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Georgieva S, Tomás JM, Navarro-Pérez JJ, Samper-García P. Systematic Review and Critical Appraisal of Five of the Most Recurrently Validated Child Maltreatment Assessment Instruments from 2010 to 2020. TRAUMA, VIOLENCE & ABUSE 2023; 24:2448-2465. [PMID: 35575249 DOI: 10.1177/15248380221097694] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Assessment of child maltreatment has been inconsistent across literature due to its complexity, multidimensionality, and the variety of conceptualizations of this construct. Five instruments have recurrently examined psychometric properties across the last years of research: Childhood Trauma Questionnaire, Maltreatment and Abuse Chronology of Exposure, Child Abuse Potential Inventory, Identification of Parents at Risk for child Abuse and Neglect, and Psychosocial Screening Tool. This article aims to examine and wrap up the knowledge regarding the psychometric properties of these instruments. A systematic review was performed through three of the most relevant databases in order to identify the most validated instruments to assess child maltreatment from 2010 to 2020, and 19 research articles were identified. Results indicate that there is a lack of information regarding some psychometric properties and therefore, in the light of this information, it is not possible to clearly determine if there are instruments with stronger scientific evidence for their psychometric properties, although the Maltreatment and Abuse Chronology of Exposure Scale (MACE) obtained the strongest psychometric evidence. This systematic review provided a comprehensive review on the main psychometric properties of five child maltreatment instruments in order to facilitate researchers and child welfare professionals the selection of the most suitable instrument for their specific purpose. We recommend addressing these gaps of information by further examining the psychometric properties of these instruments, and developing valid and reliable instruments for early detection in child maltreatment.
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Affiliation(s)
| | - José M Tomás
- Faculty of Psychology, University of Valencia, Spain
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2
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Etkin-Spigelman L, Hancock K, Nathan PC, Barrera M. Sharing psychosocial risk screening information with pediatric oncology healthcare providers: Service utilization and related factors. Pediatr Blood Cancer 2022; 69:e29456. [PMID: 34854538 DOI: 10.1002/pbc.29456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 10/06/2021] [Accepted: 10/28/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Psychosocial morbidity in pediatric oncology patients and their caregivers is widely recognized. Although routine systematic psychosocial screening has been proposed as a standard of care, screening is still limited. The present study assessed whether supplying the patient's treating team of healthcare providers with psychosocial risk screening information near diagnosis would increase the rate of documented psychosocial contacts, particularly for patients/families with elevated risk. The effect of demographic and clinical factors was also examined. PROCEDURES Ninety-three families with a child/youth newly diagnosed with cancer participated. Families were randomly assigned to a care as usual control group (n = 44) or an intervention group (n = 49) where the treating team was provided with a summary of family psychosocial risk, measured by the Psychosocial Assessment Tool (PAT). The PAT was completed by the primary caregiver, who also provided demographic information. The number of psychosocial intervention contacts documented in the medical charts was examined. RESULTS The rate of psychosocial intervention did not significantly differ between the groups (P > 0.05). The intensity of the child's cancer treatment was found to be the only significant predictor of the number of documented psychosocial intervention contacts (β = 0.396, P < 0.001). CONCLUSIONS Clinical factors appear to be more predictive of the rate of psychosocial intervention provided to pediatric oncology patients and their families than informing the treating team of family psychosocial risk. Additional research is required to address the gap between psychosocial risk screening, psychosocial intervention, and family outcomes.
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Affiliation(s)
| | - Kelly Hancock
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Paul C Nathan
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Maru Barrera
- The Hospital for Sick Children, Toronto, Ontario, Canada
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Sadeh Y, Dekel R, Brezner A, Landa J, Silberg T. Families following pediatric traumatic medical events: identifying psychosocial risk profiles using latent profile analysis. Eur J Psychotraumatol 2022; 13:2116825. [PMID: 36186160 PMCID: PMC9518403 DOI: 10.1080/20008066.2022.2116825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Post-traumatic stress symptoms (PTSS) are often experienced by children and family members after pediatric traumatic medical events (PTMEs). Assessing families' psychosocial risk factors is a crucial part of trauma-informed practice as it helps identify risk for PTSS in the aftermath of PTME. OBJECTIVES Using the Psychosocial Assessment Tool 2.0 (PAT2.0), this study describes the psychosocial risk of families following PTMEs in two ways: 1. Describing the psychosocial risk defined by the PAT2.0 based on three-tiered risk levels; 2. Using latent profile analysis (LPA); identifying psychosocial risk profiles and examining how child- and injury-related factors can affect profile membership. METHODS Caregivers of 374 children following PTMEs admitted to a pediatric rehabilitation department in Israel completed the PAT2.0. Total PAT2.0 score and the seven PAT2.0 subscales (family structure/resources, social support, child problems, sibling problems, family problems, caregiver stress reactions, and family beliefs) were included in the first analysis. Mean PAT2.0 scores of three risk categories (universal, targeted, clinical) were calculated; LPA, which allows for cross-sectional latent variable mixture models to identify heterogeneity within a population, and multinomial logistic regressions using six out of the seven PAT2.0 subscales, were used to determine distinct profile differences and predictors of profile membership. RESULTS The three-tiered risk levels revealed were relatively high, as compared to levels in families of children with other clinical diagnoses. LPA yielded a three-profile solution: low family risk (63.53%); high caregiver stress, above-average levels of family risk (22.5%); and sibling problems, above-average levels of family risk (13.94%). Ethnicity and type of injury predicted group membership. CONCLUSION Families of children following PTMEs are at increased psychosocial risk. A clinically useful approach to identifying and preventing PTSS may be to evaluate specific domain patterns rather than just the total PAT2.0 risk level alone, based on the PAT2.0 subscales.
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Affiliation(s)
- Yaara Sadeh
- The Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan, Israel.,Department of Pediatric Rehabilitation, the Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center at Tel HaShomer, Ramat Gan, Israel.,Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rachel Dekel
- The Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan, Israel
| | - Amichai Brezner
- Department of Pediatric Rehabilitation, the Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center at Tel HaShomer, Ramat Gan, Israel
| | - Jana Landa
- Department of Pediatric Rehabilitation, the Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center at Tel HaShomer, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-aviv, Israel
| | - Tamar Silberg
- Department of Pediatric Rehabilitation, the Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center at Tel HaShomer, Ramat Gan, Israel.,Department of Psychology, Bar Ilan University, Ramat Gan, Israel
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Barrera M, Desjardins L, Prasad S, Shama W, Alexander S, Szatmari P, Hancock K. Pilot randomized psychosocial trial of a screening intervention in pediatric oncology. Psychooncology 2021; 31:735-744. [PMID: 34813129 DOI: 10.1002/pon.5857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 11/05/2021] [Accepted: 11/08/2021] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Psychosocial screening is a standard of care in pediatric oncology, but there is limited information about how to intervene after screening. This pilot trial aimed to determine feasibility of the novel Enhanced Psychosocial Screening Intervention (EPSI) and explore its preliminary efficacy outcomes. We examined rates of recruitment, retention, intervention acceptability, and monthly distress screening completion, as well as exploratory efficacy outcomes (Patient-Reported Outcomes Measurement Information System: depression, anxiety and fatigue; distress thermometer, pain and sleep). METHODS Parallel-group randomized pilot trial: Caregiver-youth (10-17 years at enrollment, newly diagnosed with cancer) dyads were randomly allocated to either EPSI or standard care with 1:1 ratio allocation. EPSI consists of having a Psychosocial Navigator who shares screening results conducted near diagnosis and monthly for one year with treating teams and families, and provides recommendations tailored to screening results. RESULTS Enrollment rate was 54% (38 dyads); retention was 90% and acceptability 86% (caregivers) and 76% (youth). Exploratory symptoms of depression, anxiety, distress and fatigue outcomes consistently improved mainly for caregivers. CONCLUSIONS Results suggest EPSI is feasible and acceptable and exploratory mental and physical efficacy outcomes are promising for use in a future confirmatory multisite efficacy trial.
