Impact of caring for a child with cancer on parents' health-related quality of life

Assessment of quality of life of children and adolescents with cancer during their treatment

OBJECTIVE

The purpose of this study was to evaluate the quality of life of children and adolescents with any type of cancer in all phases of their treatment.

METHODS

Fifty-six newly diagnosed patients diagnosed with malignancy and hospitalized in a Pediatric Hematology-Oncology Unit in Athens were included in the study. Minneapolis-Manchester Quality of Life Instrument was used for data collection from July 2010 to December 2012. The assessment of children and adolescents' quality of life who were under treatment was performed in three different stages of treatment.

RESULTS

The results of the study showed that the quality of life of children and adolescents with cancer did not change notably during their treatment (F = 0.16, P = 0.86 and F = 0.03, P = 0.97). For the first measurement, at the beginning of the therapy, the score on the scale for quality of life for children and adolescents was 3.44 and 3.88, respectively, in the middle of the treatment 3.36 and 3.89, respectively, and 3.43 and 3.89, respectively, when therapy was completed. Children and adolescents diagnosed with hematologic cancer stated higher quality of life scores (z = -1.61, P = 0.05 and t = 2.64, P = 0.007). Moreover, teenage patients (F = 13.22, P = 0.001) and male patients (t = 2.31, P = 0.02 and t = 2.27, P = 0.02) expressed better quality-of-life scores.

CONCLUSION

According to the results, children and adolescents with any kind of cancer have better quality-of-life scores at the end of their treatment, and when they are supported by their family.

Acceptability and feasibility of an e-mental health intervention for parents of childhood cancer survivors: "Cascade"

PURPOSE

The aim of this study was to evaluate the feasibility and acceptability of "Cascade": an online, group-based, cognitive behavioral therapy intervention, delivered "live" by a psychologist, to assist parents of children who have completed cancer treatment.

METHODS

Forty-seven parents were randomized to Cascade (n = 25) or a 6-month waitlist (n = 22). Parents completed questionnaires at baseline, 1-2 weeks and 6 months post-intervention. Thirty parents completed full evaluations of the Cascade program (n = 21 randomized to Cascade, n = 9 completed Cascade post-waitlist).

RESULTS

Ninety-six percent of Cascade participants completed the intervention (n = 24/25). Eighty percent of parents completed every questionnaire (mean completion time 25 min (SD = 12)). Cascade was described as at least "somewhat" helpful by all parents. None rated Cascade as "very/quite" burdensome. Parents reported that the "online format was easy to use" (n = 28, 93.3 %), "I learnt new skills" (n = 28, 93.3 %), and "I enjoyed talking to others" (n = 29, 96.7 %). Peer-to-peer benefits were highlighted by good group cohesion scores.

CONCLUSIONS

Cascade is highly acceptable and feasible. Its online delivery mechanism may address inequities in post-treatment support for parents, a particularly acute concern for rural/remote families. Future research needs to establish the efficacy of the intervention.

TRIAL REGISTRATION

ACTRN12613000270718, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12613000270718.

Impact of Caregiving for a Child With Cancer on Parental Health Behaviors, Relationship Quality, and Spiritual Faith: Do Lone Parents Fare Worse?

Caregiving stress has been associated with changes in the psychological and physical health of parents of children with cancer, including both partnered and single parents. While parents who indicate "single" on a demographic checklist are typically designated as single parents, a parent can be legally single and still have considerable support caring for an ill child. Correspondingly, an individual can be married/partnered and feel alone when caring for a child with serious illness. In the current study, we report the results from our exploratory analyses of parent self-reports of behavior changes during their child's treatment. Parents (N = 263) of children diagnosed with cancer were enrolled at 10 cancer centers. Parents reported significant worsening of all their own health behaviors surveyed, including poorer diet and nutrition, decreased physical activity, and less time spent engaged in enjoyable activities 6 to 18 months following their child's diagnosis. More partnered parents found support from friends increased or stayed the same since their child's diagnosis, whereas a higher proportion of lone parents reported relationships with friends getting worse. More lone parents reported that the quality of their relationship with the ill child's siblings had gotten worse since their child's diagnosis. Spiritual faith increased for all parents.

Effect of Instructing Care Program Through Group Discussion on the Quality of Life of the Parents of the Children Afflicted With Leukemia

Purpose:

Children long-term involvement with cancer may have a negative impact on the quality of life their parents. Design and implementation of training programs for parents whose children have been diagnosed with leukemia, as the primary caregivers of children, will have a special significance and can contribute to better taking care of such children. The main purpose of the present study was to examine the impact of conducting group discussion, as care program training, on the quality of life parents whose children were suffering from leukemia.

Methods:

This quasi-experimental before-after intervention study encompassed two groups of parents (in total 41) of leukemia children. To collect data, a demographic questionnaire and the shortened version of SF-36 questionnaire were used to determine the quality of life of parents. Both groups completed the quality of life questionnaires before and two months after the intervention.

Results:

Comparison of the parents’ quality of life mean scores, obtained before and two months after training, showed that promotion in 6 domains of bodily pain, general health, emotional health, role limitation due to emotional problems, social functioning, and vitality were occurred. (P <0.05)

Conclusions:

Considering the important role of parents in taking care of children suffering from leukemia, introduction of care program training can be a positive step to help these parents and empower them to manage their children’s problems more systematically and will ultimately lead to improved quality of life of parents.

Psychological distress and coping strategies in parents of children with cancer in Lebanon

OBJECTIVES

To determine the prevalence of psychological distress (PD) among parents of Lebanese children with cancer and to investigate the associated stressors and coping strategies.

METHODS

A cross-sectional study conducted at the American University of Beirut Medical Center-Children Cancer Center of Lebanon in 2012. Parents of all children with cancer admitted for treatment were eligible participants. The General Health Questionnaire (GHQ-12) was used to estimate the prevalence of PD. Coping strategies were measured via the Coping Health Inventory for Parents (CHIP). Bivariate and multiple regression analyses were conducted to evaluate the relationship between GHQ-12 (scores 0-36), stressors, family/social support, and coping strategies.

RESULTS

One hundred fourteen parents (68.2%) completed the anonymous questionnaire. Based on GHQ-12, significant PD was considered among 56.0% of the parents. It was found to be significantly positively associated with the degree of family financial problems and significantly negatively associated with the child's disease duration. A significant negative relationship was also found between PD and Coping (CHIP) scale, coping pattern I (Maintaining Family Integration and an Optimistic Outlook for the Situation), pattern II (Seeking Social Support), yet not with pattern III (Seeking Information).

