1
|
Tutus D, Niemitz M, Plener PL, Fegert JM, Lehmann C, Weiss C, Knaevelsrud C, Biehl L, Rassenhofer M. A web-based psychological support program for caregivers of children with rare chronic diseases: a randomized controlled trial. Orphanet J Rare Dis 2024; 19:27. [PMID: 38281056 PMCID: PMC10821309 DOI: 10.1186/s13023-024-03029-9] [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: 08/25/2023] [Accepted: 01/19/2024] [Indexed: 01/29/2024] Open
Abstract
BACKGROUND Approximately 50% of rare diseases have symptom onset during childhood. A high level of nursing care and an often uncertain prognosis put caregivers of the affected children at high risk for psychological distress. At the same time, their caregivers have limited access to appropriate psychological care. The aim of this study was to evaluate a web-based psychological support program for caregivers of children with chronic rare diseases (WEP-CARE). METHODS German-speaking parents (recruited between May 2016 and March 2018) caring for children aged 0-25 years with a rare disease showing clinically relevant anxiety symptoms, were assigned to either the WEP-CARE (n = 38) or treatment as usual (n = 36) condition within a randomized controlled trial. The primary outcome measure was parental anxiety, assessed with the Generalized Anxiety Disorder Questionnaire (GAD-7). Secondary outcomes were fear of disease progression, depression, coping, quality of life and user satisfaction. The group differences were tested through repeated-measures analyses of variance. The WEP-CARE group was additionally followed up three months after the treatment. RESULTS A significant time-group interaction was found for anxiety (F (1,35) = 6.13, p = .016), fear of disease progression (F (1,331) = 18.23, p < .001), depression (F (1,74) = 10.79, p = .002) and coping (F (1,233) = 7.02, p = .010), suggesting superiority of the WEP-CARE group. Sustainability of the treatment gains regarding anxiety, fear of disease progression and coping was confirmed at the 6-month follow-up assessment (p < .01). A significant interaction effect could not be found for quality of life (F(1,2) = 0.016; p = .899). Both participating parents and therapists were satisfied with WEP-CARE. CONCLUSIONS Our results underline the efficacy and feasibility of WEP-CARE for parents of children with various rare diseases.
Collapse
Affiliation(s)
- Dunja Tutus
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Steinhoevelstr, 5, 89075, Ulm, Germany.
| | - Mandy Niemitz
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Steinhoevelstr, 5, 89075, Ulm, Germany
| | - Paul L Plener
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Steinhoevelstr, 5, 89075, Ulm, Germany
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Jörg M Fegert
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Steinhoevelstr, 5, 89075, Ulm, Germany
| | - Christine Lehmann
- Department of Paediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité University Medicine Berlin, Berlin, Germany
| | - Christa Weiss
- Department of Paediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité University Medicine Berlin, Berlin, Germany
| | | | - Lisa Biehl
- German Alliance of Chronic Rare Diseases, Berlin, Germany
| | - Miriam Rassenhofer
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Steinhoevelstr, 5, 89075, Ulm, Germany
| |
Collapse
|
2
|
Yang Y, Zhang Y, Liang L, Liao X, Meng J, Cai R, Ye H, Hu J, He X, Shi L. Fear of progression and its associated factors in parents of children undergoing cancer treatment: A CROSS-SECTIONAL STUDY. Psychooncology 2022; 31:1737-1744. [PMID: 36073576 DOI: 10.1002/pon.6027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 07/04/2022] [Accepted: 08/29/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Fear of progression (FoP) is a common psychosocial problem among adult cancer patients, but data on parents of children undergoing cancer treatment are scarce. This study aimed to determine the prevalence of FoP in parents of children undergoing cancer treatment and explore the associated factors. METHODS Overall, 285 parents of children undergoing cancer treatment were recruited from three general hospitals in China. FoP in the parents was assessed using the Chinese version of the Fear of Progression Questionnaire-parent version (FoP-Q-SF/PR). Other questionnaires included the Self-Compassion Scale, Pittsburgh Sleep Quality Index, Posttraumatic Stress Disorder Checklist-Civilian Version, and items on socio-demographic and medical characteristics. Pearson correlation and multiple linear regression analysis were used to identify factors associated with FoP. RESULTS A total of 75.1% of