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Sadeh Y, Dekel R, Brezner A, Landa J, Silberg T. Families following pediatric traumatic medical events: identifying psychosocial risk profiles using latent profile analysis. Eur J Psychotraumatol 2022; 13:2116825. [PMID: 36186160 PMCID: PMC9518403 DOI: 10.1080/20008066.2022.2116825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Post-traumatic stress symptoms (PTSS) are often experienced by children and family members after pediatric traumatic medical events (PTMEs). Assessing families' psychosocial risk factors is a crucial part of trauma-informed practice as it helps identify risk for PTSS in the aftermath of PTME. OBJECTIVES Using the Psychosocial Assessment Tool 2.0 (PAT2.0), this study describes the psychosocial risk of families following PTMEs in two ways: 1. Describing the psychosocial risk defined by the PAT2.0 based on three-tiered risk levels; 2. Using latent profile analysis (LPA); identifying psychosocial risk profiles and examining how child- and injury-related factors can affect profile membership. METHODS Caregivers of 374 children following PTMEs admitted to a pediatric rehabilitation department in Israel completed the PAT2.0. Total PAT2.0 score and the seven PAT2.0 subscales (family structure/resources, social support, child problems, sibling problems, family problems, caregiver stress reactions, and family beliefs) were included in the first analysis. Mean PAT2.0 scores of three risk categories (universal, targeted, clinical) were calculated; LPA, which allows for cross-sectional latent variable mixture models to identify heterogeneity within a population, and multinomial logistic regressions using six out of the seven PAT2.0 subscales, were used to determine distinct profile differences and predictors of profile membership. RESULTS The three-tiered risk levels revealed were relatively high, as compared to levels in families of children with other clinical diagnoses. LPA yielded a three-profile solution: low family risk (63.53%); high caregiver stress, above-average levels of family risk (22.5%); and sibling problems, above-average levels of family risk (13.94%). Ethnicity and type of injury predicted group membership. CONCLUSION Families of children following PTMEs are at increased psychosocial risk. A clinically useful approach to identifying and preventing PTSS may be to evaluate specific domain patterns rather than just the total PAT2.0 risk level alone, based on the PAT2.0 subscales.
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Affiliation(s)
- Yaara Sadeh
- The Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan, Israel.,Department of Pediatric Rehabilitation, the Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center at Tel HaShomer, Ramat Gan, Israel.,Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rachel Dekel
- The Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan, Israel
| | - Amichai Brezner
- Department of Pediatric Rehabilitation, the Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center at Tel HaShomer, Ramat Gan, Israel
| | - Jana Landa
- Department of Pediatric Rehabilitation, the Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center at Tel HaShomer, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-aviv, Israel
| | - Tamar Silberg
- Department of Pediatric Rehabilitation, the Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center at Tel HaShomer, Ramat Gan, Israel.,Department of Psychology, Bar Ilan University, Ramat Gan, Israel
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A scoping review of the experiences and well-being of siblings of children with chronic kidney disease: implications for practice and research. Pediatr Nephrol 2022; 37:3019-3029. [PMID: 35507144 PMCID: PMC9066131 DOI: 10.1007/s00467-022-05559-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/04/2022] [Accepted: 03/25/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Children with chronic kidney disease (CKD) and their families deal with challenging circumstances. While numerous studies have shown that both patients and parents in these families can experience a variety of challenges and concerns, the experience of siblings is less well understood. The focus of this scoping review was on research addressing the experiences and well-being of siblings of children with CKD. METHODS Following scoping review methodology, five databases were searched for peer-reviewed research or graduate theses published in English that addressed the experience or well-being of siblings aged 25 years or younger (biological, step or foster) of children with CKD; studies from any year or location were included. Two independent coders identified relevant studies. Findings were summarized and synthesized. RESULTS Of the 2990 studies identified, 19 were chosen for full text review and eight fit the inclusion criteria. Five of the selected studies were qualitative, two were quantitative and one used mixed-methods. Four broad themes across studies were identified including family functioning, significant relationships, psychological well-being, and coping strategies. While there was some convergence between qualitative and quantitative findings, these linkages were weak. CONCLUSIONS Several unmet needs of siblings were uncovered by this review. Sibling perceptions of differential parental treatment and desire for information about CKD emerged as priorities for practice. Using a strength-based approach in order to better understand sibling experiences and well-being was also recommended for future research. A higher resolution version of the Graphical abstract is available as Supplementary information.