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Affiliation(s)
- Maru Barrera
- Division of Hematology/Oncology, Department of Psychology, SickKids Hospital, Toronto, Ontario, Canada
| | - Leandra Desjardins
- Cancer Axis, Research Centre, Sainte-Justine University Health Centre, Montreal, Quebec, Canada
| | - Soni Prasad
- Division of Hematology/Oncology, Department of Psychology, SickKids Hospital, Toronto, Ontario, Canada
| | - Wendy Shama
- Division of Social Work, SickKids Hospital, Toronto, Ontario, Canada
| | - Sarah Alexander
- Division of Hematology/Oncology, SickKids Hospital, Toronto, Ontario, Canada
| | - Peter Szatmari
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Kelly Hancock
- Division of Hematology/Oncology, Department of Psychology, SickKids Hospital, Toronto, Ontario, Canada
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5
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Psychosocial risk, symptom burden, and concerns in families affected by childhood cancer. Support Care Cancer 2021; 30:2283-2292. [PMID: 34719739 DOI: 10.1007/s00520-021-06646-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/18/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE The revised Psychosocial Assessment Tool (PATrev) is a common family-level risk-based screening tool for pediatric oncology that has gained support for its ability to predict, at diagnosis, the degree of psychosocial support a family may require throughout the treatment trajectory. However, ongoing screening for symptoms and concerns (e.g., feeling alone, understanding treatment) remains underutilized. Resource limitations necessitate triaging and intervention based on need and risk. Given the widespread use of the PATrev, we sought to explore the association between family psychosocial risk, symptom burden (as measured by the revised Edmonton Symptom Assessment System (ESAS-r)), and concerns (as measured by the Canadian Problem Checklist (CPC)). METHODS Families (n = 87) with children ≤ 18 years of age (M = 11.72, male: 62.1%) on or off treatment for cancer were recruited from the Alberta Children's Hospital. One parent from each family completed the PATrev and the CPC. Participants 8-18 years of age completed the ESAS-r. RESULTS Risk category (universal/low risk = 67.8%, targeted/intermediate risk = 26.4%, clinical/high risk = 5.7%) predicted symptom burden (F[2, 63.07] = 4.57, p = .014) and concerns (F[2, 82.06] = 16.79, p < .001), such that universal risk was associated with significantly lower symptom burden and fewer concerns. CONCLUSION Family psychosocial risk is associated with cross-sectionally identified concerns and symptom burden, suggesting that resources might be prioritized for families with the greatest predicted need. Future research should evaluate the predictive validity of the PATrev to identify longitudinal concerns and symptom burden throughout the cancer trajectory.
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Barrera M, Young MA, Hancock K, Chung J. Early trajectory of psychosocial risk in families of children and adolescents newly diagnosed with cancer. Support Care Cancer 2021; 30:1815-1822. [PMID: 34608532 DOI: 10.1007/s00520-021-06581-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/15/2021] [Indexed: 11/25/2022]
Abstract
We explored early trajectories of psychosocial risk levels (i.e., Universal, Targeted, or Clinical) in families of children and adolescents newly diagnosed with cancer using the Psychosocial Assessment Tool (PAT) in secondary analysis of data from a randomized trial assessing the effects of psychosocial screening. Families were allocated to an intervention group (IG, PAT summary provided to patient treating team) or a control group (CG, no PAT summary provided to treating team) in two pediatric cancer centers. Primary caregivers (N = 122) of newly diagnosed children and adolescents completed the PAT along with outcome measures for the trial at 2-4 weeks post-diagnosis (T1) and 6 months post-diagnosis (T2). The CG and IG were not significantly different, in terms of PAT risk levels at T1 and T2, but at T1, the PAT total and parent stress scores were higher in the CG (p's < .05). The distribution of families across PAT risk levels did not differ significantly between T1 and T2 (p > .05) with 63% of families remaining within the same PAT risk level at T2. A subgroup of families in the Targeted risk level at T1 moved to the Universal (34%) or Clinical (13%) levels of risk at T2 (p's < .01). Another subgroup with Universal risk at T1 trended to Targeted (28%) or Clinical (2%) at T2. While psychosocial risk remained relatively consistent for the majority of families, a smaller number of families experienced changes in risk level over time. Further investigation of these exploratory trends in psychosocial trajectories is needed to guide psychosocial support during child's cancer treatment.Clinical Trial Registration Number: NCT02788604 (registered with ClinicalTrials.gov).
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Affiliation(s)
- Maru Barrera
- Department of Psychology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
| | - Melissa A Young
- Department of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kelly Hancock
- Department of Psychology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Joanna Chung
- Department of Medical Psychology, British Columbia Children's Hospital, Vancouver, BC, Canada
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Desjardins L, Hancock K, Szatmari P, Alexander S, Shama W, De Souza C, Mills D, Abla O, Barrera M. Protocol for mapping psychosocial screening to resources in pediatric oncology: a pilot randomized controlled trial. Pilot Feasibility Stud 2021; 7:143. [PMID: 34274016 PMCID: PMC8285781 DOI: 10.1186/s40814-021-00878-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 06/21/2021] [Indexed: 01/30/2023] Open
Abstract
Background A pediatric cancer diagnosis and its treatment can have a detrimental effect on the mental health of children and their families. Screening to identify psychosocial risk in families has been recognized as a standard of care in pediatric oncology, but there has been limited clinical application of this standard thus far. A significant impediment to the implementation of psychosocial screening is the dearth of information on how to translate psychosocial screening to clinical practice, and specifically, how to follow-up from screening results. This manuscript aims to describe a protocol of a new intervention examining the feasibility and acceptability of mapping via a Psychosocial Navigator (PSN) psychosocial screening results to specific recommendations of resources for families based on measured risk for psychosocial distress and mental health symptoms. Methods The pilot randomized control trial (RCT) consists of dyads of youth (10–17 years) newly diagnosed with cancer and their primary caregiver. This RCT includes two arms (intervention and control group), with each group completing measurements near diagnosis and 1 year later. After the initial assessment, dyads in the intervention group receive monthly screening results and recommendations from the study PSN that are tailored to these results. The patient’s primary healthcare team (nurse, social worker, oncologist) also receive the risk, distress, and mental health results as well as the recommendations from the PSN. Discussion This study addresses a significant barrier to the implementation of psychosocial screening in pediatric oncology: specifically, the limited knowledge of how to follow-up from screening results. Findings from this pilot will inform a future definitive RCT to test the effectiveness of the intervention on patient and family mental health outcomes. This project has implications for enhancing clinical care in pediatric oncology, as well as other pediatric populations. Strengths and limitations of this study This is the first study of screening and follow-up using a psychosocial navigator. This study involves both patient and caregiver report. The small sample size necessitates a future larger study to investigate the effects of intervention. Trial registration NCT04132856, Registered 10 October 2019—retrospectively registered.
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Affiliation(s)
- Leandra Desjardins
- Charles-Bruneau Cancer Center, Sainte-Justine University Health Center, Montreal, Canada.
| | - Kelly Hancock
- Charles-Bruneau Cancer Center, Sainte-Justine University Health Center, Montreal, Canada
| | - Peter Szatmari
- Department of Psychiatry, Hospital for Sick Children, Toronto, ON, Canada
| | - Sarah Alexander
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada
| | - Wendy Shama
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada.,Department of Social Work, Hospital for Sick Children, Toronto, ON, Canada
| | - Claire De Souza
- Department of Psychiatry, Hospital for Sick Children, Toronto, ON, Canada
| | - Denise Mills
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada
| | - Oussama Abla
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada
| | - Maru Barrera
- Charles-Bruneau Cancer Center, Sainte-Justine University Health Center, Montreal, Canada.,Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada
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Tsumura A, Okuyama T, Ito Y, Kondo M, Saitoh S, Kamei M, Sato I, Ishida Y, Kato Y, Takeda Y, Akechi T. Reliability and validity of a Japanese version of the psychosocial assessment tool for families of children with cancer. Jpn J Clin Oncol 2020; 50:296-302. [PMID: 31836884 DOI: 10.1093/jjco/hyz181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/22/2019] [Accepted: 10/30/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Patients with childhood cancer and their families frequently experience psychosocial distress associated with cancer and its treatment. We thus examined the reliability and validity of a Japanese version of the Psychosocial Assessment Tool, which was designed to screen for psychosocial risk factors among families of children with cancer. METHODS Forward-backward translation was used to develop the Japanese version of the Psychosocial Assessment Tool. We conducted a cross-sectional study. Mothers (N = 117), who were the primary caregivers of children with cancer, completed the Japanese version of the Psychosocial Assessment Tool and other measures to establish validity. The internal consistency and 2-week test-retest reliability of the Japanese version of the Psychosocial Assessment Tool were also examined. RESULTS The internal consistency of the Japanese version of the Psychosocial Assessment Tool total score was sufficient (Kuder-Richardson 20 coefficient = 0.84); however, the subscales 'structure and resources,' 'stress reactions' and 'family beliefs' were less than optimal (Kuder-Richardson 20 coefficients = 0.03, 0.49 and 0.49, respectively). The test-retest reliability for the Japanese version of the Psychosocial Assessment Tool total score was sufficient (intraclass correlation coefficient = 0.92). Significant correlations with the criteria measures indicated the validity of the Japanese version of the Psychosocial Assessment Tool total score. The optimal cut-off score for screening mothers with high psychosocial risk was 0.9/1.0, which was associated with 92% sensitivity and 63% specificity. CONCLUSIONS This study indicated that the Japanese version of the Psychosocial Assessment Tool is a valid and reliable tool to screen mothers for elevated distress.