CONCLUSIONS

PD is prevalent among parents of Lebanese children hospitalized because of cancer. Screening for PD in the latter population is feasible, would identify those who are at risk for disruptive PD, and facilitate the provision of support towards better adjustment and coping. Alleviating parental PD may facilitate the realization of optimal health outcomes.

Sleep in mother and child dyads during treatment for pediatric acute lymphoblastic leukemia

PURPOSE/OBJECTIVES

To compare the sleep of children with acute lymphoblastic leukemia (ALL) during maintenance treatment with controls and to measure the effect on maternal sleep.

DESIGN

Comparative, descriptive.

SETTING

Pediatric oncology clinic and communities in Colorado.

SAMPLE

26 dyads of mothers and children with ALL and matched controls.

METHODS

Mothers completed insomnia severity, mood, and stress questionnaires and wore a wrist actigraph, and mothers and children completed a seven-day sleep diary.

MAIN RESEARCH VARIABLES

Mother and child sleep parameters (e.g., total sleep time, sleep latency, sleep efficiency, awakenings); maternal insomnia severity, mood, and stress; child sleep habits.

FINDINGS

Mothers of children with ALL reported greater insomnia compared to controls, which was correlated with anxiety, depressive symptoms, and stress. Maternal groups did not differ on diary- and actigraph-measured sleep outcomes; both groups experienced sleep fragmentation. Children with ALL took longer to fall asleep and had more variable sleep patterns.

CONCLUSIONS

Actigraph and sleep diary data indicated adequate maternal sleep duration and sleep latency. Self-reported insomnia severity in mothers of children with ALL suggested sleep fragmentation that may be undetected by these measures.

IMPLICATIONS FOR NURSING

Oncology nurses are in a unique position to identify sleep problems in mothers and children with ALL, which may lead to recommendations for improved sleep and referrals for treatment.

Characterizing Early Psychosocial Functioning of Parents of Children with Moderate to Severe Genital Ambiguity due to Disorders of Sex Development

PURPOSE

We examined the psychosocial characteristics of parents of children with disorders of sex development at early presentation to a disorders of sex development clinic. Parental anxiety, depression, quality of life, illness uncertainty and posttraumatic stress symptoms were assessed. Additionally we evaluated the relationship of assigned child gender to parental outcomes.

MATERIALS AND METHODS

A total of 51 parents of children with ambiguous or atypical genitalia were recruited from 7 centers specializing in treatment of disorders of sex development. At initial assessment no child had undergone genitoplasty. Parents completed the Cosmetic Appearance Rating Scale, Beck Anxiety Inventory, Beck Depression Inventory, SF-36, Parent Perception of Uncertainty Scale and Impact of Event Scale-Revised.

RESULTS

A large percentage of parents (54.5%) were dissatisfied with the genital appearance of their child, and a small but significant percentage reported symptoms of anxiety, depression, diminished quality of life, uncertainty and posttraumatic stress. Few gender differences emerged.

CONCLUSIONS

Although many parents function well, a subset experience significant psychological distress around the time of diagnosis of a disorder of sex development in their child. Early screening to assess the need for psychosocial interventions is warranted.

Coping Strategies and Locus of Control in Childhood Leukemia: A Multi-Center Research

Acute lymphoblastic leukemia (ALL) is a very distressing experience for children and requires a special effort of adjustment. Therefore, it seems to be crucial to explore coping resources for the experienced risk condition. In this sense, the study focuses on coping strategies and locus of control in children with ALL during the treatment phase, and on their possible relation. The correlation between children and maternal coping strategies is also investigated. The participants involved were an experimental group of 40 children with ALL and their mothers, and 30 healthy children as the control group. The tools used were: the Child Behavioral Style Scale and the Monitor-Blunter Style Scale to assess the coping strategies of children and mothers; the locus of Control Scale for Children to analyze the children's perception of controlling the events. Both children with ALL and their mothers resorted to monitoring coping strategies with a statistically significant rate of occurrence (children: M=17.8, SD=3.8; mothers: M=10.48, SD=3.4). The data concerning the locus of control show this tendency towards internal causes (M=53.1, SD=4.7). There were statistically significant correlations between monitoring coping strategies and external locus of control (r=0.400, P<0.05). The results gained from the control group are almost equivalent. The outcomes show several interesting resources of the psychological functioning of children as well as of their mothers.

Sleep patterns, sleep instability, and health related quality of life in parents of ventilator-assisted children

STUDY OBJECTIVES

Parents of children with chronic illnesses have poorer health related quality of life (HRQoL), shorter sleep duration, and poorer sleep quality than parents of healthy children. However, night-to-night variability of sleep in parents has not previously been considered. This study compared the sleep patterns of parents of ventilator-assisted children (VENT) and healthy, typically developing children (HEALTHY), and examined the relationship between sleep variability and perceived HRQoL.

METHODS

Seventy-nine mothers and 33 fathers from 42 VENT families (n = 56) and 40 HEALTHY (n = 56) families completed the SF-36 and wore an actigraph for 2 weeks. Reported bedtime and wake time, along with actigraphic total sleep time (TST), wake after sleep onset (WASO), and sleep efficiency (SE) were examined using both average values and night-tonight instability (mean square successive differences).

RESULTS

VENT parents showed significantly later bedtimes, shorter TST, longer WASO, and lower SE than HEALTHY parents. VENT parents also exhibited greater instability in their reported wake time, WASO, and SE. Adjusting for family type and gender, greater instability of wake times, WASO and SE were related to poorer SF-36 subscale scores, while averaged sleep values were not.

CONCLUSIONS

Many parents of ventilator-assisted children experience deficient sleep and show significant instability in their sleep, which was related to HRQoL. Similar to shift workers, variable sleep schedules that may result from caregiving responsibilities or stress may impact parental caregivers' health and well-being. Additional studies are needed to determine how support and other interventions can reduce sleep disruptions in parental caregivers.

