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Chai CWE, Lau BT, Tee MKT, Al Mahmud A. Evaluating a serious game to improve childhood cancer patients' treatment adherence. Digit Health 2022; 8:20552076221134457. [PMID: 36339903 PMCID: PMC9630903 DOI: 10.1177/20552076221134457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 10/04/2022] [Indexed: 11/17/2022] Open
Abstract
Objective Childhood cancer patients need to have good treatment adherence.
Unfortunately, treatment non-adherence often occurs due to high side-effect
burdens of treatment and the lack of knowledge of one's illness and
treatment. Therefore, a serious game intervention based on the Protection
Motivation Theory (PMT) was designed and developed to motivate childhood
cancer patients to undergo treatment and to motivate them to undergo
treatment, perform daily self-care and educate them about their illness. Methods Childhood cancer patients (6–17 years old) and their caregivers were
recruited in a multi-centre, single-arm intervention in Malaysia. A total of
24 child-caregiver dyads have completed the study. This study used PMT-based
surveys to collect quantitative data regarding children's motivation to
adhere to treatment and perform daily self-care. Additionally, a 20-question
multiple-choice quiz was used to determine children's knowledge levels.
These surveys were conducted pre-test and post-test. Children's and
caregivers' feedback were also gathered post-test as qualitative data. Results The results showed that overall, the children's intention to undergo cancer
treatment had increased significantly. A significant increase in the
intention to perform daily self-care was found among younger children, while
older children showed significant improvement in their cancer knowledge
levels. The post-test feedback suggested that the game was liked by both
children and caregivers and it provided various benefits to children with
cancer. Conclusions Findings suggest that the intervention has the potential to improve childhood
cancer patients’ motivation for treatment adherence and daily self-care, in
addition to educating them about cancer and treatment.
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Affiliation(s)
- Carmen Wang Er Chai
- Faculty of Engineering, Computing and Science, Swinburne University of Technology -
Sarawak Campus, Kuching, Sarawak, Malaysia,Carmen Chai, Swinburne University of
Technology Sarawak Campus, Jalan Simpang Tiga, 93350 Kuching, Sarawak, Malaysia.
;
| | - Bee Theng Lau
- Faculty of Engineering, Computing and Science, Swinburne University of Technology -
Sarawak Campus, Kuching, Sarawak, Malaysia
| | - Mark Kit Tsun Tee
- Faculty of Engineering, Computing and Science, Swinburne University of Technology -
Sarawak Campus, Kuching, Sarawak, Malaysia
| | - Abdullah Al Mahmud
- School of Design and Architecture, Swinburne University of
Technology, Melbourne, Victoria, Australia
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2
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Olesen AMR, Boisen KA, Missel M. How Adolescents and Young Adults with Cancer Experience an Age-Appropriate Intervention When Undergoing Treatment in Adult Surgery Clinics: A Qualitative Study. J Adolesc Young Adult Oncol 2022; 12:177-184. [PMID: 35759421 DOI: 10.1089/jayao.2022.0012] [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: 11/12/2022] Open
Abstract
Purpose: Despite growing international attention, few interventions specifically target adolescents and young adults (AYAs) with cancer even though appropriate interventions may improve care delivery during cancer treatment. The study's purpose was to explore how AYAs with cancer experience an age-appropriate intervention when undergoing treatment in adult surgery clinics. Methods: Twenty AYAs with cancer, aged 18-29 years, from five surgery clinics at Copenhagen University Hospital Rigshospitalet participated in an intervention consisting of three main components: care provided by trained youth coordinator nurses (YCNs) to the greatest extent possible; a 1-hour one-on-one conversation with a YCN during hospitalization; and a postdischarge phone call. Semistructured interviews were used to collect data, which were analyzed in a stepwise process based on inductive content analysis. Results: Three themes were identified: a beacon in the dark; from patient to person; and the caring check-up. Participants felt safe and experienced a sense of presence and a caring environment in a significant and trusting relationship with YCNs, which encouraged them to share thoughts, feelings, and needs they previously had kept silent about. The one-on-one conversations helped them begin reflecting and in emotional processing and the postdischarge phone call was perceived as a caring check-up. Conclusions: The study shows how an age-appropriate intervention was experienced overall as meaningful for the participants hospitalized in adult surgery clinics, but more research is required to further examine the significance and effect of interventions that target AYAs with cancer.