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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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Kazak AE, Deatrick JA, Scialla MA, Sandler E, Madden RE, Barakat LP. Implementation of family psychosocial risk assessment in pediatric cancer with the Psychosocial Assessment Tool (PAT): study protocol for a cluster-randomized comparative effectiveness trial. Implement Sci 2020; 15:60. [PMID: 32727493 PMCID: PMC7391817 DOI: 10.1186/s13012-020-01023-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 07/14/2020] [Indexed: 01/07/2023] Open
Abstract
Background Childhood cancer affects and is affected by multiple levels of the social ecology, including social and relational determinants of health (e.g., economic stability, housing, childcare, healthcare access, child and family problems). The 2015 Standards of Psychosocial Care in Pediatric Cancer outline optimal psychosocial care sensitive to these ecological factors, starting with assessment of psychosocial healthcare needs to promote medical and psychosocial outcomes across all children with cancer. To address the first standard of family psychosocial assessment, the Psychosocial Assessment Tool (PAT) is a validated screener ready for broad implementation. Method The PAT will be implemented across a national sample of 18 pediatric cancer programs ranging in size (annual new patients) in a mixed methods, comparative effectiveness study, guided by the Interactive Systems Framework for Dissemination and Implementation, comparing two implementation strategies. It is hypothesized that implementation will be more successful at the patient/family, provider, and institutional level when training (strategy I) is combined with implementation expanded resources (strategy II). There are three aims: (1) Refine the two implementation strategies using semi-structured qualitative interviews with 19 stakeholders including parent advocates, providers, pediatric oncology organization representatives, healthcare industry leaders; (2) Compare the two theoretically based and empirically informed strategies to implement the PAT in English and Spanish using a cluster-randomized controlled trial across 18 sites. Stratified by size, sites will be randomized to cohort (3) and strategy (2). Outcomes include adoption and penetration of screening (patient/family), staff job satisfaction/burnout (provider), and cost-effective use of resources consistent with family risk (institution); (3) Based on the results of the trial and feedback from the first and second aim, we will develop and disseminate a web-based PAT Implementation Toolkit. Discussion Use of the PAT across children’s cancer programs nationally can achieve the assessment standard and inform equitable delivery of psychosocial care matched to family need for all patients. Trial Registration ClinicalTrials.gov, NCT04446728, registered 23 June 2020
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Affiliation(s)
- Anne E Kazak
- Nemours Children's Health System, Wilmington, DE, USA. .,Sidney Kimmel Medical School of Thomas Jefferson University, Philadelphia, PA, USA.
| | - Janet A Deatrick
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | | | - Eric Sandler
- Nemours Children's Clinic, Jacksonville, FL, USA
| | | | - Lamia P Barakat
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
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Verma R, Mehdian Y, Sheth N, Netten K, Vinette J, Edwards A, Polyviou J, Orkin J, Amin R. Screening for caregiver psychosocial risk in children with medical complexity: a cross-sectional study. BMJ Paediatr Open 2020; 4:e000671. [PMID: 32789196 PMCID: PMC7389766 DOI: 10.1136/bmjpo-2020-000671] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 06/27/2020] [Accepted: 06/29/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To quantify psychosocial risk in family caregivers of children with medical complexity using the Psychosocial Assessment Tool (PAT) and to investigate potential contributing sociodemographic factors. DESIGN Cross-sectional study. SETTING Family caregivers completed questionnaires during long-term ventilation and complex care clinic visits at The Hospital for Sick Children, Toronto, Ontario, Canada. PATIENTS A total of 136 family caregivers of children with medical complexity completed the PAT questionnaires from 30 June 2017 through 23 August 2017. MAIN OUTCOME MEASURES Mean PAT scores in family caregivers of children with medical complexity. Caregivers were stratified as 'Universal' low risk, 'Targeted' intermediate risk or 'Clinical' high risk. The effect of sociodemographic variables on overall PAT scores was also examined using multiple linear regression analysis. Comparisons with previous paediatric studies were made using T-test statistics. RESULTS 136 (103 females (76%)) family caregivers completed the study. Mean PAT score was 1.17 (SD=0.74), indicative of 'Targeted' intermediate risk. Sixty-one (45%) caregivers were classified as Universal risk, 60 (44%) as Targeted risk and 15 (11%) as Clinical risk. Multiple linear regression analysis revealed an overall significant model (p=0.04); however, no particular sociodemographic factor was a significant predictor of total PAT scores. CONCLUSION Family caregivers of children with medical complexity report PAT scores among the highest of all previously studied paediatric populations. These caregivers experience significant psychosocial risk, demonstrated by larger proportions of caregivers in the highest-risk Clinical category.
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Affiliation(s)
- Rahul Verma
- Department of Paediatrics, Children's Hospital, London Health Sciences Centre, London, Ontario, Canada.,Western University, London, Ontario, Canada
| | - Yasna Mehdian
- Faculty of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Neel Sheth
- Faculty of Science, Western University, London, Ontario, Canada
| | - Kathy Netten
- Department of Social Work, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jean Vinette
- Department of Social Work, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ashley Edwards
- Department of Social Work, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Joanna Polyviou
- Division of Respiratory Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Julia Orkin
- Department of Pediatric Medicine, Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada.,Child Health Evaluative Sciences (CHES) SickKids Research Institute, Toronto, Ontario, Canada
| | - Reshma Amin
- Division of Respiratory Medicine, Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada.,Child Health Evaluative Sciences (CHES) SickKids Research Institute, Toronto, Ontario, Canada
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