Design and rationale for NOURISH-T: a randomized control trial targeting parents of overweight children off cancer treatment

Approximately 40% of off-treatment pediatric cancer survivors (PCS) are overweight or obese, which increases their risk for negative long-term physical health complications. Consistent with the Institute of Medicine's (IOM) emphasis on patients transitioning from treatment to cancer survivorship and increasing long-term healthy behaviors in these survivors, we plan to conduct a pilot RCT to address the increasing overweight/obesity rates among PCS by targeting their caregivers as agents for PCS behavior change. We plan to focus on parents' behaviors, attitudes and roles in promoting healthier eating and physical activity (PA) in PCS and adapt an evidence-informed, manualized parent intervention - NOURISH - found to be effective for parents of overweight and obese children and adolescents in reducing child and adolescent BMI. We plan to adapt NOURISH for caregivers of 5-12 year old PCS (6 months-4 years off active cancer treatment). Our pilot feasibility RCT - NOURISH-T (Nourishing Our Understanding of Role modeling to Improve Support for Healthy Transitions) evaluates: 1) the preliminary efficacy of NOURISH-T for PCS, compared with an Enhanced Usual Care (EUC) control condition, and 2) factors to consider to improve future adaptations of the intervention. The project will enroll caregivers of PCS at two pediatric oncology clinics into the 6-week intervention (or EUC) with assessments occurring pre- and post-6 weeks of intervention, and at a 4-month follow-up.

Prenatally-counseled congenital diaphragmatic hernia parents exhibit positive well-being before and after surgical repair

BACKGROUND/PURPOSE

The purpose of this paper was to examine the effect of prenatal counseling in the Advanced Fetal Care Center (AFCC) on the well-being of parents of infants with congenital diaphragmatic hernia (CDH).

METHODS

From 2008 through 2012, 26 mothers and fathers of surgically repaired CDH patients who received prenatal counseling at our institution, and 15 who received no prenatal counseling, each completed the Short-Form 36 version 1 (SF-36v1) at the appropriate time points: prenatal, two weeks, and six months post-surgery.

RESULTS

Parents in both groups did not differ by demographic characteristics. Patients who received prenatal counseling had significantly longer ventilatory time and length of stay (LOS) in the ICU and in the hospital compared to those who did not receive prenatal counseling (all P<.01). Mothers and fathers had similar SF-36v1 mental and physical component summary (MCS, PCS) post-surgery scores when compared by counseling status. Prenatal MCS scores for mothers and fathers (47 vs. 41; P=.24) were similar to those at six months post-surgery (47 vs. 47; P=.90).

CONCLUSIONS

When hospital LOS was controlled between groups stratified by AFCC counseling status, MCS scores were comparable prenatally and were sustained at six months post-surgery for both parents. These findings may reflect the support services parents received beginning in the prenatal period.

Caring for a child with cancer: impact on mother's health

The life of a mother undergoes a dramatic change after a child is diagnosed with cancer. The present study aimed to determine effects on the everyday life process and health status of mothers with children suffering from leukemia. This qualitative study was based on a grounded theory approach with sixteen mothers. The results indicate that after onset of disease in their children, they marginalized their own health and tied their identities to taking care of the child and keeping the child healthy by ignoring themselves, becoming imprisoned in a taking-care-of-the-child position, and trying very hard for seek balance and stability Enduring physical pressures on the one hand, and constantly attempting to achieve balance and stability in family processes on the other hand, gradually cause exhaustion. It seems that health care providers and nurses should pay much more attention to the health status of this group of mothers.

Sleep quality, stress, caregiver burden, and quality of life in maternal caregivers of young children with bronchopulmonary dysplasia

Little is known about the influence of sleep quality, stress, and caregiver burden on quality of life in maternal caregivers of young children with bronchopulmonary dysplasia (BPD). In 61 maternal caregivers (mean age 29.59 years) of young children with BPD (mean age 13.93 months), caregivers reported sleeping a mean of 5.8 hours, and significant correlations were found between sleep quality and depressive symptoms and stress, as well as an inverse correlation with quality of life. Sleep quality was found to be the most significant predictor of quality of life in maternal caregivers.

The impact of bronchopulmonary dysplasia on caregiver health related quality of life during the first 2 years of life

OBJECTIVES

Preterm children with bronchopulmonary dysplasia (BPD) frequently require complex home medical regimens and re-hospitalization during the first 2 years of life. The burden of caring for these medically complex children may negatively affect caregiver health related quality of life (HRQoL). The objectives of this study were to measure caregiver HRQoL of children with BPD and to identify factors that impact caregiver HRQoL during the first 2 years of life.

METHODS

Children (n = 186) were recruited from the Johns Hopkins BPD Outpatient Clinic between January 2008 and July 2011. Caregiver HRQoL was measured using The PedsQL(TM) Family Impact Module. Respiratory symptoms and morbidities were assessed using questionnaires.

RESULTS

Among caregivers of BPD children, significant improvement in physical, worry, and daily domains improved longitudinally as children aged. An association was found between lower total HRQoL scores and caregivers of BPD children who reported more respiratory symptoms and acute care usage. No difference in total HRQoL scores was found between caregivers of BPD children requiring respiratory/enteral support and caregivers of children who did not. Caregiver income and educational level did not predict total HRQoL score, but Non-White race and public insurance was associated with a higher total HRQoL score at the first outpatient visit.

CONCLUSION

An association was found between lower HRQoL scores and caregivers of BPD children with frequent respiratory symptoms and acute care usage. Screening for low HRQoL in caregivers of BPD children with frequent respiratory illnesses should be considered to identify those who may benefit from additional support and intervention.

Quality of life assessment in children commencing home INR self-testing

INTRODUCTION

Management of oral anticoagulant therapy (OAT) in children is complex and frequent testing of the International Normalised Ratio (INR) is a significant burden. This study evaluates the impact of a home INR self-testing (home ST) program on the quality of life (QoL) of children and their families. The aim of the study was to determine if participation in a home ST program improves QoL for children requiring long-term OAT and their families.

MATERIALS AND METHODS

Children aged eight to 18 years requiring long-term OAT and parents of children participated. Quantitative methods comprised three validated QoL questionnaires; the anticoagulation specific PAC QL©, the PedsQL™ and the PedsQL FIM™. Questionnaires were completed before commencing home ST and 6-12 months later. Qualitative methods consisted of open-ended questions which participants answered when completing the questionnaires for the second time. Results of INRs tested at home were collected.

RESULTS

Fifty-five parents and 35 children participated. The percentage of time the children's INRs were in their target therapeutic range was 71.3. Parents reported statistically significant improvements in QoL for themselves (mean increase 6.9), their family (mean increase 8.6) and their child (mean increase 11.1) following the commencement of home ST (difference p≤0.003 on all questionnaires). The children did not report a statically significant improvement in QoL.