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Affiliation(s)
- Anne Marie Roholm Olesen
- Department of Cardiothoracic Surgery, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Kirsten A Boisen
- Department of Paediatrics and Adolescent Medicine, Centre of Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Malene Missel
- Department of Cardiothoracic Surgery, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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3
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Fyfe-Taylor L, Cockett A. Addressing the psychosocial needs of young people with thalassaemia undergoing bone marrow transplantation. Nurs Child Young People 2021; 33:19-24. [PMID: 33314809 DOI: 10.7748/ncyp.2020.e1300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2020] [Indexed: 11/09/2022]
Abstract
Beta thalassaemia major is an inherited condition that causes severe anaemia. Patients with the condition require regular blood transfusions. One curative treatment option available is bone marrow transplantation, but a bone marrow transplant is a high-risk, painful procedure requiring prolonged hospitalisation. Undergoing such a disruptive treatment can be a source of great anxiety for young people and their families, who will need honest, sensitive and empathetic communication, person-centred care, support to socialise and access education, involvement in decision-making and signposting to financial support. This article discusses the role of children's nurses in addressing the psychosocial needs of young people with thalassaemia who undergo bone marrow transplantation and in supporting young people's families.
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Affiliation(s)
| | - Andrea Cockett
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, England
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4
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Triarico S, Capozza MA, Mastrangelo S, Attinà G, Maurizi P, Ruggiero A. Gynecological cancer among adolescents and young adults (AYA). ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:397. [PMID: 32355841 PMCID: PMC7186636 DOI: 10.21037/atm.2020.02.41] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Adolescents and young adults (AYA) patients with cancer show specific biological, sociodemographic and behavioral features, with lower survival rates than younger group. Gynecologic malignancies that occur among AYA requires a multidisciplinary management and a tailored model of care, in order to enhance the early diagnosis, the adherence to the treatment, the enrollment in clinical trials, the rate of survival and the quality of life (QoL). In this article, we review the main gynecological tumors that may occur in AYA, with a focus on the clinical signs at the diagnosis and the modality of treatment. In addition, we proposed a model of multidisciplinary and personalized care for AYA with gynecological tumors, which can help the clinicians to manage the specific gynecologic concerns, such as ovarian failure, contraception, fertility, late psychosocial effects.
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Affiliation(s)
- Silvia Triarico
- Unità di Oncologia Pediatrica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | | | - Stefano Mastrangelo
- Unità di Oncologia Pediatrica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy.,Istituto di Pediatria, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giorgio Attinà
- Unità di Oncologia Pediatrica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Palma Maurizi
- Unità di Oncologia Pediatrica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy.,Istituto di Pediatria, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Ruggiero
- Unità di Oncologia Pediatrica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy.,Istituto di Pediatria, Università Cattolica del Sacro Cuore, Rome, Italy
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5
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Haase JE, Robb SL, Burns DS, Stegenga K, Cherven B, Hendricks-Ferguson V, Roll L, Docherty SL, Phillips C. Adolescent/Young Adult Perspectives of a Therapeutic Music Video Intervention to Improve Resilience During Hematopoietic Stem Cell Transplant for Cancer. J Music Ther 2020; 57:3-33. [PMID: 31802124 PMCID: PMC7041545 DOI: 10.1093/jmt/thz014] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
This empirical phenomenology study reports adolescents/young adults (AYA) experiences of the therapeutic music video (TMV) intervention arm of a randomized controlled clinical trial (Children's Oncology Group; COG-ANUR0631; R01 NR008583) during hospitalization for a hematopoietic stem cell transplant. A purposive subsample of 14 AYA were interviewed using a broad open-ended data-generating question about their TMV intervention experiences. At the end of each interview, we also asked AYA for suggestions on how to improve the TMV. Analysis of the narrative data resulted in four theme categories: (a) An Interwoven Experience of the Transplant and TMV Intervention; (b) TMV as a Guided Opportunity for Reflection, Self-Expression, and Meaning-Making; (c) Telling My Story: The Work of Deriving Meaning; and (d) A Way to Overcome the Bad Side of Cancer. AYA suggestions for improving the TMV are also summarized. Findings provide insight into ways the TMV supports AYA efforts to overcome distress and challenges by providing opportunities to reflect on what is meaningful, connect with others, and explore/identify personal strengths. Findings also inform our understanding about how the TMV may have functioned (i.e., mechanisms of action) to bring about significant change in AYA self-reported outcomes (i.e., positive coping, social support, and family function) for this trial.
