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Toprak D, Nay L, McNamara S, Rosenberg AR, Rosenfeld M, Yi-Frazier JP. Resilience in adolescents and young adults with cystic fibrosis: A pilot feasibility study of the promoting resilience in stress management intervention. Pediatr Pulmonol 2020; 55:638-645. [PMID: 31794160 PMCID: PMC8685161 DOI: 10.1002/ppul.24574] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 10/26/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Disease burden in cystic fibrosis (CF) impacts quality of life, distress, and treatment adherence. The promoting resilience in stress management (PRISM), is a brief patient-focused intervention to promote resilience in adolescents and young adults (AYAs), which may mitigate the negative outcomes, and is proven to be feasible and acceptable in other diseases. OBJECTIVE Our aim was to test the feasibility and acceptability of PRISM among AYAs with CF in addition to collecting pilot data regarding patient-reported resilience, distress, and quality of life. METHODS Eligible English speaking, 12 to 21 year patients admitted to the hospital were enrolled. We defined feasibility as 80% completion of all sessions. Acceptability was defined qualitatively based on feedback about timing, content and delivery of intervention. As an exploratory aim, questionnaires measuring resilience (Connor-Davidson resilience scale), distress (Kessler-6 scale), and disease-specific health-related quality of life (CF questionnaire-revised [CFQ-R]) were given at baseline and postintervention. RESULTS 10 out of 17 (59%) patients consented to participate. Eight were Caucasian, eight female with age range 13 to 20 years (median: 18). Nine completed all PRISM sessions with universally positive feedback. Health perception and respiratory domain scores of the CFQ-R improved (47.2-65.1; 95% confidence interval [CI], 2.6-35.6; 50.9-61.9; 95% CI, 1.7-19.9, respectively), however in the setting of inpatient exacerbation treatment it would be hard to attribute these changes to PRISM. CONCLUSION PRISM was feasible and highly acceptable among AYAs with CF. Future research is needed to test the efficacy of PRISM among a larger group of patients with CF in a multicenter trial.
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Affiliation(s)
- Demet Toprak
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington.,Seattle Children's Hospital, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington
| | - Laura Nay
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington.,Seattle Children's Hospital, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington
| | - Sharon McNamara
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington.,Seattle Children's Hospital, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington
| | - Abby R Rosenberg
- Seattle Children's Hospital, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington.,Division of Hematology and Oncology, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington.,Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Margaret Rosenfeld
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington.,Seattle Children's Hospital, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington
| | - Joyce P Yi-Frazier
- Seattle Children's Hospital, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington
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Gittzus JA, Fasciano KM, Block SD, Mack JW. Peace of mind among adolescents and young adults with cancer. Psychooncology 2019; 29:572-578. [PMID: 31825157 DOI: 10.1002/pon.5309] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 11/18/2019] [Accepted: 11/28/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Adolescents and young adults (AYAs) with cancer have high rates of psychological distress and unmet support needs. Peace of mind is an important construct among older cancer patients and parents of children with cancer but has not been explored in AYAs. We sought to evaluate the extent to which AYAs with cancer experience peace of mind and to identify factors associated with greater peace of mind. METHODS We surveyed 193 AYAs with cancer aged 15 to 29 years within 12 weeks of diagnosis; 137 patients completed the same measures again 4 and 12 months after diagnosis. Patients were asked to report peace of mind, measured using items from the Functional Assessment of Chronic Illness, Spiritual Well-being scale (FACIT-Sp); anxiety and depression, using the Hospital Anxiety and Depression Scale (HADS); and experiences surrounding medical communication and decision making. RESULTS Mean scores for peace of mind were 3.59 at diagnosis (range 1-5, standard deviation 0.84), with similar scores at 4 (3.53, P = .34) and 12 (3.59, P = .94) months. In a multivariable model adjusted for age and gender, patients who reported receiving high-quality information about their cancer had greater peace of mind at diagnosis (β = .25, P = .03), whereas those who reported holding a passive role in treatment decision making (β = -.47, P < .0001) or who had anxiety (β = -.64, P = .0003) or depression (β = -.51, P = .04) had lower peace of mind. CONCLUSION Peace of mind did not improve significantly over time for AYAs with cancer. While high-quality communication may be associated with heightened peace of mind, further study is needed to clarify relationships between peace of mind and other psychological variables.
