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Galtieri LR, Perez MN, Barakat LP. Quality of life of caregivers at the end of their child's pediatric cancer treatment: cancer-specific worry and material hardship. J Pediatr Psychol 2024; 49:348-355. [PMID: 38457310 DOI: 10.1093/jpepsy/jsae014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 02/18/2024] [Accepted: 02/19/2024] [Indexed: 03/10/2024] Open
Abstract
OBJECTIVE Emerging research suggests that completion of pediatric cancer treatment can be challenging for caregivers given shifting roles and responsibilities. Lower caregiver quality of life (QOL) has been associated with cancer-related variables, higher cancer caregiving strain, and more household material hardship during pediatric cancer treatment. Caregiver QOL at the end of treatment has not been fully investigated but has implications for child and family well-being. Using a psycho-oncology framework, this study aimed to understand the cumulative burden of household material hardship and cancer-related factors on caregiver QOL at the end of treatment. METHODS Caregivers (N = 143) of children (Mage=10.51 years) within 1 year of ending active cancer treatment completed self-report questionnaires assessing their QOL, cancer-specific worry, and material hardship (e.g., housing, insurance). Total months of active cancer treatment were extracted from the medical record. Hierarchical linear regression was used to test the relative effects of length of treatment, material hardship, and cancer-specific worry on caregiver QOL. RESULTS Cancer-specific worry was significantly associated with and accounted for significant variance in caregiver QOL, above and beyond the length of treatment and material hardship. Caregivers who endorsed more cancer-specific worry had poorer QOL. Material hardship was also significantly associated with caregivers' QOL, but length of treatment was not. CONCLUSIONS Caregivers with sufficient resources and less worry about cancer have higher QOL. Findings highlight the importance of end-of-treatment screening of caregivers' subjective cancer-specific worry in addition to material hardship, irrespective of their cancer-related stressors, for ongoing psychosocial support.
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Affiliation(s)
- Liana R Galtieri
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Megan N Perez
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Lamia P Barakat
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Leraas H, Moya-Mendez M, Donohue V, Kawano B, Olson L, Sekar A, Robles J, Wagner L, Greenup R, Haines KL, Tracy E. Using Crowdfunding Campaigns to Examine Financial Toxicity and Logistical Burdens Facing Families of Children With Wilms Tumor. J Surg Res 2023; 291:640-645. [PMID: 37542779 DOI: 10.1016/j.jss.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 06/10/2023] [Accepted: 07/01/2023] [Indexed: 08/07/2023]
Abstract
INTRODUCTION Treatment for pediatric solid tumors is often intense and multidisciplinary and can create a substantial financial burden for families. Assessing these burdens, termed the financial toxicity of treatment, can be difficult. Using Wilms tumor as an example, we evaluated crowdfunding campaigns in an attempt to better understand the impact of economic and logistic challenges associated with pediatric solid tumor care and identify features associated with successful fundraising with this method. METHODS We used a webscraping algorithm to identify crowdfunding campaigns on GoFundMe.com for pediatric patients with Wilms tumor in the United States. We conducted a cross-sectional analysis to describe the patients and families seeking crowdfunding support for cancer care. After fundraizing information was extracted using the webscraping algorithm, each fundraiser was verified and examined by two independent reviewers to assess demographic, qualitative, disease, and treatment variables. Successful fundraisers, defined as those meeting stated financial goals, were compared to unsuccessful campaigns to identify variables associated with successful crowdfunding campaigns. RESULTS We identified 603 children with Wilms tumor and an associated crowdfunding campaign. The median age was 4 y. The majority lived in two-parent households (68.5%). Patients mentioned siblings in 35.5% of fundraisers. While motivations for crowdfunding varied, hardships endured by families included loss of employment (52.2%), need for childcare for other children (9.8%), direct costs of care [co-payments, insurance, pharmaceuticals, out-of-pocket care costs, etc.] (80.9%), indirect costs associated with seeking care [transportation, parking, lodging, lost opportunity cost, etc.] (56.2%), and need for relocation to pursue complex cancer care (6.8%). Disease characteristics in this cohort were limited to self-reports by families. However, fundraisers mentioned disease characteristics, including tumor stage (47.6%), size (11.4%), positive nodal status (9.6%), metastatic disease (3.6%), pathology (11.8%), upstaging (4.6%), and disease recurrence (8.6%). No individually examined demographic, support, disease, or hardship-related factors varied significantly between successful and unsuccessful crowdfunding campaigns (all P > 0.05). However, successful campaigns requested less money ($11,783.25 successful versus $22,442.2 unsuccessful, <0.001), received more money ($16,409.5 successful vs 7427.4 unsuccessful, P < 0.001), and solicited larger donor numbers (170.3 successful versus 86.3 unsuccessful, P < 0.001). CONCLUSIONS Families whose children undergo multimodal cancer care have significant expenses and burdens and can use crowdfunding to support their costs. Careful consideration of the financial and logistic strains associated with pediatric solid tumor treatment, including thorough analysis of crowdfunding sites, may support better understanding of nonclinical burdens, supporting therapeutic relationships and patient outcomes.
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Affiliation(s)
- Harold Leraas
- M.D., Duke University Department of Surgery, Durham, North Carolina.
| | | | | | - Brad Kawano
- Department of Surgery, University of California San Diego, San Diego, California
| | - Lindsay Olson
- Duke University School of Medicine, Durham, North Carolina
| | - Akshaya Sekar
- Campbell University School of Osteopathic Medicine, Harnett County, North Carolina
| | - Joanna Robles
- Duke University Department of Pediatrics, Durham, North Carolina
| | - Lars Wagner
- Duke University Department of Pediatrics, Durham, North Carolina
| | - Rachel Greenup
- M.D., Duke University Department of Surgery, Durham, North Carolina; Yale University Department of Surgery, New Haven, Connecticut
| | - Krista L Haines
- M.D., Duke University Department of Surgery, Durham, North Carolina
| | - Elisabeth Tracy
- M.D., Duke University Department of Surgery, Durham, North Carolina
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Ritter J, Allen S, Cohen PD, Fajardo AF, Marx K, Loggetto P, Auste C, Lewis H, de Sá Rodrigues KE, Hussain S, Omotola A, Bolous NS, Thirumurthy H, Essue BM, Steliarova-Foucher E, Huang IC, Meheus F, Bhakta N. Financial hardship in families of children or adolescents with cancer: a systematic literature review. Lancet Oncol 2023; 24:e364-e375. [PMID: 37657477 PMCID: PMC10775706 DOI: 10.1016/s1470-2045(23)00320-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 09/03/2023]
Abstract
Financial hardship in childhood cancer contributes to poor health outcomes and global disparities in survival, but the extent of the financial burden on families is not yet fully understood. We systematically reviewed financial hardship prevalence and individual components characterising financial hardship across six domains (medical, non-medical, and indirect costs, financial strategies, psychosocial responses, and behavioural responses) and compared characteristics across country income levels using an established theory of human needs. We included 123 studies with data spanning 47 countries. Extensive heterogeneity in study methodologies and measures resulted in incomparable prevalence estimates and limited analysis. Components characterising financial hardship spanned the six domains and showed variation across country income contexts, yet a synthesis of existing literature cannot establish whether these are true differences in characterisation or burden. Our findings emphasise a crucial need to implement a data-driven methodological framework with validated measures to inform effective policies and interventions to address financial hardship in childhood cancer.
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Affiliation(s)
- Julie Ritter
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA.
| | | | | | | | - Kelsey Marx
- Prometheus Federal Services, Washington, DC, USA
| | - Patrícia Loggetto
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Hedley Lewis
- CHOC Childhood Cancer Foundation South Africa, Rivonia, South Africa
| | | | | | - Ayomide Omotola
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Nancy S Bolous
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Harsha Thirumurthy
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Beverley M Essue
- Institute of Health Policy, Management and Evaluation, University of Toronto, ON, Canada
| | | | - I-Chan Huang
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Filip Meheus
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Nickhill Bhakta
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA; Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
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Chong ASS, Ahmad M, Harizan NBM, Alias H, Hussain RI, Lateh A, Chan CMH. Predictors of Post-traumatic Stress Symptoms (PTSS), Depression, and Anxiety among Caregivers of Children with Acute Lymphoblastic Leukaemia (ALL). Asian Pac J Cancer Prev 2023; 24:1923-1929. [PMID: 37378920 PMCID: PMC10505900 DOI: 10.31557/apjcp.2023.24.6.1923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 06/04/2023] [Indexed: 06/29/2023] Open
Abstract
OBJECTIVE The caregivers of children diagnosed with acute lymphoblastic leukaemia (ALL) are believed to experience post-traumatic stress symptoms (PTSS), depression and anxiety. This present study endeavoured to explore the prevalence and predictors of PTSS, depression, and anxiety among the caregivers of children with ALL. METHODS Purposive sampling was used to select the 73 caregivers of children with ALL who participated in this cross-sectional study. The Post-traumatic Stress Disorder Checklist for DSM-5 (PCL-5), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) were used to measure psychological distress. RESULT There was a low prevalence (11%) of post-traumatic stress disorder (PTSD) among the participants. Although all the criteria for PTSD were not met, a few post-traumatic symptoms remained, suggesting that PTSS was likely present. Most of the participants reported minimal symptoms of depression (79.5%) and anxiety (65.8%). Anxiety, depression, and ethnicity predicted the PTSS scores (R2 = .77, p =.000). Subsequently, depression predicted the PTSS scores (R2 = 0.42, p =0.000). Participants of 'Other' or 'Indigenous' ethnicity had lower PTSS scores and higher anxiety scores (R2 = 0.75, p =0.000) than participants of Malay ethnicity. CONCLUSION The caregivers of children with ALL experience post-traumatic stress symptoms (PTSS), depression, and anxiety. These variables co-exist and may have different trajectories in different ethnic groups. Therefore, healthcare providers should take ethnicity and psychological distress into consideration when providing paediatric oncology treatment and care.