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Affiliation(s)
- Akemi Tsumura
- Department of Psycho-oncology and Palliative Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan.,Department of Nursing, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Toru Okuyama
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan.,Division of Psycho-oncology and Palliative care, Nagoya City University Hospital, Nagoya, Aichi, Japan
| | - Yoshinori Ito
- Division of Psycho-oncology and Palliative care, Nagoya City University Hospital, Nagoya, Aichi, Japan
| | - Masaki Kondo
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Shinji Saitoh
- Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Michi Kamei
- Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Iori Sato
- Department of Family Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Yuji Ishida
- Department of Pediatrics, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Yuka Kato
- Department of Nursing, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Yoshimi Takeda
- Department of Nursing, Osaka City General Hospital, Osaka, Japan
| | - Tatsuo Akechi
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan.,Division of Psycho-oncology and Palliative care, Nagoya City University Hospital, Nagoya, Aichi, Japan
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Sharkey CM, Schepers SA, Drake S, Pai ALH, Mullins LL, Grootenhuis MA. Psychosocial Risk Profiles Among American and Dutch Families Affected by Pediatric Cancer. J Pediatr Psychol 2020; 45:463-473. [PMID: 32196095 DOI: 10.1093/jpepsy/jsaa012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 02/09/2020] [Accepted: 02/17/2020] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE Little is known about relations between domains of psychosocial risk among pediatric cancer populations. The Psychosocial Assessment Tool 2.0 (PAT2.0) is one internationally validated screening measure that can examine these relations. This study aimed to examine risk profiles and predictors of these patterns exhibited by American and Dutch families. METHODS Caregivers of children newly diagnosed with cancer (N = 262; nUSA=145, nNL=117) completed the PAT2.0 as part of larger studies conducted in the United States and the Netherlands. Latent profile analysis and multinomial logistic regression examined differences in demographic and medical variables across risk profiles. Domains assessed included Family Structure/Resources, Child Problems, Sibling Problems, Family Problems, Caregiver Stress Reactions, and Family Beliefs. RESULTS Four groups were identified: "Low-Risk" (n = 162) defined by generally low risk across domains; "Moderate-Caregiver" (n = 55) defined by elevated Caregiver Stress Reactions domain; "Moderate-Children" (n = 25) defined by elevated Child Problems and/or Sibling Problems, and "Elevated-Risk" (n = 20) marked by generally high overall risk. Dutch families had higher odds of being in the Elevated-Risk group, compared to the Low-Risk group. Caregiver age, gender, and educational attainment predicted group membership. Families classified as Targeted or Clinical had higher odds of being in the Moderate or Elevated risk groups. CONCLUSION The PAT2.0 appears to identify largely similar patterns of risk, suggesting that families experience common psychosocial difficulties in both American and Dutch societies. The two Moderate groups demonstrated specific risk sources, suggesting that evaluation of domain patterns, rather than reliance on PAT2.0 risk level, could be of clinical benefit.
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10
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Kazak AE, Chen FF, Hwang WT, Askins MA, Vega G, Kolb EA, Reilly A, Barakat LP. Stability and change in family psychosocial risk over 6 months in pediatric cancer and its association with medical and psychosocial healthcare utilization. Pediatr Blood Cancer 2020; 67:e28051. [PMID: 31724814 DOI: 10.1002/pbc.28051] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 10/01/2019] [Accepted: 10/04/2019] [Indexed: 12/26/2022]
Abstract
PURPOSE Family psychosocial risk in pediatric oncology can be assessed using the Psychosocial Assessment Tool (PAT), a brief parent report screener based on the Pediatric Psychosocial Preventative Health Model (PPPHM; universal, targeted, and clinical). However, little is known about risk over the course of treatment and its association with medical and psychosocial healthcare utilization. METHODS Primary caregivers of children with cancer participated in this prospective multisite investigation, completing the PAT at diagnosis (T1; n = 396) and 6 months later (T2; n = 304). Healthcare utilization data were extracted from electronic health records. RESULTS The distribution of PPPHM risk levels at T1 and T2 was highly consistent for the samples. Two-thirds of families remained at the same level of risk, 18% decreased and 16% increased risk level. Risk was not related to sociodemographic or treatment variables. The PAT risk score correlated with psychosocial contacts over the 6-month period. CONCLUSIONS Although the majority of families reported universal (low) risk on the PAT and were stable in their risk level over 6 months, reassessing risk is helpful in identifying those families who report higher level of risk during treatment than at diagnosis. PAT scores were related to psychosocial services that are provided to most but not all families and could be tailored more specifically to match risk and delivery of evidence-based care.
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Affiliation(s)
- Anne E Kazak
- Nemours Center for Healthcare Delivery Science, Nemours Children's Health System, Wilmington, Delaware.,Sidney Kimmel Medical School at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Fang Fang Chen
- Nemours Center for Healthcare Delivery Science, Nemours Children's Health System, Wilmington, Delaware.,Sidney Kimmel Medical School at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Wei-Ting Hwang
- Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Martha A Askins
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Gabriela Vega
- Nemours Center for Healthcare Delivery Science, Nemours Children's Health System, Wilmington, Delaware
| | - E Anders Kolb
- Nemours Center for Healthcare Delivery Science, Nemours Children's Health System, Wilmington, Delaware.,Sidney Kimmel Medical School at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Anne Reilly
- Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania.,The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Lamia P Barakat
- Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania.,The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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11
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Psychosocial difficulties identified by health care providers as they predict pain-related quality of life in children with cancer. Support Care Cancer 2019; 28:3459-3466. [PMID: 31802251 DOI: 10.1007/s00520-019-05195-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 11/20/2019] [Indexed: 10/25/2022]
Abstract
This study examined the predictive validity of the Psychosocial Care Checklist (PCCL), a psychosocial screener completed by a pediatric cancer health care provider (HCP), on child pain-related and nausea-related quality of life (QOL), and whether these associations are moderated by family psychosocial risk (Psychosocial Assessment Tool, PAT). Caregivers (N = 122) of children newly diagnosed with cancer and 62 HCPs (11 social workers, 17 nurses, 34 oncologists) at two Canadian sites participated. Near diagnosis (T1) and six months later (T2), caregivers reported on child QOL and family psychosocial risk, which was categorized as universal (typical distress), targeted (targetable distress), or clinical (severe distress). HCPs completed the PCCL at T1 and T2. HCP identification of more psychosocial problems in PCCL at T1 predicted reduced child pain-related (but not nausea-related) QOL at T2 among children with universal risk. The PCCL scores did not predict pain-related QOL in families with higher psychosocial needs (i.e., targeted and clinical). HCPs may have difficulty identifying psychosocial problems among families with high risk in a manner that predicts child's pain-related QOL. A hybrid model of psychosocial screening that includes both HCP and caregiver reports is recommended to best match family problems and interventions to improve QOL.
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Quality of life in pediatric oncology patients, caregivers and siblings after psychosocial screening: a randomized controlled trial. Support Care Cancer 2019; 28:3659-3668. [PMID: 31811485 DOI: 10.1007/s00520-019-05160-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 10/30/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE We evaluated whether conducting psychosocial screening using a validated measure (the Psychosocial Assessment Tool, PAT) and providing a summary of PAT results to the patient's treating team improves quality of life (QOL) in newly diagnosed patients with cancer, their caregivers and siblings, in general, and in relation to the initial family psychosocial risk. METHODS Families were randomly allocated to an intervention (IG, treating team received PAT summary describing low, medium, or high psychosocial risk) or control group (CG, no summary provided to treating team) in two Canadian pediatric cancer centers. Caregivers (N = 122) of children newly diagnosed with cancer, patients (n = 36), and siblings (n = 25) completed QOL assessments at 2-4 weeks (T1) and 6 months post-diagnosis (T2). Caregivers also completed PAT and proxy QOL for patient and sibling. RESULTS In general, patient-proxy total QOL improved in IG compared to CG over time but only for high psychosocial risk patients (p < .05). Patient proxy cancer-related QOL improved over time regardless of group allocation; caregiver QOL also improved over time (ps < .05). CONCLUSION This study demonstrated the benefits of psychosocial screening results only on proxy patient QOL outcomes with high psychosocial risk near diagnosis. Evaluating QOL benefits in pediatric oncology patients is critical for establishing the clinical value of psychosocial screening. CLINICAL TRIAL REGISTRATION NUMBER NCT02788604 (REGISTERED WITH HTTPS://CLINICALTRIALS.GOV/CT2/SHOW/NCT02788604 ).