CONCLUSION

Parents reported significant improvement for their child's QoL, their QoL and the families' function following commencement of home ST. Children did not report a significant improvement in their QoL, but clearly identified satisfaction with home ST.

Guided self-help as intervention for traumatic stress in parents of children with cancer: conceptualization, intervention strategies, and a case study

Being a parent of a child diagnosed with cancer poses an enormous stressor. Indeed, several parents have difficulties adjusting to such a situation and react with symptoms of traumatic stress, depression, and reduced quality of life. However, there is little conceptual work on behavioral mechanisms that contribute to suboptimal adaptation in these parents. The authors present a conceptualization in which experiential avoidance and rumination are suggested to contribute to increased levels of traumatic stress and suboptimal adaption. Based on this conceptualization, a recently developed intervention for parents of children with cancer, in the form of guided self-help, is presented. Finally, the authors present a successful case study as an example of the application of this intervention. Clinical implications and suggestions for future research are discussed.

Repercussões do câncer infantil para o cuidador familiar: revisão integrativa

Trata-se de uma revisão integrativa da literatura com o objetivo de identificar as repercussões do câncer infantil para o cuidador familiar. A pesquisa foi realizada nas bases de dados LILACS, PubMed, SciELO, Adolec e Cochrane, buscando-se artigos em português, inglês e espanhol, publicados entre 2005 e 2010, usando os descritores: cuidadores, criança, câncer e enfermagem. Foram obtidos dezoito artigos. A análise das publicações selecionadas permitiu a identificação de quatro categorias temáticas: sentimentos vivenciados pelo cuidador familiar; repercussões físicas e psicológicas do sofrimento do cuidador familiar; Impacto financeiro do câncer infantil na vida do cuidador e necessidade de apoio social ao cuidador familiar. Conclui-se que os prejuízos à vida do cuidador podem fragilizar a relação criança/cuidador necessitando efetiva atuação da equipe de saúde no intuito de oferecer suporte, acompanhamento e orientação.

Correlates of physiological and psychological stress among parents of childhood cancer and brain tumor survivors

OBJECTIVE

First, we sought to determine if parents of children with cancer or a brain tumor had greater stress compared to parents of healthy children and to evaluate the correlates of stress among parents of children with cancer or brain tumors. Second, we sought to examine the relationship between perceived stress and symptoms of stress and how that relationship may differ for parents of children with cancer.

METHODS

In-person, interviewer-assisted surveys were administered to 73 case dyads (children with cancer or a brain tumor and their parents) and 133 comparison dyads (children without health problems and their parents from a community sample). Descriptive analyses and multivariable logistic regressions were performed for case-comparison and case-only analyses to distinguish correlates of parental stress.

RESULTS

Parents of children with cancer exhibited higher levels of physiological symptoms of stress than parents of healthy children. Poor sleep quality and greater social stress (negative social interactions) were significant correlates of increased levels of stress in parents of children with cancer (odds ratio 4.23, 95% confidence interval 1.15-15.60; and odds ratio 1.07, 95% confidence interval 1.00-1.14, respectively). A subset of parents reported symptoms of stress but not perceived stress, and this discordance was more pronounced among cancer caregivers.

CONCLUSIONS

Implementation of screening tools that include symptoms of stress may help clinicians to comprehensively identify parents of children with cancer who are in need of additional services. Targeted stress-reduction interventions that address sleep quality and negative social interactions may mitigate the deleterious effects of caregiving, improving the psychosocial well-being of both parents and children with cancer.

Health related quality of life for monosymptomatic enuretic children and their mothers

PURPOSE

There have been few reports addressing how nocturnal enuresis affects the health related quality of life of patients and their mothers. Thus, we evaluated the health related quality of life of enuretic children and their mothers.

MATERIALS AND METHODS

The health related quality of life of 139 patients with nocturnal enuresis and that of their mothers were evaluated before and after treatment. The children's health related quality of life was evaluated with the Kid-KINDL® protocol. The mothers' health related quality of life was evaluated using the SF-36®, the SDS (Self-Rating Depression Scale) for rating depression and the STAI (State-Trait Anxiety Inventory) for assessing anxiety.

RESULTS

In the health related quality of life of enuretic children, the family domain score was significantly lower than that of controls (p = 0.02). In the health related quality of life of the mothers as shown by SF-36, the vitality domain score was significantly lower compared to controls (p = 0.01). The evaluation of the STAI score demonstrated a higher state anxiety score (p = 0.003), which represents current suffering from anxiety, and a similar trait anxiety score (p = 0.22), which represents a similar level of underlying tendency to anxiety. There was no significant difference between the mothers of enuretic children and the controls in the SDS evaluation. After treatment for enuresis the health related quality of life score was improved not only for the enuretic children as assessed by the Kid-KINDL protocol, but also for the mothers of enuretic children as assessed by the SF-36 and STAI.

CONCLUSIONS

Similar to other pediatric chronic diseases, nocturnal enuresis is a condition that negatively affects the health related quality of life of children and their mothers. Impaired health related quality of life can be improved after the successful treatment of nocturnal enuresis.

Qualidade de vida e grau de ansiedade e depressão em cuidadores de crianças com paralisia cerebral

OBJETIVO: Avaliar o grau de ansiedade e depressão e a qualidade de vida dos cuidadores de crianças com crianças com paralisia cerebral. MÉTODOS: Estudo transversal descritivo com cuidadores de crianças acompanhadas na Associação de Pais e Amigos dos Excepcionais (Apae) e na Associação dos Deficientes Físicos de Alagoas (Adefal), em Maceió, Alagoas. Para a coleta de dados, realizada com uma amostra de 82 cuidadores, utilizou-se a Escala Hospitalar de Ansiedade e Depressão (HAD) e um instrumento genérico de avaliação de qualidade de vida, o SF-36 (Medical Outcomes Study 36 - Item Short-Form Health Survey). Os dados foram analisados utilizando-se média, desvio padrão, mediana e intervalo de confiança de 95% (IC95%). RESULTADOS: A média de idade dos cuidadores foi de 32,4±10,3 anos, variando de 18 a 77. Constatou-se ansiedade em 49% dos cuidadores (IC95% 38 - 60) e depressão em 31% (IC95% 22 - 42). No questionário SF-36, os domínios mais afetados foram: limitação por aspectos emocionais, com 56 pontos (IC95% 46 - 65), e vitalidade, com 57 (IC95% 52 - 62). CONCLUSÕES: Os cuidadores apresentaram alta ansiedade e depressão; não possuíam boa qualidade de vida, especialmente nos domínios "limitação por aspectos emocionais" e "vitalidade".