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Affiliation(s)
- Agnes Shu Sze Chong
- Centre for Community Health Studies (ReaCH)/Clinical Psychology & Behavioural Health Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
| | - Mahadir Ahmad
- Faculty of Health Science, Universiti Kebangsaan Malaysia, Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia.
| | - Nurul Batrisyia Mohd Harizan
- Clinical Psychology and Behavioural Health Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Wilayah Persekutuan Kuala Lumpur, Malaysia.
| | - Hamidah Alias
- Department of Pediatrics, UKM Medical Centre, Wilayah Persekutuan Kuala Lumpur, Malaysia.
| | - Rizuana Iqbal Hussain
- Department of Radiology, UKM Medical Centre, Wilayah Persekutuan Kuala Lumpur, Malaysia.
| | - Afifi Lateh
- Department of Educational Evaluation and Research, Faculty of Education, Prince of Songkla University, Pattani Campus , Thailand.
| | - Caryn Mei Hsien Chan
- Centre for Community Health Studies (ReaCH)/Clinical Psychology & Behavioural Health Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
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Davidson S, Contreras J, Santamaría CR, Alba-Suarez J, Patel P, Greenspahn E, Boucher L, Rodriguez EM. The Socioecology of Parental Adjustment to Pediatric Cancer: The Roles of Individual and Neighborhood Socioeconomic Status in Parental Social Support and Depressive Symptoms. J Pediatr Psychol 2023; 48:193-201. [PMID: 36644926 DOI: 10.1093/jpepsy/jsac089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 11/18/2022] [Accepted: 11/20/2022] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE Parents of children with cancer are at risk for depressive symptoms, and previous research has linked their level of distress to various demographic, social, and economic factors. However, little research has examined associations between parental depressive symptoms and multiple socioecological factors at once. The current study examined how socioeconomic status (SES) at the individual and neighborhood level is related to parental depressive symptoms and social support satisfaction in Latinx and non-Latinx parents of children recently diagnosed with cancer, and whether social support satisfaction mediated associations between SES and depressive symptoms. METHODS Parents (N = 115; 82% female; 30% Latinx) completed questionnaires reporting their demographic information, social support satisfaction, and depressive symptoms. Neighborhood SES was coded by block group level based on participants' home addresses. RESULTS Individual, but not neighborhood, SES was positively associated with social support satisfaction, and higher social support satisfaction was associated with lower depressive symptoms. There was a significant indirect effect of individual (but not neighborhood) SES on depressive symptoms through social support satisfaction. Latinx parents reported lower individual SES, but not lower social support satisfaction or depressive symptoms than non-Latinx parents. CONCLUSIONS These results highlight the important role of social support in the adjustment of parents who have a child with pediatric cancer. Findings suggest that families may benefit from services that target multiple levels of their social ecology.
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Affiliation(s)
- Savannah Davidson
- Department of Educational Psychology, The University of Texas at Austin, USA
| | - Janie Contreras
- Department of Educational Psychology, The University of Texas at Austin, USA
| | | | - Juliana Alba-Suarez
- Department of Educational Psychology, The University of Texas at Austin, USA
| | - Puja Patel
- Department of Educational Psychology, The University of Texas at Austin, USA
- Children's Blood and Cancer Center, Dell Children's Medical Center, USA
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, USA
| | - Emily Greenspahn
- Department of Educational Psychology, The University of Texas at Austin, USA
- Children's Blood and Cancer Center, Dell Children's Medical Center, USA
- Department of Neurology, Dell Medical School, USA
| | - Lori Boucher
- Children's Blood and Cancer Center, Dell Children's Medical Center, USA
| | - Erin M Rodriguez
- Department of Educational Psychology, The University of Texas at Austin, USA
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Khazaeli K, Hosseini SA, Sortiji H, Saberi F. Spirituality and depression in mothers of children with leukemia. JOURNAL OF SPIRITUALITY IN MENTAL HEALTH 2023. [DOI: 10.1080/19349637.2023.2184289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Affiliation(s)
- Khadije Khazaeli
- Department of Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Seyed Ali Hosseini
- Department of Occupational Therapy, Faculty of Rehabilitation Sciences, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Hossein Sortiji
- Department of occupational therapy, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Farzane Saberi
- Department of Occupational Therapy, School of Rehabilitation Science, Isfahan University of Medical Science, Isfahan, Iran
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7
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Tör Nurdağ F, Şengün Ïnan F. Investigation of the Role of Cognitive Emotion Regulation Strategies on Depressive Symptoms in Mothers of Children Given A Diagnosis of Cancer. Cancer Nurs 2023; Publish Ahead of Print:00002820-990000000-00117. [PMID: 36881652 DOI: 10.1097/ncc.0000000000001221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
BACKGROUND The role of cognitive emotion regulation on depressive symptoms in mothers of children given a diagnosis of cancer is not yet well understood. OBJECTIVE The aim of this study was to investigate the effect of cognitive emotion regulation strategies on depressive symptoms in mothers of children with cancer. METHODS This study was conducted with a cross-sectional correlational design. The study included 129 participants. Participants completed the sociodemographic characteristics form, Beck Depression Inventory, and Cognitive Emotion Regulation Questionnaire. Hierarchical regression analysis was performed to determine the effect of cognitive emotion regulation strategies on depressive symptoms. RESULTS Hierarchical multiple regression revealed that depressive symptoms were independently associated with self-blame (β = 0.279, P = .001) and catastrophizing (β = 0.244, P = .003) after controlling for sociodemographic characteristics of mothers. Emotion regulation strategies explained approximately 39.9% of the variance in depressive symptoms. CONCLUSION The results of the study indicate that more frequent engagement of self-blame and catastrophizing were associated with more depressive symptoms. IMPLICATIONS FOR PRACTICE Nurses should screen mothers of children with cancer for depressive symptoms and identify mothers of children with cancer who use maladaptive cognitive emotion regulation strategies, such as self-blame and catastrophizing, as a risk group. Furthermore, nurses need to be involved in developing psychosocial interventions including adaptive cognitive emotion regulation strategies to help mothers coping with adverse emotions during a childhood cancer journey.
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Affiliation(s)
- Fazilet Tör Nurdağ
- Author Affiliations: Department of Nursing, Dokuz Eylul University Institute of Health Sciences (Mrs Tör Nurdağ), Izmir; and Department of Psychiatric Nursing, Faculty of Health Sciences, Gazi University (Dr Şengün İnan), Ankara, Turkey
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Mazhari F, Heidari S, Iranmanesh S, Sabzevari S. Examining the mother's supportive role caring for a child with cancer. Int J Palliat Nurs 2022; 28:531-539. [DOI: 10.12968/ijpn.2022.28.11.531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background: Childhood cancer is a stressful experience for patients and their families; it has a profound effect on families emotionally, psychologically and financially. The mother's supportive role affects the child's treatment outcomes and the health of all family members. Aims: This study was conducted to describe the experiences of mothers of children with cancer. Methods: A total of 14 mothers of children with cancer were recruited using purposive sampling. In-depth semi-structured interviews were conducted using a qualitative inductive content analysis. Data were analysed using Graneheim et al's (2004) approach. Findings: According to data analysis, the mother's supportive role can be depicted across four subthemes: ‘being genuinely present with a sick child’; ‘keeping the family together and strengthening its cohesion’; ‘providing compassionate collaborative care for peers’; and ‘empowering the self and taking charge of one's own life’. The main overarching theme extracted from this study was ‘sacrifice’. Conclusion: This study results suggest that the mothers’ supportive role is relying on their own personal power, in which they not only give the care to the child, family and counterparts, but also drive personal growth and empowerment of mothers. A deeper understanding of mothers’ experiences of their supportive role may enhance the quality of care and promote further paediatric approaches to palliative care.
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Affiliation(s)
- Fariba Mazhari
- Assistant Professor, Faculty of Nursing and Midwifery; Geriatric Care Research Center, Rafsanjan University of Medical Sciences, Iran
| | - Shahin Heidari
- Assistant Professor, Faculty of Nursing and Midwifery; Geriatric Care Research Center, Rafsanjan University of Medical Sciences, Iran
| | - Sedigheh Iranmanesh
- Associate Professor, Nursing Research Center, Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Iran
| | - Sakineh Sabzevari
- Associate Professor, Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Iran
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Meng J, Wu J, Zhang X, Guo L, Li H. A longitudinal evaluation on 3-year change of anxiety and depression, and their risk factors among parents of childhood and adolescence patients with resectable osteosarcoma: A cohort study. Medicine (Baltimore) 2022; 101:e30981. [PMID: 36281181 PMCID: PMC9592357 DOI: 10.1097/md.0000000000030981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Psychological disorders often occur among parents of children with cancer. The current study aimed to explore the longitudinal change of anxiety and depression and their related factors among parents of childhood and adolescence patients with osteosarcoma. A total of 56 childhood and adolescence patients with osteosarcoma who underwent tumor resection and corresponding 104 parents were enrolled. Hospital Anxiety and Depression Scale-Anxiety (HADS-A) and HADS-Depression (HADS-D) of parents were evaluated at baseline (the day of patients' hospital discharge), 0.5 year, 1 year, 2 years, and 3 years. From baseline to the 3rd year, HADS-A (from 8.3 ± 3.1 to 9.4 ± 3.1. P < .001), HADS-D score (from 7.7 ± 3.2 to 8.8 ± 2.9, P = .001), anxiety rate (from 45.2% to 60.6%, P = .038), depression rate (from 38.5% to 57.7%, P = .002) were elevated; meanwhile, anxiety severity (P = .001) and depression severity (P = .001) were also increased. Furthermore, multivariate logistic regression analysis presented that the role of mother, divorced/widowed marital status, declined family annual income, elevated Enneking stage, and amputation were independently correlated with elevated risk of parents' baseline anxiety or depression (all P < .05). Additionally, declined family annual income, elevated Enneking stage, and amputation were independently correlated with increased risk of parents' 3-year anxiety or depression (all P < .05). Anxiety and depression deteriorate with time in parents of childhood and adolescence patients with osteosarcoma, which are affected by parental role, marital status, family annual income, surgery type, and Enneking stage.