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Kazak AE, Hwang WT, Chen FF, Askins MA, Carlson O, Argueta-Ortiz F, Barakat LP. Screening for Family Psychosocial Risk in Pediatric Cancer: Validation of the Psychosocial Assessment Tool (PAT) Version 3. J Pediatr Psychol 2019; 43:737-748. [PMID: 29509908 DOI: 10.1093/jpepsy/jsy012] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 02/10/2018] [Indexed: 01/09/2023] Open
Abstract
Objective Family psychosocial risk screening is an important initial step in delivering evidence-based care. The Psychosocial Assessment Tool (PAT) is a brief parent report screener based on the trilevel Pediatric Psychosocial Preventative Health Model (PPPHM; Universal, Targeted, Clinical). The current article validates a revised PAT (version 3.0) in pediatric oncology that includes new items (for families of younger patients; clinically relevant risk items) and applicable to broad health literacy levels (a 4th grade reading level). Methods Primary caregivers of 394 children newly diagnosed with cancer participated in this multisite investigation, completing the PAT and validation measures using REDCap. Results The original structure of the PAT, with seven subscales (Family Structure, Social Support, Child Problems, Sibling Problems, Family Problems, Stress Reactions, and Family Beliefs) was supported using a confirmatory factor analysis. Internal consistency for the total score (Kuder-Richardson 20 coefficient [KR20] = 0.81) and the subscales (KR20 = 0.59-0.85) was moderate to strong. Moderate to strong correlations with the criteria measures provided validation for the total and subscale scores. The validation measures varied significantly, as expected, across the three levels of the PPPHM. Receiver operating characteristic (ROC) analyses showed that the PAT total and subscale scores can discriminate families above and below clinical thresholds. Conclusions Results reinforce the psychometric properties of this approach for screening of family psychosocial risk. The PAT provides an evidence-based screener that identifies families at three levels of risk and can provide the basis for further evaluation and treatment of children with cancer and their families.
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Affiliation(s)
- Anne E Kazak
- Nemours Children's Health System.,Sidney Kimmel Medical School, Thomas Jefferson University
| | | | - Fang Fang Chen
- Nemours Children's Health System.,Sidney Kimmel Medical School, Thomas Jefferson University
| | | | | | | | - Lamia P Barakat
- Perelman School of Medicine, University of Pennsylvania.,The Children's Hospital of Philadelphia
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14
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Healthcare provider utility ratings of a psychosocial screening summary: from diagnosis to 6 months. Support Care Cancer 2019; 28:1717-1723. [PMID: 31292754 DOI: 10.1007/s00520-019-04969-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 06/26/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Psychosocial screening has been proposed as a core standard of care in pediatric oncology. However, there has been limited application of this standard thus far. Understanding healthcare provider (HCP) attitudes towards psychosocial screening is an important element towards furthering implementation initiatives of standard screening practices in pediatric oncology. OBJECTIVE To compare HCP perceptions of the utility of a psychosocial risk summary by discipline (oncologist, nurse, social worker), risk level (Universal, Targeted, Clinical) derived from the Psychosocial Assessment Tool (PAT), and time (shortly after a child's diagnosis [T1] and 6 months later [T2]). METHOD All participating HCPs (oncologists, nurses, social workers) were asked to rate how useful they found the psychosocial risk summary using a visual analogue scale (VAS). RESULTS The psychosocial risk summary was perceived as equally useful across providers (oncologists, nurses, social workers) and PAT risk levels at T1. At T2, the psychosocial risk summary was perceived as more useful by oncologists and nurses than social workers, and summaries indicating elevated risk were perceived as more useful than those indicating low risk. Overall, healthcare providers reported greater utility of psychosocial risk summary near diagnosis compared with 6 months later, largely driven by lower utility ratings reported by social workers at T2. CONCLUSION Understanding perceived utility and factors affecting perceived utility is a key component to designing effective implementation strategies for systematic psychosocial screening. Active engagement of HCPs in the screening process is critical in improving implementation of psychosocial screening throughout pediatric cancer treatment.
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Schulte F, Russell KB, Pelletier W, Scott-Lane L, Guilcher GMT, Strother D, Dewey D. Screening for psychosocial distress in pediatric cancer patients: An examination of feasibility in a single institution. Pediatr Hematol Oncol 2019; 36:125-137. [PMID: 30983467 DOI: 10.1080/08880018.2019.1600082] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Despite the availability of tools to assess psychosocial screening in pediatric oncology, little is known about the feasibility and acceptability of systematic screening. We aimed to assess the feasibility of implementing a tool, or set of tools, capable of screening for psychosocial distress in pediatric cancer patients across the cancer continuum (on treatment, off treatment). Psychometric criteria were also evaluated. Patients 8-18 years were recruited from a pediatric oncology program. Patients completed self-report measures of the Distress Thermometer (DT) and Pediatric Quality of Life Inventory (PedsQL). One parent of each patient completed three screening tools: DT (proxy-report); PedsQL (proxy-report), and the Psychosocial Assessment Tool adapted for the Canadian context (PATrev), as well as a measure of patient psychological functioning (Behavioral Assessment System for Children-2), and an assessment of screening tool acceptability. Recruitment rates and acceptability informed feasibility of implementation. Ninety-five patients (58 men) with a mean age of 11.47 participated in the study (on treatment, n = 43; off treatment, n = 52). Recruitment rates were on treatment: 56.6% and off treatment: 47.3%. Mean acceptability scores of tools ranged from 3.41 to 4.97 out of 7. Screening tools were comparable with respect to their psychometric properties. The DT took the least amount of time to complete, while the PATrev offered the most robust data with respect to psychometrics. Feasibility of screening for psychosocial distress with our tool was moderate and may be enhanced when administered by a known health-care provider. Future research exploring how to further enhance feasibility of implementation for pediatric cancer patients is warranted.
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Affiliation(s)
- Fiona Schulte
- a Department of Oncology , Cumming School of Medicine, University of Calgary , Alberta , Canada.,b Haematology, Oncology and Transplant Program , Alberta Children's Hospital , Alberta , Canada
| | - K Brooke Russell
- c Department of Psychology , Faculty of Arts, University of Calgary , Alberta , Canada
| | - Wendy Pelletier
- b Haematology, Oncology and Transplant Program , Alberta Children's Hospital , Alberta , Canada
| | - Laura Scott-Lane
- b Haematology, Oncology and Transplant Program , Alberta Children's Hospital , Alberta , Canada
| | - Gregory M T Guilcher
- a Department of Oncology , Cumming School of Medicine, University of Calgary , Alberta , Canada.,b Haematology, Oncology and Transplant Program , Alberta Children's Hospital , Alberta , Canada.,d Department of Pediatrics , Cumming School of Medicine, University of Calgary , Alberta , Canada
| | - Douglas Strother
- a Department of Oncology , Cumming School of Medicine, University of Calgary , Alberta , Canada.,b Haematology, Oncology and Transplant Program , Alberta Children's Hospital , Alberta , Canada.,d Department of Pediatrics , Cumming School of Medicine, University of Calgary , Alberta , Canada
| | - Deborah Dewey
- d Department of Pediatrics , Cumming School of Medicine, University of Calgary , Alberta , Canada.,e Department of Community Health Sciences , Cumming School of Medicine, University of Calgary , Alberta , Canada
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16
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Pai ALH, Swain AM, Chen FF, Hwang WT, Vega G, Carlson O, Ortiz FA, Canter K, Joffe N, Kolb EA, Davies SM, Chewning JH, Deatrick J, Kazak AE. Screening for Family Psychosocial Risk in Pediatric Hematopoietic Stem Cell Transplantation with the Psychosocial Assessment Tool. Biol Blood Marrow Transplant 2019; 25:1374-1381. [PMID: 30878608 DOI: 10.1016/j.bbmt.2019.03.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 03/08/2019] [Indexed: 12/29/2022]
Abstract
Family psychosocial risk screening is an important initial step in delivering evidence-based care in hematopoietic stem cell transplantation (HCT). Establishing an evidence-based screening approach that is acceptable, reliable, and valid is an essential step in psychosocial care delivery. This is a 3-institution multimethod study. In part 1, caregivers of children about to undergo HCT (n = 140) completed the Psychosocial Assessment Tool-Hematopoietic Cell Transplantation (PAT-HCT), a brief parent report screener adapted for HCT, and validating questionnaires. Families received feedback on their risks identified on the PAT-HCT. In part 2, 12 caregivers completed a semistructured interview about their perceptions of the PAT and the feedback process. The reliability and validity of the PAT-HCT total and subscale scores were tested using Kuder-Richardson-20 (KR-20) and Pearson correlations. Thematic content analysis was used to analyze the qualitative interview data. Internal consistency for the total score (KR-20 = .88) and the Child Problems, Sibling Problems, Family Problems, and Stress Reactions subscales were strong (KR-20 >.70). Family Structure, Social Support, and Family Beliefs subscales were adequate (KR-20 = .55 to .63). Moderate to strong correlations with the criteria measures provided validation for the total and subscale scores. Feedback was provided to 97.14% of the families who completed the PAT-HCT, and the mean rating of acceptability was >4.00 (on a 5-point scale). The qualitative data indicate that families appreciate the effort to provide screening and feedback. The PAT-HCT is a psychometrically sound screener for use in HCT. Feedback can be given to families. Both the screener and the feedback process are acceptable to caregivers.