Sobrecarga e qualidade de vida de cuidadores de criança e adolescentes com câncer em tratamento quimioterápico

OBJETIVO: Avaliar a sobrecarga de cuidado e a qualidade de vida (QV) de cuidadores de crianças/adolescentes com câncer durante tratamento quimioterápico e relacioná-las entre si e aos dados sociodemográficos. MÉTODOS: Estudo transversal, com 160 cuidadores. Foram coletados dados sociodemográficos, sobrecarga de cuidado, conforme "Caregiver Burden Scale" e de QV pelo SF-36. RESULTADOS: 88,7% dos cuidadores eram mães, idade média 34,9 anos, escore geral de sobrecarga 2,09±0,04 e escores do SF-36 mais comprometidos: aspectos emocionais, vitalidade, saúde mental e aspectos físicos. O modelo de regressão respondeu 36,0% da sobrecarga. CONCLUSÃO: A QV dos cuidadores e sobrecarga de cuidados vivenciada mostram-se comprometidas em diversos domínios, e essas alterações podem afetar a qualidade da assistência prestada às crianças e adolescentes e propiciar desajustes na própria saúde.

Assessing health-related quality-of-life changes in informal caregivers: an evaluation in parents of children with major congenital anomalies

PURPOSE

Relatively few attempts to measure the effects on the health-related quality of life (HRQoL) of informal caregivers within the context of economic evaluations have been reported. This paper is an exploratory attempt to find suitable methods to assess caregivers' HRQoL, using a population of parents of children with major congenital anomalies.

METHODS

A total of 306 parents of children born with either congenital anorectal malformations (ARM) or congenital diaphragmatic hernia were surveyed. They rated their current HRQoL on the EQ-VAS. After that, they rated their HRQoL again on the assumption that someone would take over their caregiving activities completely and free of charge. Finally, the parents classified their HRQoL on the EQ-5D. The caregivers' scores on the EQ-VAS and the EQ-5D were compared with scores elicited in the general population.

RESULTS

Most parents indicated that their HRQoL would not change if someone else took on their caregiving activities. Some methodological issues may have influenced this outcome, such as difficulties in self-assessing HRQoL changes due to caregiving, process utility, protest answers, and difficulties in understanding the hypothetical question. The HRQoL of the parents was relatively low compared with population statistics, especially in the parents of children with ARM and in mothers. This can be illustrated by the difference between the mean EQ-5D score of the mothers aged 25-34 years of the children with ARM and that of the general population (0.83 vs. 0.93; P = 0.002).

CONCLUSIONS

Significant HRQoL differences exist between parents caring for children with congenital anomalies and the general population. It would be useful to further improve our understanding of the HRQoL impact of informal caregiving, separating 'caregiving effects' from 'family effects', and distinguishing parent-child relationships from other caregiving situations. This study underlines the importance of considering caregivers, also in the context of economic evaluations. It indicates that general HRQoL measures, as used in patients, may be able to detect HRQoL effects in caregivers, which facilitates the incorporation in common economic evaluations of HRQoL effects in carers. Analysts and policy makers should be aware that if HRQoL improvement is an important aim, they should register HRQoL changes not only in patients but also in their caregivers.

Parental Perceptions of Care of Children at End of Life

Objective:

Little is known regarding the perceptions of parents about end-of-life care for their children. This study describes parental perceptions of the care of hospitalized, terminally ill children in the areas of (1) clinical management, (2) interdisciplinary support, and (3) pain and symptom management.

Methods:

Through a mixed methods design, researchers interviewed a representative sampling of bereaved parents via telephone.

Results:

Data provided evidence of areas which lack satisfaction with elements of end-of-life care of hospitalized children.

Conclusion:

Parental satisfaction with their child’s care during end of life indicates need for improvement in pain management, communication, and parental involvement in decision making. While education cannot guarantee desired changes in attitudes or behaviors, it may provide the essential foundation of knowledge, skills, and ethical understanding needed by professional providers.

Impact of caring for a child with cancer on single parents compared with parents from two-parent families

BACKGROUND

It is currently unknown how the intensive and often prolonged treatment of childhood cancer impacts on the lives of single parents. Our aims were to determine whether single parents differ from parents from two-parent families in terms of caregiver demand (the time and effort involved in caregiving), and health-related quality of life (HRQL).

PROCEDURES

Forty single parents and 275 parents from two-parent families were recruited between November 2004 and February 2007 from five pediatric oncology centers in Canada. Parents were asked to complete a questionnaire booklet composed of items and scales to measure caregiver demand and HRQL (SF-36). The booklet also measured the following constructs: background and context factors, child factors, caregiving strain, intrapsychic factors, and coping factors.

RESULTS

Single parents did not differ from parents from two-parent families in caregiving demand and physical and psychosocial HRQL. Compared with Canadian population norms for the SF-36, both groups reported clinically important differences (i.e., worse health) in psychosocial HRQL (effect size ≥ -2.00), while scores for physical HRQL were within one standard deviation of population norms.

CONCLUSION

Our findings suggest that the impact of caregiving on single parents, in terms of caregiving demand and HRQL is similar to that of parents from two-parent families.

The quality of life and psychological status of mothers of hospitalized pediatric oncology patients

This study compares the quality of life (QoL) and psychological status of mothers of children with cancer with those of mothers of children without cancer. One hundred hospitalized children and their mothers, as primary caregivers, were included in this study. Fifty mothers with healthy children were enrolled as the control group. A children and mother query form was used to obtain demographical data. The disease histories were extracted from patient records. QoL was measured with the Medical Outcomes Study 36-item Short Form Survey (SF-36) and the State-Trait Anxiety Inventory (STAI) in order to assess the psychological symptoms of the mothers in the study and in the control groups. The mean age of the caregivers was 35.93 ± 8.27 years, whereas the mean age of the mothers in the control group was 39.72 ± 6.88 years. The general health, vitality, social functioning, and mental health scores from the SF-36 and the STAI-trait scores were significantly poorer among the mothers of children with cancer as compared with the scores of the mothers of children without cancer (P < .05). Significant negative correlations were found between the age of the children, the age at diagnosis, and the SF-36 subscores for physical functioning, physical role, and pain (P < .05). The mothers of children with cancer, who require hospital care, have poorer QoL and psychological health than the mothers of healthy children. These results suggest that the current system for treating cancer in Turkish children should also include close monitoring of the care-giving mothers' QoL and psychological health.