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Affiliation(s)
- Jie Meng
- Department of Orthopedic Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Jing Wu
- Department of Orthopedic Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Xinying Zhang
- Department of Orthopedic Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Libo Guo
- Department of Orthopedic Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Honghe Li
- Department of Orthopedic Surgery, Harbin Medical University Cancer Hospital, Harbin, China
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Maryam D, Wu LM, Su YC, Hsu MT, Harianto S. The journey of embracing life: Mothers' perspectives of living with their children with retinoblastoma. J Pediatr Nurs 2022; 66:e46-e53. [PMID: 35718669 DOI: 10.1016/j.pedn.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/06/2022] [Accepted: 06/07/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE This study aimed to explore the experience and views of mothers with children who have been diagnosed with retinoblastoma. DESIGN AND METHODS A descriptive qualitative study was conducted in the period of 2019-2021. Interviews were conducted with 21 mothers of children diagnosed with retinoblastoma in Indonesia. Data were collected by semi-structured interviews and examined by content analysis. RESULTS Mothers evolved from a sense of unacceptability to accepting challenges and gaining inner strength. Three themes were identified: 1) physical and psychological suffering, 2) awareness of changes and demands, and 3) keep moving forward. Mothers developed positive adaptive mechanisms for coping with the problems associated with having a child with retinoblastoma. Psychological adjustment and religious beliefs were key elements in their journeys toward embracing life in the moment. CONCLUSION Findings illuminated psychological adaptation and coping strategies of mothers with seriously ill children and highlighted how difficulties and cultural norms shaped the adaptative process. Religion and health beliefs played varied and important roles in helping mothers to manage their stress and enhance their coping strategies. PRACTICE IMPLICATIONS Our findings revealed that it is important to routinely assess social support, traditional health beliefs, and spirituality on mothers, facilitate mentoring to help mothers find their inner strengths, and develop intervention programs designed to promote psychological adjustment without delaying treatment.
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Affiliation(s)
- Dewi Maryam
- School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC, and Dr Soetomo Hospital, Surabaya, Indonesia.
| | - Li-Min Wu
- School of Nursing, Kaohsiung Medical University, and Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC.
| | - Yi-Ching Su
- School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC.
| | - Min-Tao Hsu
- School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC.
| | - Susilo Harianto
- Faculty of Nursing, Airlangga University, Surabaya Indonesia, Faculty of Vocational, Airlangga Indonesia, Mulyorejo, Surabaya 60115, Indonesia.
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11
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Manikowski A, Williamson Lewis R, Bennett T, Miller H, Mertens A, Wasilewski-Masker K, Escoffery C, Gilleland Marchak J. Implementation of Electronic Psychosocial Screening Among Caregivers in Pediatric Oncology. JCO Oncol Pract 2022; 18:e1198-e1208. [DOI: 10.1200/op.21.00836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE: This study aimed to evaluate the reach and implementation of an electronic psychosocial screening program among caregivers of pediatric oncology patients, as well as characterize caregiver distress. METHODS: Participants (N = 2,013) included caregivers of patients age 0-17.99 years presenting across 9,280 outpatient oncology visits (median = 2; range = 1-52) from September 2018 to June 2019. At check-ins, caregivers electronically completed the pediatric distress thermometer via a patient-facing electronic health record (EHR) application. Caregiver distress ratings ≥ 8 triggered electronic alerts to medical teams to refer for social work support at point of care. Patient clinical and demographic differences in reach and fidelity were evaluated using univariate chi-square and t-tests. Caregivers reporting high distress were compared with caregivers without reports of high distress using univariate and multivariable logistic regression. RESULTS: The e-screening program was able to reach a caregiver for nearly all children seen during the study period, with 95.5% (1,923/2,013) of patients having a caregiver-completed pediatric distress thermometer. On screeners where caregivers reported high distress, medical teams made appropriate referrals to social work 95.5% (471/493) of the time. Overall, 16.9% (325/1,923) of caregivers ever indicated high distress (score ≥ 8), with caregivers of newly diagnosed (odds ratio = 3.16; 95% CI, 2.12 to 4.71) and on-therapy (odds ratio = 2.81; 95% CI, 2.11 to 3.76) patients being more likely to report high distress, compared with those who were off-treatment for the entire study. CONCLUSION: Leveraging EHR technology to provide evidence-based psychosocial screening can aid in successfully reaching a significant proportion of caregivers of pediatric oncology patients to identify and respond to ongoing psychosocial distress.
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Affiliation(s)
- Alison Manikowski
- Emory University School of Medicine, Atlanta, GA
- Aflac Cancer and Blood Disorders Center, Atlanta, GA
| | | | - Tonya Bennett
- Aflac Cancer and Blood Disorders Center, Atlanta, GA
| | | | - Ann Mertens
- Emory University School of Medicine, Atlanta, GA
- Aflac Cancer and Blood Disorders Center, Atlanta, GA
| | - Karen Wasilewski-Masker
- Emory University School of Medicine, Atlanta, GA
- Aflac Cancer and Blood Disorders Center, Atlanta, GA
| | - Cam Escoffery
- Emory University Rollins School of Public Health, Atlanta, GA
| | - Jordan Gilleland Marchak
- Emory University School of Medicine, Atlanta, GA
- Aflac Cancer and Blood Disorders Center, Atlanta, GA
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Alaqeel M, Alkhathaami F, Alshangiti A, Alanazi A, Alothri MA, Alqarni AT, Almahmoud FI, Masuadi E. Depression and Quality of Life Among Caregivers of Pediatric Cancer Patients. Cureus 2022; 14:e24256. [PMID: 35602782 PMCID: PMC9117091 DOI: 10.7759/cureus.24256] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2022] [Indexed: 11/05/2022] Open
Abstract
Background This study aimed to assess the prevalence of depression, depressive symptoms, and quality of life among caregivers of pediatric cancer patients and the associated risk factors. Methodology In total, 73 participants were recruited for this cross-sectional study in King Abdullah Specialist Children Hospital. Two self-administered questionnaires were used, the Patient Health Questionnaire 9 (PHQ9) and World Health Organization Quality of Life (WHOQOL), to assess the depressive symptoms as well as the prevalence of clinical depression and quality of life, respectively. Data were analyzed using SPSS (IBM Corp., Armonk, NY, USA) to assess the level of depression and quality of life and the associated factors using Fisher’s exact and Mann-Whitney tests. Results It was found that 90.4% were females and 9.6% were males, with 49.3% being between the ages of 31 and 40. Regarding the level of depression, 47.80% had mild depression. There were no significant associations between the baseline characteristics and the level of depression. Gender was significantly associated with all four domains of quality of life, age was significant in physical health and environmental domains, duration of illness was significant only in the physical health domain, while education level was found to be not significantly associated with any of the domains. Conclusions This study found that nearly half of the participants had mild levels of depression, and the four domains of the WHOQOL were significantly affected by several risk factors. We recommend further research into this topic with larger sample sizes, as well as a follow-up assessment of caregivers for a more accurate representation of caregivers’ depression and quality of life. We recommend that in addition to the assessment of pediatric cancer patients, caregivers must also be assessed due to the burden associated with the task of being a caregiver.
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13
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Borrescio-Higa F, Valdés N. The Psychosocial Burden of Families with Childhood Blood Cancer. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19010599. [PMID: 35010854 PMCID: PMC8744617 DOI: 10.3390/ijerph19010599] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 12/07/2021] [Accepted: 12/14/2021] [Indexed: 02/01/2023]
Abstract
Cancer is the second leading cause of death for children, and leukemias are the most common pediatric cancer diagnoses in Chile. Childhood cancer is a traumatic experience and is associated with distress, pain, and other negative experiences for patients and their families. Thus, psychosocial costs represent a large part of the overall burden of cancer. This study examines psychosocial experiences in a sample of 90 families of children with blood-related cancer in Chile. We provide a global overview of the family experience, focusing on patients, caregivers, and siblings. We find that most families report a negative impact upon diagnosis; disruptions in family dynamics; a range of negative feelings of the patient, such as depression, discouragement, and irritability; and difficulty with social lives. Additionally, they report negative effects in the relationship between the siblings of the patient and their parents, and within their caregivers' spouse/partner relationship, as well as a worsening of the economic condition of the primary caregiver. Furthermore, over half of the families in the sample had to move due to diagnosis and/or treatment. Promoting interventions that can help patients, siblings, and parents cope with distress and promote resilience and well-being are important.