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Affiliation(s)
| | | | - Debra S Burns
- Indiana University Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Kristin Stegenga
- Children’s Mercy Hospitals and Clinics, Kansas City, Missouri, USA
| | - Brooke Cherven
- Children’s Healthcare of Atlanta, Emory University, Atlanta, Georgia, USA
| | | | - Lona Roll
- The University of Texas Health Sciences Center, San Antonio, Texas, USA
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6
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Madi D, Badr LK. Translation, Cross-Cultural Adaptation, and Validation of the Adolescent Pediatric Pain Tool (APPT) for Multidimensional Measurement of Pain in Children and Adolescents. Pain Manag Nurs 2019; 20:549-555. [PMID: 31447300 DOI: 10.1016/j.pmn.2019.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 05/06/2019] [Accepted: 06/03/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Pain is subjective and multidimensional in nature. Its assessment is very challenging especially in the pediatric population. Adequate assessment of pain in children is the keystone for effective management. Accurate and comprehensive evaluation of the child's pain experience requires the use of multidimensional pain assessment tools such as the Adolescent Pediatric Pain Tool (APPT) which measures the intensity, location and quality of pain. AIMS The aim of this study was to translate and culturally validate the APPT for use in Lebanese children and adolescents with cancer. METHODS The instrument was translated and culturally adapted following the WHO four steps; 1) forward translation and back-translation, 2) expert panel, 3) pre-testing and 4) cognitive interviewing. The semantic validation of the pain quality descriptors was performed by healthy children and children with cancer aged 8-17 years, using the Q-sort method. RESULTS A final Arabic version with 31 pain descriptors equivalent to the original tool was produced based on the results from the pilot study and the children's interviews. Children were able to differentiate between the different words they use to describe their pain. CONCLUSION Our results showed that the Lebanese version of the APPT is a culturally sensitive tool to assess the location, intensity and quality of pain in Lebanese children with cancer. Health professionals are encouraged to use this tool to assess the pain characteristics in Lebanese children with cancer, hence leading to effective pain management.
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Affiliation(s)
- Dina Madi
- Hariri School of Nursing, American University of Beirut, Beirut, Lebanon.
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7
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Bult MK, van Bindsbergen KLA, Schepers SA, de Ridder-Sluiter HG, Verhaak CM, van Litsenburg RRL, Merks JHM, van Noesel MM, Grootenhuis MA. Health-Related Quality of Life of Adolescents with Cancer During the First Year of Treatment. J Adolesc Young Adult Oncol 2019; 8:616-622. [PMID: 31268387 DOI: 10.1089/jayao.2019.0017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Purpose: Adolescents with cancer (aged 12-18 years) are at risk for impaired health-related quality of life (HRQoL). Little is known about this population during treatment. This study aimed to (1) determine the HRQoL of adolescents with cancer during the first year of treatment and compare them with age-matched peers and (2) obtain insight into cancer-specific HRQoL of adolescents during the first year of treatment. Methods: Participants were part of a larger study focused on routine monitoring of electronic reported outcomes in standard pediatric oncology care. Adolescents completed the pediatric quality of life inventory (PedsQL) 4.0 and the PedsQL Cancer Module 3.0. Mean generic HRQoL scale scores were compared between the groups using multivariate analysis of covariance. Cancer-specific item scores were dichotomized and percentages were calculated to determine the proportion of adolescents reporting presence or absence of problems. Results: A total of 73 (mean [M]age = 14.71, standard deviation [SD] = 1.85) adolescents with cancer (Mage = 14.71, SD = 1.85, Mtimesincediagnosis = 3.51 months, SD = 2.8) and 268 healthy peers (Mage = 14.23, SD = 1.51) participated. Adolescents with cancer reported significantly lower generic HRQoL scores on all domains than their peers (p's <0.05, η2 = 0.01-0.42). Most frequently reported cancer-specific HRQoL problems were pain (hurt joint/muscle, 42.9%), nausea (during medical treatments [47.1%]; food not tasting good [54.3%]; food and smells [61.4%]), worry (about relapse [45.7%]; about side effects [52.9%]), cognitive problems (paying attention [47.1%]), and physical appearance (not good looking [47.1%]). Conclusions: Adolescents with cancer showed impaired HRQoL during treatment on both physical and psychosocial domains. Close monitoring of physical and psychosocial symptoms during treatment is, therefore, important.