the participants showed dysfunctional levels of FoP. The mean FoP-Q-SF/PR score was 39.98 (standard deviation=9.18). Parental FoP was significantly associated with a shorter time since diagnosis, lower levels of self-compassion, poor sleep quality, and severe posttraumatic stress symptoms (Adjusted R Squared=0.369, F=12.838, p<0.01). CONCLUSIONS FoP is a frequently reported problem among parents of children undergoing cancer treatment. In this cohort, parents of children with a shorter time since cancer diagnosis were at higher risk of suffering from FoP. Interventions to enhance self-compassion, improve sleep quality, and mitigate posttraumatic stress symptoms may help with the psychological adjustment and well-being of parents whose children are undergoing cancer treatment. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Yiling Yang
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Yuwei Zhang
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Lichan Liang
- Department of Pediatric Hematology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaomei Liao
- Department of Pediatric Oncology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Jiangnan Meng
- Department of Pediatrics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ruiqing Cai
- Department Pediatric Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Hongyu Ye
- Department of Pediatric Hematology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Jiamin Hu
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Xiaofeng He
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Lei Shi
- School of Nursing, Southern Medical University, Guangzhou, China
| |
Collapse
|
3
|
Sharpe L, Michalowski M, Richmond B, Menzies RE, Shaw J. Fear of Progression in chronic illnesses other than cancer: A systematic review and meta-analysis of a transdiagnostic construct. Health Psychol Rev 2022; 17:301-320. [PMID: 35132937 DOI: 10.1080/17437199.2022.2039744] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Fear of cancer recurrence (FCR) is the most common psychosocial issue amongst cancer survivors. However, fear of progression (FoP) has been studied outside of the cancer context. This review aimed to: (1) meta-synthesize qualitative studies of FoP in illnesses other than cancer; and (2) quantify the relationship between FoP and anxiety, depression, and quality of life (QoL) in non-cancer chronic illnesses. We identified 25 qualitative and 11 quantitative studies in a range of chronic illnesses. Participants described fears of progression and recurrence of their illness, including fears of dying, and fears of becoming a burden to family. Fears were often triggered by downward comparison (i.e. seeing people worse off than themselves). Participants coped in different ways, including by accepting the illness or seeking knowledge. Those for whom these fears caused distress reported hypervigilance to physical symptoms and avoidance. Distress, and seeking information, were associated with adherence. In quantitative analyses, FoP was moderately associated with QoL, and strongly associated with anxiety and depression. These results suggest that FoP in illnesses other than cancer is similar to FCR. FoP appears to be an important transdiagnostic construct associated with distress. Evidence-based FCR interventions could be adapted to better manage FoP in other illnesses.
Collapse
Affiliation(s)
- Louise Sharpe
- School of Psychology, Faculty of Science, The University of Sydney, NSW 2006
| | - M Michalowski
- School of Psychology, Faculty of Science, The University of Sydney, NSW 2006
| | - B Richmond
- School of Psychology, Faculty of Science, The University of Sydney, NSW 2006
| | - R E Menzies
- School of Psychology, Faculty of Science, The University of Sydney, NSW 2006
| | - J Shaw
- School of Psychology, Faculty of Science, The University of Sydney, NSW 2006.,Psycho-Oncology Co-operative Group (POCOG), The University of Sydney, NSW 2006
| |
Collapse
|
4
|