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Affiliation(s)
- Ahna L H Pai
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati College of Medicine
| | - Avi Madan Swain
- Division of Pediatric Hematology-Oncology, Children's of Alabama; Department of Pediatrics, University of Alabama at Birmingham
| | - Fang Fang Chen
- Center for Healthcare Delivery Science, Nemours Children's Health System; Sidney Kimmel Medical School at Thomas Jefferson University
| | - Wei-Ting Hwang
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine of the University of Pennsylvania
| | - Gabriela Vega
- Center for Healthcare Delivery Science, Nemours Children's Health System
| | - Olivia Carlson
- Center for Healthcare Delivery Science, Nemours Children's Health System
| | | | - Kimberly Canter
- Center for Healthcare Delivery Science, Nemours Children's Health System; Sidney Kimmel Medical School at Thomas Jefferson University
| | - Naomi Joffe
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati College of Medicine
| | - E Anders Kolb
- Sidney Kimmel Medical School at Thomas Jefferson University; Center for Cancer and Blood Disorders, Nemours Children's Health System
| | - Stella M Davies
- Department of Pediatrics, University of Cincinnati College of Medicine; Cancer and Blood Diseases Institute, Cincinnati Children's Hospital
| | - Joseph H Chewning
- Division of Pediatric Hematology-Oncology, Children's of Alabama; Department of Pediatrics, University of Alabama at Birmingham
| | - Janet Deatrick
- Department of Family and Community Health, University of Pennsylvania School of Nursing
| | - Anne E Kazak
- Center for Healthcare Delivery Science, Nemours Children's Health System; Department of Pediatrics, Sidney Kimmel Medical School at Thomas Jefferson University.
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Barrera M, Alexander S, Shama W, Mills D, Desjardins L, Hancock K. Perceived benefits of and barriers to psychosocial risk screening in pediatric oncology by health care providers. Pediatr Blood Cancer 2018; 65:e27429. [PMID: 30160072 DOI: 10.1002/pbc.27429] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 07/26/2018] [Accepted: 07/27/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND Although systematic psychosocial screening has been established as a standard of psychosocial care in pediatric oncology, this is not yet widely implemented in clinical practice. Limited information is available regarding the reasons behind this. In this study, we investigated perceptions of psychosocial screening by health care providers (HCPs) involved in pediatric cancer care. METHODS Using purposeful sampling, 26 HCPs (11 oncologists, 8 nurses, and 7 social workers) from a large North American pediatric cancer center participated in semistructured interviews. Interviews were recorded and transcribed verbatim. Themes were then derived using content analysis. RESULTS The themes were organized into perceived benefits of and barriers to psychosocial risk screening, and practical issues regarding implementation. Perceived benefits of screening included obtaining concise documentation of family psychosocial risk, identifying psychosocial factors important to medical treatment, starting a conversation, and triaging patients to psychosocial services. Barriers included perceived limited institutional support, commitment, and resources for psychosocial services, limited knowledge and appreciation of existing evidence-based validated tools, concerns about diverse family cultural backgrounds regarding psychosocial issues and language proficiency, and HCPs' personal values regarding psychosocial screening. Finally, practical issues of implementation including training in psychosocial risk screening, when and how to screen were discussed. CONCLUSIONS These findings highlight the importance of addressing HCPs' perceptions of benefits, barriers, and practical issues regarding implementing psychosocial risk screening.
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Affiliation(s)
- Maru Barrera
- Department of Psychology, The Hospital for Sick Children, Toronto, Canada
| | - Sarah Alexander
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Wendy Shama
- Department of Social Work, The Hospital for Sick Children, Toronto, Canada
| | - Denise Mills
- Department of Social Work, The Hospital for Sick Children, Toronto, Canada
| | - Leandra Desjardins
- Department of Psychology, The Hospital for Sick Children, Toronto, Canada
| | - Kelly Hancock
- Department of Psychology, The Hospital for Sick Children, Toronto, Canada
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Kapa HM, Litteral JL, Pearson GD, Eastman K, Kirschner RE, Crerand CE. Assessment of Psychosocial Risk in Families of Children With Craniofacial Conditions Using the Psychosocial Assessment Tool—Craniofacial Version. Cleft Palate Craniofac J 2018; 56:556-561. [DOI: 10.1177/1055665618791417] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Hillary M. Kapa
- Center for Biobehavioral Health, The Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
| | - Jennifer L. Litteral
- Center for Biobehavioral Health, The Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
| | - Gregory D. Pearson
- Cleft Lip and Palate Center and Center for Complex Craniofacial Disorders, Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Plastic Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Katherine Eastman
- Cleft Lip and Palate Center and Center for Complex Craniofacial Disorders, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Richard E. Kirschner
- Cleft Lip and Palate Center and Center for Complex Craniofacial Disorders, Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Plastic Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Canice E. Crerand
- Center for Biobehavioral Health, The Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
- Cleft Lip and Palate Center and Center for Complex Craniofacial Disorders, Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Plastic Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
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Cousino MK, Schumacher KR, Rea KE, Eder S, Zamberlan M, Jordan J, Fredericks EM. Psychosocial functioning in pediatric heart transplant recipients and their families. Pediatr Transplant 2018; 22. [PMID: 29316050 DOI: 10.1111/petr.13110] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2017] [Indexed: 12/28/2022]
Abstract
Across pediatric organ transplant populations, patient and family psychosocial functioning is associated with important health-related outcomes. Research has suggested that pediatric heart transplant recipients and their families are at increased risk for adverse psychosocial outcomes; however, recent investigation of psychosocial functioning in this population is lacking. This study aimed to provide a contemporary characterization of psychosocial functioning in pediatric heart transplant recipients and their families. Associations between psychosocial function, demographic variables, and transplant-related variables were investigated. Fifty-six parents/guardians of pediatric heart transplant recipients completed a comprehensive psychosocial screening measure during transplant follow-up clinic visits. Descriptive statistics, correlational analyses, and independent samples t tests were performed. Forty percent of pediatric heart transplant recipients and their families endorsed clinically meaningful levels of total psychosocial risk. One-third of patients presented with clinically significant psychological problems per parent report. Psychosocial risk was unassociated with demographic or transplant-related factors. Despite notable improvements in the survival of pediatric heart transplant recipients over the past decade, patients and families present with sustained psychosocial risks well beyond the immediate post-transplant period, necessitating mental health intervention to mitigate adverse impact on health-related outcomes.
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Affiliation(s)
- Melissa K Cousino
- Department of Pediatrics, Michigan Medicine, Ann Arbor, MI, USA.,University of Michigan Transplant Center, Ann Arbor, MI, USA
| | - Kurt R Schumacher
- Department of Pediatrics, Michigan Medicine, Ann Arbor, MI, USA.,University of Michigan Transplant Center, Ann Arbor, MI, USA
| | - Kelly E Rea
- Department of Pediatrics, Michigan Medicine, Ann Arbor, MI, USA
| | - Sally Eder
- Department of Pediatrics, Michigan Medicine, Ann Arbor, MI, USA
| | - Mary Zamberlan
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, MI, USA
| | - Jessica Jordan
- Department of Pediatrics, Michigan Medicine, Ann Arbor, MI, USA
| | - Emily M Fredericks
- Department of Pediatrics, Michigan Medicine, Ann Arbor, MI, USA.,University of Michigan Transplant Center, Ann Arbor, MI, USA.,Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, USA
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20
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Crerand CE, Kapa HM, Litteral J, Pearson GD, Eastman K, Kirschner RE. Identifying Psychosocial Risk Factors Among Families of Children With Craniofacial Conditions: Validation of the Psychosocial Assessment Tool-Craniofacial Version. Cleft Palate Craniofac J 2018; 55:536-545. [PMID: 29315004 DOI: 10.1177/1055665617748010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the psychometric properties of the Psychosocial Assessment Tool-Craniofacial Version (PAT-CV), a screening instrument for psychosocial risk in families of children with craniofacial conditions, and to examine risk classification of patients in a craniofacial population. DESIGN Prospective, cross-sectional, single-center study. SETTING Interdisciplinary cleft lip and palate/craniofacial center at a US children's hospital. PARTICIPANTS Parents/caregivers (n = 242) of 217 children ages 1 month to 17 years being treated for a congenital syndromic or nonsyndromic craniofacial condition completed the PAT-CV and validating measures from July 2015 to July 2016. The PAT-CV was completed by 121 caregivers a second time to assess test-retest reliability. MAIN OUTCOME MEASURES PAT-CV, Child Behavior Checklist, Adult Self-Report, Pediatric Quality of Life Inventory, Craniofacial Experiences Questionnaire, and Family Environment Scale. RESULTS Construct validity of the PAT-CV was supported by significant correlations ( P < .001) between PAT-CV total and subscale scores and the validated measures. PAT-CV total scores categorized 59.9% of families within the universal risk group, 32.3% within the targeted risk group, and 7.8% within the clinical range. Good criterion validity was indicated by significantly higher scores ( P < .0001) obtained on the validated measures for those in the targeted and clinical risk groups. Internal consistency (Cronbach's α = 0.86) and test-retest reliability for the PAT-CV total score ( r = 0.77, P < .0001) were acceptable. CONCLUSIONS The PAT-CV appears to be a reliable and valid screening instrument for psychosocial risk. Accurate identification of risk and implementation of appropriate interventions may contribute to improvements in medical and psychosocial outcomes.