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Affiliation(s)
- Maureen K Bult
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | | | - Sasja A Schepers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Amsterdam, The Netherlands
| | | | - Chris M Verhaak
- Amalia Children's Hospital/Radboud University Medical Center, Nijmegen, The Netherlands
| | - Raphaële R L van Litsenburg
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - Johannes H M Merks
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Amsterdam, The Netherlands
| | - Max M van Noesel
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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8
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Donovan E, Martin SR, Seidman LC, Zeltzer LK, Cousineau TM, Payne LA, Trant M, Weiman M, Knoll M, Federman NC. A Mobile-Based Mindfulness and Social Support Program for Adolescents and Young Adults With Sarcoma: Development and Pilot Testing. JMIR Mhealth Uhealth 2019; 7:e10921. [PMID: 30882352 PMCID: PMC6441858 DOI: 10.2196/10921] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 10/23/2018] [Accepted: 11/22/2018] [Indexed: 01/30/2023] Open
Abstract
Background Approximately 70,000 adolescents and young adults (AYA) are diagnosed with cancer each year in the United States. Sarcomas carry a particularly high symptom burden and are some of the most common cancers among AYA. Recent work has documented significant levels of unmet needs among AYA with cancer, particularly the need for psychosocial support. Mobile technology may be a cost-effective and efficient way to deliver a psychosocial intervention to AYA with cancer and cancer survivors. Objective The two aims of this study were to (1) develop a pilot version of a mobile-based mindfulness and social support program and (2) evaluate program usage and acceptability. An exploratory aim was to examine change in psychosocial outcomes. Methods Thirty-seven AYA with sarcoma or sarcoma survivors, parents, and health care providers participated in the study. Semistructured interviews were conducted with 10 AYA, parents of five of the adolescents, and six health care providers. Themes from the interviews helped to inform the development of a mobile-based mindfulness pilot program and a companion Facebook-based social support group. Twenty AYA consented to participate in a single-arm pre-post evaluation of the program; 17 downloaded the app and joined the Facebook group. Seven of these participants had participated in the semistructured interviews. Six additional health care providers consented to participate in the evaluation stage. Results On average, participants completed 16.9 of the 28 unique sessions and used the mindfulness app for a mean 10.2 (SD 8.2) days during the 28-day evaluation period. The majority of participants (16/17) engaged in the social group and posted at least one reply to the moderator’s prompts. The mean number of responses per person to the moderator of the social group was 15.2 of 31 (49%, range 0%-97%). Both AYA and health care providers responded positively to the Mindfulness for Resilience in Illness program and offered useful recommendations for improvements. Exploratory psychosocial analyses indicated there were no significant differences from pretest to posttest on measures of perceived social support, mindfulness, body image, or psychological functioning. Conclusions This study offers preliminary support for the feasibility and acceptability of a mobile-based mindfulness and Facebook-based social support program for AYA with sarcoma. The feedback from AYA and health care providers will assist in creating a fully developed intervention. Trial Registration ClinicalTrials.gov NCT03130751; https://clinicaltrials.gov/ct2/show/NCT03130751
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Affiliation(s)
- Elizabeth Donovan
- Department of Psychology, College of Natural, Behavioral, and Health Sciences, Simmons University, Boston, MA, United States.,BodiMojo, Inc, Boston, MA, United States
| | - Sarah R Martin
- Pediatric Pain and Palliative Care Program, Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, CA, United States
| | - Laura C Seidman
- Pediatric Pain and Palliative Care Program, Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, CA, United States
| | - Lonnie K Zeltzer
- Pediatric Pain and Palliative Care Program, Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, CA, United States
| | | | - Laura A Payne
- Pediatric Pain and Palliative Care Program, Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, CA, United States
| | | | - Marjorie Weiman
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, CA, United States
| | - Marla Knoll
- Department of Care Coordination, Mattel Children's Hospital, University of California, Los Angeles, CA, United States
| | - Noah C Federman
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, CA, United States
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9
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Beentjes R, Cockett A. Meeting the psychosocial needs of adolescents and their families during a diagnosis of acute lymphoblastic leukaemia. Nurs Child Young People 2019; 31:33-37. [PMID: 31468878 DOI: 10.7748/ncyp.2018.e1033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2018] [Indexed: 06/10/2023]
Abstract
Acute lymphoblastic leukaemia (ALL), an oncological condition affecting blood-producing cells, is the most common type of childhood cancer. It is more common in younger children but the number of young people diagnosed is significant, with about 125 new cases diagnosed each year. While survival rates are high, diagnostic tests, symptoms and treatment regimens can have negative psychological and sociological implications for patients and their families. This article examines the role of the registered children's nurse in meeting the psychosocial needs of adolescents and their families during a diagnosis of ALL. The psychosocial needs considered in this article include those for information, emotional support, collaborative decision-making, education and socialisation. The article also considers physical health needs and financial concerns. The importance of focusing on patients' and families' concerns when arranging psychosocial support is highlighted, together with the requirement to reassess their needs continually throughout the trajectory of the illness.
