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Zhong J, Zhang Z, Zhao Z, Peng L, Zhang Y, Zhang B, Zhai X, Wu Y. Relating caregiver experiences to personalized "push" content in mobile applications among caregivers of pediatric patients with oncology conditions. Pediatr Blood Cancer 2024; 71:e31198. [PMID: 39016596 DOI: 10.1002/pbc.31198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 06/08/2024] [Accepted: 07/01/2024] [Indexed: 07/18/2024]
Abstract
OBJECTIVE With the evolution of data algorithms and personalized push systems in mobile applications, patients who have searched for disease-related information may repeatedly receive similar content on app homepages or through notifications. This study aims to assess the influence of health-related content delivered through mobile applications on the anxiety and depression levels of caregivers of pediatric oncology patients. METHODS A survey consisting of 16 questions was conducted among 91 caregivers of pediatric oncology patients at the Children's Hospital affiliated with Chongqing Medical University. The questionnaire was designed by oncologists and the Hospital Anxiety and Depression Scale was used to assess the caregivers' psychological states. RESULTS The study found that 31.5% of caregivers exhibited borderline anxiety symptoms, while 20.2% displayed borderline depression symptoms. Caregivers who noticed changes in homepage recommendations reported higher levels of anxiety (p = .004) and depression (p = .034). Additionally, 50.6% occasionally felt anxious or uneasy due to personalized notifications and 19.1% frequently felt this way. Moreover, 53.9% of the caregivers reported a negative impact on their emotions or daily life. SIGNIFICANCE Personalized push notifications related to disease information in mobile applications can impose a significant psychological burden on patients and their caregivers. Mobile application developers and healthcare providers must strengthen their support in the digital health domain to enhance the emotional well-being of cancer patients and their caregivers.
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Affiliation(s)
- Jiaqiao Zhong
- School of Medicine and Life Sciences, Chengdu University of Chinese Medicine, Chengdu, China
| | - Zaiyu Zhang
- Department of Surgical Oncology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing, China
| | - Zhenzhen Zhao
- Department of Surgical Oncology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing, China
| | - Liang Peng
- Department of Surgical Oncology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing, China
| | - Yunlong Zhang
- Department of Surgical Oncology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing, China
| | - Bao Zhang
- Department of Surgical Oncology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing, China
| | - Xuan Zhai
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing, China
- Department of Neurosurgery, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yuxin Wu
- Department of Surgical Oncology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing, China
- Department of Neurosurgery, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
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Bernstein E, Jones AM, Jurbergs N, Harman JL, Phipps S, Heidelberg RE. Integrated Psychological Services in Pediatric Oncology: Caregiver Perspectives at Diagnosis. Cancers (Basel) 2024; 16:3137. [PMID: 39335108 PMCID: PMC11430554 DOI: 10.3390/cancers16183137] [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: 08/09/2024] [Revised: 09/06/2024] [Accepted: 09/10/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND/OBJECTIVES Pediatric oncology patients and families are at risk for increased distress at diagnosis. The New Oncology Program in Psychology (NOPP) aligns psychological care with the established standards of care at diagnosis. This project aimed to evaluate NOPP and understand the differences between caregivers' perceptions of feeling informed and prepared to navigate psychosocial concerns for those who did and did not receive psychological services at diagnosis. METHODS A survey was administered via a virtual platform. Frequency analyses summarize caregiver experiences and concerns. Mann-Whitney U tests assess the differences in caregiver knowledge and preparedness between caregivers who did and did not receive psychological services. RESULTS Caregivers reported difficult emotions at diagnosis and expressed concern for the impact of diagnosis and treatment across broad domains of patient functioning. Caregivers of patients who received psychology consultation felt more informed about difficult emotions and how these may change over time. They felt more prepared and equipped with strategies to manage difficult emotions. Caregivers of patients who completed a cognitive assessment also felt more informed and prepared regarding the potential effects of the diagnosis and treatment on patient cognitive/academic functioning. CONCLUSIONS Psychological services were associated with caregivers' positive perceptions surrounding the management of difficult emotions and with their knowledge regarding the cognitive/academic impact. The results inform the ongoing modification of NOPP.
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Affiliation(s)
- Emily Bernstein
- Department of Psychology and Biobehavioral Sciences, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Anna M Jones
- Department of Psychology and Biobehavioral Sciences, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Niki Jurbergs
- Department of Psychology and Biobehavioral Sciences, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Jennifer L Harman
- Department of Psychology and Biobehavioral Sciences, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Sean Phipps
- Department of Psychology and Biobehavioral Sciences, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - R Elyse Heidelberg
- Department of Psychology and Biobehavioral Sciences, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
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Davies J, O'Connor M, Halkett GKB, Kelada L, Gottardo NG. In their own words: advice from parents of children with cancer. J Pediatr Psychol 2024; 49:628-635. [PMID: 39073864 DOI: 10.1093/jpepsy/jsae048] [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: 02/26/2024] [Revised: 05/08/2024] [Accepted: 05/27/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND Approximately 770 children are diagnosed with cancer in Australia every year. Research has explored their experiences and developed recommendations for improving support provided to families. These have included the provision of psychology services, improved communication between healthcare professionals and parents, and increased information for families. METHODOLOGY In our hermeneutic phenomenological study, 44 participants (21 fathers and 23 mothers), with ages ranging from 28 to 51 years (M = 37 years, SD = 5.6 years) were interviewed. Interviews ranged from 45 to 150 min (M = 65 min, SD = 18 min) duration. FINDINGS Thematic analysis of the data generated seven themes. Take it second by second; Find some normality; Take care of yourself; You need to talk to someone; Just take all the help; Speaking up for your child; and Take care of the siblings. CONCLUSION The results of our study provide firsthand advice from parents. The overwhelming theme that emerged is that while many parents revealed that they had not asked for or received support, in hindsight they unanimously reflected that they wished they had sought out services. The strength of this study is that parents are more likely to accept the advice of other parents with a shared lived experience. The results of our study can be used to develop resources that could be provided to parents. These resources would emphasize that the recommendations come from parents who have traveled the same path and have learnt from hindsight and experience.
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Affiliation(s)
- Jenny Davies
- Faculty of Health Sciences, School of Population Health, Curtin University, Perth, WA, Australia
| | - Moira O'Connor
- Faculty of Health Sciences, School of Population Health, Curtin University, Perth, WA, Australia
- School of Population Health, Curtin Health Innovation Research Institute (CHIRI)/Enable Institute Curtin University, Perth, WA, Australia
| | - Georgia K B Halkett
- Curtin School of Nursing/Curtin Health Innovation Research Institute (CHIRI), Curtin University, Perth, WA, Australia
| | - Lauren Kelada
- School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Nicholas G Gottardo
- Brain Tumour Research Program, Telethon Kids Cancer Centre, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- Department of Paediatric and Adolescent Oncology/Haematology, Perth Children's Hospital, Perth, Western Australia, Australia
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Shaygani F, Jalali K, Javanmardi Fard H, Afrasiabi Z, Ahmadi Marzaleh M. Exploring the lived experience of mothers of children with leukemia: a qualitative study from Iran. BMC Womens Health 2024; 24:457. [PMID: 39152443 PMCID: PMC11328460 DOI: 10.1186/s12905-024-03300-y] [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: 11/20/2023] [Accepted: 08/08/2024] [Indexed: 08/19/2024] Open
Abstract
BACKGROUND Leukemia, as one of the most common pediatric cancers, has negatively affected many children around the world. Parents often experience increased feeling of distress shortly after being informed about their child's diagnosis. The distress experienced by parents can adversely affect various aspects of their life. This study aimed to develop an understanding of the lived experience of the mothers whose children suffer from leukemia in Shiraz, Iran. METHODS This phenomenological study was performed from April to August 2023, and 10 people were selected as participants by purposive sampling. In-depth and semi-structured interviews were performed for collecting the data. RESULTS The participants' lived experiences during their children's leukemia were classified into five main categories, namely behavioral problems, spiritual issues, psychological problems, issues related to treatment, and economic matters. CONCLUSION Knowing the experiences of parents, especially mothers, in managing and planning for the care of these children seems essential.
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Affiliation(s)
- Fatemeh Shaygani
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Katayoun Jalali
- Department of Medical Education, Clinical Education Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Hana Javanmardi Fard
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Afrasiabi
- Midwifery Department, Estahban Branch, Islamic Azad University, Estahban, Iran
| | - Milad Ahmadi Marzaleh
- Department of Health in Disasters and Emergencies, Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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Bates CR, Gilbert RM, Dean KM, August KJ, Befort CA, Ward S, Gibson M, Dreyer Gillette ML. Tailored approach to participant recruitment and retention to maximize health equity in pediatric cancer research. BMC Med Res Methodol 2024; 24:161. [PMID: 39049026 PMCID: PMC11267736 DOI: 10.1186/s12874-024-02287-2] [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: 12/22/2023] [Accepted: 07/16/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Lack of diversity in participants throughout the research process limits the generalizability of findings and may contribute to health disparities. There are unique challenges to recruitment of families to pediatric cancer research studies, especially for those from disadvantaged backgrounds. Thus, there is a need to evaluate the most effective recruitment and retention strategies to optimize equitable recruitment of diverse participants. METHODS The present study adapted and implemented methods outlined previously in the literature. These previous efforts were developed to address barriers to pediatric research, behavioral health intervention research and research with Black adolescents. Recruitment and retention strategies are described across four different time points: pre-approach, initial connection, building connection and follow-up. Eligible families of children with a pediatric cancer diagnosis were approached during a routine oncology visit. Once consented, enrollment and retention rates over three timepoints of data collection were recorded and evaluated. RESULTS Results indicated high rates of enrollment (86%) and retention (95%) for eligible participants. There were no trends in heightened attrition for any specific subgroup. CONCLUSIONS The findings of this study are promising and suggest these recruitment and retention strategies may be useful in recruiting individuals from disadvantaged backgrounds.
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Affiliation(s)
- Carolyn R Bates
- Department of Pediatrics, University of Kansas Medical Center, 2000 W Olathe Blvd, Mailstop, 4004, Kansas City, KS, 66160, USA.
- University of Kansas Cancer Center, Westwood, KS, USA.
| | - Renee M Gilbert
- Department of Pediatrics, University of Kansas Medical Center, 2000 W Olathe Blvd, Mailstop, 4004, Kansas City, KS, 66160, USA
| | - Kelsey M Dean
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Keith J August
- University of Kansas Cancer Center, Westwood, KS, USA
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA
- Department of Pediatrics, University of Missouri - Kansas City School of Medicine, Kansas City, MO, USA
| | - Christie A Befort
- University of Kansas Cancer Center, Westwood, KS, USA
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA
| | - Shallyn Ward
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Mary Gibson
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Meredith L Dreyer Gillette
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA
- Department of Pediatrics, University of Missouri - Kansas City School of Medicine, Kansas City, MO, USA
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Zucchetti G, Ciappina S, Roccia E, Concas D, Giordano M, Battaglini C, Geuna T, Peirolo C, Faretta E, Fernandez I, Quarello P, Fagioli F. EMDR and standard psychotherapy for paediatric cancer patients and their families: a pilot study. Front Psychol 2024; 15:1407985. [PMID: 39045437 PMCID: PMC11263944 DOI: 10.3389/fpsyg.2024.1407985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 06/27/2024] [Indexed: 07/25/2024] Open
Abstract
Introduction This study examined the efficacy of eye movement desensitisation and reprocessing (EMDR) therapy compared with standard psychotherapy (SP) in treating post-traumatic stress disorder (PTSD) in paediatric oncology patients and their families in the early stage of cancer treatment. The secondary aim of this study was to assess whether EMDR therapy has a different impact on post-traumatic growth compared to SP. Methods Forty patients were randomly assigned to EMDR or SP groups. The Impact of Event Scale - Revised (IES-R) and the Distress Thermometer (DT) were used to assess PTSD symptoms at pre-treatment (at cancer diagnosis) and in the post-treatment stages (after 8 sessions). The Post-traumatic Growth Inventory-PTGI was administered in the post-treatment stage in order to evaluate positive changes. Results Both EMDR and SP are effective in reducing PTSD, but EMDR was significantly more effective than the SP in reducing scores on the IES-R, especially regarding the intrusive symptom subscale. Also, in the EMDR group there were higher scores of PTGI than in the standard group. Conclusion EMDR thus represents a promising treatment in the paediatric psycho-oncology setting.