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Affiliation(s)
- Canice E Crerand
- 1 Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- 2 Departments of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
- 3 Cleft Lip and Palate Center and Center for Complex Craniofacial Disorders, Section of Plastic and Reconstructive Surgery, Nationwide Children's Hospital, Columbus, OH, USA
- 4 Department of Plastic Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Hillary M Kapa
- 1 Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Jennifer Litteral
- 1 Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Gregory D Pearson
- 3 Cleft Lip and Palate Center and Center for Complex Craniofacial Disorders, Section of Plastic and Reconstructive Surgery, Nationwide Children's Hospital, Columbus, OH, USA
- 4 Department of Plastic Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Katherine Eastman
- 3 Cleft Lip and Palate Center and Center for Complex Craniofacial Disorders, Section of Plastic and Reconstructive Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Richard E Kirschner
- 3 Cleft Lip and Palate Center and Center for Complex Craniofacial Disorders, Section of Plastic and Reconstructive Surgery, Nationwide Children's Hospital, Columbus, OH, USA
- 4 Department of Plastic Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
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Sint Nicolaas SM, Schepers SA, van den Bergh EMM, de Boer Y, Streng I, van Dijk-Lokkart EM, Grootenhuis MA, Verhaak CM. Match of psychosocial risk and psychosocial care in families of a child with cancer. Pediatr Blood Cancer 2017; 64. [PMID: 28914485 DOI: 10.1002/pbc.26687] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 05/23/2017] [Accepted: 05/23/2017] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The Psychosocial Assessment Tool (PAT) was developed to screen for psychosocial risk, aimed to be supportive in directing psychosocial care to families of a child with cancer. This study aimed to determine (i) the match between PAT risk score and provided psychosocial care with healthcare professionals blind to outcome of PAT assessment, and (ii) the match between PAT risk score and team risk estimation. METHODS Eighty-three families of children with cancer from four pediatric oncology centers in the Netherlands participated (59% response rate). The PAT and team risk estimation was assessed at diagnosis (M = 40.2 days, SD = 14.1 days), and the content of provided psychosocial care in the 5-month period thereafter resulting in basic or specialized care. RESULTS According to the PAT, 65% of families were defined as having low (universal), 30% medium (targeted), and 5% high (clinical) risk for developing psychosocial problems. Thirty percent of patients from universal group got basic psychosocial care, 63% got specialized care, and 7% did not get any care. Fourteen percent of the families at risk got basic care, 86% got specialized care. Team risk estimations and PAT risk scores matched with 58% of the families. CONCLUSIONS This study showed that families at risk, based on standardized risk assessment with the PAT, received more specialized care than families without risk. However, still 14% of the families with high risks only received basic care, and 63% of the families with standard risk got specialized care. Standardized risk assessment can be used as part of comprehensive care delivery, complementing the team.
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Affiliation(s)
- S M Sint Nicolaas
- Department of Medical Psychology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - S A Schepers
- Psychosocial Department, Emma Children's Hospital Academic Medical Center, Amsterdam, The Netherlands.,Psychosocial Department, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - E M M van den Bergh
- Psychosocial Department, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Y de Boer
- Psychosocial Department, Emma Children's Hospital Academic Medical Center, Amsterdam, The Netherlands
| | - I Streng
- Department of Medical Psychology, Sophia Children's Hospital Erasmus Medical Center, Rotterdam, The Netherlands
| | - E M van Dijk-Lokkart
- Department of Medical Psychology, VU University Medical Center, Amsterdam, The Netherlands
| | - M A Grootenhuis
- Psychosocial Department, Emma Children's Hospital Academic Medical Center, Amsterdam, The Netherlands.,Psychosocial Department, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - C M Verhaak
- Department of Medical Psychology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
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22
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Schepers SA, Sint Nicolaas SM, Maurice-Stam H, Haverman L, Verhaak CM, Grootenhuis MA. Parental distress 6 months after a pediatric cancer diagnosis in relation to family psychosocial risk at diagnosis. Cancer 2017; 124:381-390. [DOI: 10.1002/cncr.31023] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 07/31/2017] [Accepted: 08/14/2017] [Indexed: 12/17/2022]
Affiliation(s)
- Sasja A. Schepers
- Psychosocial Department; Emma Children's Hospital, Academic Medical Center; Amsterdam the Netherlands
- Princess Máxima Center for Pediatric Oncology; Utrecht the Netherlands
- Department of Psychology; St. Jude Children's Research Hospital; Memphis Tennessee
| | - Simone M. Sint Nicolaas
- Department of Medical Psychology; Amalia Children's Hospital, Radboud University Medical Center; Nijmegen the Netherlands
| | - Heleen Maurice-Stam
- Psychosocial Department; Emma Children's Hospital, Academic Medical Center; Amsterdam the Netherlands
| | - Lotte Haverman
- Psychosocial Department; Emma Children's Hospital, Academic Medical Center; Amsterdam the Netherlands
| | - Chris M. Verhaak
- Department of Medical Psychology; Amalia Children's Hospital, Radboud University Medical Center; Nijmegen the Netherlands
| | - Martha A. Grootenhuis
- Psychosocial Department; Emma Children's Hospital, Academic Medical Center; Amsterdam the Netherlands
- Princess Máxima Center for Pediatric Oncology; Utrecht the Netherlands
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Healthcare Professionals' Knowledge of Family Psychosocial Problems in Pediatric Cancer: A Pilot Study. Cancer Nurs 2017; 39:263-71. [PMID: 26632881 DOI: 10.1097/ncc.0000000000000321] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Best practice guidelines for the treatment of cancer now advocate for a child- and family-centered model of care and a psychosocial model of risk prevention. However, healthcare professionals (HCPs) report a number of barriers preventing the implementation of psychosocial care, including an absence of tools to help identify psychosocial problems within the family. OBJECTIVES The aims of this study are to (1) explore the psychometric properties of the Psychosocial Care Checklist (PCCL) and (2) test if the PCCL can differentiate the degree to which HCPs are aware of psychosocial problems within the family (patient, siblings, parents) of a child with cancer. METHODS Thirty-seven HCPs caring for a child with cancer completed the PCCL at time 1 (2-4 weeks after diagnosis) and 29 HCPs completed the PCCL at time 2 (2-3 weeks after). RESULTS The PCCL had strong test-retest reliability for all domains (α > .60) and strong internal consistency for the total PCCL (α = .91). Interrater reliability was moderate for the oncologist-nurse dyad with regard to sibling knowledge (r = 0.56) and total psychosocial knowledge (r = 0.65). Social workers were significantly more knowledgeable than both nurses and oncologists about total family problems (P = .01) and sibling problems (P = .03). CONCLUSIONS Preliminary findings suggest that the PCCL has adequate test-retest reliability and validity and is useful in differentiating the degree to which HCPs are aware of psychosocial problems within the family, with social workers being the most knowledgeable. IMPLICATIONS FOR PRACTICE Using the PCCL may help HCPs to identify psychosocial problems within the family and appropriately allocate psychosocial resources.