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Affiliation(s)
| | - Andrea Cockett
- Nursing education, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, England
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10
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Nunns M, Mayhew D, Ford T, Rogers M, Curle C, Logan S, Moore D. Effectiveness of nonpharmacological interventions to reduce procedural anxiety in children and adolescents undergoing treatment for cancer: A systematic review and meta-analysis. Psychooncology 2018; 27:1889-1899. [DOI: 10.1002/pon.4749] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 04/13/2018] [Accepted: 04/17/2018] [Indexed: 11/12/2022]
Affiliation(s)
- Michael Nunns
- University of Exeter Medical School, University of Exeter; Exeter UK
| | - Dominic Mayhew
- University of Exeter Medical School, University of Exeter; Exeter UK
| | - Tamsin Ford
- University of Exeter Medical School, University of Exeter; Exeter UK
| | - Morwenna Rogers
- University of Exeter Medical School, University of Exeter; Exeter UK
| | | | - Stuart Logan
- University of Exeter Medical School, University of Exeter; Exeter UK
| | - Darren Moore
- University of Exeter Medical School, University of Exeter; Exeter UK
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11
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Abstract
Background Total pain is a concept that approaches pain holistically: physically, psychologically, socially, and spiritually. Any individual may experience pain in each domain at a different level. This is the case report of an adolescent who suffered from total pain and how his healthcare team and peers helped to relieve it. Case presentation A 15-years-old Thai male was diagnosed with recurrent T-cell lymphoma and readmitted to hospital. He was admitted to an adult ward and suffered from pain due to his disease and from the fear of being alienated. As a result, he had an existential crisis. His parents felt unsure whether they or the patient should make the medical decisions and advance care plan. Conclusions This case report emphasises the importance of total pain assessment in the relief of total pain in an adolescent whose needs are different from both children and adults. It also highlights the role of medical decision-making in adolescents and the importance of the social support of peers in the alleviation of pain.
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12
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13
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The Resilience in Illness Model Part 2: Confirmatory Evaluation in Adolescents and Young Adults With Cancer. Cancer Nurs 2017; 40:454-463. [PMID: 27984241 DOI: 10.1097/ncc.0000000000000450] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Empirically derived and tested models are necessary to develop effective, holistic interventions to improve positive health outcomes in adolescents and young adults (AYA) with cancer, yet few exist. This article is the second of 2 articles reporting on evaluation of the Resilience in Illness Model (RIM) as a predictive model to guide positive health research and practice. OBJECTIVE The aim of this study was to report the confirmatory model evaluation of the RIM. METHODS A confirmatory evaluation of RIM was done using baseline data from a sample of 113 AYA aged 11 to 24 years who were undergoing hematopoietic stem cell transplant and enrolled in a randomized controlled trial of a behavioral intervention to enhance resilience. Data were analyzed using latent variable structural equation modeling. RESULTS Goodness-of-fit indices supported RIM as a confirmed model that accounted for large amounts of variance in the outcomes of self-transcendence (62%) and resilience (72%), and in 3 of 5 mediators, specifically social integration (74%), courageous coping (80%), and hope-derived meaning (87%), as well as small to moderate amounts of variance in the remaining mediators of defensive coping (1%) and family environment (35%). CONCLUSIONS Findings establish the RIM as a plausible predictive framework for explaining ways AYA with cancer transcend their illness and achieve resilience resolution and for guiding intervention studies in this population. Additional research is needed to explore RIM's transferability based on stage of illness, other chronic diseases, and cultural diversity. IMPLICATIONS FOR PRACTICE Results support the RIM as an appropriate guide for developing and evaluating interventions to foster positive adjustment in AYA with cancer.