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14
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Jiménez S, Moral de la Rubia J, Varela-Garay RM, Merino-Soto C, Toledano-Toledano F. Resilience measurement scale in family caregivers of children with cancer: Multidimensional item response theory modeling. Front Psychiatry 2022; 13:985456. [PMID: 36727086 PMCID: PMC9885114 DOI: 10.3389/fpsyt.2022.985456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 12/23/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Currently, information about the psychometric properties of the Resilience Measurement Scale (RESI-M) in family caregivers of children with cancer according to item response theory (IRT) is not available; this information could complement and confirm the findings available from classical test theory (CTT). The objective of this study was to test the five-factor structure of the RESI-M using a full information confirmatory multidimensional IRT graded response model and to estimate the multidimensional item-level parameters of discrimination (MDISC) and difficulty (MDIFF) from the RESI-M scale to investigate its construct validity and level of measurement error. METHODS An observational study was carried out, which included a sample of 633 primary caregivers of children with cancer, who were recruited through nonprobabilistic sampling. The caregivers responded to a battery of tests that included a sociodemographic variables questionnaire, the RESI-M, and measures of depression, quality of life, anxiety, and caregiver burden to explore convergent and divergent validity. RESULTS The main findings confirmed a five-factor structure of the RESI-M scale, with RMSEA = 0.078 (95% CI: 0.075, 0.080), TLI = 0.90, and CFI = 0.91. The estimation of the MDISC and MDIFF parameters indicated different values for each item, showing that all the items contribute differentially to the measurement of the dimensions of resilience. CONCLUSION That regardless of the measurement approach (IRT or CTT), the five-factor model of the RESI-M is valid at the theoretical, empirical, and methodological levels.
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Affiliation(s)
- Said Jiménez
- Unidad de Investigación en Medicina Basada en Evidencias, Hospital Infantil de México Federico Gómez, National Institute of Health, Mexico City, Mexico
| | | | - Rosa María Varela-Garay
- Departamento de Trabajo Social y Servicios Sociales, Facultad de Ciencias Sociales, Universidad Pablo de Olavide, Seville, Spain
| | - Cesar Merino-Soto
- Instituto de Investigación en Psicología, Universidad de San Martin de Porres, Lima, Peru
| | - Filiberto Toledano-Toledano
- Unidad de Investigación en Medicina Basada en Evidencias, Hospital Infantil de México Federico Gómez, National Institute of Health, Mexico City, Mexico.,Unidad de Investigación Sociomédica, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico.,Dirección de Investigación y Diseminación del Conocimiento, Instituto Nacional de Ciencias e Innovación para la Formación de Comunidad Científica, INDEHUS, Mexico City, Mexico
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15
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Atout M, Almomani EM, Alhusban RY, Al-Tarawneh FS, Mohammad S. Stress levels and coping strategies among Jordanian parents caring for newly diagnosed children with leukemia: A cross sectional descriptive correlational study. J Psychosoc Oncol 2021; 40:632-651. [PMID: 34711128 DOI: 10.1080/07347332.2021.1995802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The purpose of this study was to describe the stress experienced and coping approaches exhibited by Jordanian parents of children recently diagnosed with leukemia. This cross-sectional study collected data from parents of children who had been diagnosed with leukemia within the previous three months (N = 130; 57 fathers (43.8%) and 73 mothers (56.2%), age (Mean = 37.5, SD = 8.4)). The Parenting Stress Index-Short Form was used. Similarly, parents' coping approaches were assessed with the Coping Health Inventory for Parents. Parents' mean total stress and coping strategies scores were 108 (± 26.8) and 93.9 (± 15.6), respectively. There were significant negative relationships between parents' stress levels and age (r = -0.46, p = .01), education level (f = 28.5, p < .05), and income (r = -0.65, p = .01). Additionally, there were significant positive relationships between parents' coping strategies and age (r = 0.34, p = .01) and income (r = 0.53, p < .01). There were non-significant differences between fathers' and mothers' stress levels and coping strategies. Parents of children with leukemia experienced high stress. The findings also confirmed the negative relationship between parents' stress, age, education level, and income; and the positive relationship between parents' coping strategies, age, and income. Several strategies are needed to manage said stress; for example, respite care for parents who spend long hours at the hospital. Volunteers to care for children at home or hospital might also relieve parents' stress.
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Affiliation(s)
- Maha Atout
- School of Nursing, Philadelphia University, Amman, Jordan
| | - Eshraf M Almomani
- USAID Health Service Delivery-Abt Associates, Sweifieh, Amman, Jordan
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16
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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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17
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Mueller EL, Cochrane AR, Campbell ME, Nikkhah S, Miller AD. Co-Design and Testing of mHealth App to Support Caregivers in the Medical Management of their Child with Cancer (Preprint). JMIR Cancer 2021; 8:e33152. [PMID: 35293867 PMCID: PMC8968552 DOI: 10.2196/33152] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 02/07/2022] [Accepted: 02/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background Caregivers face new challenges and tasks when their child is diagnosed with cancer, which can be overwhelming. Mobile technology has the capacity to provide immediate support at their fingertips to aid in tracking symptoms, managing medication, and planning for emergencies. Objective The objective of this study is to engage directly with end users and proxies to co-design and create a mobile technology app to support caregivers in the medical management of their child with cancer. Methods We engaged directly with caregivers of children with cancer and pediatric oncology nurse coordinators (proxy end users) to co-design and create the prototype of the Cope 360 mobile health app. Alpha testing was accomplished by walking the users through a series of predetermined tasks that encompassed all aspects of the app including tracking symptoms, managing medications, and planning or practicing for a medical emergency that required seeking care in the emergency department. Evaluation was accomplished through recorded semistructured interviews and quantitative surveys to capture demographic information and measure the system usability score. Interviews were transcribed and analyzed iteratively using NVivo (version 12; QSR International). Results This study included 8 caregivers (aged 33-50 years) of children with cancer, with most children receiving chemotherapy, and 6 nurse coordinators, with 3 (50%) of them having 11 to 20 years of nursing experience. The mean system usability score given by caregivers was 89.4 (95% CI 80-98.8). Results were grouped by app function assessed with focus on specific attributes that were well received and those that required refinement. The major issues requiring refinement included clarity in the medical information and terminology, improvement in design of tasks, tracking of symptoms including adjusting the look and feel of certain buttons, and changing the visual graph used to monitor symptoms to include date anchors. Conclusions The Cope 360 app was well received by caregivers of children with cancer but requires further refinement for clarity and visual representation. After refinement, testing among caregivers in a real-world environment is needed to finalize the Cope 360 app before its implementation in a randomized controlled trial.
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Affiliation(s)
- Emily L Mueller
- Center for Pediatric and Adolescent Comparative Effectiveness Research, Indiana University, Indianapolis, IN, United States
- Section of Pediatric Hematology Oncology, Department of Pediatrics, Indiana University, Indianapolis, IN, United States
| | - Anneli R Cochrane
- Center for Pediatric and Adolescent Comparative Effectiveness Research, Indiana University, Indianapolis, IN, United States
- Section of Pediatric Hematology Oncology, Department of Pediatrics, Indiana University, Indianapolis, IN, United States
| | - Madison E Campbell
- Indiana University-Purdue University Indianapolis, Indianapolis, IN, United States
| | - Sarah Nikkhah
- Human-Centered Computing Department, School of Informatics and Computing, Indiana University - Purdue University Indianapolis, Indianapolis, IN, United States
| | - Andrew D Miller
- Human-Centered Computing Department, School of Informatics and Computing, Indiana University - Purdue University Indianapolis, Indianapolis, IN, United States
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18
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Alcohol Use Behaviors and Reasons to Abstain From or Limit Drinking Among Medically Vulnerable Youth. J Addict Med 2021; 14:311-318. [PMID: 31985512 DOI: 10.1097/adm.0000000000000603] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Youth with chronic medical conditions (YCMC) use alcohol at levels similar to their healthy peers but face elevated risk for adverse health consequences. As salient reasons to abstain from or limit drinking (RALD) among YCMC are unknown, we sought to identify clusters of RALD and test associations with use behaviors. METHODS Eligible YCMC (ages 9-18) recruited from outpatient clinics reported their use behaviors and importance of potential RALD. Cluster analysis was used to discern RALD patterns, which were examined as predictors of alcohol use using multivariate regression. RESULTS Among 398 participants, 30.9% reported past year alcohol use. Concerns about impacts on medications, school, and disease status were the most frequently endorsed RALD; prior negative experiences with alcohol and family history were the least frequently endorsed. Five RALD clusters were identified for all YCMC and 2 for recent drinkers. Compared to the cluster with high endorsement of multiple general and health-related RALD, those predominantly citing concerns about addiction and those not strongly endorsing any RALD consistently reported greater alcohol use. Among recent drinkers, the cluster characterized by low concern across multiple RALD also consistently reported greater alcohol use compared to their counterparts expressing moderate concern. CONCLUSIONS For YCMC, RALD are complex but endorsement of multiple general and health-related RALD is associated with less use, and health concerns are especially prevalent. More research is needed to understand how salient RALD can inform tailored interventions that aim to delay and reduce substance use and improve health outcomes for YCMC.