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Schepers SA, Sint Nicolaas SM, Maurice-Stam H, van Dijk-Lokkart EM, van den Bergh EMM, de Boer N, Verhaak CM, Grootenhuis MA. First experience with electronic feedback of the Psychosocial Assessment Tool in pediatric cancer care. Support Care Cancer 2017; 25:3113-3121. [PMID: 28497388 PMCID: PMC5577050 DOI: 10.1007/s00520-017-3719-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 04/17/2017] [Indexed: 12/03/2022]
Abstract
Purpose The Psychosocial Assessment Tool (PAT) is a brief family screener, identifying families at universal or elevated risk for psychosocial problems. This study aimed to determine the feasibility and usability of the electronic PAT (ePAT) in pediatric cancer care. Methods Eighty-six parents of newly diagnosed children with cancer (0–18 years) agreed to participate and registered at the website www.hetklikt.nu (58%). Seventy-five families completed the ePAT at approximately 1 month post-diagnosis. Answers were transformed into an electronic PROfile (PAT ePROfile) and fed back to the psychosocial team. Team members completed a semi-structured evaluation questionnaire. Feasibility was measured as the percentage of website registrations, completed ePATs, and PAT ePROfiles reviewed or discussed by the team. Usability included perceived match of the PAT ePROfile with the team’s own risk estimation, perceived added value, and perceived actions undertaken as a result of the PAT ePROfile. Results Feasibility was 70% for website registration, 87% for completed ePATs, 85% for PAT ePROfile reviewing, and 67% for ePROfile discussion. Team members reported that the PAT ePROfile matched with their own risk estimation (M = 7.92, SD = 1.88) and did not provide additional information (M = 2.18, SD = 2.30). According to the team, actions were undertaken for 25% of the families as a result of the PAT ePROfile. More actions were undertaken for families with elevated risk scores compared to universal risk scores (p = .007). Conclusions Implementation of the ePAT seems generally feasible, but it is not always clear how this screener adds to current clinical practice. Strategies should be developed together with team members to improve quick exchange of ePAT results and allocate care according to the needs of the families.
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Affiliation(s)
- Sasja A Schepers
- Psychosocial Department, Academic Medical Center/Emma Children's Hospital, Amsterdam, the Netherlands.
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, USA.
| | - Simone M Sint Nicolaas
- Department of Medical Psychology, Radboud University Medical Center/Amalia Children's Hospital, Nijmegen, the Netherlands
| | - Heleen Maurice-Stam
- Psychosocial Department, Academic Medical Center/Emma Children's Hospital, Amsterdam, the Netherlands
| | | | | | - Nienke de Boer
- Psychosocial Department, Academic Medical Center/Emma Children's Hospital, Amsterdam, the Netherlands
| | - Chris M Verhaak
- Department of Medical Psychology, Radboud University Medical Center/Amalia Children's Hospital, Nijmegen, the Netherlands
| | - Martha A Grootenhuis
- Psychosocial Department, Academic Medical Center/Emma Children's Hospital, Amsterdam, the Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
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McCarthy MC, Wakefield CE, DeGraves S, Bowden M, Eyles D, Williams LK. Feasibility of clinical psychosocial screening in pediatric oncology: Implementing the PAT2.0. J Psychosoc Oncol 2016; 34:363-75. [DOI: 10.1080/07347332.2016.1210273] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Sultan S, Leclair T, Rondeau É, Burns W, Abate C. A systematic review on factors and consequences of parental distress as related to childhood cancer. Eur J Cancer Care (Engl) 2016; 25:616-37. [PMID: 26354003 PMCID: PMC5049674 DOI: 10.1111/ecc.12361] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2015] [Indexed: 01/08/2023]
Abstract
The literature including correlates of parental distress as related to childhood cancer is abundant. It is important to identify predictive factors and outcomes of this distress in parents. The objective of this review was to update previous syntheses on factors of distress and to identify outcomes of parents' distress in the recent literature (2007-2012). We performed a systematic review to identify all quantitative studies including measures of parental distress and associated factors during the study period. We found 56 eligible studies, of which 43 had a Low risk of bias (Cochrane guidelines). Forty-two reports included potential predictive factors. Significant relationships were found with clinical history of the child, sex of the parent, coping response and personal resources, pre-diagnosis family functioning, but not education/income or marital status. Twenty-five reports studied potential consequences of distress and focused on psychological adjustment in parents and children. Compared to past periods, a higher proportion of studies included fathers. Measures used to evaluate distress were also more homogeneous in certain domains of distress. This review underscores the need for appropriate methods for selecting participants and reporting results in future studies. Appropriate methods should be used to demonstrate causality between factors/consequences and distress.
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Affiliation(s)
- S Sultan
- Department of Psychology, Université de Montréal, Montreal, QC, Canada
- Centre de cancérologie Charles-Bruneau, Hôpital Sainte-Justine, CHU Sainte-Justine, Montreal, QC, Canada
| | - T Leclair
- Department of Psychology, Université de Montréal, Montreal, QC, Canada
| | - É Rondeau
- Centre de cancérologie Charles-Bruneau, Hôpital Sainte-Justine, CHU Sainte-Justine, Montreal, QC, Canada
| | - W Burns
- Department of Psychology, Université de Montréal, Montreal, QC, Canada
| | - C Abate
- Department of Psychology, Université de Montréal, Montreal, QC, Canada
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McCarthy MC, Hearps SJC, Muscara F, Anderson VA, Burke K, Hearps SJ, Kazak AE. Family Psychosocial Risk Screening in Infants and Older Children in the Acute Pediatric Hospital Setting Using the Psychosocial Assessment Tool. J Pediatr Psychol 2016; 41:820-9. [PMID: 27342305 DOI: 10.1093/jpepsy/jsw055] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 05/27/2016] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To examine the validity of the Psychosocial Assessment Tool (PAT) with families of infants (<2 years) and children admitted to hospital with acute life-threatening illnesses. METHODS A total of 235 parents of 177 children admitted to oncology, cardiology, or pediatric intensive care completed the PAT and measures of acute stress, trait anxiety, family functioning, and quality of life, a mean 3.7 weeks following diagnosis. A modified PAT was used for families of infants, rendering two forms, PAT (<2) and PAT (2+). RESULTS Psychometrics for PAT (<2) and PAT (2+) were acceptable. PAT Total and Subscale scores for each version were significantly correlated with validation measures. Internal consistency for PAT subscales was variable. Receiver Operating Characteristics provided some support for PAT cutoffs. PAT scores across illness groups were comparable. CONCLUSIONS This study provides promising support for the PAT as a psychosocial screener for families of infants and older children across illness conditions.
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Affiliation(s)
- Maria C McCarthy
- Children's Cancer Centre, Royal Children's Hospital Clinical Sciences, Murdoch Childrens Research Institute
| | | | - Frank Muscara
- Clinical Sciences, Murdoch Childrens Research Institute Psychology Service, Royal Children's Hospital Department of Paediatrics, School of Psychological Sciences, University of Melbourne
| | - Vicki A Anderson
- Clinical Sciences, Murdoch Childrens Research Institute Psychology Service, Royal Children's Hospital Department of Paediatrics, School of Psychological Sciences, University of Melbourne
| | - Kylie Burke
- Parenting and Family Support Centre, School of Psychology, University of Queensland
| | | | - Anne E Kazak
- Nemours Center for Healthcare Delivery Science, Alfred I. duPont Hospital for Children
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Pierce L, Hocking MC, Schwartz LA, Alderfer MA, Kazak AE, Barakat LP. Caregiver distress and patient health-related quality of life: psychosocial screening during pediatric cancer treatment. Psychooncology 2016; 26:1555-1561. [PMID: 27321897 DOI: 10.1002/pon.4171] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 03/31/2016] [Accepted: 05/08/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND Reports of acceptability of psychosocial screening are limited, and the utility of screening in identifying risk factors for health-related quality of life (HRQL) of children with cancer has not been established. This study aimed to assess acceptability of screening for parents and evaluate associations between family risk factors and patient HRQL in the first year post-diagnosis. PROCEDURE Sixty-seven parents of children with cancer completed the Psychosocial Assessment Tool (family risk), Distress Thermometer (caregiver distress), Posttraumatic Stress Disorder Checklist-Civilian 6 (caregiver traumatic stress), PedsQL 4.0 (parent-proxy report of patient HRQL) and four acceptability questions via a tablet (iPad). RESULTS Patients (Mage = 9.5 SD = 5.5 years) were equally distributed across major pediatric cancer diagnoses. The majority of parents endorsed electronic screening as acceptable (70%-97%). Patient gender, diagnosis, intensity of treatment and time since diagnosis were not significantly correlated with family risk, caregiver distress, traumatic stress, or patient HRQL. The full regression model predicting total HRQL was significant (R2 = .42, F(4,64) = 10.7, p = .000). Age (older) was a significant covariate, family risk and caregiver distress were significant independent predictors of poorer total HRQL. The full regression models for physical and psychosocial HRQL were significant; age and caregiver distress were independent predictors of physical HRQL, and age and family risk were independent predictors of psychosocial HRQL. CONCLUSIONS Screening is acceptable for families and important for identifying risk factors associated with poorer patient HRQL during childhood cancer treatment. Targeted interventions addressing family resource needs as well as parent distress identified through screening may be effective in promoting patient HRQL. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Lisa Pierce
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Matthew C Hocking
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lisa A Schwartz
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Melissa A Alderfer
- The Center for Healthcare Delivery Science, Nemours Children's Health System, Wilmington, DE, USA.,Department of Pediatrics, Sidney Kimmel Medical School of Thomas Jefferson University, Philadelphia, PA, USA
| | - Anne E Kazak
- The Center for Healthcare Delivery Science, Nemours Children's Health System, Wilmington, DE, USA.,Department of Pediatrics, Sidney Kimmel Medical School of Thomas Jefferson University, Philadelphia, PA, USA
| | - Lamia P Barakat
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Di Battista A, Hancock K, Cataudella D, Johnston D, Cassidy M, Punnett A, Shama W, Barrera M. Healthcare Providers' Perceptions of the Utility of Psychosocial Screening Tools in Childhood Cancer: A Pilot Study. Oncol Nurs Forum 2016; 42:391-7. [PMID: 26148318 DOI: 10.1188/15.onf.391-397] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To examine the perceptions of healthcare providers (HCPs) regarding the utility of two psychosocial screening tools designed for pediatric oncology, the Psychosocial Assessment Tool-Revised (PATrev) and the Psychosocial Care Checklist (PCCL). DESIGN Repeated measures comparative study. SETTING Four pediatric health centers in Ontario, Canada. SAMPLE 15 oncologists, 14 nurses, and 8 social workers. METHODS Using a visual analog scale (VAS), participants were asked to rate how useful they found (a) the psychosocial summary derived from the parent-completed PATrev, used to assess family psychosocial risk, and (b) the HCP-completed PCCL, used to identify family psychosocial needs. Measures were completed soon after diagnosis and six months later. Mann-Whitney U tests were used for analyses. MAIN RESEARCH VARIABLE VAS scores. FINDINGS Pediatric oncology HCPs differ in their acceptance of the psychosocial screening tools tested. The highest utility ratings for both instruments were from nurses, and the lowest utility ratings were from social workers; moderate ratings were obtained from oncologists. CONCLUSIONS Psychosocial screening tools can identify the psychosocial needs of children with cancer and their families throughout the cancer trajectory. Consequently, these tools could foster communication among colleagues (medical and nonmedical) who are caring for children with cancer about the psychosocial needs of this population and the allocation of resources to address those needs. IMPLICATIONS FOR NURSING Nurses seem to value these tools more than other HCPs, which may have positive implications for their clinical practice.