Mahendran R, Liu J, Kuparasundram S, Griva K. Validation of the English and simplified Mandarin versions of the Fear of Progression Questionnaire - Short Form in Chinese cancer survivors. BMC Psychol 2020; 8:10. [PMID: 32005291 PMCID: PMC6995061 DOI: 10.1186/s40359-020-0374-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 01/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The fear of illness progression is common amongst those with chronic illnesses including cancers, and contributes to high psychological morbidity. Research in Asia on such fears however, is limited by a paucity of validated measurement instruments. Amongst the many available instruments, the Fear of Progression Questionnaire has a high quality rating, an important consideration in its selection. This study developed a simplified Mandarin version of the Fear of Progression Questionnaire - Short Form (FoP-Q-SF), and validated the English and Mandarin versions for use in Chinese populations. METHODS The translation to a simplified Mandarin version was through a forward-backward translation with emphasis on conceptual and cultural equivalence. Cancer survivors (N = 341) completed a self-report questionnaire, the Fear of Progression Questionnaire - Short Form, other measures of fear of progression, depression, anxiety, and quality of life. Reliability and criterion validity were assessed, and the factor-structure was replicated with a confirmatory factor analysis. RESULTS The Fear of Progression Questionnaire - Short Form demonstrated high internal and test-retest reliability. Criterion validity was also demonstrated through convergent, concurrent and discriminant validity. The factor structure was supported and replicated. The goodness-of-fit indices of the original model indicated some misfit, which could be adequately addressed by freeing five parameters in the error covariance matrix, without changing the one-factor structure. CONCLUSIONS The Fear of Progression Questionnaire - Short Form is a reliable and valid measure of fear of progression applicable to a mixed-cancer survivor population in Singapore. The simplified Mandarin version of the questionnaire will be useful in other parts of Asia and for Chinese migrants in the West, further extending the use of this questionnaire.
Collapse
Affiliation(s)
- Rathi Mahendran
- Department of Psychological Medicine, National University of Singapore, NUHS Tower Block, Level 9, 1E Kent Ridge Road, Singapore, 119228, Singapore. .,Academic Development Department, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.
| | - Jianlin Liu
- Department of Psychological Medicine, National University of Singapore, NUHS Tower Block, Level 9, 1E Kent Ridge Road, Singapore, 119228, Singapore.,Institue of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore
| | - Sangita Kuparasundram
- SingHealth Residency, Ministry of Health Holdings, 1 Maritime Square, Singapore, 099253, Singapore
| | - Konstadina Griva
- Lee Kong Chian School of Medicine, Nanyang Technological University, 59 Nanyang Drive, Experimental Medicine Building, Singapore, 636921, Singapore
| |
Collapse
|
5
|
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.
Collapse
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
| | | |
Collapse
|
6
|
Psychometric properties of the Fear of Progression Questionnaire for parents of children with cancer (FoP-Q-SF/PR). J Psychosom Res 2018; 107:7-13. [PMID: 29502766 DOI: 10.1016/j.jpsychores.2018.01.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 01/14/2018] [Accepted: 01/14/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Psychometric properties of the Fear of Progression Questionnaire - Short Form (FoP-Q-SF) were shown to be good in samples of adult cancer patients and their partners but have so far not been investigated in parents of children with cancer. This study therefore aimed to examine psychometric properties of the previously adapted parent version of the Fear of Progression Questionnaire (FoP-Q-SF/PR) in pediatric oncology. METHODS N=181 parents (119 mothers, 62 fathers) of n=128 children with diverse cancer entities, up to ten years after diagnosis were recruited at six hospitals and six registered parent associations in Germany and Austria between 06/2015 and 05/2016 (cross-sectional design). Parents provided medical information about their child and completed standardized questionnaires (Hospital Anxiety and Depression Scale, HADS; State-Trait Anxiety Inventory, STAI; Impact of Event Scale-Revised, IES-R; Ulm Quality of Life Inventory for Parents, ULQIE; Giessen Physical Complaints Inventory for children and adolescents, GBB-KJ). RESULTS Exploratory factor analysis yielded two factors (50.2% explained variance) and internal consistency was good (Cronbach's α=0.89). Significant medium to large correlations of the FoP-Q-SF/PR were observed with anxiety (HADS: r=0.68; STAI: r=0.60-0.61), depression (HADS: r=0.58), posttraumatic stress (IES-R: r=0.42-0.64) and quality of life (ULQIE: r=-0.59). The FoP-Q-SF/PR discriminated between sub-groups, e.g. parents with and without clinical anxiety levels (Cohen's d=1.26). CONCLUSION The FoP-Q-SF/PR demonstrated good reliability and validity for parents of children with cancer. The FoP-Q-SF/PR is a feasible screening instrument, which is suitable for the assessment of parental FoP in pediatric oncology.