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14
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Ander M, Wikman A, Ljótsson B, Grönqvist H, Ljungman G, Woodford J, Lindahl Norberg A, von Essen L. Guided internet-administered self-help to reduce symptoms of anxiety and depression among adolescents and young adults diagnosed with cancer during adolescence (U-CARE: YoungCan): a study protocol for a feasibility trial. BMJ Open 2017; 7:e013906. [PMID: 28132011 PMCID: PMC5278290 DOI: 10.1136/bmjopen-2016-013906] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION A subgroup of adolescents and young adults diagnosed with cancer during adolescence reports elevated levels of anxiety and depressive symptoms and unmet needs for psychological support. Evidence-based psychological treatments tailored for this population are lacking. This protocol describes a feasibility study of a guided-internet-administered self-help programme (YoungCan) primarily targeting symptoms of anxiety and depression among young persons diagnosed with cancer during adolescence and of the planned study procedures for a future controlled trial. METHODS/ANALYSIS The study is an uncontrolled feasibility trial with a pre-post and 3-month follow-up design. Potential participants aged 15-25 years, diagnosed with cancer during adolescence, will be identified via the Swedish Childhood Cancer Registry. 30 participants will be included. Participants will receive YoungCan, a 12-week therapist-guided, internet-administered self-help programme consisting primarily of cognitive-behavioural therapy organised into individually assigned modules targeting depressive symptoms, worry and anxiety, body dissatisfaction and post-traumatic stress. Interactive peer support and psychoeducative functions are also available. Feasibility outcomes include: recruitment and eligibility criteria; data collection; attrition; resources needed to complete the study and programme; safety procedures; participants' and therapists' adherence to the programme; and participants' acceptability of the programme and study methodology. Additionally, mechanisms of impact will be explored and data regarding symptoms of anxiety, depression, post-traumatic stress, body dissatisfaction, reactions to social interactions, quality of life, axis I diagnoses according to the Mini International Neuropsychiatric Interview and healthcare service use will be collected. Exploratory analyses of changes in targeted outcomes will be conducted. ETHICS/DISSEMINATION This feasibility protocol was approved by the Regional Ethical Review Board in Uppsala, Sweden (ref: 2016/210). Findings will be disseminated to relevant research, clinical, health service and patient communities through publications in peer-reviewed and popular science journals and presentations at scientific and clinical conferences. TRIAL REGISTRATION NUMBER ISRCTN97835363.
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Affiliation(s)
- Malin Ander
- Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Anna Wikman
- Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Brjánn Ljótsson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Helena Grönqvist
- Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Gustaf Ljungman
- Pediatric Oncology, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Joanne Woodford
- Clinical Education Development and Research (CEDAR), Psychology, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Annika Lindahl Norberg
- Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Louise von Essen
- Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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15
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Johnson RH, Macpherson CF, Smith AW, Block RG, Keyton J. Facilitating Teamwork in Adolescent and Young Adult Oncology. J Oncol Pract 2016; 12:1067-1074. [PMID: 27624944 DOI: 10.1200/jop.2016.013870] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A case of a young adult patient in the days immediately after a cancer diagnosis illustrates the critical importance of three interrelated core coordinating mechanisms-closed-loop communication, shared mental models, and mutual trust-of teamwork in an adolescent and young adult multidisciplinary oncology team. The case illustrates both the opportunities to increase team member coordination and the problems that can occur when coordination breaks down. A model for teamwork is presented, which highlights the relationships among these coordinating mechanisms and demonstrates how balance among them works to optimize team function and patient care. Implications for clinical practice and research suggested by the case are presented.