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Affiliation(s)
- Jordan A Gittzus
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | - Karen M Fasciano
- Department of Psychosocial Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts
| | - Susan D Block
- Department of Psychosocial Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jennifer W Mack
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts.,Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts
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Steineck A, Bradford MC, Lau N, Scott S, Yi-Frazier JP, Rosenberg AR. A Psychosocial Intervention's Impact on Quality of Life in AYAs with Cancer: A Post Hoc Analysis from the Promoting Resilience in Stress Management (PRISM) Randomized Controlled Trial. CHILDREN-BASEL 2019; 6:children6110124. [PMID: 31684055 PMCID: PMC6915541 DOI: 10.3390/children6110124] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 10/11/2019] [Accepted: 10/23/2019] [Indexed: 01/15/2023]
Abstract
Promoting Resilience in Stress Management (PRISM), a psychosocial intervention for adolescents and young adults (AYAs) with serious illness, enhances resilience resources via four skills-based training sessions. A recent randomized controlled trial showed PRISM improved health-related quality of life (HRQOL) compared to usual care (UC). This post hoc exploratory analysis aimed to better understand the effect of PRISM on HRQOL by describing changes in HRQOL subdomain scores. English-speaking AYAs (12–25 years) with cancer were randomized to PRISM or UC. At enrollment and six months later, HRQOL was assessed using the Pediatric Quality of Life Inventory (PedsQL) Generic Short Form (SF-15) and Cancer Module. Scores at each time point were summarized descriptively and individual HRQOL trajectories were categorized (<70 vs. ≥70). “Positive” trajectories indicate participants maintained scores ≥70 or improved from <70 to ≥70 during the study period. Baseline assessments were completed by 92 participants (48 PRISM, 44 UC); six-month assessments were completed by 74 participants (36 PRISM, 38 UC). For the SF-15, positive trajectories in psychosocial domains were more common with PRISM; trajectories in the physical subdomain were similar across groups. For the Cancer Module, positive trajectories were more common with PRISM in the following subdomains: nausea, treatment anxiety, worry, cognitive, physical appearance, and communication. From this, we conclude PRISM may improve HRQOL, especially in psychosocial domains of wellbeing.
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Affiliation(s)
- Angela Steineck
- Center for Cancer and Blood Disorders Center, Seattle Children's Hospital, Seattle, WA 98105, USA.
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA 98105, USA.
| | - Miranda C Bradford
- Children's Core for Biomedical Statistics, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA 98105, USA.
| | - Nancy Lau
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA 98105, USA.
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA 98105, USA.
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA 98105, USA.
| | - Samantha Scott
- Center for Cancer and Blood Disorders Center, Seattle Children's Hospital, Seattle, WA 98105, USA.
| | - Joyce P Yi-Frazier
- Center for Cancer and Blood Disorders Center, Seattle Children's Hospital, Seattle, WA 98105, USA.
| | - Abby R Rosenberg
- Center for Cancer and Blood Disorders Center, Seattle Children's Hospital, Seattle, WA 98105, USA.
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA 98105, USA.
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA 98105, USA.
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Greer S, Ramo D, Chang YJ, Fu M, Moskowitz J, Haritatos J. Use of the Chatbot "Vivibot" to Deliver Positive Psychology Skills and Promote Well-Being Among Young People After Cancer Treatment: Randomized Controlled Feasibility Trial. JMIR Mhealth Uhealth 2019; 7:e15018. [PMID: 31674920 PMCID: PMC6913733 DOI: 10.2196/15018] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 09/05/2019] [Accepted: 09/24/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Positive psychology interventions show promise for reducing psychosocial distress associated with health adversity and have the potential to be widely disseminated to young adults through technology. OBJECTIVE This pilot randomized controlled trial examined the feasibility of delivering positive psychology skills via the Vivibot chatbot and its effects on key psychosocial well-being outcomes in young adults treated for cancer. METHODS Young adults (age 18-29 years) were recruited within 5 years of completing active cancer treatment by using the Vivibot chatbot on Facebook messenger. Participants were randomized to either immediate access to Vivibot content (experimental group) or access to only daily emotion ratings and access to full chatbot content after 4 weeks (control). Created using a human-centered design process with young adults treated for cancer, Vivibot content includes 4 weeks of positive psychology skills, daily emotion ratings, video, and other material produced by survivors, and periodic feedback check-ins. All participants were assessed for psychosocial well-being via online surveys at baseline and weeks 2, 4, and 8. Analyses examined chatbot engagement and open-ended feedback on likability and perceived helpfulness and compared experimental and control groups with regard to anxiety and depression symptoms and positive and negative emotion changes between baseline and 4 weeks. To verify the main effects, follow-up analyses compared changes in the main outcomes between 4 and 8 weeks in the control group once participants had access to all chatbot content. RESULTS Data from 45 young adults (36 women; mean age: 25 [SD 2.9]; experimental group: n=25; control group: n=20) were analyzed. Participants in the experimental group spent an average of 74 minutes across an average of 12 active sessions chatting with Vivibot and rated their experience as helpful (mean 2.0/3, SD 0.72) and would recommend it to a friend (mean 6.9/10; SD 2.6). Open-ended feedback noted its nonjudgmental nature as a particular benefit of the chatbot. After 4 weeks, participants in the experimental group reported an average reduction in anxiety of 2.58 standardized t-score units, while the control group reported an increase in anxiety of 0.7 units. A mixed-effects models revealed a trend-level (P=.09) interaction between group and time, with an effect size of 0.41. Those in the experimental group also experienced greater reductions in anxiety when they engaged in more sessions (z=-1.9, P=.06). There were no significant (or trend level) effects by group on changes in depression, positive emotion, or negative emotion. CONCLUSIONS The chatbot format provides a useful and acceptable way of delivering positive psychology skills to young adults who have undergone cancer treatment and supports anxiety reduction. Further analysis with a larger sample size is required to confirm this pattern.