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Affiliation(s)
- Giulia Zucchetti
- Department of Paediatric Onco-Haematology, Regina Margherita Children’s Hospital, AOU Città della Salute e della Scienza, Turin, Italy
| | - Sabrina Ciappina
- Department of Paediatric Onco-Haematology, Regina Margherita Children’s Hospital, AOU Città della Salute e della Scienza, Turin, Italy
| | - Elvia Roccia
- Department of Paediatric Onco-Haematology, Regina Margherita Children’s Hospital, AOU Città della Salute e della Scienza, Turin, Italy
| | - Deborah Concas
- Department of Paediatric Onco-Haematology, Regina Margherita Children’s Hospital, AOU Città della Salute e della Scienza, Turin, Italy
| | - Mario Giordano
- Department of Paediatric Onco-Haematology, Regina Margherita Children’s Hospital, AOU Città della Salute e della Scienza, Turin, Italy
| | - Chiara Battaglini
- Department of Paediatric Onco-Haematology, Regina Margherita Children’s Hospital, AOU Città della Salute e della Scienza, Turin, Italy
| | - Tiziana Geuna
- Department of Paediatric Onco-Haematology, Regina Margherita Children’s Hospital, AOU Città della Salute e della Scienza, Turin, Italy
| | - Claudia Peirolo
- Department of Paediatric Onco-Haematology, Regina Margherita Children’s Hospital, AOU Città della Salute e della Scienza, Turin, Italy
| | | | | | - Paola Quarello
- Department of Paediatric Onco-Haematology, Regina Margherita Children’s Hospital, AOU Città della Salute e della Scienza, Turin, Italy
- University of Turin, Turin, Italy
| | - Franca Fagioli
- Department of Paediatric Onco-Haematology, Regina Margherita Children’s Hospital, AOU Città della Salute e della Scienza, Turin, Italy
- University of Turin, Turin, Italy
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Owusu WE, Burger JR, Lubbe MS, Joubert R. Treatment Cost and Psychological Impact of Burkitt Lymphoma on Ghanaian Families and Caregivers. Value Health Reg Issues 2024; 44:101016. [PMID: 38917509 DOI: 10.1016/j.vhri.2024.101016] [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: 10/14/2023] [Revised: 04/13/2024] [Accepted: 05/20/2024] [Indexed: 06/27/2024]
Abstract
OBJECTIVE Before June 2022, the treatment cost of Burkitt lymphoma (BL) in Ghana was mainly borne by the child's family or caregiver. We determined the treatment cost of BL in children and its psychological impact on parents and caregivers. METHOD This prospective observational study assessed the direct medical and nonmedical costs (US dollars [USD]) incurred during the treatment of a child with BL for 6 consecutive months using a cost diary. Productivity losses and the psychological impact on parents and caregivers were assessed using a self-administered questionnaire and the Caregiver Quality of Life Index-Cancer (CQOLC). RESULTS Of the 25 participants, 7 abandoned the treatment of their children, and 4 withdrew because the children passed away. The median (Q1, Q3) cost for treating BL per child for caregivers/parents (N = 12) was USD 947.42 (USD 763.03, USD 1953.05). Direct medical costs formed 71% (USD 11 458.97) of total treatment costs. Working hours of parents before the child's cancer diagnosis decreased from a median (Q1, Q3) of 44.00 (20.00, 66.00) hours to 1.50 (0, 20.00) hours after the diagnosis. The mean (SD) CQOLC score was 107.92 (15.89), with higher scores in men (111.00 [17.26]), married participants (111.26 [17.29]), Higher National Diploma certificate holders (113.00 [1.41]), and participants earning a monthly income more than USD 84.60. CONCLUSION Treatment costs reduced the overall household income of 5 families. Parents and caregivers experienced reduced work hours and loss of employment. CQOLC scores were higher in married participants, those with a higher educational background, and those with higher income.
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Affiliation(s)
- Winifred E Owusu
- Medicine Usage in South Africa (MUSA), North-West University, Faculty of Health Sciences, Potchefstroom, South Africa
| | - Johanita R Burger
- Medicine Usage in South Africa (MUSA), North-West University, Faculty of Health Sciences, Potchefstroom, South Africa.
| | - Martie S Lubbe
- Medicine Usage in South Africa (MUSA), North-West University, Faculty of Health Sciences, Potchefstroom, South Africa
| | - Rianda Joubert
- Medicine Usage in South Africa (MUSA), North-West University, Faculty of Health Sciences, Potchefstroom, South Africa
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Sze Chong AS, Ahmad M, Alias H, Iqbal Hussain R, Lateh A, Chan CMH. An intervention module for caregivers of children with acute lymphoblastic leukemia (ALL). J Psychosoc Oncol 2024:1-15. [PMID: 38873844 DOI: 10.1080/07347332.2024.2364670] [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: 06/15/2024]
Abstract
INTRODUCTION Childhood cancer caregivers report psychological distress and unmet psychosocial needs, affecting outcomes for their children. An experimental study was carried out to measure the effectiveness of an intervention in addressing traumatic stress, depression and anxiety. METHODS Caregivers (n = 59) of children with ALL were allocated to both groups (intervention, n = 29; TAU control, n = 30) via the SNOSE method. The intervention is a physical copy of a 2-week psychosocial self-help guidebook. Scores on the PCL-5, BDI and BAI were recorded at baseline, post-intervention and 1-month follow-up. RESULTS There was a statistically significant difference in traumatic stress symptoms post intervention (F(1, 57) = 5.760, p = .020, np2 = 0.093) in favor of the intervention group. No statistical significance was found for its effect at one-month follow-up, overall depression and anxiety. CONCLUSION A psychosocial module developed for caregivers of children with ALL was found to be effective in reducing symptoms of traumatic stress and potentially depression. However, the maintenance of its effectiveness and the effectiveness on anxiety requires further study.
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Affiliation(s)
- Agnes Shu Sze Chong
- Clinical Psychology and Behavioural Health Program/Center for Community Health Studies (ReaCH), Faculty of Health Sciences, Universiti Kebangsaan, Malaysia
| | - Mahadir Ahmad
- Clinical Psychology and Behavioural Health Program/Center for Community Health Studies (ReaCH), Faculty of Health Sciences, Universiti Kebangsaan, Malaysia
| | - Hamidah Alias
- Department of Paediatrics, UKM Medical Centre, Kuala Lumpur, Malaysia
| | | | - Afifi Lateh
- Department of Educational Evaluation and Research, Faculty of Education, Prince of Songkla University, Thailand
| | - Caryn Mei Hsien Chan
- Clinical Psychology and Behavioural Health Program/Center for Community Health Studies (ReaCH), Faculty of Health Sciences, Universiti Kebangsaan, Malaysia
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Al-Saadi LS, Chan MF, Al Sabahi A, Alkendi J, Al-Mashaikhi N, Sumri HA, Al-Fahdi A, Al-Azri M. Prevalence of anxiety, depression, and post-traumatic stress disorder among Omani children and adolescents diagnosed with cancer: a prospective cross-sectional study. BMC Cancer 2024; 24:518. [PMID: 38654218 DOI: 10.1186/s12885-024-12272-z] [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: 01/23/2024] [Accepted: 04/16/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Children and adolescents diagnosed with cancer often experience psychological distress, encompassing anxiety, depression, and post-traumatic stress disorder (PTSD). This study aimed to evaluate the prevalence of these conditions among Omani children and adolescents diagnosed with cancer, alongside identifying contributing factors. METHODS A prospective cross-sectional study was conducted from October 2021 to June 2023 among a cohort of Omani children and adolescents (6-18 years old) diagnosed with cancer at three primary cancer referral centres in Oman. Validated Arabic-language versions of the Screen for Child Anxiety Related Disorders, the Center for Epidemiologic Studies Depression Scale for Children, and the Impact of Event Scale-Revised instruments were used to assess symptoms of anxiety, depression, and PTSD, respectively. An initial assessment (T1) was undertaken within the first 3 months of diagnosis, followed by a second assessment (T2) 3-6 months later. RESULTS Of 113 eligible participants, 101 agreed to participate in the study (response rate: 95.6%), with 92 (91.0%) completing both assessments and included in the final analysis. Prevalence rates of anxiety, depression, and PTSD decreased from 43.5%, 56.5%, and 32.6%, respectively, at T1, to 38.0%, 35.9%, and 23.9% at T2. All average scores were below diagnostic cut-off points, except for the depression score at T1. Anxiety and depression scores decreased significantly (p = 0.043 and 0.001, respectively) between T1 and T2, as did the overall prevalence of depression (p = 0.004). At T1, linear regression analysis showed significant correlations between anxiety scores and the child's age and PTSD score (p < 0.05); these variables were also correlated with depression scores (p ≤ 0.001). At T2, significant correlations were observed between anxiety scores and the child's age and PTSD scores (p < 0.001). At both T1 and T2, anxiety, depression, and PTSD scores remained significantly correlated (p < 0.001). CONCLUSIONS Omani children and adolescents recently diagnosed with cancer exhibit a high prevalence of anxiety, depression, and PTSD over time. Age-appropriate communication, ongoing support, and mental health services are recommended to help this patient group cope with their diagnosis and manage their emotional wellbeing. There is a need for future research to determine the effectiveness of specific psychological interventions in reducing the frequency of these disorders.
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Affiliation(s)
- Laila S Al-Saadi
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Postal Code 123, Al Khoud, Al Khoud, Muscat, PO Box 38, Oman
| | - Moon Fai Chan
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Postal Code 123, Al Khoud, Al Khoud, Muscat, PO Box 38, Oman
| | - Amal Al Sabahi
- National Oncology Centre, Royal Hospital, Bawshar, Muscat, Oman
| | - Jalila Alkendi
- National Oncology Centre, Royal Hospital, Bawshar, Muscat, Oman
| | - Nawal Al-Mashaikhi
- Department of Child Health, Sultan Qaboos University Hospital, Al Khoud, Muscat, Oman
| | - Hana Al Sumri
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Postal Code 123, Al Khoud, Al Khoud, Muscat, PO Box 38, Oman
| | - Amal Al-Fahdi
- Sultan Qaboos Comprehensive Cancer Care and Research Centre (SQCCCRC), Al Khoud, Muscat, Oman
| | - Mohammed Al-Azri
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Postal Code 123, Al Khoud, Al Khoud, Muscat, PO Box 38, Oman.
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Hu X, Grosse SD, Han X, Marchak JG, Ji X. Mental Health Care Utilization Among Parents of Children With Cancer. JAMA Netw Open 2024; 7:e244531. [PMID: 38564218 PMCID: PMC10988353 DOI: 10.1001/jamanetworkopen.2024.4531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/05/2024] [Indexed: 04/04/2024] Open
Abstract
Importance Caring for children diagnosed with cancer may adversely affect the mental health (MH) of parents. Objective To characterize utilization of MH services among parents of children with vs without cancer using nationwide commercial claims data. Design, Setting, and Participants For this cross-sectional study, the Merative MarketScan Commercial Claims Database was used to identify continuously insured families of children treated for cancer (aged ≤21 years at diagnosis) during 2010 to 2018, compared with families who matched eligibility criteria but did not have a child with a cancer history. Parents were assessed from 18 months before to 12 months after their child's cancer diagnosis. Analyses were conducted from February 2022 to September 2023. Exposures Children's cancer diagnosis. Main Outcomes and Measures Outcomes included parents' MH-related visits during the first year following their child's cancer diagnosis. Logistic regressions compared outcomes between families of children with vs without cancer, adjusting for sociodemographic and clinical factors. Results This study included 4837 families of children with cancer (4210 mothers and 4016 fathers) and 24 185 families of children without cancer (21 444 mothers and 19 591 fathers) with continuous insurance enrollment. Most household leads were aged 35 to 54 years (3700 [76.5%] in families of children with cancer vs 17 812 [73.6%] in families of children without cancer) and resided in urban areas (4252 [87.9%] vs 21 156 [87.5%]). The probabilities of parents having anxiety-related visits (10.6% vs 7.0%), depression-related visits (8.4% vs 6.1%), and any MH-related visits (18.1% vs 13.3%) were higher in families of children with vs without cancer. Adjusted analyses showed absolute increases of 3.2 percentage points (95% CI, 2.3 to 4.0; 45.7% relative increase), 2.2 percentage points (95% CI, 1.4 to 3.0; 36.1% relative increase), and 4.2 percentage points (95% CI, 3.1 to 5.3; 31.3% relative increase) in the probabilities of 1 or both parents having anxiety-related visits, depression-related visits, and any MH-related visits, respectively, among families of children with vs without cancer. Such differences were greater in magnitude among mothers than fathers. Conclusions and Relevance In this cohort study of privately insured parents, those caring for children with cancer had a higher likelihood of utilizing MH care than other parents. These findings underline the importance of interventions toward targeted counseling and support to better meet MH care needs among parents and caregivers of children with cancer.
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Affiliation(s)
- Xin Hu
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville
| | - Scott D. Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Xuesong Han
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Jordan Gilleland Marchak
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Xu Ji
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
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11
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Luo Y, Xu J, Xie J, Xiao P, Cai Q. The mediating role of resilience in the relationship between stress and psychological distress in parents of children with cancer. J Health Psychol 2024; 29:266-274. [PMID: 37840285 DOI: 10.1177/13591053231202635] [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] [Indexed: 10/17/2023] Open
Abstract
Caring for children with cancer is stressful for parents and leads to psychological distress, which is mainly manifested as depressive symptoms and anxiety. This study explored the mediating role of resilience in the relationship between stress and psychological distress in parents of children with cancer. We recruited 258 parents of children with cancer in three tertiary hospitals in Mainland China. The results revealed that the mediating effect of resilience for the relationships between stress and depressive symptoms and between stress and anxiety accounted for 23.4% and 11.4%, respectively, of the total effect. Resilience was confirmed as a protective factor that can be incorporated into future intervention programmes to improve the psychological well-being of parents of children with cancer. Future studies could develop resilience training programmes to enhance the resilience of parents of children with cancer to alleviate parents' psychological distress.