Anxiety, depression, and life satisfaction in parents caring for children with cystic fibrosis

OBJECTIVE

To assess the prevalence of symptoms of anxiety and depression and the extent of life satisfaction in parents caring for children with cystic fibrosis (CF) in Germany.

METHODS

The study included 650 caregivers of 564 children with CF ages 0-17, who completed the Hospital Anxiety Depression Scale (HADS), the Center for Epidemiologic Studies Depression Scale (CES-D) and the Questions on Life Satisfaction (FLZ(M) ).

RESULTS

More than one-third (37.2%) of parents showed elevated levels of anxious symptoms, compared to 18.9% of a population sample (P≤0.001) and significantly more parents reported elevated levels of depressive symptoms compared to a community sample (28% vs. 21%, P=0.01). Higher levels of anxious and depressive symptoms were associated with lower life satisfaction (P<0.001).

CONCLUSIONS

High levels of anxious and depressive symptoms among parents of children with CF suggested that annual symptom screening is warranted. This will facilitate identification of those at risk and provide referrals and intervention for those who are in need of it.

Challenging issues in pediatric oncology

Improvements in protocol-driven clinical trials and supportive care for children and adolescents with cancer have reduced mortality rates by more than 50% over the past three decades. Overall, the 5-year survival rate for patients with pediatric cancer has increased to approximately 80%. Recognition of the biological heterogeneity within specific subtypes of cancer, the discovery of genetic lesions that drive malignant transformation and cancer progression, and improved understanding of the basis of drug resistance will undoubtedly catalyze further advances in risk-directed treatments and the development of targeted therapies, boosting the cure rates further. Emerging new treatments include novel formulations of existing chemotherapeutic agents, monoclonal antibodies against cancer-associated antigens, and molecular therapies that target genetic lesions and their associated signaling pathways. Recent findings that link pharmacogenomic variations with drug exposure, adverse effects, and efficacy should accelerate efforts to develop personalized therapy for individual patients. Finally, palliative care should be included as an essential part of cancer management to prevent and relieve the suffering and to improve the quality of life of patients and their families.

Taking care of children with cancer: evaluation of the caregivers' burden and quality of life

Introduction: Cancer is a disease of high incidence among children and the patients need a caregiver during the treatment. Aim: to evaluate: the burden of care and quality of life (QOL) of caregivers of children/adolescents with cancer during chemotherapy treatment and relate them to each other and to the socio-demographic data and the presence and degree of signs of depression, Method: It is a cross-sectional study, with 32 caregivers. Socio-demographic, care burden (Caregiver Burden Scale) and QOL data (SF-36) were collected. Results: 87.5% of the caregivers were mothers, total score of burden 1.92±0.09 and most compromised score of the SF-36: emotional aspects (59.3), vitality (60.0), pain (60.9). There was a significant correlation between burden and mental health and vitality. Conclusion: Caregivers presented care burden and compromised aspects of QOL and possibly need interventions that will promote social and emotional wellbeing to reduce the burden, improve the quality of life QOL and consequently deliver better care.

Parenting a child with phenylketonuria or galactosemia: implications for health-related quality of life

Parents of children with chronic disorders have an impaired health-related quality of life (HRQoL) compared to parents of healthy children. Remarkably, parents of children with a metabolic disorder reported an even lower HRQoL than parents of children with other chronic disorders. Possibly, the uncertainty about the course of the disease and the limited life expectancy in many metabolic disorders are important factors in the low parental HRQoL. Therefore, we performed a cross-sectional study in parents of children with phenylketonuria (PKU, OMIM #261600) and galactosemia (OMIM #230400), metabolic disorders not affecting life expectancy, in order to investigate their HRQoL compared to parents of healthy children and to parents of children with other metabolic disorders. A total of 185 parents of children with PKU and galactosemia aged 1-19 years completed two questionnaires. Parents of children with PKU or galactosemia reported a HRQoL comparable to parents of healthy children and a significantly better HRQoL than parents of children with other metabolic disorders. Important predictors for parental mental HRQoL were the psychosocial factors emotional support and loss of friendship. As parental mental functioning influences the health, development and adjustment of their children, it is important that treating physicians also pay attention to the wellbeing of the parents. The insight that emotional support and loss of friendship influence the HRQoL of the parents enables treating physicians to provide better support for these parents.

Children receiving treatment for cancer and their caregivers: a mixed methods study of their sleep characteristics

BACKGROUND

Sleep has a significant impact on the daily functioning of children and their parents. The purpose of this study was to describe and gain an understanding of the sleep characteristics of children receiving treatment for cancer and their caregivers using a mixed methods concurrent triangulation design.

PROCEDURE

Data were collected from questionnaires completed by 35 caregivers of children receiving treatment for cancer and compared to similar data from 64 caregivers of healthy children.

RESULTS

There was considerable variability in the sleep characteristics of the children receiving treatment for cancer as reported by their caregivers. However, as a group, the magnitude of their sleep problems, particularly among the adolescents, was significantly greater than that of the comparison group and had the potential to impact negatively on their participation in everyday life. They had poorer sleep efficiency. Many impairments, particularly pain, nightmares, and symptoms associated with steroid administration, impacted their sleep. Their caregivers also experienced an increased prevalence of sleep issues, which impacted their daytime functioning. Suggestions to prevent and treat the sleep issues of children receiving treatment for cancer focused on practicing good sleep habits, ensuring a safe, secure, and comfortable sleep environment, and using non-pharmaceutical and pharmaceutical interventions to address impairments interfering with sleep. Caregivers noted that it was important to take care of themselves by getting sufficient sleep and accepting help from others.

CONCLUSIONS

Sleep issues are prevalent in families of children receiving treatment for cancer and should be assessed routinely and addressed.

Health-related quality of life after completion of successful treatment for childhood cancer

BACKGROUND

Previous studies have assessed health-related quality of life (HRQOL) during several treatment stages in children with cancer, but there is limited knowledge about HRQOL shortly after completing therapy. This study determined HRQOL of children with cancer shortly after the end of successful treatment compared with normative values.

PROCEDURE

Several age-specific HRQOL questionnaires were administered: the ITQOL (generic, proxy-report, 0-4 years), CHQ PF 50 (generic, proxy-report, 5-7 years), Kidscreen (generic, self-report, 8-18 years) and Disabkids (chronic generic, self-report, 8-18 years).

