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Lau N, Palermo TM, Zhou C, Badillo I, Hong S, Aalfs H, Yi-Frazier JP, McCauley E, Chow EJ, Weiner BJ, Ben-Zeev D, Rosenberg AR. Mobile App Promoting Resilience in Stress Management for Adolescents and Young Adults With Cancer: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e57950. [PMID: 39079108 DOI: 10.2196/57950] [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: 03/01/2024] [Revised: 05/16/2024] [Accepted: 06/14/2024] [Indexed: 08/03/2024] Open
Abstract
BACKGROUND Adolescents and young adults (AYAs) with cancer are at risk of poor psychosocial outcomes. AYAs grew up with the internet and digital technology, and mobile Health (mHealth) psychosocial interventions have the potential to overcome care access barriers. OBJECTIVE This pilot randomized controlled trial (RCT) aimed to establish the feasibility, acceptability, and preliminary efficacy of a fully automated mobile app version of the Promoting Resilience in Stress Management intervention (mPRISM). Promoting Resilience in Stress Management is an evidence-based intervention developed in collaboration with AYAs, based on stress and coping theory, resilience theory, and evidence-based coping strategies. We hypothesized that mPRISM would be feasible, acceptable, and appropriate. METHODS This is a parallel, 2-arm, single-site pilot RCT with a waitlist control design. The study will recruit 80 AYAs with cancer from a clinic. Eligible AYAs are aged 12 to 25 years, within 12 months of a new cancer diagnosis, receiving chemotherapy or radiation therapy, speak, read, or write in English, and are cognitively able to participate in study procedures. Recruitment by clinical research coordinators will occur remotely by phone, video, or text. Participants will be randomized to psychosocial usual care (UC) alone or UC plus mPRISM for an 8-week intervention period, and will remain unblinded to study condition. Enrolled participants will complete surveys at baseline before randomization, 8 weeks, and 3-month follow-up. Using a waitlist design, the UC arm will receive mPRISM upon completion of 3-month follow-up surveys. Those in the UC arm will complete 2 additional measurement points at immediate posttreatment and 3 months later. The primary outcomes of interest are feasibility, defined as ≥60% enrollment and ≥70% retention (ie, percentage of participants who completed the study), and "feasibility, acceptability, and appropriateness" as defined by cut-off scores ≥4/5 on 3 brief validated implementation outcome measures (feasibility of implementation measure, acceptability of intervention measure [AIM], intervention appropriateness measure [IAM]). We will apply top-box scoring for the implementation measures. Exploratory outcomes of interest include patient-reported health-related quality of life, resilience, distress, anxiety, depression, pain, and sleep. We will conduct an intention-to-treat analysis to compare the outcomes of the mPRISM arm versus the control arm with covariate-adjusted regression models. We will summarize individual digital usage metrics using descriptive statistics. RESULTS Since September 2023, we have enrolled 20 participants and recruitment is ongoing. CONCLUSIONS Although our previous work suggests AYAs with cancer are interested in mHealth psychosocial interventions, such interventions have not yet been sufficiently evaluated or implemented among AYA oncology patients. mPRISM may serve as a potential mHealth intervention to fill this gap. In this study, we will test the feasibility, acceptability, and preliminary efficacy of mPRISM. This work will inform future larger-scale RCTs powered for efficacy outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT05842902; https://clinicaltrials.gov/study/NCT05842902. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/57950.
