A qualitative study exploring experiences of treatment in paediatric rheumatology - children's, young people's, parents' and carers' perspectives.

Background: There is limited literature in paediatric rheumatology describing holistic lived experiences of medical treatment from perspectives of children and young people (CYP) and their parents or carers (PC). This is important as it could have implications for adherence. This study aimed to explore treatment experiences of CYP and PC in a paediatric rheumatology service.
Methods: Participants were recruited at a day-case unit for intravenous infusions at a tertiary paediatric rheumatology centre. Joint qualitative semi-structured interviews with CYP and PC were used to collect data. Data were transcribed, quality checked and thematically analysed using NVivo 12.4 to identify findings.
Results: Thirty-two participants (15 CYP between the ages of 6 and 16 years, 17 PC) took part in interviews lasting 41 min and 43 s, on average. Participants described experiences using infliximab, followed by tocilizumab and abatacept. Participants experienced a wave, oscillating between positive and negative trajectories. Experiences of medical treatments were described as temporary, eventually changing and leading to treatment changes or cessation. Behaviours were influenced through somatic factors (pain, function), social factors (advice from health professionals, encouragement from friends, family and teachers, practicality of using treatment in relation to school, work and finance) and cognitive factors (fear of needles, fear of specific medications, beliefs about necessity).
Conclusions: Collectively, findings demonstrate experiences of medical treatment reflect the nature of many paediatric rheumatology conditions, oscillating between periods of positive and negative trajectories. Somatic, social and cognitive experiences can be positive, when treatment is considered 'successful'. Negative somatic, social or cognitive experiences led to behaviours such as treatment non-adherence. A limitation of the study is interviews were conducted jointly with CYP and PC, which may have influenced what participants were willing to say in front of one another however this does mean findings relate to both CYP and PC and so could be suitable targets for interventions to improve adherence.
Competing Interests: Declarations. Ethics approval and consent to participate: Ethical approval for the study was given the Faculty of Medical Sciences Research Ethics Committee (Reference number 33823/2023) and the project was registered on the Trust’s Clinical Effectiveness Register. Consent for publication: We confirm that all authors have approved the manuscript for submission. Also, I, Adam Pattison Rathbone, confirm that the manuscript has not been published, and have not been submitted for publication elsewhere. Competing interests: The authors declare they have no competing interests. Author information: KGP was an MRes student working under the supervision of SS and APR. SS is a Paediatric Rheumatology Consultant in at the Great North Children’s Hospital, AM is a Reader in Pharmacy Practice at Liverpool John Moore’s Hospital, CLR is a Senior Lecturer in Pharmacy Practice at Newcastle University, and APR is a Lecturer in Clinical and Social Pharmacy at Newcastle University and Advanced Clinical Pharmacist at the Children’s Hospital.
(© 2025. The Author(s).)