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Affiliation(s)
- Yuanhui Luo
- Xiangya School of Nursing, Central South University, China
| | - Jing Xu
- The Second Xiangya Hospital of Central South University, China
| | | | - Pin Xiao
- Hunan Children's Hospital, China
| | - Qian Cai
- The Third Xiangya Hospital of Central South University, China
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12
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Herzog K, Schepper F, Kamm-Thonwart R, Herrmann J, Budich M, Weiler-Wichtl L, Pletschko T, Suttorp M, Christiansen H, Martini J. Trajectories of illness perceptions in paediatric cancer patients and their parents and associations with health-related quality of life: Results of a prospective-longitudinal study. Psychooncology 2024; 33:e6332. [PMID: 38520473 DOI: 10.1002/pon.6332] [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: 12/04/2023] [Revised: 02/16/2024] [Accepted: 03/12/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVE In paediatric oncology, little is known about trajectories of illness perceptions and their longitudinal associations with health-related quality of life (HRQoL). Therefore, the aim of this study was to investigate changes in illness perceptions in children and parents over a one-year-period and to investigate predictive value of child's and parent's illness perceptions during acute treatment for child's HRQoL 1 year later. METHODS N = 65 child-parent-dyads participated in a longitudinal study (retention rate: 80.2%). Children were 4-18 years of age and underwent acute cancer treatment at baseline. Children and parents reported on their own illness perceptions (Illness-Perception-Questionnaire-Revised), as well as on the child's HRQoL (KINDL-R) at baseline and one-year-follow-up. Paired-samples t-tests were calculated to investigate changes over time. A hierarchical multiple regression analysis was performed to investigate predictive value of child's and parent's illness perceptions for child's HRQoL. RESULTS Child's HRQoL t(63) = -6.73, p < 0.001, their perceptions of coherence (i.e. understanding; t(54) = -2.36, p = 0.022) and consequences of their illness (t(54) = 2.86, p = 0.006), and parent's perception of cyclical trajectory (t(61) = 2.06, p = 0.044) improved from baseline to 1-year-follow-up. All other illness perceptions remained stable. Exploratory post-hoc analyses showed differences in the pattern of change in age-, gender-, and diagnosis-specific subgroups. After controlling for baseline levels of HRQoL, child's perceptions of symptoms and consequences were independent predictors of their HRQoL 1 year later (R2 = 0.396, F(2,52) = 10.782, p < 0.001), whereas no parent's illness perceptions added predictive value. CONCLUSION In paediatrics, child's and parent's illness perceptions should be assessed. Our findings highlight the importance of illness perceptions as potential modifiable variables in interventions to improve child's HRQoL.
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Affiliation(s)
- Kristina Herzog
- Department of Psychiatry and Psychotherapy, Faculty of Medicine of the Technische Universität Dresden, Dresden, Germany
- Elternhilfe für krebskranke Kinder e.V. Leipzig, Leipzig, Germany
| | - Florian Schepper
- Department of Paediatric Oncology, Haematology and Haemostaseology, Leipzig University, Leipzig, Germany
- Department of Paediatric Psychiatry, Psychotherapy and Psychosomatics, Leipzig University, Leipzig, Germany
| | - Remo Kamm-Thonwart
- Sonnenstrahl e.V. Dresden-Förderkreis für krebskranke Kinder und Jugendliche, Dresden, Germany
| | - Jessy Herrmann
- Elternhilfe für krebskranke Kinder e.V. Leipzig, Leipzig, Germany
| | - Mihaela Budich
- Department of Paediatrics, Paediatric Haematology and Oncology, University Hospital Carl Gustav Carus Dresden, Dresden, Germany
| | - Liesa Weiler-Wichtl
- Department of Paediatric and Adolescent Medicine, Medical University Vienna, Vienna, Austria
| | - Thomas Pletschko
- Department of Paediatric and Adolescent Medicine, Medical University Vienna, Vienna, Austria
| | - Meinolf Suttorp
- Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Holger Christiansen
- Department of Paediatric Oncology, Haematology and Haemostaseology, Leipzig University, Leipzig, Germany
| | - Julia Martini
- Department of Psychiatry and Psychotherapy, Faculty of Medicine of the Technische Universität Dresden, Dresden, Germany
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13
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Ay A, Semerci R, Erkul M. Prediction of family-centered care on the unmet care needs of parents of pediatric oncology patients and their psychosocial problems. Pediatr Blood Cancer 2024; 71:e30795. [PMID: 38038401 DOI: 10.1002/pbc.30795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/14/2023] [Accepted: 11/19/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND/OBJECTIVES It was aimed to determine the predictive power of family-centered care of parents of children with cancer on their unmet care needs and psychosocial problems (anxiety, depression, stress). This study was conducted as a descriptive, correlational, and cross-sectional study. DESIGN/METHODS The study was conducted on 136 parents at a university hospital between January and September 2023, involving parents of children receiving care at the pediatric oncology clinic. Data collection instruments included an Information Form, Family Inventory of Needs Pediatric II (FINPED-II), Family-Centered Care Scale (FCCS), and Depression Anxiety Stress Scale (DASS-21). Data were analyzed using IBM SPSS 28, employing Pearson correlation analysis and linear regression to assess the relationships between variables. RESULTS The study revealed significant positive correlations between Family-Centered Care and Met Needs (r = .676, p < .001) and significant negative correlations between Met Needs and Stress scores (r = -.256, p < .001). Additionally, there were positive correlations between Anxiety and Depression scores (r = .700, p < .001), Anxiety and Stress scores (r = .768, p < .001), and Depression and Stress scores (r = .835, p < .001). Family-centered care significantly predicted Met Needs (p < .001) and accounted for 47% of the variation in Anxiety, Depression, Stress, and Family Inventory of Needs scores. CONCLUSION The findings highlight that family-centered care significantly predicts Met Needs, emphasizing its pivotal role in supporting parents of children with cancer. These findings underscore the importance of family-centered care in pediatric oncology, but also point to the need for further studies to address identified limitations and provide a comprehensive understanding of this complex healthcare dynamic.
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Affiliation(s)
- Ayşe Ay
- Nursing Department, Faculty of Health Sciences, Başkent University, Ankara, Turkey
| | - Remziye Semerci
- Child and Disease Nursing Department, Nursing Faculty, Koç University, İstanbul, Turkey
| | - Münevver Erkul
- Nursing Department, Faculty of Health Sciences, Antalya Science University, Antalya, Turkey
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14
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Bates CR, Staggs VS, Dean KM, August KJ, Befort CA, Covitz LM, Dreyer Gillette ML. Family Rules and Routines During the Early Phases of Pediatric Cancer Treatment: Associations With Child Emotional and Behavioral Health. J Pediatr Psychol 2024; 49:66-76. [PMID: 37990581 DOI: 10.1093/jpepsy/jsad079] [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: 05/10/2023] [Revised: 10/19/2023] [Accepted: 10/19/2023] [Indexed: 11/23/2023] Open
Abstract
OBJECTIVE Consistent family rules and routines promote positive adaptation to stress and may be protective to child emotional and behavioral functioning. Few studies have quantified family engagement in these behaviors during pediatric cancer treatment or examined associations with child emotional and behavioral health. METHODS In this cross-sectional observational study, 86 primary caregivers of youth ages 2-14 years (M = 7.9) with an initial diagnosis of cancer within 16 weeks reported on their frequency of engagement in family rules and routines (e.g., sleep, schoolwork, and meal routines) before their child's cancer diagnosis and their current frequency of engagement in the same routines. Caregivers also reported demographics, psychosocial distress, and child emotional and behavioral health outcomes. Analyses examined demographic and psychosocial factors associated with engagement in rules and routines during cancer treatment, and associations with child emotional and behavioral health. RESULTS Families reported a lower frequency of engagement in rules and routines during cancer treatment, compared to before treatment (mean difference 0.8 SDs [95% confidence interval 0.7-1.1 SDs]). Caregiver factors associated with lower engagement in rules and routines during treatment included being married, having lower educational attainment, and higher levels of psychosocial distress. Families who engaged in higher levels of rules and routines during treatment reported fewer child externalizing and behavioral challenges. There was limited evidence of association between family rules and routines and child internalizing outcomes. CONCLUSIONS Results found that engaging in family rules and routines during cancer treatment was associated with fewer child behavioral challenges during treatment. Future directions include longitudinal examinations of family rules, routines, and child emotional/behavioral outcomes to examine directional impact over time.
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Affiliation(s)
- Carolyn R Bates
- Department of Pediatrics, University of Kansas Medical Center, USA
- University of Kansas Cancer Center, USA
- Center for Children's Healthy Lifestyles & Nutrition, USA
| | - Vincent S Staggs
- Department of Pediatrics, Children's Mercy Kansas City, USA
- University of Missouri Kansas City School of Medicine, USA
| | - Kelsey M Dean
- Center for Children's Healthy Lifestyles & Nutrition, USA
| | - Keith J August
- University of Kansas Cancer Center, USA
- Department of Pediatrics, Children's Mercy Kansas City, USA
- University of Missouri Kansas City School of Medicine, USA
| | - Christie A Befort
- Department of Pediatrics, University of Kansas Medical Center, USA
- Department of Population Health, University of Kansas Medical Center, USA
| | - Lynne M Covitz
- Department of Pediatrics, Children's Mercy Kansas City, USA
- University of Missouri Kansas City School of Medicine, USA
| | - Meredith L Dreyer Gillette
- Center for Children's Healthy Lifestyles & Nutrition, USA
- Department of Pediatrics, Children's Mercy Kansas City, USA
- University of Missouri Kansas City School of Medicine, USA
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15
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Camoni L, Santos A, Luporsi M, Grilo A, Pietrzak A, Gear J, Zucchetta P, Bar-Sever Z. EANM procedural recommendations for managing the paediatric patient in diagnostic nuclear medicine. Eur J Nucl Med Mol Imaging 2023; 50:3862-3879. [PMID: 37555902 PMCID: PMC10611649 DOI: 10.1007/s00259-023-06357-3] [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: 05/26/2023] [Accepted: 07/23/2023] [Indexed: 08/10/2023]
Abstract
PURPOSE The manuscript aims to characterize the principles of best practice in performing nuclear medicine procedures in paediatric patients. The paper describes all necessary technical skills that should be developed by the healthcare professionals to ensure the best possible care in paediatric patients, as it is particularly challenging due to psychological and physical conditions of children. METHODS We performed a comprehensive literature review to establish the most relevant elements of nuclear medicine studies in paediatric patients. We focused the attention to the technical aspects of the study, such as patient preparation, imaging protocols, and immobilization techniques, that adhere to best practice principles. Furthermore, we considered the psychological elements of working with children, including comforting and distraction strategies. RESULTS The extensive literature review combined with practical conclusions and recommendations presented and explained by the authors summarizes the most important principles of the care for paediatric patient in the nuclear medicine field. CONCLUSION Nuclear medicine applied to the paediatric patient is a very special and challenging area, requiring proper education and experience in order to be performed at the highest level and with the maximum safety for the child.
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Affiliation(s)
- Luca Camoni
- University of Brescia, 25123, Brescia, Italy.
- Nuclear Medicine Department, University of Brescia, ASST Spedali Civili Di Brescia, P.Le Spedali Civili 1, 25123, Brescia, Italy.
| | - Andrea Santos
- Nuclear Medicine Department, CUF Descobertas Hospital, Lisbon, Portugal
| | - Marie Luporsi
- Department of Nuclear Medicine, Institut Curie, PSL Research University, 75005, Paris, France
- LITO Laboratory INSERM U1288, Institut Curie, 91440, Orsay, France
| | - Ana Grilo
- H&TRC - Health and Technology Research Center, ESTeSL - Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, Lisbon, Portugal
| | - Agata Pietrzak
- Electroradiology Department, Poznan University of Medical Sciences, Poznan, Poland
- Nuclear Medicine Department, Greater Poland Cancer Centre, Poznan, Poland
| | - Jonathan Gear
- Joint Department of Physics, Royal Marsden Hospital and Institute of Cancer Research, Sutton, UK
| | - Pietro Zucchetta
- Nuclear Medicine Department, Padova University Hospital, 35128, Padua, Italy
| | - Zvi Bar-Sever
- Department of Nuclear Medicine, Schneider Children's Medical Center, Tel-Aviv University, Petach Tikva, Israel
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16
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Umaretiya PJ, Koch VB, Flamand Y, Aziz-Bose R, Ilcisin L, Valenzuela A, Cole PD, Gennarini LM, Kahn JM, Kelly KM, Tran TH, Michon B, Welch JJG, Wolfe J, Silverman LB, Bona K. Disparities in parental distress in a multicenter clinical trial for pediatric acute lymphoblastic leukemia. J Natl Cancer Inst 2023; 115:1179-1187. [PMID: 37261858 PMCID: PMC10560600 DOI: 10.1093/jnci/djad099] [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: 03/21/2023] [Revised: 05/19/2023] [Accepted: 05/22/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Parent psychological distress during childhood cancer treatment has short- and long-term implications for parent, child, and family well-being. Identifying targetable predictors of parental distress is essential to inform interventions. We investigated the association between household material hardship (HMH), a modifiable poverty-exposure defined as housing, food, or utility insecurity, and severe psychological distress among parents of children aged 1-17 years with acute lymphoblastic leukemia (ALL) enrolled on the multicenter Dana-Farber ALL Consortium Trial 16-001. METHODS This was a secondary analysis of parent-reported data. Parents completed an HMH survey within 32 days of clinical trial enrollment (T0) and again at 6 months into therapy (T1). The primary exposure was HMH at T0 and primary outcome was severe parental distress at T0 and T1, defined as a score greater than or equal to 13 on the Kessler-6 Psychological Distress Scale. Multivariable models were adjusted for ALL risk group and single parent status. RESULTS Among 375 evaluable parents, one-third (32%; n = 120/375) reported HMH at T0. In multivariable analyses, T0 HMH was associated with over twice the odds of severe psychological distress at T0 and T1 HMH was associated with over 5 times the odds of severe distress at T1. CONCLUSIONS Despite uniform clinical trial treatment of their children at well-resourced pediatric centers, HMH-exposed parents-compared with unexposed parents-experienced statistically significantly increased odds of severe psychological distress at the time of their child's leukemia diagnosis, which worsened 6 months into therapy. These data identify a high-risk parental population who may benefit from early psychosocial and HMH-targeted interventions to mitigate disparities in well-being.