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Affiliation(s)
- Nancy Lau
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States
| | - Tonya M Palermo
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States
- Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Chuan Zhou
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States
| | - Isabel Badillo
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States
| | - Shannon Hong
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States
| | - Homer Aalfs
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States
| | - Joyce P Yi-Frazier
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Elizabeth McCauley
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States
| | - Eric J Chow
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States
- Clinical Research and Public Health Sciences Divisions, Fred Hutch Cancer Center, Seattle, WA, United States
| | - Bryan J Weiner
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Dror Ben-Zeev
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States
| | - Abby R Rosenberg
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, United States
- Department of Pediatrics, Boston Children's Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
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Steiner JM, Marshall AR, Kovacs AH, Engelberg RA, Brumback L, Stout KK, Longenecker CT, Yi-Frazier JP, Rosenberg AR. Rationale and design of a randomized controlled clinical trial of a resilience-building intervention in adults with congenital heart disease. Contemp Clin Trials 2024; 145:107638. [PMID: 39047811 DOI: 10.1016/j.cct.2024.107638] [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: 03/13/2024] [Revised: 07/11/2024] [Accepted: 07/17/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Adults with congenital heart disease (ACHD) are at risk for lower quality of life (QOL) and psychological health. Behavioral interventions to meet their psychosocial needs are lacking. The aim of this study is to evaluate the feasibility of implementing the Promoting Resilience in Stress Management (PRISM) intervention in ACHD and its efficacy in increasing resilience in this population. METHODS We designed a phase II randomized controlled clinical trial of patients with moderate or complex ACHD, physiological stages C or D. Enrolled participants will be randomized to receive PRISM or usual care. PRISM is a manualized, skills-based behavioral intervention comprised of four one-on-one sessions targeting resilience resources (stress-management, goal-setting, cognitive reframing, meaning making), an optional session on advance care planning, and a facilitated family meeting. Participants in both groups will complete study questionnaires at enrollment and 3-months later. The primary aim is to describe feasibility, namely the proportions of patients who a) enroll in the study among those eligible, and b) complete the PRISM intervention among those randomized to that arm. We will also evaluate PRISM's efficacy by using linear regression models to compare changes in mean resilience scores between assigned groups. In exploratory analyses, we will evaluate effects on QOL, psychological distress, perceived competence for health care management, and comfort with advance care planning. DISCUSSION This study will provide rigorous evidence to determine the feasibility and efficacy of a brief intervention to promote resilience and psychosocial health in ACHD. Findings may guide the development of a future multi-site effectiveness study. CLINICAL TRIAL REGISTRATION NCT04738474.
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Affiliation(s)
- Jill M Steiner
- Division of Cardiology, Department of Medicine & Cambia Palliative Care Center of Excellence, University of Washington, 1959 NE Pacific St., Seattle, WA 98195, USA.
| | - Arisa Rei Marshall
- Division of Cardiology, Department of Medicine, University of Washington, 1959 NE Pacific St., Seattle, WA 98195, USA
| | - Adrienne H Kovacs
- Equilibria Psychological Health, 10-255 The East Mall, Toronto, Ontario M9B 0A9, Canada
| | - Ruth A Engelberg
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine & Cambia Palliative Care Center of Excellence, University of Washington, Harborview Medical Center, 325 9th Ave, Seattle, WA 98104, USA
| | - Lyndia Brumback
- Department of Biostatistics, University of Washington, 1959 NE Pacific St., Seattle, WA 98195, USA
| | - Karen K Stout
- Division of Cardiology, Department of Medicine, University of Washington, 1959 NE Pacific St., Seattle, WA 98195, USA
| | - Chris T Longenecker
- Division of Cardiology and Department of Global Health, University of Washington, 3980 15th Ave NE, Seattle, WA 98105, USA
| | - Joyce P Yi-Frazier
- Center for Clinical and Translational Research, Seattle Children's Research Institute, 1920 Terry Ave, Seattle, WA 98101, USA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute & Department of Pediatrics, Harvard Medical School; 450 Brookline Ave, Boston, MA 02215, USA
| | - Abby R Rosenberg