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The association of psychosocial screening and service provision in pediatric oncology: the Psychosocial Assessment Tool (PAT2.0) into clinical practice. Support Care Cancer 2016; 24:2945-52. [PMID: 26857925 DOI: 10.1007/s00520-016-3107-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 01/26/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Distress screening in oncology has been widely endorsed in recent years. However, current knowledge of the impact of screening on delivery of clinical psychosocial services is limited. This study investigated the association between screening and psychosocial services in the early period following diagnosis of childhood cancer. METHODS The Psychosocial Assessment Tool (PAT2.0) was administered by clinical social workers in two pediatric oncology centers shortly following diagnosis. Psychosocial service activity in the first 8 weeks post diagnosis was collected via social work surveys and extraction of information from hospital databases. RESULTS PAT2.0 and psychosocial service data were obtained for 89 families with a child newly diagnosed with cancer. Distribution of PAT2.0 risk categories was consistent with previous studies (57.3 % universal, 38.2 % targeted, 4.5 % clinical). Significant, weak to moderate correlations between PAT2.0 and social workers' estimates of psychosocial risk were observed. No significant differences in the amount of psychosocial services provided to families with "universal" versus "elevated" (i.e., targeted or clinical) risk were found. Number of days in hospital was strongly and positively associated with the amount of psychosocial services families received in the first 8 weeks following diagnosis. CONCLUSIONS Psychosocial risk, as measured by the PAT2.0, and allocation of psychosocial services were not significantly associated in the early period following diagnosis. Further investigation is required to understand if differences emerge over time when psychosocial screening is implemented clinically. Development of clinical pathways of care needs to account for patients who may predominantly be treated in the outpatient setting.
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Sint Nicolaas SM, Schepers SA, Hoogerbrugge PM, Caron HN, Kaspers GJL, van den Heuvel-Eibrink MM, Grootenhuis MA, Verhaak CM. Screening for Psychosocial Risk in Dutch Families of a Child With Cancer: Reliability, Validity, and Usability of the Psychosocial Assessment Tool. J Pediatr Psychol 2015; 41:810-9. [DOI: 10.1093/jpepsy/jsv119] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 11/21/2015] [Indexed: 11/13/2022] Open
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32
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Kazak AE, Abrams AN, Banks J, Christofferson J, DiDonato S, Grootenhuis MA, Kabour M, Madan-Swain A, Patel SK, Zadeh S, Kupst MJ. Psychosocial Assessment as a Standard of Care in Pediatric Cancer. Pediatr Blood Cancer 2015; 62 Suppl 5:S426-59. [PMID: 26700916 DOI: 10.1002/pbc.25730] [Citation(s) in RCA: 141] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 08/03/2015] [Indexed: 12/22/2022]
Abstract
This paper presents the evidence for a standard of care for psychosocial assessment in pediatric cancer. An interdisciplinary group of investigators utilized EBSCO, PubMed, PsycINFO, Ovid, and Google Scholar search databases, focusing on five areas: youth/family psychosocial adjustment, family resources, family/social support, previous history/premorbid functioning, and family structure/function. Descriptive quantitative studies, systematic reviews, and meta-analyses (n = 149) were reviewed and evaluated using grading of recommendations, assessment development, and evaluation (GRADE) criteria. There is high quality evidence to support a strong recommendation for multifaceted, systematic assessments of psychosocial health care needs of youth with cancer and their families as a standard of care in pediatric oncology.
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Affiliation(s)
- Anne E Kazak
- Center for Healthcare Delivery Science, Nemours Children's Health System, Wilmington, Delaware.,Center for Pediatric Traumatic Stress, Nemours Children's Health System, Wilmington, Delaware.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Annah N Abrams
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Jennifer Christofferson
- Center for Healthcare Delivery Science, Nemours Children's Health System, Wilmington, Delaware.,Center for Pediatric Traumatic Stress, Nemours Children's Health System, Wilmington, Delaware
| | - Stephen DiDonato
- Center for Healthcare Delivery Science, Nemours Children's Health System, Wilmington, Delaware.,Center for Pediatric Traumatic Stress, Nemours Children's Health System, Wilmington, Delaware
| | | | | | - Avi Madan-Swain
- University of Alabama Birmingham at Children's of Alabama, Birmingham, Alabama
| | - Sunita K Patel
- City of Hope Medical Center and Beckman Research Institute, Duarte, California
| | - Sima Zadeh
- National Cancer Institute Pediatric Oncology Branch, Bethesda, Maryland
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Kazak AE, Schneider S, Didonato S, Pai ALH. Family psychosocial risk screening guided by the Pediatric Psychosocial Preventative Health Model (PPPHM) using the Psychosocial Assessment Tool (PAT). Acta Oncol 2015; 54:574-80. [PMID: 25752970 DOI: 10.3109/0284186x.2014.995774] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Although families of children with cancer and other serious medical conditions have documented psychosocial needs, the systematic identification of needs and delivery of evidence-based care remain challenges. Screening for multifaceted family psychosocial risk is a means by which psychosocial treatment needs for pediatric patients and their families can be identified in an effective and inclusive manner. MATERIAL AND METHODS The Pediatric Psychosocial Preventative Health Model (PPPHM) is a model that can guide systematic assessment of family psychosocial risk. The Psychosocial Assessment Tool (PAT) is a brief parent report screener of psychosocial risk based on the PPPHM that can be used for families of infants through adolescents. The PPPHM and the PAT are described in this paper, along with a summary of data supporting systematic risk assessment. RESULTS The PPPHM outlines three tiers of family psychosocial risk - Universal (low), Targeted (medium), and Clinical (high). The PAT is a validated measure of psychosocial risk. Scores on the PAT, derived from multiple sites and disease conditions, map on to the PPPHM with indications that one-half to two-thirds of families score at the Universal level of risk based on the PAT. CONCLUSION The PAT is a unique screener of psychosocial risk, both in terms of its breadth and underlying model (PPPHM), and its length and format. As an example of a means by which families can be screened early in the treatment process, PAT scores and corresponding PPPHM levels can provide direction for the delivery of evidence-based psychosocial care.
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Affiliation(s)
- Anne E Kazak
- Nemours Children's Health System , Wilmington, DE , USA
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