Collapse
|
7
|
Abstract
Fear of progression (or fear of recurrence) is an appropriate, adequate response to the real threat of cancer. However, elevated levels of fear of progression can become dysfunctional, affecting well-being, quality of life, and social functioning. Research has shown that fear of progression is one of the most frequent distress symptoms of patients with cancer. As a clear consensus concerning clinically relevant states of fear of progression is still lacking, it is difficult to provide a valid estimate of the rate of cancer patients who clearly suffer from fear of progression. Current evidence suggests that probably 50% of cancer survivors experience moderate to severe fear of progression. Furthermore, many patients express unmet needs in dealing with the fear of cancer spreading. These results underscore the need to provide effective psychological treatments for clinical states of fear of progression. Some psychosocial interventions for treating fear of progression have been developed. Our own, targeted intervention study showed that clinical fear of progression can be effectively treated with brief group therapy.
Collapse
|
8
|
Wallenwein A, Schwarz M, Goldbeck L. Quality of life among German parents of children with cystic fibrosis: the effects of being a single caregiver. Qual Life Res 2017; 26:3289-3296. [DOI: 10.1007/s11136-017-1662-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2017] [Indexed: 10/19/2022]
|
9
|
Pohlig F, Lenze U, Muhlhofer HML, Lenze FW, Schauwecker J, Knebel C, Zimmermann T, Herschbach P. IT-based Psychosocial Distress Screening in Patients with Sarcoma and Parental Caregivers via Disease-specific Online Social Media Communities. ACTA ACUST UNITED AC 2017; 31:443-450. [PMID: 28438877 DOI: 10.21873/invivo.11081] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 03/11/2017] [Accepted: 03/14/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Psychosocial distress can be frequently observed in patients with sarcoma, depicting a relevant clinical problem. However, prospective data collection on psychosocial distress in patients with rare tumors is often time-consuming. In this context, social media such as Facebook can serve as a potential platform to expand research. The aim of this study was to assess the feasibility of psychosocial distress screening in patients with osteosarcoma and Ewing's sarcoma via social media. MATERIALS AND METHODS For this study an online questionnaire including general information and self-assessment distress measurement tools for patients and parents was created. The link to the questionnaire was then posted on the main page of the two largest disease-specific Facebook communities on osteosarcoma and Ewing's sarcoma. RESULTS Within 2 months, 28 patients and 58 parents of patients were enrolled. All patients with osteosarcoma and Ewing's sarcoma, as well as the majority of parental caregivers of such patients, showed relevant psychosocial distress levels. CONCLUSION Crowdsourcing via disease-specific patient communities on Facebook is feasible and provides great potential for acquisition of medical data of rare diseases.
Collapse
Affiliation(s)
- Florian Pohlig
- Department of Orthopedic Surgery, Rechts der Isar Hospital, Technical University Munich, Munich, Germany
| | - Ulrich Lenze
- Department of Orthopedic Surgery, Rechts der Isar Hospital, Technical University Munich, Munich, Germany
| | - Heinrich M L Muhlhofer
- Department of Orthopedic Surgery, Rechts der Isar Hospital, Technical University Munich, Munich, Germany
| | - Florian W Lenze
- Department of Orthopedic Surgery, Rechts der Isar Hospital, Technical University Munich, Munich, Germany.,Department of Traumatology, Traunstein HospitaI, Traunstein, Germany
| | - Johannes Schauwecker
- Department of Orthopedic Surgery, Rechts der Isar Hospital, Technical University Munich, Munich, Germany
| | - Carolin Knebel
- Department of Orthopedic Surgery, Rechts der Isar Hospital, Technical University Munich, Munich, Germany
| | - Tanja Zimmermann
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hannover, Hannover, Germany
| | - Peter Herschbach
- Roman-Herzog-Comprehensive Cancer Center, Department of Psychosomatic Medicine and Psychotherapy, Rechts der Isar Hospital, Technical University Munich, Munich, Germany
| |
Collapse
|