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute & Department of Pediatrics, Harvard Medical School; 450 Brookline Ave, Boston, MA 02215, USA
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Fladeboe KM, Stock NM, Heike CL, Evans KN, Junkins C, Stueckle L, O'Daffer A, Rosenberg AR, Yi-Frazier JP. Feasibility and Acceptability of the Promoting Resilience in Stress Management-Parent (PRISM-P) Intervention for Caregivers of Children with Craniofacial Conditions. Cleft Palate Craniofac J 2024; 61:1125-1133. [PMID: 36802967 DOI: 10.1177/10556656231157449] [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: 02/23/2023] Open
Abstract
OBJECTIVES Few evidence-based psychosocial programs exist within craniofacial care. This study (a) assessed feasibility and acceptability of the Promoting Resilience in Stress Management-Parent (PRISM-P) intervention among caregivers of children with craniofacial conditions and (b) described barriers and facilitators of caregiver resilience to inform program adaptation. DESIGN In this single-arm cohort study, participants completed a baseline demographic questionnaire, the PRISM-P program, and an exit interview. PARTICIPANTS Eligible individuals were English-speaking legal guardians of a child <12-years-old with a craniofacial condition. INTERVENTION PRISM-P included 4 modules (stress-management, goal-setting, cognitive-restructuring, meaning-making) delivered in 2 one-on-one phone or videoconference sessions 1-2 weeks apart. MAIN OUTCOME MEASURES Feasibility was defined as >70% program completion among enrolled participants; acceptability was defined as >70% willingness to recommend PRISM-P. Intervention feedback and caregiver-perceived barriers and facilitators of resilience were summarized qualitatively. RESULTS Twenty caregivers were approached and 12 (60%) enrolled. The majority were mothers (67%) of a child <1-year-old diagnosed with a cleft lip and/or palate (83%) or craniofacial microsomia (17%). Of these, 8 (67%) completed PRISM-P and 7 (58%) completed interviews; 4 (33%) were lost-to-follow-up before PRISM-P and 1 (8%) before the interview. Feedback was highly positive, with 100% willing to recommend PRISM-P. Perceived barriers to resilience included uncertainty about their child's health; facilitators included social support, parental identity, knowledge, and control. CONCLUSIONS PRISM-P was acceptable among caregivers of children with craniofacial conditions but not feasible based on program completion rates. Barriers and facilitators of resilience support the appropriateness of PRISM-P for this population and inform adaptation.
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Affiliation(s)
- Kaitlyn M Fladeboe
- Department of Pediatrics. University of Washington School of Medicine, Seattle, WA, USA
- Seattle Children's Research Institute, Center for Clinical & Translational Research, Seattle, WA, USA
| | - Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Carrie L Heike
- Department of Pediatrics. University of Washington School of Medicine, Seattle, WA, USA
- Seattle Children's Research Institute, Center for Clinical & Translational Research, Seattle, WA, USA
| | - Kelly N Evans
- Department of Pediatrics. University of Washington School of Medicine, Seattle, WA, USA
- Seattle Children's Research Institute, Center for Clinical & Translational Research, Seattle, WA, USA
| | - Courtney Junkins
- Seattle Children's Research Institute, Center for Clinical & Translational Research, Seattle, WA, USA
| | - Laura Stueckle
- Seattle Children's Research Institute, Center for Clinical & Translational Research, Seattle, WA, USA
| | - Alison O'Daffer
- Seattle Children's Research Institute, Center for Clinical & Translational Research, Seattle, WA, USA
| | - Abby R Rosenberg
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Palliative Care, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Joyce P Yi-Frazier
- Seattle Children's Research Institute, Center for Clinical & Translational Research, Seattle, WA, USA
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Rosenberg AR, Taylor MR, Fladeboe KM, Zhou C, Levine DR, Johnston EE, Freyer DR, Comiskey L, Junkins CC, Bradford M, Odom JN, Baker KS, Yi-Frazier JP. Resilience and distress among adolescents and young adults receiving hematopoietic cell transplantation: The Promoting Resilience in Stress Management randomized trial. Cancer 2024. [PMID: 39031841 DOI: 10.1002/cncr.35440] [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: 04/18/2024] [Revised: 05/29/2024] [Accepted: 06/03/2024] [Indexed: 07/22/2024]
Abstract