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Affiliation(s)
- Puja J Umaretiya
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, MA, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Victoria B Koch
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Yael Flamand
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Rahela Aziz-Bose
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Lenka Ilcisin
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Surgery, Boston Children’s Hospital, Boston, MA, USA
| | - Ariana Valenzuela
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Peter D Cole
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | | | - Justine M Kahn
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Columbia, University Medical Center, New York, NY, USA
| | - Kara M Kelly
- Department of Pediatrics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
- Division of Pediatric Hematology/Oncology, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Thai Hoa Tran
- Division of Pediatric Hematology Oncology, Charles-Bruneau Cancer Center, CHU Sainte-Justine, Université de Montréal, Montréal, QC, Canada
| | - Bruno Michon
- Centre Hospitalier Universitaire de Quebec, Saint-Foy, QC, Canada
| | - Jennifer J G Welch
- Division of Pediatric Hematology/Oncology, Hasbro Children’s Hospital, Brown University, Providence, RI, USA
| | - Joanne Wolfe
- Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, MA, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Lewis B Silverman
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Kira Bona
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
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Phiri L, Li WHC, Cheung AT, Phiri PGMC. Effectiveness of psychoeducation interventions in reducing negative psychological outcomes and improving coping skills in caregivers of children with cancer: A systematic review and meta-analysis. Psychooncology 2023; 32:1514-1527. [PMID: 37639282 DOI: 10.1002/pon.6208] [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: 02/10/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 08/29/2023]
Abstract
PURPOSE Psychoeducation interventions (PEIs) have been used as an adjunct treatment for negative psychological outcomes in caregivers of children with cancer. This systematic review and meta-analysis aimed to evaluate the evidence on the effectiveness of PEIs in reducing anxiety and depressive symptoms and improving health-related quality of life (HRQoL) and coping skills in caregivers of children with cancer. METHOD Ten English databases were searched to identify studies on PEIs for caregivers of children with cancer. Studies inclusion criteria were as follows: (1) participants who were caregivers of children with cancer receiving treatment; (2) psychoeducational interventions assessing anxiety, depressive symptoms, HRQoL, and coping outcomes; and (3) usual care, waitlist, or active control as a control group. Meta-analysis and narrative synthesis were used to analyse data. RESULTS Fourteen randomised control trials were included. PEIs have a beneficial effect on anxiety levels (SMD: -0.59, 95% CI [-0.92, -0.25], p = 0.0007), quality of life (SMD: -0.31, 95% CI [-0.00, -0.61], p = 0.05) and depressive symptoms (SMD: -1.18, 95% CI [-2.08, -0.28], p = 0.01) immediately post-intervention. The effect of PEIs was maintained at long-term follow-up on depressive symptoms (SMD: -0.52, 95% CI [-1.54, -0.36], p = 0.0004). Similarly, the synthesised data suggest that PEIs are effective in improving coping skills. CONCLUSION The review provides evidence that PEIs effectively reduce negative psychological outcomes and improve coping skills in caregivers of children with cancer. However, due to methodological flaws and heterogeneity of the interventions evaluated, more research is needed to determine the most effective PEI design and improve the quality of evidence.
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Affiliation(s)
- Lophina Phiri
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - William Ho Cheung Li
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ankie Tan Cheung
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Patrick G M C Phiri
- Institute of Applied Technology, Fatima College of Health Sciences, Al Ain, United Arab Emirates
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18
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Tan BWZ, Teo LL, Tong JWK, Chan MY. An exploration of the psychosocial needs of children diagnosed with cancer and their parents in Singapore: a cross-sectional study. Singapore Med J 2023; 64:580-584. [PMID: 35509214 PMCID: PMC10564097 DOI: 10.11622/smedj.2022050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 09/26/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Beron Wei Zhong Tan
- Psychology Service, KK Women’s and Children’s Hospital, Singapore
- Children’s Blood and Cancer Centre, KK Women’s and Children’s Hospital, Singapore
| | - Lois Ling’en Teo
- Psychology Service, KK Women’s and Children’s Hospital, Singapore
| | | | - Mei-Yoke Chan
- Children’s Blood and Cancer Centre, KK Women’s and Children’s Hospital, Singapore
- Haematology/Oncology Service, KK Women’s and Children’s Hospital, Singapore
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19
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Carlisle EM, Shinkunas LA, Lieberman MT, Hoffman RM, Reisinger HS. Empowering Parents of Pediatric Surgical Oncology Patients Through Collaborative Engagement with Surgeons. J Pediatr Surg 2023; 58:1736-1743. [PMID: 36697360 PMCID: PMC10310883 DOI: 10.1016/j.jpedsurg.2022.12.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/15/2022] [Accepted: 12/25/2022] [Indexed: 01/02/2023]
Abstract
BACKGROUND Ninety percent of parents of pediatric oncology patients report distressing, emotionally burdensome healthcare interactions. Assuring supportive, informative treatment discussions may limit parental distress. Here, we interview parents of pediatric surgical oncology patients to better understand parental preferences for surgical counseling. METHODS We interviewed 10 parents of children who underwent solid tumor resection at a university-based, tertiary children's hospital regarding their preferences for surgical discussions. Thematic content analysis of interview transcripts was performed using deductive and inductive methods. RESULTS Three main themes were identified: (1) the emotional burden of a pediatric cancer diagnosis; (2) complexities of treatment discussions; (3) collaborative engagement between parents and surgeons. Within the collaborative engagement theme, there were four sub-themes: (1) variable informational needs; (2) parents as advocates; (3) parents as gatekeepers of information delivery to their children, family, friends, and community; (4) parental receptivity to structured guidance to support treatment discussions. Two cross-cutting themes were identified: (1) perception that no treatment decision needed to be made regarding surgery and (2) reliance on diverse support resources. CONCLUSIONS Parents feel discussions with surgeons promote informed involvement in their child's care, but they recognize that there may be few decisions to make regarding surgery. Even when parents perceive that there are there are no decisions to make, they prioritize asking questions to advocate for their children. The emotional burden of a cancer diagnosis often prevents parents from knowing what questions to ask. Merging this data with our prior pediatric surgeon interviews will facilitate development of a novel decision support tool that can empower parents to ask meaningful questions. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Erica M Carlisle
- University of Iowa Hospitals and Clinics, Department of Surgery, Division of Pediatric Surgery, Iowa City, IA, USA; University of Iowa Carver College of Medicine, Program in Bioethics and Humanities, Iowa City, IA, USA.
| | - Laura A Shinkunas
- University of Iowa Carver College of Medicine, Program in Bioethics and Humanities, Iowa City, IA, USA
| | | | | | - Heather Schacht Reisinger
- University of Iowa Carver College of Medicine, Program in Bioethics and Humanities, Iowa City, IA, USA; University of Iowa Hospitals and Clinics, Iowa City, IA, USA; Department of Internal Medicine, University of Iowa, Institute for Clinical and Translational Science, Iowa City, IA, USA
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20
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Bates CR, Pallotto IK, Moore RM, Covitz LM, Dreyer Gillette ML. Barriers and facilitators of family rules and routines during pediatric cancer treatment. J Pediatr Nurs 2023; 72:e33-e39. [PMID: 37308340 DOI: 10.1016/j.pedn.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Pediatric nurses work closely with families of children with new cancer diagnoses and can provide essential supports to promote coping and adjustment. This cross-sectional qualitative study aimed to gather caregiver perspectives on barriers and facilitators to adaptive family functioning during the early phases of cancer treatment, with a focus on family rules and routines. METHODS Caregivers (N = 44) of a child diagnosed with cancer and receiving active treatment completed a semi-structured interview about their engagement in family rules and routines. Time since diagnosis was abstracted from the medical record. A multi-pass inductive coding strategy was utilized to extract themes identifying caregiver-reported facilitators and barriers to maintaining consistent family rules and routines during the first year of pediatric treatment. RESULTS Caregivers identified three primary contexts that presented barriers and facilitators to engagement in family rules and routines: the hospital setting (n = 40), the family system (n = 36), and the broader social and community setting (n = 26). Caregivers reported barriers primarily related to the demands of their child's treatment, additional caregiving needs, and needing to prioritize basic daily tasks (e.g., food, rest, household needs). Caregivers reported that different networks of support across contexts facilitated family rules and routines by expanding caregiver capacity in distinctive ways. CONCLUSIONS Findings provided insight into the importance of having multiple networks of support to extend caregiving capacity in the context of cancer treatment demands. PRACTICE IMPLICATIONS Providing nurses with training to facilitate problem-solving skills in the context of competing demands may provide a new avenue of clinical intervention at the bedside.
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Affiliation(s)
- Carolyn R Bates
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, KS, USA; Center for Children's Healthy Lifestyles and Nutrition, Kansas City, MO, USA; University of Kansas Cancer Center, Kansas City, KS, USA.
| | | | - Rachel M Moore
- Division of Developmental and Behavioral Health, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA; University of Missouri - Kansas City School of Medicine, Kansas City, MO, USA
| | - Lynne M Covitz
- Division of Developmental and Behavioral Health, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA; University of Missouri - Kansas City School of Medicine, Kansas City, MO, USA
| | - Meredith L Dreyer Gillette
- Center for Children's Healthy Lifestyles and Nutrition, Kansas City, MO, USA; Division of Developmental and Behavioral Health, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA; University of Missouri - Kansas City School of Medicine, Kansas City, MO, USA
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21
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Smith NDW, Boone DM, Schimmel-Bristow A, Rawlins J, Ellingham L, Sobalvarro S, Faith MA. The mediating role of caregiver hope in relations among caregivers' coping and emotional socialization beliefs in pediatric oncology. J Psychosoc Oncol 2023; 42:271-285. [PMID: 37589450 DOI: 10.1080/07347332.2023.2241855] [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] [Indexed: 08/18/2023]
Abstract
The purpose of this study is to identify links between caregiver hope, caregiver coping behaviors, and caregivers' coaching versus dismissing emotion socialization (ES) beliefs in a pediatric cancer sample. Self-report measures. Caregivers (N = 183, 80.20% mothers; 58.5% white; 32.2% Hispanic) of youth undergoing cancer treatment (51.10% hematological malignancy, 15.30% brain or spinal [CNS] tumor, and 25.14% non-CNS solid tumor) for at least six weeks. We used a series of mediation models to examine links between caregivers' coping behaviors, hope, and ES beliefs. Caregivers' hope significantly mediated a positive relation between caregivers' coping and their emotion coaching beliefs, as well as an inverse relation between caregivers' maladaptive coping and their emotion dismissing beliefs. Enhancing caregivers' hope or adaptive coping may support caregivers' beliefs during the pediatric cancer experience. Our findings support future research to evaluate whether enhancing caregivers' hope or adaptive coping may help support evidence-based interventions that target ES beliefs and behaviors.
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Affiliation(s)
- Nicholas David W Smith
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida Health System, Tampa, Florida, USA
| | - Dianna M Boone
- Center for Behavioral Health, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Allison Schimmel-Bristow
- Center for Behavioral Health, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Jonathan Rawlins
- Center for Behavioral Health, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Lauren Ellingham
- Center for Behavioral Health, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Sarah Sobalvarro
- Center for Behavioral Health, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | - Melissa A Faith
- Center for Behavioral Health, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland, USA
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22
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Boparai S, Dunning ED, Keim M, Galtieri LR, King K, Friedman D, Compas B, Breiger D, Lengua L, Katz LF. Caregiver emotion regulation predicts trajectories of psychopathology during pediatric cancer treatment. JOURNAL OF FAMILY PSYCHOLOGY : JFP : JOURNAL OF THE DIVISION OF FAMILY PSYCHOLOGY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION (DIVISION 43) 2023; 37:635-646. [PMID: 36892923 PMCID: PMC10403380 DOI: 10.1037/fam0001071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Elevated child and caregiver psychopathology are observed in families of children with cancer, with a subset developing clinically significant symptoms. This study examines whether caregivers' resting respiratory sinus arrhythmia (RSA) and observed emotion regulation (ER) are protective against caregiver and child psychopathology during the first year of pediatric cancer treatment. Primary caregivers of children recently diagnosed with cancer (N = 159; child Mage = 5.6 years; children 48% male, 52% female) completed 12 monthly questionnaires. At Month 3, primary caregivers were interviewed about their experiences of emotions, and their resting RSA was measured. Data were analyzed using multilevel models. Observed ER was associated with lower caregiver anxiety, depression, and posttraumatic stress symptoms (PTSS) 1 year postdiagnosis but was not associated with children's symptoms. Resting RSA had a significant positive association with child depression/anxiety at the start of treatment and Month 12 child PTSS. Findings suggest that caregivers would benefit from interventions to manage their negative emotions at the start of cancer treatment. Additionally, caregivers who are more physiologically regulated may be more attuned to their children's negative emotions. Our findings highlight the importance of taking a multimethod approach to understanding how ER impacts functioning. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | - Kevin King
- Department of Psychology, University of Washington
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23
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Cowfer BA, Dietrich MS, Akard TF, Gilmer MJ. Relationships Between Parental Anxiety and Child Quality of Life in Advanced Childhood Cancer. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2023; 40:209-216. [PMID: 37032466 DOI: 10.1177/27527530221147876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
Background: Family factors, such as household income and parental psychosocial distress, have been associated with quality of life in children with cancer. However, relationships between parent anxiety and child health-related quality of life (HRQoL) have not been evaluated in children with advanced cancer. Objective: To examine relationships between parent anxiety and both parent-reported and child self-reported HRQoL for children with advanced cancer. Method: Children (aged 5-17 years) with relapsed or refractory cancer and their parents participated in this single-institution cross-sectional study. Parents completed measures of their own baseline anxiety (State-Trait Anxiety Inventory-Trait [STAI-T] form) and their ill child's HRQoL (PedsQL Generic and PedsQL Cancer, parent report). Children completed age-specific PedsQL Generic and PedsQL Cancer, child report. Spearman's rho coefficients assessed correlations between total parent STAI-T score and both parent-reported and child-reported HRQoL scales. Results: Twenty children (Mage = 9.5 years, 50% female) and their 20 parents (90% mothers) participated. The strongest and statistically significant (p < .05) correlations were inverse associations between parental trait anxiety and parent-reported child psychosocial HRQoL (rs = -.54), emotional functioning (rs = -.49), school functioning (rs = -.45), and child pain and hurt (rs = -.45). Correlations of parental anxiety with all dimensions of child-reported HRQoL were generally smaller (rs < .40), positive, and not statistically significant (p > .05). Discussion: Given the inverse correlations between parental anxiety and child psychosocial HRQoL, assessment of parent mental health needs and access to interventions should be provided routinely for parents of children with advanced cancer.