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Affiliation(s)
- Rebecca H Johnson
- Mary Bridge Hospital, MultiCare Health System, Tacoma, WA; Children's Hospital Los Angeles, Los Angeles, CA; National Cancer Institute, Bethesda, MD; Critical Mass: The Young Adult Cancer Alliance, Austin, TX; and North Carolina State University Raleigh, NC
| | - Catherine Fiona Macpherson
- Mary Bridge Hospital, MultiCare Health System, Tacoma, WA; Children's Hospital Los Angeles, Los Angeles, CA; National Cancer Institute, Bethesda, MD; Critical Mass: The Young Adult Cancer Alliance, Austin, TX; and North Carolina State University Raleigh, NC
| | - Ashley W Smith
- Mary Bridge Hospital, MultiCare Health System, Tacoma, WA; Children's Hospital Los Angeles, Los Angeles, CA; National Cancer Institute, Bethesda, MD; Critical Mass: The Young Adult Cancer Alliance, Austin, TX; and North Carolina State University Raleigh, NC
| | - Rebecca G Block
- Mary Bridge Hospital, MultiCare Health System, Tacoma, WA; Children's Hospital Los Angeles, Los Angeles, CA; National Cancer Institute, Bethesda, MD; Critical Mass: The Young Adult Cancer Alliance, Austin, TX; and North Carolina State University Raleigh, NC
| | - Joann Keyton
- Mary Bridge Hospital, MultiCare Health System, Tacoma, WA; Children's Hospital Los Angeles, Los Angeles, CA; National Cancer Institute, Bethesda, MD; Critical Mass: The Young Adult Cancer Alliance, Austin, TX; and North Carolina State University Raleigh, NC
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Winterling J, Wiklander M, Obol CM, Lampic C, Eriksson LE, Pelters B, Wettergren L. Development of a Self-Help Web-Based Intervention Targeting Young Cancer Patients With Sexual Problems and Fertility Distress in Collaboration With Patient Research Partners. JMIR Res Protoc 2016; 5:e60. [PMID: 27073057 PMCID: PMC4846786 DOI: 10.2196/resprot.5499] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 02/26/2016] [Accepted: 02/26/2016] [Indexed: 12/02/2022] Open
Abstract
Background The Internet should be suitable for delivery of interventions targeting young cancer patients. Young people are familiar with the technologies, and this patient group is small and geographically dispersed. Still, only few psycho-educational Web-based interventions are designed for this group. Young cancer patients consider reproductive health, including sexuality, an area of great importance and approximately 50% report sexual problems and fertility-related concerns following cancer treatment. Therefore, we set out to develop a self-help Web-based intervention, Fex-Can, to alleviate such problems. To improve its quality, we decided to involve patients and significant others as research partners. The first 18 months of our collaboration are described in this paper. The intervention will subsequently be tested in a feasibility study followed by a randomized controlled trial. Objective The study aims to describe the development of a Web-based intervention in long-term collaboration with patient research partners (PRPs). Methods Ten former cancer patients and two significant others participated in building the Web-based intervention, using a participatory design. The development process is described according to the design step in the holistic framework presented by van Gemert-Pijnen et al and evaluates the PRPs’ impact on the content, system, and service quality of the planned intervention. Results The collaboration between the research group and the PRPs mainly took place in the form of 1-day meetings to develop the key components of the intervention: educational and behavior change content, multimedia (pictures, video vignettes, and audios), interactive online activities (eg, self-monitoring), and partial feedback support (discussion forum, tailored feedback from experts). The PRPs influenced the intervention’s content quality in several ways. By repeated feedback on prototypes, the information became more comprehensive, relevant, and understandable. The PRPs gave suggestions concerning the number of exercises and pointed out texts and pictures needing revision (eg, experienced as normative or stereotypical) to increase the persuasiveness of the program. The system quality was improved by PRPs’ feedback on design, technical malfunctions, and navigation on the website. Based on feedback about availability of professional support (technical problems and program content), the organization for support was clarified, which increased service quality. The PRPs also influenced the research project on an overall level by suggesting modifications of inclusion criteria for the RCT and by questioning the implementation plan. Conclusions With suggestions and continuous feedback from PRPs, it was possible to develop a Web-based intervention with persuasive design, believed to be relevant and attractive for young persons with cancer who have sexual problems or fertility distress. In the next step, the intervention will be tested in a feasibility study, followed by an RCT to test the intervention’s effectiveness in reducing sexual problems and fertility distress. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN): 36621459; http://www.isrctn.com/ISRCTN36621459 (Archived by WebCite at http://www.webcitation.org/6gFX40F6T)
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Affiliation(s)
- Jeanette Winterling
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
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