BACKGROUND Adolescents and young adults (AYAs) receiving hematopoietic cell transplantation (HCT) are at high risk of poor psychosocial health. This study aimed to determine whether the Promoting Resilience in Stress Management (PRISM) intervention mitigated these risks during the first 6 months posttransplant. METHODS This multisite, parallel, randomized trial was conducted from April 2019 to March 2023. Eligible AYAs were aged 12-24 years, English speaking, and within 1 month of HCT for cancer or cancer predisposition syndrome. They were assigned 1:1 to PRISM (a brief, skills-based intervention targeting "resilience resources" [stress management, goal setting, cognitive reframing, and meaning making]) or usual care (UC). Outcomes included total symptoms of depression and anxiety (Hospital Anxiety and Depression Scale; primary outcome), hope (Snyder Hope Scale), resilience (10-item Connor-Davidson Resilience Scale), and health-related quality of life (HRQOL; Pediatric Quality of Life Inventory Cancer Module). Analyses leveraged multivariable linear regressions; exploratory analyses assessed the influence of baseline depression or anxiety. RESULTS Of 94 enrolled and randomized AYAs, the mean age was 16.7 years (SD, 4.2); 43 (46%) were female, 56 (60%) were non-Hispanic White, 22 (23%) were Hispanic, and nine (10%) were Black. Most (77%) had leukemia. Of n = 50 randomized to PRISM and n = 44 to UC, 37 (74%) and 33 (73%) completed all study procedures, respectively. In intention-to-treat analyses, PRISM did not affect 6-month depression and anxiety (β = -1.1; 95% CI, -3.7 to 1.5), hope (β = 0.83; 95% CI, -3.3 to 4.9), resilience (β = -0.01; 95% CI, -3.0 to 3.0), or HRQOL (β = 1.5; 95% CI, -4.7 to 7.9). Among AYAs with preexisting anxiety or depression, PRISM recipients reported greater 6-month improvements in hope (score change, +3.71; SD, 6.9) versus UC recipients (score change, -2.76; SD, 6.5) (p = .04). CONCLUSIONS Resilience coaching did not influence outcomes in this sample. Exploratory findings suggest it may be more effective when directed toward those with concurrent distress.
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Affiliation(s)
- Abby R Rosenberg
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- 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
| | - Mallory R Taylor
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
- Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Kaitlyn M Fladeboe
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
- Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Chuan Zhou
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Deena R Levine
- Division of Quality of Life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Emily E Johnston
- Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - David R Freyer
- Departments of Pediatrics, Medicine, and Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Liam Comiskey
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Courtney C Junkins
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Miranda Bradford
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - J Nicholas Odom
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - K Scott Baker
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Joyce P Yi-Frazier
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA
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Iio M, Nagata M, Narita M. Factors associated with positive mental health in Japanese young adults with a history of chronic diseases during childhood: A qualitative study. J Pediatr Nurs 2024; 76:e9-e18. [PMID: 38281893 DOI: 10.1016/j.pedn.2024.01.012] [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: 03/13/2023] [Revised: 01/11/2024] [Accepted: 01/11/2024] [Indexed: 01/30/2024]
Abstract
PURPOSE Factors associated with positive mental health in children with chronic diseases remain unclear. Supporting the development of positive mental health in children with chronic diseases can enhance their mental health throughout childhood and adulthood. This study aimed to identify the factors associated with positive mental health among Japanese young adults with a history of chronic pediatric diseases. DESIGN AND METHODS Participants aged 18-25 years, with a history of chronic pediatric diseases, were recruited from a population of students at a university. Semi-structured interviews were conducted. The data were analyzed using thematic analysis. After the initial coding of each transcript, the researchers discussed and identified a set of main themes, categories, and subcategories. RESULTS Ten participants aged 19-22 years were interviewed. Their chronic diseases were diverse and included childhood cancers and allergic diseases. Seven themes (proactive coping, positive coping, negative coping, eudaimonia, hedonia, independence, and awareness) emerged from 21 categories and 70 subcategories identified. A thematic map was applied to two domains (protective factors and well-being factors) and to three inter-related constructs (individual, family, and community/society). CONCLUSIONS The findings indicated that within the well-being factors, meaning in life was prominent, and within the protective factors, stress coping was found to facilitate positive mental health among individuals with a history of chronic pediatric diseases. PRACTICE IMPLICATIONS In children with chronic diseases, support for finding appropriate coping strategies that enhance their optimism and symbiotic relationships in the community/society are important, including valuing little things in their lives, such as play and learning.