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19
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Evans AM, Thabrew H, Arroll B, Cole N, Drake R. Audit of Psychosocial and Palliative Care Support for Children Having Allogeneic Stem Cell Transplants at the New Zealand National Allogeneic Transplant Centre. CHILDREN (BASEL, SWITZERLAND) 2021; 8:356. [PMID: 33946879 PMCID: PMC8146388 DOI: 10.3390/children8050356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/19/2021] [Accepted: 04/26/2021] [Indexed: 11/17/2022]
Abstract
Psychosocial and palliative care support during stem cell transplants (SCT) is known to improve outcomes. AIM evaluate the support provided to children and families at the New Zealand National Allogeneic Stem Cell Transplant unit (NATC). METHOD the psychosocial and palliative care support for children who received SCT between December 2012 and April 2018 was audited. RESULTS of the 101 children who received SCT, 97% were reviewed by the social work team (SW) and 82% by the psychiatric consult liaison team (CLT) at least once during their illness. However, pre-transplant psychological assessment only occurred in 16%, and during the SCT admission, only 55% received SW support, and 67% received CLT support. Eight out of eighty-five families (9%) were offered support for siblings. Eight of the sixteen children who died were referred for pediatric palliative care (PPC) with all supported and half the families who experienced a death (n = 8; 50%) received bereavement follow up. CONCLUSION although the majority received some social work and psychological support, auditing against the standards suggests the consistency of involvement could be improved. Referrals for PPC were inadequate and largely for end-of-life phase. Sibling support, in particular donor siblings, had insufficient psychological assessment and support. Key recommendations are provided to address this underperformance.
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Affiliation(s)
- Amanda M. Evans
- Paediatric Palliative Care Service, Starship Children’s Health, Auckland and Mary Potter Hospice, Wellington 6242, New Zealand
| | - Hiran Thabrew
- Consult Liaison Psychiatry Team, Starship Children’s Health and University of Auckland, Auckland 1010, New Zealand;
| | - Bruce Arroll
- Department of General Practice and Primary Health Care, University of Auckland, Auckland 1010, New Zealand;
| | - Nyree Cole
- Oncology and Haematogy Service, Birmingham Women’s and Children’s, Birmingham B15 2TG, UK;
| | - Ross Drake
- Paediatric Palliative Care and Pain Service, Starship Children’s Health, Auckland 1023, New Zealand;
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20
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Psychosocial Factors Predicting Resilience in Family Caregivers of Children with Cancer: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020748. [PMID: 33477253 PMCID: PMC7830523 DOI: 10.3390/ijerph18020748] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/02/2020] [Accepted: 12/09/2020] [Indexed: 01/10/2023]
Abstract
Chronic diseases in childhood can affect the physical and mental health of patients and their families. The objective of this study was to identify the sociodemographic and psychosocial factors that predict resilience in family caregivers of children with cancer and to define whether there are differences in the levels of resilience derived from these sociodemographic variables. Three hundred and thirty family caregivers of children with cancer, with an average age of 32.6 years were interviewed. The caregivers responded to a battery of tests that included a questionnaire of sociodemographic variables, the Measuring Scale of Resilience, the Beck Depression Inventory, the Inventory of Quality of Life, the Beck Anxiety Inventory, an interview of caregiver burden and the World Health Organization Well-Being Index. The main findings indicate that family caregivers of children with cancer reported high levels of resilience, which were associated positively with quality of life, psychological well-being and years of study and associated negatively with depression, anxiety and caregiver burden. The variables that predicted resilience in families of children with cancer were quality of life, psychological well-being, depression and number of children. Family caregivers who were married and Catholic showed higher resilience scores. We conclude that being a caregiver in a family with children with cancer is associated with symptoms of anxiety and with depressive episodes. These issues can be overcome through family strength, well-being, quality of life and positive adaptation processes and mobilization of family resources.
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21
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Srivastava S, Menon V, Kayal S, Hari M, Dubashi B. Level of Anxiety and Depression and Its Clinical and Sociodemographic Determinants among the Parents of Children with Cancer Undergoing Chemotherapy. J Neurosci Rural Pract 2020; 11:530-537. [PMID: 33144787 PMCID: PMC7595768 DOI: 10.1055/s-0040-1713581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective
The aim of this study was to find the level of anxiety and depression and its clinical and sociodemographic determinants among the parents of children with cancer on chemotherapy.
Materials and Methods
Hamilton-A (HAM-A) and Hamilton-D (HAM-D) scales were used to assess anxiety and depression, respectively, in this cross-sectional study. The assessed parents were administered the questionnaire along with collection of sociodemographic and clinical data through a structured data collection proforma between August 2018 and November 2018.
Statistical Analysis
The sociodemographic factors and the clinical characteristics were analyzed and have been expressed descriptively and associations between the sociodemographic characteristics, clinical characteristics of the children, and the calculated scores obtained from HAM-A and HAM-D scales were analyzed using chi-squared test. A
p
-value of <0.05 was considered statistically significant.
Results
Out of 101 parents, 86 (85.14%) were found to have a mild, moderate, or severe depression score. Parents of children with solid tumors undergoing chemotherapy had higher frequency of severe and very severe depression. Majority of the parents (56.4%) assessed with HAM-A scale had mild level of anxiety that was significantly affected by the level of education.
Conclusion
This study confirmed a very high frequency of depression and anxiety in the parents of children affected with cancer undergoing chemotherapy. Type of cancer (solid or hematological) was found to be a predictor of depression, while education level was found to be a predictor of anxiety in the parents.
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Affiliation(s)
- Shivayan Srivastava
- Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Vikas Menon
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Smita Kayal
- Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Meenatchi Hari
- Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Biswajit Dubashi
- Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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22
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Toledano-Toledano F, Luna D. The psychosocial profile of family caregivers of children with chronic diseases: a cross-sectional study. Biopsychosoc Med 2020; 14:29. [PMID: 33110443 PMCID: PMC7583305 DOI: 10.1186/s13030-020-00201-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 10/18/2020] [Indexed: 12/23/2022] Open
Abstract
Background A family caregiver is defined as a person who has a significant emotional bond with the patient; this caregiver is a family member who is a part of the patient’s family life cycle; offers emotional-expressive, instrumental, and tangible support; and provides assistance and comprehensive care during the chronic illness, acute illness, or disability of a child, adult, or elderly person. The objectives of this study were to identify the psychosocial profiles of family caregivers of children with chronic diseases and to establish the relationship between these profiles and sociodemographic variables. Methods A cross-sectional study was conducted involving 401 family caregivers of children with chronic diseases at the National Institute of Health in Mexico City. The participants responded to the Sociodemographic Variables Questionnaire (Q-SV) for research on family caregivers of children with chronic disease and a battery of 7 instruments that examined anxiety, caregiver burden, family support, depression, resilience, parental stress, and the World Health Organization Well-Being Index. Results A hierarchical cluster analysis and its confirmation through a nonhierarchical cluster analysis confirmed two profiles of caregivers of pediatric patients with chronic diseases. Profile 1, called Vulnerability of family caregivers, is characterized by high levels of anxiety, depression, parental stress and caregiver burden, accompanied by low levels of family support, resilience, and well-being. Profile 2, called Adversity of family caregivers, shows an inverse pattern, with high levels of family support, resilience, and well-being and low levels of anxiety, depression, parental stress and caregiver burden. The sociodemographic characteristics are similar for both profiles, with the exception of the caregiver’s family type. Profile 1 shows more single-parent caregivers, while profile 2 includes more caregivers with a nuclear family. However, the type of family did not reach significance for predicting the caregiver’s profile in a bivariate logistic regression model. Conclusions The psychosocial profile of family caregivers of children with chronic diseases can be structured according to their psychosocial characteristics. Although no causal factors were detected that define criteria for belonging to one or another profile, the characteristics identified for each indicate the need for specific and differentiated intervention strategies for families facing adversity, risk and vulnerability during a child’s disease.
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Affiliation(s)
- Filiberto Toledano-Toledano
- Evidence-Based Medicine Research Unit, Hospital Infantil de México Federico Gómez, National Institute of Health, Dr. Márquez 162, Doctores, Cuauhtémoc, 06720 México City, Mexico
| | - David Luna
- Comisión Nacional de Arbitraje Médico, Mitla No. 250-8° Piso, esq. Eje 5 Sur (Eugenia). Vertiz Narvarte, 03020, Benito Juárez, Mexico City, Mexico
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23
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Gilleland Marchak J, Halpin SN, Escoffery C, Owolabi S, Mertens AC, Wasilewski-Masker K. Using formative evaluation to plan for electronic psychosocial screening in pediatric oncology. Psychooncology 2020; 30:202-211. [PMID: 32931620 DOI: 10.1002/pon.5550] [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: 04/30/2020] [Revised: 08/21/2020] [Accepted: 09/08/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To demonstrate how formative research methods can be used to plan for implementation of evidence-based psychosocial screening in pediatric oncology. METHODS Multidisciplinary pediatric oncology professionals participated in focus groups to adapt the distress thermometer for electronic administration and develop health systems processes to promote psychosocial screening in the pediatric oncology outpatient clinic setting. Seven 1-hour focus groups were conducted using a structured guide based on the reach, efficacy, adoption, implementation, and maintenance framework and transcribed verbatim. Two independent raters coded transcripts using a quasi-deductive approach with high inter-coder reliability (Cohen kappa >0.80). RESULTS Participants' (N = 44) responses were used to identify overarching topics related to the adoption, implementation, and maintenance of electronic screening (e-screening) including: barriers to meeting families' psychosocial needs, identification of champions, suggestions to adapt the proposed e-screening program, perceived barriers to e-screening, and potential impact of carrying out e-screening. Following review of qualitative data, we employed specific implementation strategies to promote adoption, implementation, and maintenance of an e-screening program. CONCLUSIONS Perceived barriers to the implementation of psychosocial screening remain substantial, yet enthusiasm for using electronic health records (EHRs) technology to help meet patient needs through regular assessment was evident among pediatric oncology professionals. Electronic administration of screening and integration of results into the EHR in real time were identified as critical needs to overcome barriers to e-screening. Formative research including qualitative data from stakeholders can be used to tailor implementation strategies to successfully support the adoption, implementation, and maintenance of e-screening programs in pediatric oncology.