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Affiliation(s)
| | - Danielle Ramo
- Hopelab, San Francisco, CA, United States.,Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | | | - Michael Fu
- Hopelab, San Francisco, CA, United States
| | - Judith Moskowitz
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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Conducting Psychosocial Intervention Research among Adolescents and Young Adults with Cancer: Lessons from the PRISM Randomized Clinical Trial. CHILDREN-BASEL 2019; 6:children6110117. [PMID: 31652895 PMCID: PMC6915330 DOI: 10.3390/children6110117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/03/2019] [Accepted: 10/09/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND Adolescents and young adults (AYAs) with cancer have poor psychosocial outcomes, in part because their limited participation in clinical trials precludes intervention-testing. We previously reported results of a successful randomized trial testing an AYA-targeted psychosocial intervention. Here, we aimed to describe strategies learned during the trial's conduct. METHODS We summarized data from the medical record and staff field notes regarding reasons for participation/non-participation. We conducted two focus groups with study staff; directed content analyses identified strategies for success. RESULTS 92 AYAs enrolled (77% of approached; n = 50 Usual Care (control), n = 49 PRISM (intervention)). In eligible families who declined participation (n = 22 AYAs, n = 8 parents), the AYAs more commonly had advanced cancer (n = 11 (37%) declined vs. n = 25 (26%) enrolled). AYA reasons for non-enrollment were predominantly "not interested"; parents worried participation was "too burdensome." Staff strategies for accrual included having significant time to introduce the study and underscoring a desire to learn from the patient. After enrollment, AYAs who discontinued participation were more commonly assigned to control (n = 5 (10%) control vs. n = 2 (4%) intervention). Only n = 1 AYA chose to discontinue participation after receiving the intervention. CONCLUSIONS Efforts to engage AYAs prior to and during studies may help with accrual and retention.
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Rosenberg AR, Yi-Frazier JP. How to Balance "Scalable" with "Individualized" Palliative Care Interventions: The Story of the Promoting Resilience in Stress Management Intervention. J Palliat Med 2019; 22:1178-1179. [PMID: 31584329 DOI: 10.1089/jpm.2019.0249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Abby R Rosenberg
- Palliative Care and Resilience Laboratory, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington.,Divisions of Hematology/Oncology and Bioethics/Palliative Care, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Joyce P Yi-Frazier
- Palliative Care and Resilience Laboratory, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington
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Rosenberg AR, Bradford MC, Junkins CC, Taylor M, Zhou C, Sherr N, Kross E, Curtis JR, Yi-Frazier JP. Effect of the Promoting Resilience in Stress Management Intervention for Parents of Children With Cancer (PRISM-P): A Randomized Clinical Trial. JAMA Netw Open 2019; 2:e1911578. [PMID: 31532518 PMCID: PMC6751761 DOI: 10.1001/jamanetworkopen.2019.11578] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
IMPORTANCE Parents of children with serious illness, such as cancer, experience high stress and distress. Few parent-specific psychosocial interventions have been evaluated in randomized trials. OBJECTIVE To determine if individual- or group-based delivery of a novel intervention called Promoting Resilience in Stress Management for Parents (PRISM-P) improves parent-reported resilience compared with usual care. DESIGN, SETTING, AND PARTICIPANTS This parallel, phase 2 randomized clinical trial with enrollment from December 2016 through December 2018 and 3-month follow-up was conducted at Seattle Children's Hospital. English-speaking parents or guardians of children who were 2 to 24 years old, who had received a diagnosis of a new malignant neoplasm 1 to 10 weeks prior to enrollment, and who were receiving cancer-directed therapy at Seattle Children's Hospital were included. Parents were randomized 1:1:1 to the one-on-one or group PRISM-P intervention or to usual care. Data were analyzed in 2019 (primary analyses from January to March 2019; final analyses in July 2019). INTERVENTIONS The PRISM-P is a manualized, brief intervention targeting 4 skills: stress management, goal setting, cognitive reframing, and meaning making. For one-on-one delivery, skills were taught privately and in person for 30 to 60 minutes approximately every other week. For group delivery, the same skills were taught in a single session with at least 2 parents present. MAIN OUTCOMES AND MEASURES Participants completed patient-reported outcome surveys at enrollment and at 3 months. Linear regression modeling evaluated associations in the intention-to-treat population between each delivery format and the primary outcome (Connor-Davidson