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Affiliation(s)
- Misa Iio
- Department of Nursing, College of Nursing, Kanto-Gakuin University, Yokohama, Kanagawa Prefecture, Japan.
| | - Mayumi Nagata
- Department of Nursing, College of Nursing, Kanto-Gakuin University, Yokohama, Kanagawa Prefecture, Japan
| | - Masami Narita
- Department of Pediatrics, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
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Collins MKR, Lazard AJ, Dillman Carpentier F, Comello ML, Benedict C, Kent EE, Yu C. Reel reflections: the role of entertainment media narratives in coping among young adult cancer survivors. J Psychosoc Oncol 2024:1-22. [PMID: 38661002 DOI: 10.1080/07347332.2024.2337043] [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: 04/26/2024]
Abstract
INTRODUCTION Young adult cancer survivors (YACS; ages 18-39) report a significant psychological burden. Entertainment media narratives (e.g., books, movies, shows that are produced for mass consumption) might be an effective tool for reducing this distress, although little is known about present use among YACS. METHOD YACS completed a survey about their use of entertainment media narratives to cope with cancer using an adapted version of the Brief COPE. Additionally, YACS reported their use of entertainment media narratives to start conversations about their experience with others, and they described features of entertainment media narratives that they found helpful in coping. RESULTS We recruited 108 YACS from three recruitment sites. Most participants were White (n = 65), female (n = 54), and recruited from Prolific (n = 56), an Internet-based, crowdsourced data collection platform. Participants were, on average, 30 years old and 45 months from the completion of their primary cancer treatment. YACS who used entertainment media to cope with cancer (n = 32; 29.6%) were significantly younger and significantly closer to the end of their primary treatment. Compared to nonusers, users of entertainment media narratives to cope were also more likely to identify as Black; identifying as Black was associated with a 2.05-factor increase in using narrative entertainment media to cope with cancer even when controlling for other demographic differences. Additionally, compared to their peers, Black YACS reported greater use of narratives to start cancer-related conversations. Emotional and inspirational storylines were the most helpful story features. DISCUSSION Some YACS, especially Black YACS, use stories to cope with their cancer experience. YACS patients could find stories useful in exploring their cancer-related emotions, although the exact benefits are still unknown.
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Affiliation(s)
- Meredith K Reffner Collins
- Section of Pediatric Population Science, Outcomes, and Disparities Research, Division of Pediatric Hematology/Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Allison J Lazard
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Maria Leonora Comello
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Catherine Benedict
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Palo Alto, CA, USA
- Stanford Cancer Institute, Stanford, CA, USA
| | - Erin E Kent
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Clara Yu
- Section of Pediatric Population Science, Outcomes, and Disparities Research, Division of Pediatric Hematology/Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
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Cousino MK, Dusing CR, Rea KE, Glenn T, Armstrong B, Les AS, Hansen JE, Pasquali SK, Schumacher KR. Developing the WE BEAT Well-Being Education Programme to foster resilience and build connection in paediatric heart disease. Cardiol Young 2024:1-7. [PMID: 38622972 DOI: 10.1017/s1047951124000556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
BACKGROUND The study of psychological well-being and related resilient outcomes is of increasing focus in cardiovascular research. Despite the critical importance of psychological well-being and related resilient outcomes in promoting optimal cardiac health, there have been very few psychological interventions directed towards children with heart disease. This paper describes the development and theoretical framework of the WE BEAT Wellbeing Education Program, a group-based psychoeducation and coping skills training intervention designed to improve psychological well-being and resilience in adolescents with paediatric heart disease. METHODS Program development was informed by patient and family needs and input gathered via large, international survey methods as well as qualitative investigation, a theoretical framework, and related resilience intervention research. RESULTS An overview of the WE BEAT intervention components and structure of the programme is provided. CONCLUSIONS The WE BEAT Wellbeing Education Program was developed as one of the first resiliency-focused interventions in paediatric heart disease with an overall objective to foster positive psychological well-being and resilient outcomes through a health promotion and prevention lens in an accessible format while providing access to safe, peer-to-peer community building. Feasibility pilot results are forthcoming. Future directions include mobile app-based delivery and larger-scale efficacy and implementation trials.