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Affiliation(s)
- Brittany A Cowfer
- Vanderbilt University Medical Center and Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Mary S Dietrich
- Vanderbilt University School of Nursing and Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Terrah Foster Akard
- Vanderbilt University School of Nursing and Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Mary Jo Gilmer
- Vanderbilt University School of Nursing and Vanderbilt University School of Medicine, Nashville, TN, USA
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24
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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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25
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Howard Sharp KM, Tillery Webster R, Cook J, Okado Y, Long A, Phipps S. Profiles of Resilience, Distress, and Posttraumatic Growth in Parents of Children with Cancer and the Relation to Subsequent Parenting and Family Functioning. J Pediatr Psychol 2023; 48:375-385. [PMID: 36668686 PMCID: PMC10118855 DOI: 10.1093/jpepsy/jsac097] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 12/16/2022] [Accepted: 12/22/2022] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE The aim of this study was to identify patterns of distress and growth in parents of children with cancer and examine associations with subsequent parenting, parent-child relationship, and family environment. METHODS Participants included children with cancer history (8-17 years) stratified by time since diagnosis and their parent. At enrollment, parents (n = 254) reported depression and anxiety, and post-traumatic stress symptoms, posttraumatic growth (PTG), and benefit finding in relation to their child's cancer. Three years later, children (n = 214) reported parenting behavior, parent reactions to their distress, and family environment. Parents reported their reaction to children's distress and qualities of the parent-child relationship. RESULTS Latent profile analysis empirically identified 3 cross-sectional profiles using baseline data: "Resilience, High Growth" (50%), characterized by the lowest distress and the highest PTG/benefit finding; "Moderate Distress with Growth" (33%), characterized by relatively high levels of all indicators; and "Resilience, Low Growth" (17%), characterized by relatively low distress with low PTG/benefit finding. Membership in profiles was associated with parent gender; parents' stressful life events; socioeconomic status; and child diagnosis, on versus off treatment status, and treatment intensity. Parent membership in the Moderate Distress with Growth profile was generally linked with poorer parenting behavior, parent-child relationship quality, and family functioning. CONCLUSION The majority of parents exhibited resilience and growth. However, a subset of parents displaying moderate distress may be at risk for subsequent parenting and family functioning challenges. Findings further highlight the importance of screening for even moderate parent distress and the possible impact of parent psychosocial interventions indirectly on parenting and family functioning.
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Affiliation(s)
| | | | - Jessica Cook
- Department of Psychology, St. Jude Children’s Research Hospital, USA
- Department of Psychology, The University of Memphis, USA
| | - Yuko Okado
- Department of Psychology, California State University, USA
| | - Alanna Long
- Department of Psychology, St. Jude Children’s Research Hospital, USA
| | - Sean Phipps
- Department of Psychology, St. Jude Children’s Research Hospital, USA
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26
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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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27
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Gilbert R, Bates CR, Khetawat D, Dreyer Gillette ML, Moore R. Risk and Resilient Functioning of Families of Children with Cancer during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5208. [PMID: 36982118 PMCID: PMC10048924 DOI: 10.3390/ijerph20065208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/11/2023] [Accepted: 03/13/2023] [Indexed: 06/18/2023]
Abstract
Previous literature highlights the impact of COVID-19 on family functioning. Less is known about the impact of the pandemic on families of pediatric cancer patients. In order to determine universal and unique risk and resilience factors of these families during the pandemic, a qualitative analysis was conducted on families currently receiving cancer treatment at a Midwestern hospital. Results of the data analysis depict ways in which these families have been impacted by and have adapted to COVID-19. These findings suggest that families of pediatric cancer patients have unique experiences in the context of COVID-19, in addition to universal experiences outlined in previous literature.
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Affiliation(s)
- Renee Gilbert
- Clinical Child Psychology Program, Dole Human Development Center, University of Kansas, Lawrence, KS 66044, USA
| | - Carolyn R. Bates
- Department of Pediatrics, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 64114, USA
- University of Kansas Cancer Center, 4001 Rainbow Blvd, Kansas City, KS 64114, USA
| | - Devanshi Khetawat
- Clinical Child Psychology Program, Dole Human Development Center, University of Kansas, Lawrence, KS 66044, USA
| | | | - Rachel Moore
- Department of Pediatrics, Children’s Mercy Kansas City, 2401 Gillham Rd, Kansas City, MO 64108, USA
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28
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Yaffe Ornstein M, Friedlander E, Katz S, Elhasid R. Prospective assessment of anxiety among pediatric oncology patients and their caregivers during the COVID-19 pandemic a cohort study. J Psychosoc Oncol 2023; 41:182-195. [PMID: 35703090 DOI: 10.1080/07347332.2022.2086092] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
To assess COVID-19-pandemic related anxiety and emotional-behavioral difficulties among oncologic children and their caregivers. Prospective cohort study conducted from March to November 2020. 76 pediatric oncological and 28 nonmalignant hematological patients aged 1.6-23.4 years and their caregivers. A total of 104 families completed an age-specific self-report psychological assessment; of these, 20 oncologic families completed the assessment at two time points. Ten percent of the caregivers and 13.9% of the patients reported anxiety disorder. Additionally, 3.1% of the caregivers reported behavioral difficulties. No significant differences emerged between patients' self-reports and caregivers' reports. No differences emerged between oncological and nonmalignant hematological participants. The prevalence of anxiety associated with the COVID-19 pandemic was similar to the reported prevalence of anxiety following a diagnosis of pediatric malignancy. Real-time assessment of psychological effects revealed no COVID-19-associated anxiety. Nonetheless, late effects will need to be monitored.
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Affiliation(s)
- Michal Yaffe Ornstein
- Department of Pediatric Hemato-Oncology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Edwa Friedlander
- Department of Pediatric Hemato-Oncology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Shir Katz
- Department of Pediatric Hemato-Oncology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Ronit Elhasid
- Department of Pediatric Hemato-Oncology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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29
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Fan Y, Cao M, Zhou Y, Duan P, Xing L. Relationship between workplace bullying, spirituality, and job burnout in paediatric nurses: A cross-sectional study. Nurs Open 2023; 10:3872-3880. [PMID: 36790919 PMCID: PMC10170933 DOI: 10.1002/nop2.1645] [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: 06/07/2022] [Revised: 11/21/2022] [Accepted: 02/05/2023] [Indexed: 02/16/2023] Open
Abstract
AIMS To investigate the relationships and pathways between workplace bullying, workplace spirituality, and job burnout in Chinese paediatric nurses. DESIGN A cross-sectional descriptive survey was conducted with paediatric nurses from six tertiary hospitals in Hubei Province, China. METHODS The study consisted of 402 paediatric nurses. The data were collected using a sociodemographic data questionnaire, Negative Acts Questionnaire-Revised, Maslach Burnout Inventory-General Survey and Workplace Spirituality Scale. The model was tested using path analysis techniques within structural equation modelling. RESULTS Workplace bullying had positive and direct effects on the job burnout of paediatric nurses. Workplace spirituality partially mediated the relationship between workplace bullying and burnout. PATIENT OR PUBLIC CONTRIBUTION Workplace spirituality may reduce the incidence of work bullying and job burnout in paediatric nurses. Nursing managers need to consider and cultivate the workplace spirituality of paediatric nurses, with the aim of creating a healthy working environment and ensuring the stability of the nursing team.
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Affiliation(s)
- Ying Fan
- Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang City, China
| | - Mi Cao
- Hubei Polytechnic Institute, Xiaogan, China
| | - Yumei Zhou
- Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang City, China
| | - Peng Duan
- Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang City, China
| | - Limin Xing
- Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang City, China
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30
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Fathers' Experiences of Caring for a Child with a Chronic Illness: A Systematic Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020197. [PMID: 36832326 PMCID: PMC9955404 DOI: 10.3390/children10020197] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/09/2023] [Accepted: 01/13/2023] [Indexed: 01/22/2023]
Abstract
The prevalence of children living with chronic health conditions is increasing worldwide and can disrupt family roles, relationships, function, and parental involvement in family caregiving. The purpose of this systematic review was to explore fathers' experiences and involvement in caring for a child with a chronic condition. Systematic searches using seven databases were conducted. Study criteria included (1) peer-reviewed original research in English, Spanish, French, or Portuguese, (2) children less than 19 years of age with a chronic condition, (3) fathers (biological or guardian) as direct informants, and (4) outcomes addressing fathers' experience, perceptions, and/or involvement in the child's care. Data were synthesized from ten articles reflecting eight separate studies that utilized quantitative designs. Three areas of focus were identified: Family Functioning, Father's Psychological Health, and Need for Support. Data suggested increased involvement from the father in caring for their child with a chronic condition was associated with improved family functioning, increased anxiety and distress, decreased self-esteem, and increased need for support. This review revealed a paucity of data regarding fathers' experiences and involvement when caring for a child with a chronic condition, with that available primarily from developed countries. Rigorous empirical studies are needed to deepen understanding of how fathers are involved in the care of their child with a chronic condition.
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31
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Eklund R, Lövgren M. The Family Talk Intervention in Pediatric Oncology: Ill Children's Descriptions of Feasibility and Potential Effects. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2022; 39:143-154. [PMID: 35467434 DOI: 10.1177/27527530221068423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Background: There are few scientifically evaluated psychosocial interventions in pediatric oncology, despite the needs for families. The family-based psychosocial intervention "The Family Talk Intervention" (FTI) has shown promising results in other care contexts and was therefore pilot-tested in pediatric oncology. In this study, we examined the experiences of participating in FTI from ill children's perspectives regarding feasibility and potential effects. Methods: This pilot study involved 26 families in pediatric oncology that had participated in FTI. The paper is focused on those ill children who answered surveys (n = 19) and/or participated in interviews (n = 11) when FTI had ended. Data were analyzed with descriptive statistics and thematic analysis. Results: For most ill children, FTI came at the right time, included a reasonable number of meetings, and the length of the meetings was appropriate. The children felt listened to and understood by the interventionists and almost all children reported that FTI had helped them in some way. The children's perceptions indicated that FTI improved communication within the family and strengthened family relations. Children reported that the parents and their siblings seemed to feel better after participation and became more understanding. Discussion: The findings of this pilot study indicated that a full-scale study could be valuable from the ill children's perspective, as FTI was reported as feasible and had positive effects. The findings showed that FTI gave families an opportunity to open up communication about the illness, adjust their behaviors, and strengthen family relationships. Trial registration: ClinicalTrials.gov Identifier NCT03650530.
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Affiliation(s)
- Rakel Eklund
- 7643Ersta Sköndal Bräcke University College, Department of Health Care Sciences, Palliative Research Centre, Stockholm, Sweden
- Department of Neuroscience, National Centre for Disaster Psychiatry, 8097Uppsala University, Uppsala, Sweden
| | - Malin Lövgren
- 7643Ersta Sköndal Bräcke University College, Department of Health Care Sciences, Palliative Research Centre, Stockholm, Sweden
- Advanced Pediatric Home Care, Astrid Lindgren Children's Hospital, 59562Karolinska University Hospital, Stockholm, Sweden
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32
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Hancock K, Barrera M, Prasad S, Desjardins L, Shama W, Alexander S, Szatmari P. A qualitative examination of the benefits and challenges of a psychosocial screening intervention in pediatric oncology: "Support comes to us". Pediatr Blood Cancer 2022; 69:e29578. [PMID: 35084106 DOI: 10.1002/pbc.29578] [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: 10/09/2021] [Revised: 12/30/2021] [Accepted: 01/01/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Pediatric cancer diagnosis and treatment can have detrimental mental health effects on parents (caregivers) and their children/adolescents (youth). Psychosocial screening and intervention have been recognized as standards of care in pediatric oncology. The most effective psychosocial interventions to support those in need post screening have not been determined. AIMS This qualitative study aimed to investigate the perceived benefits and challenges for caregiver and youth participants in the screening-intervention arm of an Enhanced Psychosocial Screening Intervention (EPSI) pilot study. METHODS EPSI consists of a psychosocial navigator (PSN) who shares screening results conducted near diagnosis (T1) and monthly for 1 year (T2) with treating teams and families. All 17 caregiver-youth dyads who had completed EPSI were invited to participate in a semi-structured interview. RESULTS Ten caregivers and nine youth participated. Identified themes were grouped into benefits and challenges of EPSI: feeling supported and cared for (support comes to us regularly, having someone to talk to); and feeling empowered through knowledge of resources and services were perceived as benefits. Caregivers were challenged by feeling overwhelmed, and youth by screening questions perceived as too repetitive. CONCLUSIONS Regular monthly contacts for a year by the PSN with screening results and recommendations were perceived as beneficial by youth newly diagnosed with cancer and their caregivers who participated in EPSI. Feeling that support came to them and they had someone to talk to was a critical component. While information about psychosocial resources was not always used right away, it did evoke feelings of being empowered.