RESULTS

Children with cancer (N = 191, mean age 9.25, SD 5.06, 47.1% female) participated. Physical well-being was affected for all ages. Compared to normative values 0- to 7-year-olds were rated significantly lower on the majority of the scales. In addition, 12- to 18-year-olds had significantly better HRQOL than the norm on social scales. Compared to chronically ill norms, 8- to 18-year-olds demonstrated no differences, except for 12- to 18-year-olds who experienced significantly more physical limitations. Additionally, we found that HRQOL of parents of 0- to 7-year-olds was poorer than the norm.

CONCLUSION

HRQOL in children with cancer and their parents can be impaired compared with the norm. Therefore, HRQOL should be monitored in clinical practice to make paediatric oncologists aware of these problems. For young children, we recommend checking whether certain HRQOL problems can be explained by parental worries. For older children and adolescents, paediatric oncologists need to consider social desirability and the child's adaptive style.

Quality of life among parents of children with cancer or brain tumors: the impact of child characteristics and parental psychosocial factors

PURPOSE

Understanding the impact of childhood cancer on the family is increasingly important. This study aimed to (1) examine the relationship between child clinical characteristics and health-related quality of life (QOL) among parents of children with cancer or brain tumors, and (2) determine how parental psychosocial factors impact this relationship.

METHODS

Using a within-group approach, this study examined 75 children with cancer or brain tumors and their parent. In-person interviewer-assisted surveys assessed sociodemographics, psychosocial factors, and QOL. Child clinical characteristics were obtained through medical record abstraction. Regressions were performed to determine factors related to parental QOL.

RESULTS

Children's activity limitation and active treatment status were associated with worse parental mental QOL (5.4 and 4.4 points lower, respectively; P < 0.05). Adding parental psychosocial characteristics to the model eliminated the relationship between child clinical characteristics and parental mental QOL (P > 0.05 for all child characteristics).

CONCLUSIONS

While child clinical characteristics appear to be related to poor parental QOL, this relationship was mediated by caregiver burden and stress. Interventions to reduce burden and stress may mitigate the deleterious effects of caregiving. Systematic screening of parents' mental and physical health may facilitate interventions and improve the health and well-being of parents and children.

Quality of life during active treatment for pediatric acute lymphoblastic leukemia

The objectives of the study were to describe quality of life (QoL), identify predictors of worse QoL and examine QoL during different phases of active therapy for acute lymphoblastic leukemia (ALL). A multiinstitutional cross-sectional study was performed in children with ALL. We included children at least 2 months from diagnosis who were receiving treatment in first remission. Parents described QoL using the PedsQL 4.0 Generic Core Scales and the PedsQL 3.0 Acute Cancer Module. The 206 children on treatment for ALL had overall [median 62.5, 95% confidence interval (CI) 34.8-94.4], physical (median 62.5, 95% CI 18.8-100.0) and psychosocial (median 65.4, 95% CI 38.3-94.2) summary scores that were one to two standard deviations lower than population norms. In high-risk ALL, girls and older children had worse QoL. In standard-risk ALL, those with lower household incomes and unmarried parents had worse QoL. QoL scores were generally constant across phases of ALL therapy. Children on therapy for ALL have lower QoL compared to healthy children. Age and gender predicted QoL in high-risk ALL, whereas socioeconomics predicted QoL in standard-risk ALL. Future efforts should focus on longitudinal studies that describe QoL over time within individual patients.

Feasibility study: the effect of therapeutic yoga on quality of life in children hospitalized with cancer

PURPOSE

To describe the effect of therapeutic yoga on child and parental reports of quality of life in children hospitalized with oncological diagnoses.

METHODS

Six children participated in 5 yoga sessions over 2 months. The PedsQL 4.0 was administered to each child and participating parent/caregivers at baseline and after completion of the yoga intervention. The Wilcoxon nonparametric rank test measured individual differences over time.

RESULTS

Statistically significant differences (P < .05) were found in child perception of gross motor function.

CONCLUSION

These feasibility study data suggest that therapeutic yoga positively affected child perception of gross motor function measured on the PedsQL 4.0. Further studies are needed, including a randomized control trial and with a larger number of participants, to clarify and confirm the effect of therapeutic yoga.

Parents of children with cancer: which factors explain differences in health-related quality of life

Research with parents of children with cancer has identified factors related to their adjustment and coping, but it is not fully understood why some parents do well and others do not. Guided by a stress process model, we examined the interrelationships among a comprehensive set of factors to identify the most important determinants of health-related quality of life (HRQoL) in parents of children in active treatment for cancer. A cross-sectional survey of 411 parents (80% response rate) of children receiving cancer treatment in Canada was conducted between November 2004 and February 2007. The following constructs were measured: background and context factors, child characteristics, family-centered service delivery, caregiver strain, intrapsychic factors, coping/supportive factors and parental HRQoL. The model was evaluated using structural equation modeling. Analysis was stratified by time since diagnosis (i.e., <12 months and ≥12 months). For those within 12 months of their child's diagnosis, family-centred service provision, caregiver strain, and self-perception accounted for 58% of the variation in psychosocial health, whereas caregiver strain and social support explained 50% of the variation in physical health. For parents in the >12 month group, caregiving strain was the only factor with a direct relationship with parental psychosocial and physical health, accounting for 66% and 55% of the variance in these constructs, respectively. Our findings reinforce the need for health professionals to be particularly attuned to family caregivers in the early stages of treatment and identify potential areas for interventions to promote parental health.

Pediatric oncology: the use of cluster analysis to examine maternal concerns

PURPOSE/OBJECTIVES

To examine data from mothers whose children have cancer and to identify the characteristics of uncertainty and distress that they reported. The objectives were (a) to use cluster analysis to identify subgroups of maternal uncertainty and distress, (b) to examine whether the subgroups differed based on demographics and children's illness-related variables, and (c) to explore whether mothers in the subgroups differed on quality of life (QOL) and hope.

DESIGN

Descriptive, correlational study.

SETTING

Pediatric oncology units in northern Taiwan.

SAMPLE

200 mothers of children with cancer.

METHODS

Participants completed the Parental Perception of Uncertainty Scale, the Symptom Checklist-35-Revised, the Short-Form 36 Health Survey, the Herth Hope Index, and a demographic questionnaire. Cluster analyses were used to identify subgroups of mothers regarding maternal perceived uncertainty and distress. Differences in demographic variables, disease characteristics, and outcome measures were evaluated with descriptive statistics, analysis of variance, and chi-square analysis.