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Affiliation(s)
- Melissa K Cousino
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
- University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, MI, USA
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA
| | | | - Kelly E Rea
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Thomas Glenn
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
- University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, MI, USA
| | - Blake Armstrong
- University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, MI, USA
| | - Andrea S Les
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Jesse E Hansen
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
- University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, MI, USA
| | - Sara K Pasquali
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
- University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, MI, USA
| | - Kurt R Schumacher
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
- University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, MI, USA
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Rosenberg AR, Salsman JM. Resilience in adolescent and young adult oncology: Problems and prospects. Cancer 2024; 130:1015-1018. [PMID: 38150308 DOI: 10.1002/cncr.35180] [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: 12/28/2023]
Abstract
Although resilience research in adolescent and young adult oncology is promising for improving patient‐centered outcomes, it does not adequately incorporate diverse perspectives of marginalized individuals. Including the unique aspects of minoritized adolescents and young adults and incorporating cultural, community, and system‐level considerations is essential to understanding and promoting resilience in an equitable fashion.
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Affiliation(s)
- Abby R Rosenberg
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - John M Salsman
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, North Carolina, USA
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Salsman JM, Rosenberg AR. Fostering resilience in adolescence and young adulthood: Considerations for evidence-based, patient-centered oncology care. Cancer 2024; 130:1031-1040. [PMID: 38163249 DOI: 10.1002/cncr.35182] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/02/2023] [Accepted: 12/07/2023] [Indexed: 01/03/2024]
Abstract
Adolescence and young adulthood are times of growth and change. For adolescents and young adults (AYAs) who are diagnosed with cancer, the demands of illness may compound normal developmental challenges and adversely affect physical, emotional, and social health. Nevertheless, AYAs have a tremendous capacity for psychosocial adaptation and resilience. Informed by the Transactional Model of Stress and Coping, observational studies in AYA oncology suggest consistent individual, social, and existential resources that may promote resilience. To date, few interventions have been designed to examine whether resilience can be taught and whether doing so affects patient-centered outcomes. Findings point to the potential value of multicomponent programs that include various skills-building strategies, such as stress management, mindfulness, gratitude, and positive reappraisal coping, among others. New research directions include the need to evaluate delivery strategies to enhance participant adherence and retention (e.g., eHealth modalities, optimization studies) and to examine program effectiveness in community-based oncology practices (e.g., less resource-rich settings in which most AYAs receive care). Ultimately, this scholarship may inform, refine, and strengthen intervention science in resilience more broadly.
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Affiliation(s)
- John M Salsman
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, North Carolina, USA
| | - Abby R Rosenberg
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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10
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Bischops AC, Sieper L, Dukart J, Schaal NK, Reinauer C, Oommen PT, Tomoiaga C, David O, Mayatepek E, Meissner T. Resilience strengthening in youth with a chronic medical condition: a randomized controlled feasibility trial of a combined app and coaching program. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02395-w. [PMID: 38431540 DOI: 10.1007/s00787-024-02395-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 02/11/2024] [Indexed: 03/05/2024]
Abstract
Youth with a chronic medical condition (CMC) are often affected by comorbid mental disorders. Resilience-strengthening interventions can protect youth's mental health, yet evidence-based programs remain scarce. To address this lack, this study aimed to evaluate the feasibility of a dual approach combining app-based resilience training and cognitive behavioral group coaching. Fifty-one youths with CMC treated at a German university children's hospital aged 12-16 years were recruited. They were randomly assigned to a combined app game and coaching intervention or sole app gameplay. At pre-, post-intervention, and at a 2-month follow-up resilience, automatic negative thoughts and an app and coaching evaluation were assessed. Feasibility was defined as a recruitment rate of 70%, an 85% adherence rate for the REThink game, and 70% participation in both coaching sessions. Feasibility criteria were reached for coaching participation but not for recruitment or app adherence. While both the REThink game app and coaching intervention had high acceptance rates among youth with CMC, participants receiving additional coaching sessions showed higher satisfaction and adherence rates. Participants preferred remote to in-person meetings. The findings support a combination of a gamification app approach with online group coaching. Group coaching can improve adherence while online options increase accessibility. Future research should focus on testing in diverse participant samples, language, and age-adapted updates of the REThink game app. These findings provide guidance for increasing adherence in future intervention studies in youth with CMC cohorts.