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Affiliation(s)
- Kelly Hancock
- Department of Psychology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Maru Barrera
- Department of Psychology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Soni Prasad
- Department of Psychology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Leandra Desjardins
- Research Centre, Sainte-Justine University Health Center, Montreal, Quebec, Canada
| | - Wendy Shama
- Department of Social Work, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sarah Alexander
- Division of Haematology, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Peter Szatmari
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Bates CR, Fairclough D, Noll RB, Barrera ME, Kupst MJ, Egan AM, Gartstein MA, Ach EL, Gerhardt CA, Vannatta KA. Psychosocial functioning of caregivers of pediatric brain tumor survivors. Pediatr Blood Cancer 2022; 69:e29565. [PMID: 35044078 PMCID: PMC8860870 DOI: 10.1002/pbc.29565] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 12/06/2021] [Accepted: 12/23/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Assessment of caregiver needs is a recommended standard of care in pediatric oncology. Caregivers of pediatric brain tumor survivors (PBTS) are a subgroup that may be at highest psychosocial risk. This study examined psychosocial functioning of caregivers of PBTS in comparison to caregivers of youth without cancer history. We hypothesized that caregivers of PBTS would exhibit more psychological symptoms, higher caregiver burden, and lower perceptions of social support than caregivers of comparison youth. PROCEDURE As part of a five-site study, we utilized a matched sample design to evaluate psychosocial functioning of 301 caregivers of 189 PBTS (ages 8-15) who were 1-5 years post treatment, and 286 caregivers of 187 comparison youth matched for sex, race, and age. Caregivers completed measures of psychological symptoms, caregiver burden, and perceptions of social support. Repeated measures mixed models compared outcomes between groups and examined differences based on caregiver sex. Socioeconomic status (SES) was examined as a moderator of significant main effects. RESULTS Caregivers of PBTS reported similar levels of psychological symptoms to caregivers of comparison youth. Mothers of PBTS mothers reported higher caregiver burden and lower perceptions of social support than mothers of comparison youth. Low SES exacerbated group differences in caregiver burden. CONCLUSIONS Mothers of PBTS may have more caregiving responsibilities and perceive less social support, but reported similar levels of psychological symptoms to comparison mothers; fathers of PBTS were similar to comparison fathers. The mechanisms involved in this complex psychosocial dynamic require further investigation.
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Affiliation(s)
- Carolyn R. Bates
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, KS
| | - Diane Fairclough
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado, USA
| | - Robert B. Noll
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Maru E. Barrera
- Division of Hematology/Oncology, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mary Jo Kupst
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Anna M. Egan
- Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, MO,University of Missouri Kansas City School of Medicine, Kansas City, Missouri, USA
| | | | - Emily L. Ach
- Department of Psychiatry, Stanford University School of Medicine, Stanford, California, USA
| | - Cynthia A. Gerhardt
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA,Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | - Kathryn A. Vannatta
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA,Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
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Sharp K, Tillery R, Long A, Wang F, Pan H, Phipps S. Trajectories of resilience and posttraumatic stress in childhood cancer: Consistency of child and parent outcomes. Psychol Health 2022; 41:256-267. [PMID: 34855418 PMCID: PMC9809178 DOI: 10.1037/hea0001132] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Childhood cancer represents a potentially traumatic experience for both patients and caregivers. We examined trajectories of posttraumatic stress symptoms (PTSS) across a 5-year period in children with a history of cancer and their parents/caregivers. Medical, demographic, and dispositional variables were examined as predictors of PTSS trajectories. METHOD Using a longitudinal design, children with cancer history (n = 254, age 8-17 years at baseline) and one parent or caregiver (n = 255) completed measures of PTSS at baseline, and 1-, 3-, and 5-years poststudy entry. Children and caregivers completed dispositional measures including optimism, positive or negative affect, and Five-Factor Inventories. Latent class growth analysis (LCGA) was used to identify latent trajectories of PTSS, and univariate logistic regression models were conducted to predict LCGA class membership from medical, demographic, and disposition factors Results: Very similar trajectories were observed in children and caregivers, with two-class solutions providing the best fit: a "resilient" class, with low PTSS at baseline, which declined significantly over time (83.5% in children; 71.5% in parents), and an "elevated PTSS" class, which was moderately high at baseline and increased significantly over time. There was a small, but significant relationship between child and caregiver trajectories. Latent trajectories observed in children and parents were more strongly associated with dispositional variables than medical factors. CONCLUSIONS Resilience, depicted by low PTSS, is by far the most common outcome observed in both children and caregivers. However, the smaller subset with elevated PTSS do not show recovery over time, and are identified as a group in need of targeted interventions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Katianne Sharp
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Rachel Tillery
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Alanna Long
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Fang Wang
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN
| | - Haitao Pan
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN
| | - Sean Phipps
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
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Kim SY, Kim SJ, Jo YU, Ma Y, Yoo HJ, Choi HS. Development and pilot implementation of an activity-based emotional support intervention for caregivers of children with cancer. Pediatr Hematol Oncol 2022; 39:1-15. [PMID: 33999757 DOI: 10.1080/08880018.2021.1926609] [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] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This study aimed to pilot PAX ("Play, Act & Interact"), an activity-based emotional support intervention for caregivers of child with cancer, which focuses on addressing their psychological distress and post-traumatic stress symptoms (PTSSs). METHOD Sixteen mothers whose children were child with cancer participated in this 4-week intervention. Their children (n = 16; 14 males; median age at diagnosis = 10.3 years; the median amount of time from diagnosis = 9 months) were at different treatment stages for a range of different diagnoses. Caregivers completed self-report instruments assessing their psychological distress including PTSSs and family functioning before and after the intervention and a brief open-response exit survey. Paired sample t-tests were computed to compare the pre-and post-intervention scores. RESULTS The Post-traumatic Stress Disorder Checklist scores significantly decreased from pre- (M = 37.00, SD = 14.75) to post-intervention (M = 32.56, SD = 15.52), t(15) = 4.25, p < .001. There was also a significant difference between pre- (M = 33.5, SD = 3.18) and post-intervention (M = 35.7, SD = 3.14) scores on the Family Adherence subscale of the Family Adaptability and Cohesion Evaluation Scales III, t(15) = -2.58, p = .02. CONCLUSIONS PAX was a promising intervention for supporting caregivers' PTSSs and family adaptability. Future studies investigating the long-term effects and replicating the current study with more participants and a control group are needed.
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Affiliation(s)
- So Yoon Kim
- Department of Teacher Education, Duksung Women's University, Seoul, South Korea
| | - Seung Joo Kim
- Department of Psychiatry, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Ye Ul Jo
- Department of Psychiatry, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Youngeun Ma
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Hee Jeong Yoo
- Department of Psychiatry, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Hyoung Soo Choi
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
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Jones AM, Browne EK, Adams K, Potter BS, McLaughlin Crabtree V, Jurbergs N, Heidelberg RE, Webster RT. The Toll of Transition: Caregiver Perceptions of Family Adjustment During the Transition off Pediatric Cancer Therapy. Psychooncology 2022; 31:985-994. [PMID: 35083824 DOI: 10.1002/pon.5888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 12/28/2021] [Accepted: 01/07/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The role of transition-focused psychology appointments in managing the transition off therapy is unclear. The objective of this research was to explore caregiver perceived familial distress and the role of psychology in preparing families for transition. METHODS Fifty-seven caregivers of youth, who finished treatment, completed an online questionnaire through a quality improvement project on experiences of families at transition. Twenty-two percent of caregivers had children who completed a transition-focused psychology consult and 63% completed a cognitive assessment at transition. Retrospective analyses were conducted assessing the association of psychology visits on caregiver perceptions of being informed of and prepared to manage transition-related challenges. RESULTS Most caregivers reported experiencing adjustment concerns for family members. Caregivers of children completing a transition-focused psychology consult or cognitive assessment reported feeling more informed and greater preparedness to manage difficulties. Although decreased distress was not associated with the visit, those who felt more informed and prepared reported lower distress. CONCLUSIONS Caregivers perceive transitioning off therapy as stressful for their family, though they experience decreased familial distress when informed of and prepared to manage transition-related challenges. These findings highlight the importance of psychosocial support at transition. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Anna M Jones
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN
| | - Emily K Browne
- Transition Program, St. Jude Children's Research Hospital, Memphis, TN
| | - Kristen Adams
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Brian S Potter
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN
| | - Valerie McLaughlin Crabtree
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN.,St. Jude Graduate School of Biomedical Sciences, Memphis, TN
| | - Niki Jurbergs
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN
| | - R Elyse Heidelberg
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN
| | - Rachel Tillery Webster
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN.,Comprehensive Cancer Center, St. Jude Children's Research Hospital, Memphis, TN
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Desjardins L, Solomon A, Shama W, Mills D, Chung J, Hancock K, Barrera M. The impact of caregiver anxiety/depression symptoms and family functioning on child quality of life during pediatric cancer treatment: From diagnosis to 6 months. J Psychosoc Oncol 2022; 40:790-807. [PMID: 35016592 DOI: 10.1080/07347332.2021.2015646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
A pediatric cancer diagnosis can have a significant impact on the quality of life (QOL) of the child. Diagnosis and treatment impact caregiver anxiety/depression symptoms and family functioning, and these in turn may influence child QOL. However, there has been limited longitudinal examination of the impact of both caregiver anxiety/depression symptoms and family functioning on youth QOL at specific points during the early diagnosis and treatment period. Ninety-six caregivers of youth (diagnosed with leukemia/lymphoma or a solid tumor) reported on their own anxiety/depression symptoms, family functioning, demographic and medical factors, and on their child's generic and cancer-specific QOL shortly after diagnosis (T1) and 6 months later (T2). Caregiver anxiety/depression symptoms were associated with poorer cancer-specific and generic child QOL within and across time points. Family conflict was associated with youth cancer-related QOL at T1. Attendance to caregiver anxiety/depression symptoms and family functioning, beginning early in the cancer trajectory, is an important aspect of family-centered care. Routine psychosocial screening and triage may help identify and intervene to support both caregiver and child psychosocial well-being.
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Affiliation(s)
- Leandra Desjardins
- Charles-Bruneau Cancer Care Centre, Sainte-Justine University Health Centre, Montreal, Canada.,Department of Psychology, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Aden Solomon
- Department of Psychology, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Wendy Shama
- Department of Social Work, Division of Hematology/Oncology, BC Children's Hospital, Vancouver, Canada
| | - Denise Mills
- Department of Nursing, Division of Hematology/Oncology, BC Children's Hospital, Vancouver, Canada
| | - Joanna Chung
- Department of Psychology, Division of Hematology/Oncology, BC Children's Hospital, Vancouver, Canada
| | - Kelly Hancock
- Department of Psychology, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Maru Barrera
- Department of Psychology, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada
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Aguilera V, Schaefer MR, Parris K, Long A, Triplett B, Phipps S. Psychosocial outcomes of parents in pediatric haploidentical transplant: parental hematopoietic cell donation as a double-edged sword. Bone Marrow Transplant 2022; 57:377-383. [PMID: 35001081 DOI: 10.1038/s41409-021-01547-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/16/2021] [Accepted: 11/30/2021] [Indexed: 12/26/2022]
Abstract
Parents are increasingly used as donors for their child's haploidentical hematopoietic cell transplant, creating a dual role for parents that may increase the stress of caring for their ill child. Empiric research on the psychological adjustment of parental donors is lacking. We conducted a retrospective survey of parents (n = 136) whose child underwent transplant with a parental donor or a matched-unrelated donor, including both donor and nondonors, and both parents of survivors and bereaved. All parents completed standardized measures of quality of life, depression, anxiety, post-traumatic stress, and life satisfaction. Bereaved parents also completed measures of their grief response, while parents of survivors completed measures of the parent-child relationship. The overall sample reported psychological functioning near normative levels, but bereaved parents demonstrated significantly poorer outcomes across all measures. The effect of donor status differed by transplant outcome: for parents of survivors, donors reported better mental health than nondonors, but amongst bereaved parents, donors fared more poorly than nondonors. Bereaved donors reported greater difficulties with grief than nondonors. Results suggest that serving as donor can be a double-edged sword, acting as a protective factor when there is a successful outcome but a significant risk factor when the child does not survive.
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Affiliation(s)
- Vanessa Aguilera
- Department of Psychology, St. Jude Children's Research Hospital Memphis, Memphis, TN, USA
| | - Megan R Schaefer
- Department of Psychology, St. Jude Children's Research Hospital Memphis, Memphis, TN, USA
| | - Kendra Parris
- Department of Psychology, St. Jude Children's Research Hospital Memphis, Memphis, TN, USA
| | - Alanna Long
- Department of Psychology, St. Jude Children's Research Hospital Memphis, Memphis, TN, USA
| | - Brandon Triplett
- Department of Bone Marrow Transplantation & Cellular Therapy, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Sean Phipps
- Department of Psychology, St. Jude Children's Research Hospital Memphis, Memphis, TN, USA.
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The Psychological Adaptation Process in Chinese Parent Caregivers of Pediatric Leukemia Patients: A Qualitative Analysis. Cancer Nurs 2021; 45:E835-E842. [PMID: 34966062 DOI: 10.1097/ncc.0000000000001034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Psychological stresses caused by caring for pediatric leukemia patients can affect their parent caregivers' health. How these stressors are successfully managed determines how well these caregivers adapt to the illness situation over time. Previous studies suggest that caregivers will adapt gradually to the adverse consequences of caring for their child with a long-term illness. However, studies of the psychological adaptation process of family caregivers of children with leukemia are limited. OBJECTIVE The aim of this study was to study the psychological adaptation process of the parent caregivers of pediatric leukemia patients. METHODS In this qualitative study, we interviewed 32 caregivers of children with leukemia in China. Data were collected through semistructured interviews and analyzed using the content analysis method. RESULTS The psychological adaptation process in caregivers of pediatric leukemia patients seems to involve 5 stages: initial devastation, accumulation of hope, fluctuation in feelings, integration, and psychological adaptation. Significant emotional changes were observed at each stage. CONCLUSIONS This study identified commonalities in the psychological adaptation process experienced by caregivers of children with leukemia in the Chinese social and cultural context. It also characterized the different emotions that the caregivers had in the 5 stages of adaptation. In addition, our research identified the possible psychological interventions at different stages. IMPLICATIONS FOR PRACTICE The study described the adaptation process of Chinese parents of children with leukemia. The findings of this study will help nurses identify main coping resources, controllable intervention factors, and the timing of intervention for these caregivers of children with leukemia.