MAIN RESEARCH VARIABLES

Subgroup, maternal uncertainty, distress, QOL, and hope.

FINDINGS

Four subgroups were identified by the cluster analyses: high uncertainty and high distress, moderate uncertainty and moderate distress, low uncertainty and low distress, and high uncertainty and low distress.

CONCLUSIONS

The subgroup of mothers who reported low uncertainty and low distress reported the highest QOL and hope.

IMPLICATIONS FOR NURSING

The findings of this study provide insight for pediatric oncology clinicians and offer issues related to uncertainty, distress, and QOL that such professionals can discuss with the mothers of their patients.

Caregiving demands in parents of children with cancer: psychometric validation of the Care of My Child with Cancer questionnaire

A comprehensive evaluation of the psychometric properties of Care of My Child With Cancer (CMCC) was performed in a sample of 411 parents of children undergoing treatment of cancer at five Canadian pediatric oncology centers. Psychometric tests used to assess data quality, targeting, reliability, and construct validity demonstrated that the CMCC is a scientific sound measure. The CMCC will be helpful for assessing increasing parental responsibility for caregiving tasks associated with cancer care.

Sleep Habits and Fatigue of Children Receiving Maintenance Chemotherapy for ALL and Their Parents

The study of potential contributors to fatigue, such as sleep disturbance, has been identified as a research priority in pediatric cancer. The primary objective of this descriptive study was to explore relationships between sleep habits, sleep disturbance, and fatigue for children receiving maintenance chemotherapy for acute lymphoblastic leukemia (ALL). This study also described sleep habits, sleep disturbance, and fatigue of parents of children and adolescents with ALL and determined if relationships existed between parent and child sleep disturbance and fatigue. Using a descriptive, cross-sectional design, children aged 4-18 years receiving maintenance chemotherapy for ALL and their parents completed questionnaires about their sleep and fatigue. Sleep disturbance was common in both children (87%) and parents (48%) and sleep disturbance scores were positively correlated with fatigue scores. From qualitative written responses to open-ended questions, 9 themes emerged related to sleep for children undergoing maintenance chemotherapy for ALL. Sleep differences noted since diagnosis included (1) sleep is disturbed, (2) sleep habits have changed, and (3) sleep is unchanged or improved. Things that got in the way of children sleeping well included (4) side effects of medication, especially dexamethasone; and (5) medication schedules. Things that helped children get sleep at night were (6) sleeping with someone, (7) comforting activities or routine, (8) medications, and (9) food and drink. Sleep disturbance in children on ALL maintenance and their parents is common and likely contributes to increased fatigue and is a potential target for nursing interventions.

Stress-mediated quality of life outcomes in parents of childhood cancer and brain tumor survivors: a case-control study

PURPOSE

To determine if caring for a child with cancer or a brain tumor affects parental health and mental health and if and to what extent stress mediates the relationship between case status and parental quality of life.

METHODS

In person interviewer-assisted surveys were administered to 74 case dyads (children diagnosed with cancer or a brain tumor and their parents) and 129 control dyads (children without health problems and their parents from a community sample) to assess health-related quality of life and perceived levels of stress.

RESULTS

Parents of children with cancer or a brain tumor had significantly worse health-related quality of life, including worse overall mental health. Overall physical health was no different between cases and controls. Staged multivariate analysis revealed that worse health-related quality of life is completely mediated by perceived stress in these parents.

CONCLUSIONS

The experience of caring for a child with cancer is not in itself related to poor quality of life, but is related to an increased level of stress that may adversely impact parental mental health and quality of life.

Behavioral risk factors and use of preventive screening services among spousal caregivers of cancer patients

PURPOSE

Caregiving of cancer patients is burdensome and is likely to affect health behavior and outcome of caregivers. However, there are only a small number of studies on lifestyle behavior and use of preventive services by caregivers of cancer patients, especially in Asian populations. The aim of this study was to compare the status of lifestyle behavior and use of preventive services in spousal caregivers of cancer patients and controls.

METHODS

One hundred pairs of cancer patients and their spousal caregivers who visited the Cancer Daycare Center of Seoul National University Hospital were requested to fill out constructed self-administered questionnaires. Four age- and sex-matched controls were selected randomly for each caregiver from the Korea National Health and Nutritional Examination Survey III (KNHANES III) (n = 400) in order to compare adherence to recommended health behavior and use of preventive services.

RESULTS

Compared to controls, caregivers were more likely to receive all types of cancer screening: gastric (adjusted proportion, 53.8% vs 37.1%, p = 0.011), colorectal (adjusted proportion, 54.3% vs 20.5%, p = 0.002), cervical (adjusted proportion, 66.4% vs 46.5%, p = 0.006), and breast cancer (adjusted proportion, 62.9% vs 40.6%, p = 0.003). However, no differences were observed for health risk behaviors (current smoking, high-risk drinking, and physical inactivity) and screening for chronic diseases (hypertension, diabetes mellitus, and hypercholesterolemia).

CONCLUSION

Although spousal caregivers of cancer patients were more likely to use cancer screening services, their health behavior with regard to other aspects were not different from controls. There is a need to improve other types of health behaviors, especially lifestyle behavior, and balance these with cancer screenings in caregivers.

Factors affecting the delivery of family-centered care in pediatric oncology

BACKGROUND

The provision of family-centered care (FCC) emphasizes a partnership between parents and health-care providers so that families are involved in every aspect of services for their child. Our study examines factors related to parental perception of the family-centeredness of pediatric oncology services.

PROCEDURE

This Canadian multi-institutional cross-sectional study included children with cancer receiving active treatment. One parent from each family provided information about the child, parent/family demographics, diagnosis, and treatment. FCC was measured with the MPOC-20, a valid and reliable tool in the pediatric oncology setting that consists of two subscales: "Family-Centered Service" and "Providing General Information." Logistic multiple regression analyses were used to identify factors that were associated with lower ratings of FCC for each subscale.

RESULTS

Completed questionnaires were received back from 411 parents, giving an overall response rate of 80%. Worse perceived prognosis and worse parental psychosocial health were associated with less favorable ratings for both MPOC-20 subscales. In addition, parents who were not married or living common-law scored lower ratings for the Family-Centered Services subscale, whereas scores for the Provision of General Information subscale differed depending on the treatment facility at which the child received care.

CONCLUSIONS

Our study identified child/parent factors and health-care delivery factors associated with FCC provided in the pediatric oncology setting. These results could be used as the starting point for future research looking at optimization of the FCC process.