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Affiliation(s)
- Jordan Gilleland Marchak
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.,Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Sean N Halpin
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Cam Escoffery
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Shadé Owolabi
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Ann C Mertens
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.,Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Karen Wasilewski-Masker
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.,Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
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24
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Essue BM, Iragorri N, Fitzgerald N, de Oliveira C. The psychosocial cost burden of cancer: A systematic literature review. Psychooncology 2020; 29:1746-1760. [PMID: 32783287 PMCID: PMC7754376 DOI: 10.1002/pon.5516] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 07/29/2020] [Accepted: 08/03/2020] [Indexed: 12/21/2022]
Abstract
Background and Objective Psychosocial costs, or quality of life costs, account for psychological distress, pain, suffering and other negative experiences associated with cancer. They contribute to the overall economic burden of cancer that patients experience. But this category of costs remains poorly understood. This hinders opportunities to make the best cancer control policy decisions. This study explored the psychosocial cost burden associated with cancer, how studies measure psychosocial costs and the impact of this burden. Methods A systematic literature review of academic and grey literature published from 2008 to 2018 was conducted by searching electronic databases, guided by the Institute of Medicine’s conceptualization of psychosocial burden. Results were analyzed using a narrative synthesis and a weighted proportion of populations affected was calculated. Study quality was assessed using the Ottawa‐Newcastle instrument. Results A total of 25 studies were included. There was variation in how psychosocial costs were conceptualized and an inconsistent approach to measurement. Most studies measured social dimensions and focused on the financial consequences of paying for care. Fewer studies assessed costs associated with the other domains of this burden, including psychological, physical, and spiritual dimensions. Fourty‐four percent of cancer populations studied were impacted by psychosocial costs and this varied by disease site (38%‐71%). Two studies monetized the psychosocial cost burden, estimating a lifetime cost per case ranging from CAD$427753 to CAD$528769. Studies were of varying quality; 60% of cross‐sectional studies had a high risk of bias. Conclusions Consistency in approach to measurement would help to elevate this issue for researchers and decision makers. At two‐thirds of the total economic burden of cancer, economic evaluations should account for psychosocial costs to better inform decision‐making. More support is needed to address the psychosocial cost burden faced by patients and their families.
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Affiliation(s)
- Beverley M Essue
- Health Economics and Organization Performance, The Canadian Partnership Against Cancer, Toronto, Ontario, Canada.,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Nicolas Iragorri
- Health Economics and Organization Performance, The Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - Natalie Fitzgerald
- Health Economics and Organization Performance, The Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - Claire de Oliveira
- Health Economics and Organization Performance, The Canadian Partnership Against Cancer, Toronto, Ontario, Canada.,University of York, York, England
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Junkins CC, Kent E, Litzelman K, Bevans M, Cannady RS, Rosenberg AR. Cancer across the ages: a narrative review of caregiver burden for patients of all ages. J Psychosoc Oncol 2020; 38:782-798. [DOI: 10.1080/07347332.2020.1796887] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Courtney C. Junkins
- Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Erin Kent
- Gillings School of Global Public Health, Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kristin Litzelman
- Department of Human Development and Family Studies, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Margaret Bevans
- Office of Research on Women’s Heath, National Institutes of Health, Bethesda, Maryland, USA
| | - Rachel S. Cannady
- Cancer Control Department, American Cancer Society, Atlanta, Georgia, USA
| | - Abby R. Rosenberg
- Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, Washington, USA
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Research Institute, Seattle, Washington, USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
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26
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Mekonnen H, Gebreyohannis GT, Cherie A. Depression and associated factors among parents of children diagnosed with cancer at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. Psychooncology 2020; 29:1141-1147. [PMID: 32281208 DOI: 10.1002/pon.5389] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 03/28/2020] [Accepted: 03/30/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND The global cancer burden is estimated to have risen to 18.1 million new cases and 9.6 million deaths in 2018. The period of child's diagnosis negatively influences parents socially and psychologically leading to depression. OBJECTIVES The aim of the study was to assess the prevalence of depression, its associated factors and parent's experience towards care of their cancer diagnosed child. METHODS A mixed approach quantitative and qualitative cross-sectional study was employed between 15 March and 1 April 2017. Systematic random sampling involving 275 participants in the quantitative and 20 conveniently selected participants for qualitative study were included in the study. Beck's depression inventory scale was used to collect data. Logistic regression including bivariate and multivariate analysis considering 95% confidence interval (CI) was utilized to examine association between dependent and independent variables. P-value <.05 was considered statistically significant. Thematic analysis was used to analyze qualitative data. RESULTS The prevalence of depression among parents was 72.4%, with depression levels of: borderline 7.3%, moderate 6.2%, severe 6.5%, and extreme severe depression 3.3%. Single parenting, income, history of depression, and support source were associated with parental depression (adjusted odds ratio, AOR = 6.21; 95% CI: 2.66-14.52), (AOR = 0.34; 95% CI: 0.02-0.86), (AOR = 8; 95% CI: 1.7-37.4), (AOR = 38; 95% CI: 2.6-560), respectively. CONCLUSION Family income, single parenting, and support sources are determinant factors for parental depression in this study. Nurses should early detect parents at risk and give due attention to reduce the risk of depression.
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Affiliation(s)
- Helina Mekonnen
- Pediatric Oncology, Tikur Anbessa Hospital, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Amsale Cherie
- Department of Nursing, College of Health Sciences, School of Nursing and Midwifery, Addis Ababa University, Addis Ababa, Ethiopia
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Howard Sharp KM, Fisher RS, Clark OE, Dunnells ZDO, Murphy LK, Prussien KV, Vannatta K, Compas BE, Gerhardt CA. Long-term trajectories of depression symptoms in mothers of children with cancer. Health Psychol 2019; 39:89-98. [PMID: 31789559 DOI: 10.1037/hea0000826] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To identify trajectories of depression symptoms in mothers of children with cancer from diagnosis/relapse through 5 years and examine maternal factors at diagnosis/relapse predicting membership in these trajectories. METHOD Mothers (n = 327; Mage = 37.6 years, SD = 7.7 years; 85.9% White) reported depression symptoms near the time of their child's diagnosis/relapse and then again at 1-, 3-, and 5-years postdiagnosis/relapse. Mothers also reported perceived stress, coping (primary control, secondary control, and disengagement coping), and spirituality near the time of diagnosis. Latent class growth analysis was used to identify latent trajectories of depression symptoms, and a 3-step multinomial logistic regression tested covariate predictors of membership in the trajectories. RESULTS Three trajectories were identified: "low depression symptoms" (63.3%), "moderate depression symptoms" (31.5%), and "high depression symptoms" (5.2%). Mothers who used more primary and secondary control coping were more likely to be in the low depression symptom trajectory as compared with the moderate (OR = 1.64, p = .024 and OR = 1.38, p = .013, respectively) or high trajectories (OR = 1.99, p = .008 and OR = 1.81, p = .001, respectively). CONCLUSIONS Although mothers of children with cancer generally displayed improved mental health further from diagnosis, mothers with more depression symptoms after diagnosis/relapse displayed substantial stability in depression symptoms over the 5 years. Mothers of children with cancer may benefit from early screening of mental health and coping strategies, as well as interventions to bolster effective coping for those with elevated depression symptoms. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | - Rachel S Fisher
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital
| | - Olivia E Clark
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital
| | - Zackery D O Dunnells
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital
| | - Lexa K Murphy
- Department of Psychology and Human Development, Vanderbilt University
| | - Kemar V Prussien
- Department of Psychology and Human Development, Vanderbilt University
| | - Kathryn Vannatta
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital
| | - Bruce E Compas
- Department of Psychology and Human Development, Vanderbilt University
| | - Cynthia A Gerhardt
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital
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Depression, Anxiety, and Stress in Parents of Patients With Retinoblastoma. Am J Ophthalmol 2019; 207:130-143. [PMID: 31163135 DOI: 10.1016/j.ajo.2019.05.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 04/25/2019] [Accepted: 05/24/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE To assess depression, anxiety, and stress in parents of patients with retinoblastoma and to evaluate the impact of unifocal vs multifocal retinoblastoma. METHODS A cross-sectional, self-reported psychological assessment of parents of patients with retinoblastoma at a tertiary care ocular oncology center was performed. The Beck Depression Inventory-II (BDI), Beck Anxiety Inventory (BAI), The Parental Stress Index 4-Short Form, and a retinoblastoma Knowledge Assessment questionnaire were administered. Descriptive statistics for outcomes and comparative analyses were made. RESULTS There were 138 parents of children with retinoblastoma (unifocal: n = 77, multifocal: n = 61). Overall, parents displayed mild, moderate, or severe depression (BDI) (n = 37, 26.7%); mild, moderate, or severe anxiety (BAI) (n = 49, 35.8%), and stress scores within normal limits (n = 138, 100%). A comparison (unifocal vs multifocal) revealed parents of children with multifocal retinoblastoma with severe depression (1.4% vs 10.2%, P < .02), and no differences in anxiety or stress. Factors associated with moderate or severe parental depression included previous history of depression (30.0% vs 3.9%, P < .001) and factors for moderate or severe anxiety included previous history of depression (33.3% vs 8.6%, P < .001), parent highest level of education at high school or less vs college or beyond (29.2% vs 10.9%, P = .031), and parental report of "child developmental delay" (31.5% vs 11.3%, P = .019). CONCLUSIONS The majority of parents displayed minimal depression (73.3%), anxiety (64.2%), or stress (100%). However, severe depression is more often found in those whose children have multifocal disease, and previous history of depression and less education can impact psychological function. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