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40
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Greenzang KA, Kelly CA, Al-Sayegh H, Ma C, Mack JW. Thinking ahead: Parents' worries about late effects of childhood cancer treatment. Pediatr Blood Cancer 2021; 68:e29335. [PMID: 34520114 PMCID: PMC8541904 DOI: 10.1002/pbc.29335] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/20/2021] [Accepted: 08/23/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Many childhood cancersurvivors experience at least one late effect of treatment, and both late effects and persistent cancer-related worry can negatively impact quality of life in survivorship. Little is known about the prevalence or impact of parental worry about late effects early in treatment. This study evaluated parental perceived likelihood, impact, and worry about late effects of childhood cancer. PROCEDURE We surveyed 96 parents of pediatric cancer patients at Dana-Farber/Boston Children's Cancer and Blood Disorders Center within a year of diagnosis. Parents were asked about their experiences with late effects communication, general worry about late effects, and specific late effect worries. RESULTS Most (96%) parents valued information about late effects, and 93% considered late effects in their treatment decision-making. Yet, 24% could not recall receiving any information about late effects, and only 51% felt well prepared for potential late effects. Though only 20% of parents considered their child at high risk of experiencing late effects, 61% were extremely/very worried about late effects. Those who felt their child was at high risk of experiencing late effects were more likely to worry (OR = 4.7, P = 0.02). CONCLUSIONS Many parents feel inadequately informed about late effects of cancer treatment, and only one-fifth of parents consider late effects to be likely for their child. However, a majority of parents worry about late effects, including ones they think their child is unlikely to experience. Although some worry is anticipated, disproportionate worry may be mitigated by addressing both educational shortfalls and emotional concerns.
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Affiliation(s)
- Katie A. Greenzang
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts;,Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts;,Division of Pediatric Hematology/Oncology, Boston Children’s Hospital;,Department of Pediatrics, Boston Children’s Hospital;,Harvard Medical School, Harvard University
| | - Colleen A. Kelly
- Department of Pediatrics, Boston Children’s Hospital;,Harvard Medical School, Harvard University,Boston University School of Medicine, and Boston Medical Center
| | - Hasan Al-Sayegh
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts;,Division of Pediatric Hematology/Oncology, Boston Children’s Hospital
| | - Clement Ma
- Centre for Addiction and Mental Health, Toronto, Canada,Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Jennifer W. Mack
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts;,Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts;,Division of Pediatric Hematology/Oncology, Boston Children’s Hospital;,Department of Pediatrics, Boston Children’s Hospital;,Harvard Medical School, Harvard University
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Barrera M, Desjardins L, Prasad S, Shama W, Alexander S, Szatmari P, Hancock K. Pilot randomized psychosocial trial of a screening intervention in pediatric oncology. Psychooncology 2021; 31:735-744. [PMID: 34813129 DOI: 10.1002/pon.5857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 11/05/2021] [Accepted: 11/08/2021] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Psychosocial screening is a standard of care in pediatric oncology, but there is limited information about how to intervene after screening. This pilot trial aimed to determine feasibility of the novel Enhanced Psychosocial Screening Intervention (EPSI) and explore its preliminary efficacy outcomes. We examined rates of recruitment, retention, intervention acceptability, and monthly distress screening completion, as well as exploratory efficacy outcomes (Patient-Reported Outcomes Measurement Information System: depression, anxiety and fatigue; distress thermometer, pain and sleep). METHODS Parallel-group randomized pilot trial: Caregiver-youth (10-17 years at enrollment, newly diagnosed with cancer) dyads were randomly allocated to either EPSI or standard care with 1:1 ratio allocation. EPSI consists of having a Psychosocial Navigator who shares screening results conducted near diagnosis and monthly for one year with treating teams and families, and provides recommendations tailored to screening results. RESULTS Enrollment rate was 54% (38 dyads); retention was 90% and acceptability 86% (caregivers) and 76% (youth). Exploratory symptoms of depression, anxiety, distress and fatigue outcomes consistently improved mainly for caregivers. CONCLUSIONS Results suggest EPSI is feasible and acceptable and exploratory mental and physical efficacy outcomes are promising for use in a future confirmatory multisite efficacy trial.
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Affiliation(s)
- Maru Barrera
- Division of Hematology/Oncology, Department of Psychology, SickKids Hospital, Toronto, Ontario, Canada
| | - Leandra Desjardins
- Cancer Axis, Research Centre, Sainte-Justine University Health Centre, Montreal, Quebec, Canada
| | - Soni Prasad
- Division of Hematology/Oncology, Department of Psychology, SickKids Hospital, Toronto, Ontario, Canada
| | - Wendy Shama
- Division of Social Work, SickKids Hospital, Toronto, Ontario, Canada
| | - Sarah Alexander
- Division of Hematology/Oncology, SickKids Hospital, Toronto, Ontario, Canada
| | - Peter Szatmari
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Kelly Hancock
- Division of Hematology/Oncology, Department of Psychology, SickKids Hospital, Toronto, Ontario, Canada
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Fair C, Thompson A, Barnett M, Flowers S, Burke J, Wiener L. Utilization of Psychotherapeutic Interventions by Pediatric Psychosocial Providers. CHILDREN 2021; 8:children8111045. [PMID: 34828757 PMCID: PMC8625037 DOI: 10.3390/children8111045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/05/2021] [Accepted: 11/10/2021] [Indexed: 01/15/2023]
Abstract
One of the Standards of Psychosocial Care for Children with Cancer and their Families recommends that all youth with cancer and their family members have access to psychotherapeutic interventions and support throughout the cancer trajectory. This study was created to identify the psychosocial interventions and services provided to children with cancer and their family members, to ascertain whether there are differences in interventions provided by age of the patient and stage of treatment, and to learn about barriers to psychosocial service provision. An online survey was disseminated to psychosocial providers through the listservs of national and international professional organizations. The majority of the 242 respondents were either psychologists (39.3%) or social workers (26.9%) and 79.7% worked in the United States. The intervention offered most often to pediatric patients, caregivers, and siblings, at every stage of treatment, was psychoeducation (41.7–48.8%). Evidence-based interventions, including cognitive behavioral therapy (56.6%) and mindfulness-based interventions (57.9%) were reported to be frequently used with patients. Interventions designed specifically for the pediatric oncology population were not commonly endorsed. Psychosocial providers reported quality of care would be improved by additional staff, better communication/collaboration with medical team members and increased community-based resources. Future research should focus on improving accessibility to population-specific evidenced-based interventions and translating science to practice.
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Affiliation(s)
- Cynthia Fair
- Department of Public Health Studies, Elon University, Elon, NC 27244, USA;
- Correspondence: ; Tel.: +1-336-278-6457
| | | | - Marie Barnett
- Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA;
| | - Stacy Flowers
- Department of Family Medicine, Boonshoft School of Medicine, Wright State University, Dayton, OH 45406, USA;
| | - June Burke
- Department of Public Health Studies, Elon University, Elon, NC 27244, USA;
| | - Lori Wiener
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA;
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43
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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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44
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Basile NL, Chardon ML, Peugh J, Edwards CS, Szulczewski L, Morrison CF, Nagarajan R, El-Sheikh A, Chaney JM, Pai ALH, Mullins LL. Relationship Between Caregiver Uncertainty, Problem-Solving, and Psychological Adjustment in Pediatric Cancer. J Pediatr Psychol 2021; 46:1258-1266. [PMID: 34350968 DOI: 10.1093/jpepsy/jsab065] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/26/2021] [Accepted: 05/19/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The current study examined the roles of constructive and dysfunctional problem-solving strategies in the relationships between illness uncertainty and adjustment outcomes (i.e., anxious, depressive, and posttraumatic stress symptoms) in caregivers of children newly diagnosed with cancer. METHODS Two hundred thirty-eight caregivers of children (0-19 years of age) newly diagnosed with cancer (2-14 weeks since diagnosis) completed measures of illness uncertainty, problem-solving strategies, and symptoms of anxiety, depression, and posttraumatic stress. RESULTS A mediation model path analysis assessed constructive and dysfunctional problem-solving strategies as mediators between illness uncertainty and caregiver anxious, depressive, and posttraumatic stress symptoms. Dysfunctional problem-solving scores partially mediated the relationships between illness uncertainty and anxious, depressive, and posttraumatic stress symptoms. Constructive problem-solving scores did not mediate these relationships. CONCLUSIONS The current findings suggest that illness uncertainty and dysfunctional problem-solving strategies, but not constructive problem-solving strategies, may play a key role in the adjustment of caregivers of children newly diagnosed with cancer. Interventions aimed at managing illness uncertainty and mitigating the impact of dysfunctional problem-solving strategies may promote psychological adjustment.
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Affiliation(s)
- Nathan L Basile
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University
| | - Marie L Chardon
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center
| | - James Peugh
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center.,Department of Pediatrics, University of Cincinnati College of Medicine
| | - Clayton S Edwards
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University
| | - Lauren Szulczewski
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center.,Department of Pediatrics, University of Cincinnati College of Medicine
| | | | - Rajaram Nagarajan
- Division of Hematology/Oncology, Cincinnati Children's Hospital Medical Center
| | - Ayman El-Sheikh
- Department of Hematology/Oncology, Dayton Children's Hospital
| | - John M Chaney
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University
| | - Ahna L H Pai
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center.,Department of Pediatrics, University of Cincinnati College of Medicine
| | - Larry L Mullins
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University
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45
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Yeung NCY, Cheung KC, Chau HC, Leung AWK, Li CK, Lam TTN, Cheng HY, Cheung YT. Transition from Acute Treatment to Survivorship: Exploring the Psychosocial Adjustments of Chinese Parents of Children with Cancer or Hematological Disorders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157815. [PMID: 34360108 PMCID: PMC8345777 DOI: 10.3390/ijerph18157815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 02/06/2023]
Abstract
Objectives: Parents of children diagnosed with critical illnesses face multiple challenges during their caregiving experience. However, relevant studies have been limited in the Chinese context. Guided by the stress and coping model, we conducted a qualitative study to identify the stressors, coping strategies, and adjustment experiences of Hong Kong parents of children with cancer or hematological disorders. Methods: We recruited 15 parents of children with cancer or hematological disorders requiring bone marrow transplantation and were currently >2 years post-treatment. They participated in a 30-min semi-structured interview. Thematic analysis was performed using the grounded theory approach. Results: The stressors reported by parents included a high caregiving burden during their children’s diagnosis and treatment stages. The fear of recurrence, the need for information, and concerns about late effects were also common among the parents during their children’s transition/survivorship stage. To cope with these stressors, the parents commonly used problem-focused (e.g., seeking help from professionals and support groups) and emotion-focused (e.g., behavioral distractions, venting, and crying) strategies. Despite these stressors, parents reported positive changes through the caregiving experience, such as improved family relationships, developing health-protective habits, and the reprioritization of different aspects of life. Conclusions: Parents encounter different stressors during the cancer care continuum. Using different coping strategies, parents experience positive changes amidst caregiving. Future studies should explore culturally relevant adaptive coping strategies to enhance parents’ psychosocial adjustment.
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Affiliation(s)
- Nelson Chun Yiu Yeung
- Faculty of Medicine, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
- Correspondence: (N.C.Y.Y.); (Y.T.C.)
| | - Ka Chun Cheung
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong; (K.C.C.); (H.C.C.); (T.T.N.L.)
| | - Ho Cheung Chau
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong; (K.C.C.); (H.C.C.); (T.T.N.L.)
| | - Alex Wing Kwan Leung
- Department of Paediatrics & Adolescent Medicine, Hong Kong Children’s Hospital, Hong Kong; (A.W.K.L.); (C.K.L.)
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Chi Kong Li
- Department of Paediatrics & Adolescent Medicine, Hong Kong Children’s Hospital, Hong Kong; (A.W.K.L.); (C.K.L.)
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong
| | - Teddy Tai Ning Lam
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong; (K.C.C.); (H.C.C.); (T.T.N.L.)
- Little Life Warriors Society Hong Kong, Hong Kong
| | - Ho Yu Cheng
- Faculty of Medicine, Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong;
| | - Yin Ting Cheung
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong; (K.C.C.); (H.C.C.); (T.T.N.L.)
- Correspondence: (N.C.Y.Y.); (Y.T.C.)
