A qualitative study to explore symptoms and impacts of pediatric and adolescent Crohn's disease from patient and caregiver perspective

Abstract

Background: Crohn's disease (CD) is a chronic inflammatory condition of the gastrointestinal tract that affects people across the age spectrum but often starts in childhood or early adulthood. Despite this, almost all published research examining the symptomatic and health-related quality of life (HRQL) experiences of CD has been conducted in an adult population. Studies providing a comprehensive overview of the lived experience of pediatric and adolescent CD are virtually non-existent. The experiences of younger children aged 2-7 years are especially unknown.

Results: A total of 49 participants (31 children and 18 parents) were interviewed. This included 11 dyads (i.e., parents and children from the same family). Analyses were conducted based on reporter-type (patient self-report vs parent observer-report) and age subgroups (ages 2-4 vs 5-7 vs 8-11 vs 12-17). Key symptoms were identified across the age subgroups and reporter types. Abdominal/stomach pain, passing gas/feeling gassy, diarrhea/liquid stools, fatigue/tiredness, bowel urgency, blood in stools, stomach cramping, constipation, and incomplete evacuation were discussed most frequently. The most common HRQL impacts included impact on physical activity, school, social life, and mood (i.e., feeling sad/low), and were mostly consistent between reporter type and across age spectrum. Concept agreement between parents and children in the dyad analysis was > 60% for most symptoms and impacts.

Conclusions: Qualitative interviews revealed the substantial symptom and HRQL burden of pediatric CD from the child and parent perspectives and that disease experiences were largely consistent across the age range and based on both reporter perspectives. This is an important first step towards implementing a robust measurement strategy for the assessment of symptoms and HRQL impacts in pediatric CD.

Keywords: Adolescent; Caregiver; Concept elicitation; Crohn’s disease; Interview; Observer; Parent; Pediatric; Qualitative.

Fig. 1

Patient-Centered Conceptual Model of Pediatric CD. Abbreviations: CD = Crohn’s disease; GI = gastrointestinal; HRQL = health-related quality of life. ^aNot discussed by children 5–7 years old; ^bnot discussed by children 8–11 years old; ^cnot discussed by parents of children 2–4 years old; ^dnot discussed by parents of children 5–7 years old. Essential Daily Functioning refers to activities, functions, or practices necessary within a child/adolescent’s daily life