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Emotional adjustment among parents of adolescents and young adults with cancer: the influence of social constraints on cognitive processing and fear of recurrence. J Behav Med 2019; 43:237-245. [DOI: 10.1007/s10865-019-00072-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 06/19/2019] [Indexed: 10/26/2022]
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Toledano-Toledano F, Domínguez-Guedea MT. Psychosocial factors related with caregiver burden among families of children with chronic conditions. Biopsychosoc Med 2019; 13:6. [PMID: 30899323 PMCID: PMC6407238 DOI: 10.1186/s13030-019-0147-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 02/21/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The impact of looking after children who live with complex chronic conditions is a growing public health issue. However, it is unclear whether sociodemographic and psychosocial variables can be used to predict the burden on the caregiver and how the profiles of families of children with chronic diseases are defined and structured. The objective of this study was to identify multivariate sociodemographic and psychosocial variables as well as sociocultural and familial factors to analyze the caregiver burden of family caregivers of children with chronic diseases. METHODS A cross-sectional study was conducted involving 416 family caregivers of children with chronic diseases at the National Institute of Health in Mexico City. The participants responded to a questionnaire on sociodemographic variables and a battery of 7 instruments that examined caregiver burden, family support, parental stress, anxiety, support networks, family functioning, historic-psycho-socio-cultural premises and the World Health Organization Well-Being Index. RESULTS A multivariate analysis using hierarchical multiple regression models showed that the variables included in the psychosocial and sociodemographic profile as a whole explained 40% of the variance in caregiver burden, taking sociocultural historical premises, stressors and anxiety into account as positive individual predictors. Negative individual predictors for caregiver burden included upper secondary education, social support networks, family support, family functioning and well-being. The sociodemographic profiles of family caregivers were as follows: female (81.7%); mean age, 31.7 years (standard deviation [SD], 8 years); married (79.3%); nuclear family (60%); basic education (62.7%); unpaid work (66.3%); and a daily household income of approximately 4 USD (61.1%). CONCLUSIONS The caregiver burden of family caregivers of children with chronic diseases is defined and structured based on personal, family, and sociocultural factors. These features provide evidence to conduct research and implement intervention strategies with regard to families facing adversity, risk and vulnerability during a child's disease.
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Affiliation(s)
- Filiberto Toledano-Toledano
- Evidence-Based Medicine Research Unit, Children’s Hospital of Mexico Federico Gómez, National Institute of Health, Mexico. Dr. Márquez 162, Col. Doctores, Del. Cuauhtémoc, C.P. 06720 Mexico City, Mexico
| | - Miriam Teresa Domínguez-Guedea
- Department of Psychology and Communication Sciences, University of Sonora. Blvd. Luis Encinas y Rosales, Col. Centro S/N, 83000 Hermosillo, Sonora Mexico
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Witt S, Escherich G, Rutkowski S, Kappelhoff G, Frygner-Holm S, Russ S, Bullinger M, Quitmann J. Exploring the Potential of a Pretend Play Intervention in Young Patients With Leukemia. J Pediatr Nurs 2019; 44:e98-e106. [PMID: 30503254 DOI: 10.1016/j.pedn.2018.11.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 11/14/2018] [Accepted: 11/14/2018] [Indexed: 01/05/2023]
Abstract
PURPOSE The aims of the study are 1) to gain knowledge of parents' and professionals' perceptions about cancer stricken children's resources, burdens, and ability to pretend play, and 2) to prepare the initiation of a pretend play intervention based on children's needs and included parents' and professionals' feedback. DESIGN AND METHODS Qualitative design using semi-structured interviews with 13 parents of children diagnosed with leukemia and 15 professionals in the field of pediatric oncology. Themes were derived with content analysis via deductive and inductive coding. RESULTS Analysis resulted in five topics. (1) Ability to play in the context of leukemia (2) ways of coping with leukemia (3) difficulty in transition to normality (4) parental quality of life and parents' needs (5) perceptions of the potential of pretend play. CONCLUSION Study results indicate the potential of pretend play interventions for young cancer patients and the need for additional professional support of parents. PRACTICE IMPLICATIONS Pretend play is a tool children carry with them regardless of their circumstances. If we can enhance their ability to play, doing so should give them an advantage in creative problem solving and creative expression as they deal with a life threatening disease.
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Affiliation(s)
- Stefanie Witt
- University Medical Center Hamburg-Eppendorf, Center for Psychosocial Medicine, Department of Medical Psychology, Hamburg, Germany.
| | - Gabriele Escherich
- University Medical Center Hamburg-Eppendorf, Center for Obstetrics and Pediatrics, Department of Pediatric Hematology and Oncology, Hamburg, Germany.
| | - Stefan Rutkowski
- University Medical Center Hamburg-Eppendorf, Center for Obstetrics and Pediatrics, Department of Pediatric Hematology and Oncology, Hamburg, Germany.
| | - Gerhard Kappelhoff
- University Medical Center Hamburg-Eppendorf, Center for Obstetrics and Pediatrics, Department of Pediatric Hematology and Oncology, Hamburg, Germany.
| | - Sara Frygner-Holm
- Uppsala University, Centre for Research Ethics & Bioethics, Uppsala, Sweden.
| | - Sandra Russ
- Case Western Reserve University, Department of Psychological Sciences, Cleveland, OH, USA.
| | - Monika Bullinger
- University Medical Center Hamburg-Eppendorf, Center for Psychosocial Medicine, Department of Medical Psychology, Hamburg, Germany.
| | - Julia Quitmann
- University Medical Center Hamburg-Eppendorf, Center for Psychosocial Medicine, Department of Medical Psychology, Hamburg, Germany.
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Toledano-Toledano F, Contreras-Valdez JA. Validity and reliability of the Beck Depression Inventory II (BDI-II) in family caregivers of children with chronic diseases. PLoS One 2018; 13:e0206917. [PMID: 30485299 PMCID: PMC6261561 DOI: 10.1371/journal.pone.0206917] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 10/22/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Information on the psychometric properties of the Beck Depression Inventory II (BDI-II) in family caregivers of children with chronic diseases is currently unavailable, indicating a significant gap in the literature. Therefore, we investigated 1) which of the five evaluated measurement models had the best fit, 2) the scale's reliability, and 3) the scale's convergent validity. METHODS In 2018, a cross-sectional ex post facto study with non-probability convenience sampling was conducted in 446 family caregivers of children with chronic diseases at the National Institute of Health in Mexico City; the family caregivers responded to the BDI-II and a battery of instruments measuring anxiety, caregiver burden, parental stress, well-being, and quality of life. A confirmatory factor analysis was conducted to determine the fit of the five models. Cronbach's alpha and composite reliability were calculated to assess the scale's reliability, and Spearman´s rank correlation was used to investigate the scale's convergent validity. RESULTS This study provided evidence that the two-factor somatic-affective and cognitive model had the best fit. The BDI-II demonstrated adequate reliability and evidence of convergent validity, as the BDI-II factors were positively correlated with anxiety, caregiver burden, and parental stress and negatively correlated with well-being and quality of life. CONCLUSIONS The findings reveal that the BDI-II is a valid, reliable, and culturally relevant instrument to measure depression in family caregivers of children with chronic diseases.
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Affiliation(s)
- Filiberto Toledano-Toledano
- Unidad de Investigación en Medicina Basada en Evidencias, Hospital Infantil de México Federico Gómez Instituto Nacional de Salud, México City, México
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Well-being, Self-transcendence, and Resilience of Parental Caregivers of Children in Active Cancer Treatment. Cancer Nurs 2018; 42:E41-E52. [DOI: 10.1097/ncc.0000000000000662] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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35
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Molinaro ML, Fletcher PC. The Balancing Act: Mothers' Experiences of Providing Care to Their Children With Cancer. J Pediatr Oncol Nurs 2018; 35:439-446. [PMID: 30146923 DOI: 10.1177/1043454218794667] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The effect of pediatric cancer and its treatment are overwhelming-these effects are multifaceted and felt by the entire family unit throughout the diagnosis and treatment process. Children experience a plethora of effects as a result of the treatment process; however, it is imperative to remember that a pediatric cancer diagnosis affects parents physically, emotionally, and psychologically as well. While much of the pediatric cancer treatment occurs at the hospital or in clinics, parents are often faced with additional caregiving responsibilities at home, and in many cases, it is mothers who provide care to their children, while also attempting to care for the siblings of their ill children. This secondary data analysis examines the caregiving responsibilities of mothers from Southern Ontario, Canada, during the time from diagnosis to after their children's pediatric cancer treatment. Three subthemes emerged from the overall theme of caregiving: (1) "We tried to do as much as we could outside of the clinic," (2) "I had to be there for everything," and (3) "Most of the time we relied on other people." Each will be discussed in turn. The findings from this work provides insight to health care professionals on how to create or improve the current supports and resources provided to caregivers of children with cancer.