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46
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Desjardins L, Hancock K, Szatmari P, Alexander S, Shama W, De Souza C, Mills D, Abla O, Barrera M. Protocol for mapping psychosocial screening to resources in pediatric oncology: a pilot randomized controlled trial. Pilot Feasibility Stud 2021; 7:143. [PMID: 34274016 PMCID: PMC8285781 DOI: 10.1186/s40814-021-00878-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 06/21/2021] [Indexed: 01/30/2023] Open
Abstract
Background A pediatric cancer diagnosis and its treatment can have a detrimental effect on the mental health of children and their families. Screening to identify psychosocial risk in families has been recognized as a standard of care in pediatric oncology, but there has been limited clinical application of this standard thus far. A significant impediment to the implementation of psychosocial screening is the dearth of information on how to translate psychosocial screening to clinical practice, and specifically, how to follow-up from screening results. This manuscript aims to describe a protocol of a new intervention examining the feasibility and acceptability of mapping via a Psychosocial Navigator (PSN) psychosocial screening results to specific recommendations of resources for families based on measured risk for psychosocial distress and mental health symptoms. Methods The pilot randomized control trial (RCT) consists of dyads of youth (10–17 years) newly diagnosed with cancer and their primary caregiver. This RCT includes two arms (intervention and control group), with each group completing measurements near diagnosis and 1 year later. After the initial assessment, dyads in the intervention group receive monthly screening results and recommendations from the study PSN that are tailored to these results. The patient’s primary healthcare team (nurse, social worker, oncologist) also receive the risk, distress, and mental health results as well as the recommendations from the PSN. Discussion This study addresses a significant barrier to the implementation of psychosocial screening in pediatric oncology: specifically, the limited knowledge of how to follow-up from screening results. Findings from this pilot will inform a future definitive RCT to test the effectiveness of the intervention on patient and family mental health outcomes. This project has implications for enhancing clinical care in pediatric oncology, as well as other pediatric populations. Strengths and limitations of this study This is the first study of screening and follow-up using a psychosocial navigator. This study involves both patient and caregiver report. The small sample size necessitates a future larger study to investigate the effects of intervention. Trial registration NCT04132856, Registered 10 October 2019—retrospectively registered.
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Affiliation(s)
- Leandra Desjardins
- Charles-Bruneau Cancer Center, Sainte-Justine University Health Center, Montreal, Canada.
| | - Kelly Hancock
- Charles-Bruneau Cancer Center, Sainte-Justine University Health Center, Montreal, Canada
| | - Peter Szatmari
- Department of Psychiatry, Hospital for Sick Children, Toronto, ON, Canada
| | - Sarah Alexander
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada
| | - Wendy Shama
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada.,Department of Social Work, Hospital for Sick Children, Toronto, ON, Canada
| | - Claire De Souza
- Department of Psychiatry, Hospital for Sick Children, Toronto, ON, Canada
| | - Denise Mills
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada
| | - Oussama Abla
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada
| | - Maru Barrera
- Charles-Bruneau Cancer Center, Sainte-Justine University Health Center, Montreal, Canada.,Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada
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47
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Development of a Structured Peer Mentoring Program for Support of Parents and Caregivers of Children with Cancer. J Pediatr Nurs 2021; 59:131-136. [PMID: 33878538 DOI: 10.1016/j.pedn.2021.03.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/25/2021] [Accepted: 03/27/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Parents of children newly diagnosed with cancer have increased anxiety, depression, and numerous questions. Many of these concerns can only be answered by parents who have undergone a similar experience. LOCAL PROBLEM Our institution lacked a formal parent-to-parent mentoring program for parents of children newly diagnosed with cancer. METHODS The Parent Family Advisory Council (PFAC) recommended implementation of a formalized program that would promote a structured approach to mentoring, with a formal referral process and designated parent mentors who had been vetted, trained, and supported by the institution. INTERVENTION In 2010, a pilot parent-to-parent mentoring program was initiated. RESULTS Since the programs initiation, 4062 encounters have been documented. This represents an annual average of 72 mentees paired with 20 mentors, averaging 677 annual encounters. Parents view the mentoring relationship as positive and report that they feel understood, less anxious, and less isolated. CONCLUSION We show that a parent-to-parent mentoring program is feasible and sustainable over time. Our model is now transitioning from a staff referral to self-referral, as well as incorporating real-time mentoring into the new commons area for patients and their families. A formal volunteer mentoring program can assist parents in navigating the trajectory of childhood cancer, decreasing isolation.
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48
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Keim MC, Fladeboe K, Galtieri LR, Kawamura J, King K, Friedman D, Compas B, Breiger D, Lengua L, Katz LF. Primary and secondary caregiver depressive symptoms and family functioning following a pediatric cancer diagnosis: an exploration of the buffering hypothesis. Psychooncology 2021; 30:928-935. [PMID: 33724595 DOI: 10.1002/pon.5676] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 03/04/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVE After diagnosis, caregivers of children with cancer, particularly mothers or primary caregivers (PCs), often show elevated depressive symptoms which may negatively impact family functioning. We tested PC and secondary caregiver (SC) depressive symptoms as predictors of family, co-parenting, and marital functioning and whether having a non-depressed SC buffers against potential negative effects of PC depressive symptoms. METHODS Families (N = 137) were recruited from two major children's hospitals following a diagnosis of pediatric cancer. Caregivers completed self-report measures of depressive symptoms (Center for Epidemiological Studies-Depression Scale; Depression, Anxiety, and Stress Scale) and marital functioning (Dyadic Adjustment Scale) at 1-month post-diagnosis. A subset of families (n = 75) completed videotaped interaction tasks at approximately 3-months post-diagnosis that were coded for family and co-parenting interactions. RESULTS Higher PC depressive symptoms at 1-month post-diagnosis was associated with higher adaptability and lower conflict in family functioning. PC depressive symptoms were also associated lower dyadic consensus and lower dyadic satisfaction. SC depressive symptoms were not significantly associated with any family/co-parenting/marital functioning variables. Significant interaction analyses suggested that SC depressive symptoms moderated the effect of PC depressive symptoms on family cohesion, withdrawn parenting, and affective expression in the marriage, such that the relationship between PC depressive symptoms and poorer functioning was attenuated when SC depressive symptoms were at low or average levels. CONCLUSIONS Having a nondepressed SC buffered against negative effects of PC depressive symptoms on certain domains of family, coparenting, and marital functioning. SCs may play a protective role for families of children with cancer.
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Affiliation(s)
- Madelaine C Keim
- Department of Psychology, University of Washington, Seattle, Washington, USA
| | - Kaitlyn Fladeboe
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA.,Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Liana R Galtieri
- Department of Psychology, University of Washington, Seattle, Washington, USA
| | - Joy Kawamura
- Department of Psychology, University of Washington, Seattle, Washington, USA.,Seattle Children's Hospital, Seattle, Washington, USA
| | - Kevin King
- Department of Psychology, University of Washington, Seattle, Washington, USA
| | - Debra Friedman
- Department of Pediatrics, Vanderbilt University, Nashville, Tennessee, USA
| | - Bruce Compas
- Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA
| | - David Breiger
- Department of Psychology, University of Washington, Seattle, Washington, USA.,Seattle Children's Hospital, Seattle, Washington, USA
| | - Liliana Lengua
- Department of Psychology, University of Washington, Seattle, Washington, USA
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49
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Roberts CM, Sharkey CM, Bakula DM, Perez MN, Delozier AJ, Austin PF, Baskin LS, Chan YM, Cheng EY, Diamond DA, Fried AJ, Kropp B, Lakshmanan Y, Meyer SZ, Meyer T, Nokoff NJ, Palmer BW, Paradis A, Reyes KJS, Tishelman A, Williot P, Wolfe-Christensen C, Yerkes EB, Aston C, Wisniewski AB, Mullins LL. Illness Uncertainty Longitudinally Predicts Distress Among Caregivers of Children Born With DSD. J Pediatr Psychol 2021; 45:1053-1062. [PMID: 32929478 DOI: 10.1093/jpepsy/jsaa069] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 07/18/2020] [Accepted: 07/20/2020] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE A subset of parents of children with disorders/differences of sex development (DSD) including ambiguous genitalia experience clinically elevated levels of anxious and depressive symptoms. Research indicates that uncertainty about their child's DSD is associated with parent psychosocial distress; however, previous studies have been cross-sectional or correlational in nature. The current study is the first to examine the longitudinal trajectory of the relationship between caregiver-perceived uncertainty about their child's DSD and caregiver anxious and depressive symptoms across the first 12 months following genital surgery in young children, or if surgery was not performed, the first 12 months following study entry. METHODS One hundred and thirteen caregivers (Mage = 32.12; 57.5% mothers; 72.6% Caucasian) of children (N = 70; Mage = 9.81 months; 65.7% female) with DSD were recruited from 12 DSD specialty clinics in the United States. Caregivers completed psychosocial measures at baseline, 6 and 12 months following genitoplasty, or study entry if parents elected not to have surgery for their child. RESULTS Caregiver illness uncertainty and both anxious and depressive symptoms were highest at baseline and decreased over time (ps < .05). Caregiver illness uncertainty predicted symptoms of anxious and depressive symptoms across all time points (ps < .05). CONCLUSIONS Caregivers' perceptions of uncertainty about their child's DSD are highest soon after diagnosis, and uncertainty continues to predict both anxious and depressive symptoms across time. Thus, the initial diagnostic period is a critical time for psychological assessment and intervention, with parent illness uncertainty being an important clinical target.
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Affiliation(s)
- Caroline M Roberts
- Center for Pediatric Psychology, Department of Psychology, Oklahoma State University
| | - Christina M Sharkey
- Center for Pediatric Psychology, Department of Psychology, Oklahoma State University
| | - Dana M Bakula
- Center for Pediatric Psychology, Department of Psychology, Oklahoma State University
| | - Megan N Perez
- Center for Pediatric Psychology, Department of Psychology, Oklahoma State University
| | | | | | - Laurence S Baskin
- Department of Urology, University of California San Francisco Medical Center
| | - Yee-Ming Chan
- Division of Endocrinology, Department of Pediatrics, Harvard Medical School, Boston Children's Hospital
| | - Earl Y Cheng
- Department of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago
| | - David A Diamond
- Department of Urology, Boston Children's Hospital, Harvard Medical School
| | - Allyson J Fried
- Pediatric Urology of Western New York, John R. Oishei Children's Hospital
| | | | | | - Sabrina Z Meyer
- Pediatric Urology of Western New York, John R. Oishei Children's Hospital
| | - Theresa Meyer
- Department of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago
| | - Natalie J Nokoff
- Department of Endocrinology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus
| | - Blake W Palmer
- Department of Pediatric Urology, Cook Children's Medical Center
| | | | | | - Amy Tishelman
- Department of Urology, Boston Children's Hospital, Harvard Medical School.,Department of Psychiatry, Boston Children's Hospital, Harvard Medical School
| | - Pierre Williot
- Pediatric Urology of Western New York, John R. Oishei Children's Hospital
| | | | - Elizabeth B Yerkes
- Department of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago
| | - Christopher Aston
- Department of Pediatrics, University of Oklahoma Health Sciences Center
| | - Amy B Wisniewski
- Center for Pediatric Psychology, Department of Psychology, Oklahoma State University
| | - Larry L Mullins
- Center for Pediatric Psychology, Department of Psychology, Oklahoma State University
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50
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Perez MN, Clawson AH, Baudino MN, Austin PF, Baskin LS, Chan YM, Cheng EY, Coplen D, Diamond DA, Fried AJ, Kolon T, Kropp B, Lakshmanan Y, Meyer T, Nokoff NJ, Palmer BW, Paradis A, Poppas DP, Reyes KJS, Williot P, Wolfe-Christensen C, Yerkes EB, Wisniewski AB, Mullins LL. Distress Trajectories for Parents of Children With DSD: A Growth Mixture Model. J Pediatr Psychol 2021; 46:588-598. [PMID: 33594414 DOI: 10.1093/jpepsy/jsab004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/06/2020] [Accepted: 01/09/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE This study identifies trajectories of parent depressive symptoms after having a child born with genital atypia due to a disorder/difference of sex development (DSD) or congenital adrenal hyperplasia (CAH) and across the first year postgenitoplasty (for parents who opted for surgery) or postbaseline (for parents who elected against surgery for their child). Hypotheses for four trajectory classes were guided by parent distress patterns previously identified among other medical conditions. METHODS Participants included 70 mothers and 50 fathers of 71 children diagnosed with a DSD or CAH with reported moderate to high genital atypia. Parents were recruited from 11 US DSD specialty clinics within 2 years of the child's birth and prior to genitoplasty. A growth mixture model (GMM) was conducted to identify classes of parent depressive symptoms over time. RESULTS The best fitting model was a five-class linear GMM with freely estimated intercept variance. The classes identified were termed "Resilient," "Recovery," "Chronic," "Escalating," and "Elevated Partial Recovery." Four classes have previously been identified for other pediatric illnesses; however, a fifth class was also identified. The majority of parents were classified in the "Resilient" class (67.6%). CONCLUSIONS This study provides new knowledge about the trajectories of depressive symptoms for parents of children with DSD. Future studies are needed to identify developmental, medical, or familial predictors of these trajectories.
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Affiliation(s)
- Megan N Perez
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University
| | - Ashley H Clawson
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University
| | - Marissa N Baudino
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University
| | | | - Laurence S Baskin
- Department of Urology, University of California San Francisco Medical Center
| | - Yee-Ming Chan
- Division of Endocrinology, Department of Pediatrics, Harvard Medical School and Boston Children's Hospital
| | - Earl Y Cheng
- Department of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago
| | | | - David A Diamond
- Department of Urology, Boston Children's Hospital, Harvard Medical School
| | - Allyson J Fried
- Pediatric Urology of Western New York, John R. Oishei Children's Hospital
| | - Thomas Kolon
- Division of Urology, Children's Hospital of Philadelphia
| | - Bradley Kropp
- Department of Pediatric Urology, Cook Children's Medical Center
| | | | - Theresa Meyer
- Department of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago
| | - Natalie J Nokoff
- Department of Endocrinology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus
| | - Blake W Palmer
- Department of Pediatric Urology, Cook Children's Medical Center
| | | | - Dix P Poppas
- Department of Urology, New York Presbyterian Weill Cornell Medicine
| | | | - Pierre Williot
- Pediatric Urology of Western New York, John R. Oishei Children's Hospital
| | | | - Elizabeth B Yerkes
- Department of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago
| | - Amy B Wisniewski
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University
| | - Larry L Mullins
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University
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