Counsel and plan with a family switching from IVIG to home SCIG — OSCE

OSCE communication and shared-planning station: explaining a route switch from hospital intravenous to home subcutaneous immunoglobulin to the family of a boy with X-linked agammaglobulinaemia, the pharmacokinetic and quality-of-life rationale, what home therapy involves and how the family will be trained and supported, and the breakthrough-infection reassessment plan — while addressing the family's fear of self-infusion and the travel burden they currently carry.

osce communication and shared decision-making1 min readVerification in progress

Prompt

The parents of a six-year-old boy with X-linked agammaglobulinaemia, established on hospital intravenous immunoglobulin every four weeks, have travelled two hours for today's review. He has had three breakthrough pneumonias this year despite a trough in the lower half of the normal range. You are proposing a switch to home subcutaneous immunoglobulin and a reassessment of his regimen. The parents are frightened of giving infusions themselves, worried that home therapy means less expert oversight, and unsure why the trough that looked 'normal' was not protecting him.

Candidate brief

You have eight minutes to counsel the parents of a six-year-old boy with X-linked agammaglobulinaemia about switching from hospital intravenous to home subcutaneous immunoglobulin and about reassessing his regimen after breakthrough infection. Use a structured, honest, empathic approach. ^[1] ^[8]

References5Show

[1]Bonilla FA, Khan DA, Ballas ZK, et al. Practice parameter for the diagnosis and management of primary immunodeficiency. J Allergy Clin Immunol, 2015.PMID 26371839
[2]Perez EE, Orange JS, Bonilla F, et al. Update on the use of immunoglobulin in human disease: A review of evidence. J Allergy Clin Immunol, 2017.PMID 28041678
[5]Suez D, Stein M, Gupta S, et al. Efficacy, Safety, and Pharmacokinetics of a Novel Human Immune Globulin Subcutaneous, 20% in Patients with Primary Immunodeficiency Diseases in North America. J Clin Immunol, 2016.PMID 27582171
[8]Abolhassani H, Sadaghiani MS, Aghamohammadi A, et al. Home-based subcutaneous immunoglobulin versus hospital-based intravenous immunoglobulin in treatment of primary antibody deficiencies: systematic review and meta analysis. J Clin Immunol, 2012.PMID 22730009
[9]Duff C, Ballow M Nuts and Bolts of Subcutaneous Therapy. Immunol Allergy Clin North Am, 2020.PMID 32654697

Counsel and plan with a family switching from IVIG to home SCIG — OSCE

osce communication and shared decision-making1 min readVerification in progress

Candidate brief

References5Show

[1]Bonilla FA, Khan DA, Ballas ZK, et al. Practice parameter for the diagnosis and management of primary immunodeficiency. J Allergy Clin Immunol, 2015.PMID 26371839
[2]Perez EE, Orange JS, Bonilla F, et al. Update on the use of immunoglobulin in human disease: A review of evidence. J Allergy Clin Immunol, 2017.PMID 28041678
[5]Suez D, Stein M, Gupta S, et al. Efficacy, Safety, and Pharmacokinetics of a Novel Human Immune Globulin Subcutaneous, 20% in Patients with Primary Immunodeficiency Diseases in North America. J Clin Immunol, 2016.PMID 27582171
[8]Abolhassani H, Sadaghiani MS, Aghamohammadi A, et al. Home-based subcutaneous immunoglobulin versus hospital-based intravenous immunoglobulin in treatment of primary antibody deficiencies: systematic review and meta analysis. J Clin Immunol, 2012.PMID 22730009
[9]Duff C, Ballow M Nuts and Bolts of Subcutaneous Therapy. Immunol Allergy Clin North Am, 2020.PMID 32654697