Resilience Scale scores, ranging from 0 to 40, with higher scores reflecting greater resilience) and secondary outcomes (benefit finding, social support, health-related quality of life, stress, and distress) at 3 months. RESULTS In total, 94 parents enrolled, were randomized to 1 of the 3 groups, and completed baseline surveys (32 parents in one-on-one sessions, 32 in group sessions, and 30 in usual care). Their median (interquartile range) ages were 35 to 38 (31-44) years across the 3 groups, and they were predominantly white, college-educated mothers. Their children had median (interquartile range) ages of 5 to 8 (3-14) years; slightly more than half of the children were boys, and the most common cancer type was leukemia or lymphoma. One-on-one PRISM-P delivery was significantly associated with improvement compared with usual care in parent-reported outcomes for resilience (β, 2.3; 95% CI, 0.1-4.6; P = .04) and for benefit finding (β, 0.5; 95% CI, 0.2-0.8; P = .001). No significant associations were detected between either platform and other parent-reported outcomes. CONCLUSIONS AND RELEVANCE When delivered individually, PRISM-P was associated with improved parent-reported resilience and benefit finding. This scalable psychosocial intervention may help parents cope and find meaning after their child receives a diagnosis of a serious illness. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02998086.
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Affiliation(s)
- Abby R. Rosenberg
- Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, Washington
- Division of Hematology/Oncology, Department of Pediatrics, University of Washington School of Medicine, Seattle
- Division of Bioethics/Palliative Care, Department of Pediatrics, University of Washington School of Medicine, Seattle
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle
| | - Miranda C. Bradford
- Children’s Core for Biomedical Statistics, Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, Washington
| | - Courtney C. Junkins
- Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, Washington
| | - Mallory Taylor
- Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, Washington
- Division of Hematology/Oncology, Department of Pediatrics, University of Washington School of Medicine, Seattle
| | - Chuan Zhou
- Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, Washington
- Division of General Pediatrics, Department of Pediatrics, University of Washington School of Medicine, Seattle
| | - Nicole Sherr
- Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, Washington
| | - Erin Kross
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle
| | - J. Randall Curtis
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle
| | - Joyce P. Yi-Frazier
- Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, Washington
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Zhang P, Mo L, Torres J, Huang X. Effects of cognitive behavioral therapy on psychological adjustment in Chinese pediatric cancer patients receiving chemotherapy: A randomized trial. Medicine (Baltimore) 2019; 98:e16319. [PMID: 31277176 PMCID: PMC6635241 DOI: 10.1097/md.0000000000016319] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Cognitive behavioral therapy (CBT) has been widely used in pediatric cancer patients to promote psychological adjustment (PA). Considering the diversity of region and culture in China, its effect in Chinese population is not well defined. Therefore, our study is to explore the effect of CBT on improving PA in Chinese pediatric cancer patients receiving chemotherapy. METHODS One hundred four Chinese pediatric cancer patients receiving chemotherapy were divided into CBT group and control group randomly and equally. The resilience and negative mood were applied to evaluate the ability of psychological adjustment (PA). The Conner-Davidson Resilience Scale (CD-RISC) and depression anxiety stress scale (DASS) were employed to measure resilience and negative mood before and after intervention. The SPSS 22.0 software was used to analyze data. RESULTS Prior to the intervention, the ability of psychological adjustment between 2 groups showed no significant difference (P > .05 for all). After intervention, the total CD-RISC score was significantly higher (56.09 ± 7.29 vs 44.75 ± 5.40), whereas the scores of depression (4.57 ± 2.94 vs 7.25 ± 4.25), anxiety (5.83 ± 3.07 vs 8.66 ± 4.92), stress (7.51 ± 4.33 vs 11.17 ± 4.25) were obviously lower in CBT group than those in the control group (P < .05 for all). Moreover, the decline of negative mood score in Yolk sac tumor children was the most evident in CBT group. While the resilience changes of cancer children in stage III was most obvious. CONCLUSIONS CBT can effectively help Chinese pediatric cancer patients modify distorted cognition to have a positive attitude towards cancer and chemotherapy. This treatment enhances resilience and relieves negative mood, which results in good psychological adjustment ability, especially in Yolk sac tumor and stage III. It has a beneficial effect on better treatment cooperation and high long-term quality of life.