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Supporting Caregivers of Children With Acute Lymphoblastic Leukemia via a Smartphone App. ACTA ACUST UNITED AC 2016; 34:520-527. [DOI: 10.1097/cin.0000000000000265] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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37
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Fayad D, Genadry KC, Hanna K, Itani A, Kibbi N, Rustam LB, Saab R, Nabulsi M. Predictors of benzodiazepine use among parents of children with cancer: a cross-sectional study from Lebanon. Psychooncology 2016; 26:1225-1228. [PMID: 27548760 DOI: 10.1002/pon.4252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 07/31/2016] [Accepted: 08/14/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Danielle Fayad
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | | | - Kamil Hanna
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Aya Itani
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Nadine Kibbi
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | | | - Raya Saab
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon.,Children's Cancer Institute, American University of Beirut, Beirut, Lebanon.,Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
| | - Mona Nabulsi
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon.,Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
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Safarabadi-Farahani A, Maarefvand M, Biglarian A, Khubchandani J. Effectiveness of a Brief Psychosocial Intervention on Quality of Life of Primary Caregivers of Iranian Children With Cancer: A Randomized Controlled Trial. J Pediatr Nurs 2016; 31:e262-70. [PMID: 26860879 DOI: 10.1016/j.pedn.2016.01.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 01/08/2016] [Accepted: 01/09/2016] [Indexed: 12/17/2022]
Abstract
UNLABELLED Cancer in children has a great impact on primary caregiver quality of life (QOL). OBJECTIVE This study examined the effectiveness of a brief psychosocial intervention (BPI) on QOL of Primary Caregivers of Children with Cancer (PCCCs). METHODS Sixty-five PCCCs participated in a randomized controlled trial in Mahak Hospital and Rehabilitation Complex in Tehran, Iran. A 5-week long BPI (which comprised of counseling sessions and telephone follow-up) was delivered to the intervention group in addition to usual service, while the control group was provided with usual service. Data were collected using the Caregiver Quality of Life Index-Cancer-Persian version (CQOLC-P) prior to intervention, post-intervention, and at follow-up (i.e. 30days after the intervention). Repeated measures analysis of variance analysis (ANOVA) was used to evaluate outcomes. RESULTS Majority of the participants were mothers (95%), between ages of 24-47 years (95%) with children between ages of 2-12 years. Most child cancer diagnoses were for brain tumors (n=31) and blood cancers (n=17). Significant improvement was found within the intervention group on QOL (p<0.001) including improvements on subscale measures of mental/emotional burden (p<0.001), disruption (p<0.001), and positive adaptation (p<0.001), compared with the control group over time. There was no difference between the intervention and control groups on the financial subscale measure after intervention (p>0.05). CONCLUSION BPI was an effective strategy to improve the quality of life of PCCCs. Similar interventions can be planned by practitioners to reduce the burden of childhood cancer on PCCCs.
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Affiliation(s)
| | - Masoomeh Maarefvand
- Substance Abuse and Dependence Research Center, Department of Social Work, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; Department of Social Work, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
| | - Akbar Biglarian
- Biostatistics Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Jagdish Khubchandani
- Department of Physiology and Health Science, Ball State University, Muncie, IN, USA
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Understanding psychological distress among pediatric cancer caregivers. Support Care Cancer 2016; 24:3147-55. [PMID: 26928441 DOI: 10.1007/s00520-016-3136-z] [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] [Received: 07/23/2015] [Accepted: 02/22/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Few studies have examined distress in caregivers of pediatric cancer patients. We evaluated the association of socioeconomic, demographic, and patient clinical factors on caregivers' self-reported psychological distress associated with having a child with cancer. METHODS N = 366 pediatric cancer caregivers completed a self-administered questionnaire from July 2010 to July 2012. The Impact of Event Scale (IES), along with two subscales "intrusion" and "avoidance" measured caregiver cancer-specific distress, with higher scores indicating greater distress. Multivariable linear regression models were used to calculate coefficients (β) and 95 % confidence intervals (95 % CI) of IES by socioeconomic, demographic, and clinical factors. RESULTS Average caregiver IES score was 31.2 (standard deviation (SD) = 16.9, range 0-75). Mean intrusion score was 18.1 (SD 9.8, range 0-35) and avoidance score was 12.8 (SD 9.0, range 0-40). Caregivers with household incomes <$40,000 reported higher mean distress scores than those with incomes ranging from $40,000 to $79,999 (β = 4.45, 95 % CI 0.04-8.87, p = 0.05). Infrequently or never attending religious services, younger child age, and a diagnosis of AML were associated with higher intrusion (all p < 0.05). Caregivers with a child currently receiving therapy reported higher overall IES (β = 5.9, 95 % CI 2.15-9.7, p < 0.01) and intrusion (β = 4.1, 95 % CI 1.9-6.3, p < 0.001) scores compared to those off therapy (β = 3.13, 95 % CI 0.93-5.33, p < 0.01). CONCLUSIONS Our findings identify socioeconomic and clinical factors that influence psychological distress for caregivers of pediatric oncology patients. These findings underscore the importance of developing and testing interventions aimed at evaluating and addressing the psychosocial needs for high-risk caregivers in addition to those of patients.
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Kearney JA, Salley CG, Muriel AC. Standards of Psychosocial Care for Parents of Children With Cancer. Pediatr Blood Cancer 2015; 62 Suppl 5:S632-83. [PMID: 26700921 PMCID: PMC5066591 DOI: 10.1002/pbc.25761] [Citation(s) in RCA: 199] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 08/24/2015] [Indexed: 11/12/2022]
Abstract
Parents and caregivers of children with cancer are both resilient and deeply affected by the child's cancer. A systematic review of published research since 1995 identified 138 studies of moderate quality indicating that parent distress increases around diagnosis, then returns to normal levels. Post-traumatic symptoms are common. Distress may be impairing for vulnerable parents and may impact a child's coping and adjustment. Moderate quality evidence and expert consensus informed a strong recommendation for parents and caregivers to receive early and ongoing assessment of their mental health needs with access to appropriate interventions facilitated to optimize parent, child, and family well being.
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Affiliation(s)
- Julia A Kearney
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York City, New York
| | - Christina G Salley
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York City, New York
| | - Anna C Muriel
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, Massachusetts
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Pelletier W, Bona K. Assessment of Financial Burden as a Standard of Care in Pediatric Oncology. Pediatr Blood Cancer 2015; 62 Suppl 5:S619-31. [PMID: 26700920 DOI: 10.1002/pbc.25714] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 07/22/2015] [Indexed: 12/21/2022]
Abstract
Family financial hardship has emerged as a burden of pediatric cancer treatment with negative implications for family well-being. As part of an extensive project to create evidence-based standards for the psychosocial care of children with cancer, we performed a literature review of pediatric cancer-associated financial hardship utilizing six databases, and identified 24 publications for incorporation into this review. Financial hardship during childhood cancer was found to affect a significant proportion of the population and to negatively impact family well-being. Existing literature supports a strong recommendation for assessment of financial hardship as a component of comprehensive psychosocial care in pediatric oncology.
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Affiliation(s)
- Wendy Pelletier
- Pediatric Hematology/Oncology/Transplant Program, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Kira Bona
- Department of Medicine, Boston Children's Hospital, Boston, Massachusetts.,Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Center for Outcomes and Population Research, Dana-Farber Cancer Institute, Boston, Massachusetts
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Wang J, Yao N, Wang Y, Zhou F, Liu Y, Geng Z, Yuan C. Developing "Care Assistant": A smartphone application to support caregivers of children with acute lymphoblastic leukaemia. J Telemed Telecare 2015; 22:163-71. [PMID: 26271029 DOI: 10.1177/1357633x15594753] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 04/10/2015] [Indexed: 12/14/2022]
Abstract
Acute lymphoblastic leukaemia (ALL) is the most common childhood malignancy. Caring for children with ALL is an uncommon experience for parents without medical training. They urgently need professional assistance when their children are recovering at home. This paper documents the process of developing an Android application (app) "Care Assistant" for family caregivers of children with ALL. Key informant interviews and focus group studies were used before programming the app. The key informants and focus group members included: caregivers of children with ALL, cancer care physicians and nurses, and software engineers. We found several major challenges faced by caregivers: limited access to evidence-based clinic information, lack of financial and social assistance, deficient communications with doctors or nurses, lack of disease-related knowledge, and inconvenience of tracking treatments and testing results. This feedback was used to develop "Care Assistant". This app has eight modules: personal information, treatment tracking, family care, financial and social assistance, knowledge centre, self-assessment questionnaires, interactive platform, and reminders. We have also developed a web-based administration portal to manage the app. The usability and effectiveness of "Care Assistant" will be evaluated in future studies.
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Affiliation(s)
- Jingting Wang
- School of Nursing, Second Military Medical University, China
| | - Nengliang Yao
- Department of Healthcare Policy and Research, Virginia Commonwealth University, USA
| | - Yuanyuan Wang
- School of Nursing, Second Military Medical University, China
| | - Fen Zhou
- Department of Hematology, Shanghai Children’s Medical Centre, China
| | - Yanyan Liu
- School of Nursing, Second Military Medical University, China
| | - Zhaohui Geng
- School of Nursing, Second Military Medical University, China
| | - Changrong Yuan
- School of Nursing, Second Military Medical University, China
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