleansing. Two different questionnaires were used to evaluate both the acceptability and the tolerability of the laxatives. In total, 67 protocols were analysed according to the OBPQS. No significant difference in bowelcleansing quality was detected between the two groups. However, rates of acceptability 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 of IBD, an interview study with seven children was conducted. The meaning of their lived experience of IBD was interpreted as A daily struggle to adapt and to be perceived as normal. This interpretation was discussed in relation to Ingmar 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 were reluctant to talk about their problems, including colonoscopy. However, they were willing to share their experiences in order to help other children with similar problems, or in order to influence and improve paediatric care. It emerged that both children and parents need to feel confident in their dealings with healthcare professionals and to feel that healthcare professionals take their opinions seriously when preparing the child for colonoscopy. It is also important that the children have the opportunity to choose the bowel-cleansing protocol. NaPico can be recommended as the option for bowel cleansing in children aged 10 years and older. The meaning that can be extracted from the children’s experience of IBD is that they are struggling to adapt and to be perceived as normal. This is a conscious process entailing a confrontation with various problems, such as ambitions and goals that are hard to achieve, due to reduced abilities resulting from the illness or from an insufficiently adapted environment.
Publisher Malmö university, Faculty of Health and Society
Series/Issue Malmö University Health and Society Dissertations;5
ISSN 1653-5383
ISBN 9789171046819
9789171046822
Pages 89
Language eng (iso)
Subject(s) Colonoscopy
Inflammatory bowel diseases
Randomised control trial
Content analysis
Phenomenological hermeneutics
Humanities/Social Sciences
Research Subject Categories::MEDICINE
Included papers
  1. I. Vejzovic, V., Wennick, A., Idvall, E., & Bramhagen, A. C. (2014). A private affair: children’s experiences prior to colonoscopy. Journal of Clinical Nursing, 24, 1038–1047.

  2. II. Vejzovic, V., Bramhagen, A. C., Idvall, E., & Wennick, A. (2015). Parents’ experiences when their child is undergoing an elective colonoscopy. Journal for Specialists in Pediatric Nursing, 20,123–130.

  3. III. Vejzovic, V., Wennick, A., Idvall, E., Agardh, D., & Bramhagen, A. C. (2015). Polyethylene Glycol- or Sodium Picosulphate-Based Laxatives before Colonoscopy in Children. Journal of Pediatric Gastroenterology and Nutrition, 62(3), 414-419.

  4. IV. Vejzovic, V., Bramhagen, A. C., Idvall, E., & Wennick, A. Swedish Childrens’ Lived Experience of Inflammatory Bowel Disease. (Submitted 2016)

Handle http://hdl.handle.net/2043/20697 (link to this page)

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