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Affiliation(s)
- Ping Zhang
- The Academy of Pediatrics of Chongqing Medical University, Chongqing, China
- Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing
- China International Science and Technology Cooperation base of Child Development and Critical Disorders
- Chongqing Key Laboratory of Pediatrics, Chongqing
| | - Lin Mo
- VIP Outpatient in Children's Hospital of Chongqing Medical University, Chongqing, China
- Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing
- China International Science and Technology Cooperation base of Child Development and Critical Disorders
- Chongqing Key Laboratory of Pediatrics, Chongqing
| | - Joseph Torres
- University Hospital “General Calixto Garcia”; Department of Plastic Surgery and Burns Care, Havana University of Health Sciences, Havana
| | - Xiaoyan Huang
- Department of Oncology, Children's Hospital Affiliated to Chongqing Medical University; Chongqing, China
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Lau N, Bradford MC, Steineck A, Junkins CC, Yi-Frazier JP, McCauley E, Rosenberg AR. Exploratory analysis of treatment response trajectories in the PRISM trial: Models of psychosocial care. Psychooncology 2019; 28:1470-1476. [PMID: 31037789 DOI: 10.1002/pon.5098] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 04/15/2019] [Accepted: 04/18/2019] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Adolescents and young adults (AYAs) with cancer are at high risk of negative psychosocial outcomes. Promoting Resilience in Stress Management (PRISM), a novel, brief, skill-based intervention, has demonstrated efficacy in improving psychosocial well-being for AYAs. We utilized data from a recent randomized trial of PRISM versus usual care (UC) to categorize and explore group differences in change trajectories of patient reported outcomes (PROs) over time. METHODS One hundred English-speaking AYAs (aged 12-25 years old) with cancer were randomized to PRISM versus UC. At enrollment and 6 months later, AYAs completed validated PROs measuring resilience (Connor-Davidson Resilience Scale [CDRISC-10]), hope (Hope Scale), benefit finding (Benefit and Burden Scale for Children), cancer-specific quality of life (Pediatric Quality of Life [PedsQL] Cancer Module), and distress (Kessler-6). Patient response trajectories were categorized as "improved," "consistently well," "consistently at risk," or "deteriorated" using minimal clinically important differences (MCIDs) or established measure cutoffs for all PROs. Positive response trajectories consisted of the first two categories ("improved" and "consistently well"), and negative response trajectories consisted of the latter two categories ("consistently at risk" and "deteriorated"). RESULTS Across all PROs, more patients in the PRISM arm "improved" in psychosocial well-being over time, and fewer PRISM recipients "deteriorated" over time. Across all PROs, a greater proportion of PRISM participants (vs UC) experienced positive response trajectories. Across all PROs, a greater proportion of UC participants experienced negative response trajectories. CONCLUSIONS PRISM shows evidence of both a prevention effect and an intervention effect. Thus, PRISM may serve as a viable prevention and early intervention model for psychosocial care.
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Affiliation(s)
- Nancy Lau
- Palliative Care and Resilience Research Program, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington.,Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington.,Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Miranda C Bradford
- Palliative Care and Resilience Research Program, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington.,Children's Core for Biomedical Statistics, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington
| | - Angela Steineck
- Palliative Care and Resilience Research Program, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington.,Division of Hematology/Oncology, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Courtney C Junkins
- Palliative Care and Resilience Research Program, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington
| | - Joyce P Yi-Frazier
- Palliative Care and Resilience Research Program, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington
| | - Elizabeth McCauley
- Division of Child Psychiatry, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington.,Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington
| | - Abby R Rosenberg
- Palliative Care and Resilience Research Program, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington.,Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington.,Division of Hematology/Oncology, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington.,Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
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