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Affiliation(s)
- Anne Christine Bischops
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany.
| | - L Sieper
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - J Dukart
- Institute for Neurosciences and Medicine: Brain and Behavior (INM-7), Research Center Jülich, Jülich, Germany
- Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - N K Schaal
- Department of Experimental Psychology, Heinrich Heine University, Düsseldorf, Germany
| | - C Reinauer
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - P T Oommen
- Division of Pediatric Rheumatology, Department of Pediatric Oncology, Hematology and Clinical Immunology, Medical Faculty, University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - C Tomoiaga
- International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babes-Bolyai University, Cluj-Napoca, Romania
| | - O David
- International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babes-Bolyai University, Cluj-Napoca, Romania
| | - E Mayatepek
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - T Meissner
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany
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11
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Johnston EE, Rosenberg AR. Palliative Care in Adolescents and Young Adults With Cancer. J Clin Oncol 2024; 42:755-763. [PMID: 37862672 DOI: 10.1200/jco.23.00709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/27/2023] [Accepted: 08/25/2023] [Indexed: 10/22/2023] Open
Abstract
Palliative care (PC) aims to improve quality of life (QOL) for patients with serious illness and their families by recognizing and alleviating the physical, emotional, social, existential, and spiritual suffering of patients and their communities. Because adolescents and young adults (AYAs, age 15-39 years) with cancer commonly report distress across all these domains and because that distress translates to their QOL during and after their cancers, PC is particularly relevant for this population. Here, we review the evidence for PC among AYAs with cancer, including its rationale, gaps, opportunities, and implications for care delivery. For example, nearly 90% of AYAs with cancer report distressing symptoms during their treatment, those who survive report ongoing unmet psychosocial and physical health needs, and those who die from their cancers are highly likely to receive medically intense care that is discordant with their goals and values. AYA communication and decision making can be challenging because of ethical and developmental considerations regarding the patient's autonomy and competing priorities of patients and caregivers. PC interventions (including primary PC delivered by oncologists, routine PC subspecialty care, symptom tracking, advance care planning, and psychosocial programs promoting AYA resilience) are all associated with improved patient-centered outcomes. However, PC is inconsistently integrated into AYA oncology care, and access to PC programs is not equitable; marginalized groups continue to experience poorer outcomes. Ongoing and future research and clinical initiatives must continue to bridge these gaps. Improving the QOL of AYAs with cancer is a shared goal of the larger clinical oncology community, and including PC in AYA cancer care delivery can help attain that goal.
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Affiliation(s)
- Emily E Johnston
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
- Pediatric Hematology/Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Abby R Rosenberg
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA
- Department of Pediatrics, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
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12
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Liu Z, Hong L. Work-Family Conflict and Mental Health among Chinese Female Healthcare Workers during the COVID-19 Pandemic: The Moderating Effects of Resilience. Healthcare (Basel) 2023; 11:1696. [PMID: 37372814 DOI: 10.3390/healthcare11121696] [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: 05/11/2023] [Revised: 06/01/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
(1) Background: The mental health of female healthcare workers is at greater risk during the COVID-19 pandemic due to increased psychological stress and heightened work-family conflict. This study investigated whether resilience, as a protective factor for mental health, can safeguard the well-being of female healthcare workers. This study assessed the mental health of female healthcare workers (n = 431) from a small inland city in Central China, explored the impact of work-family conflict on their mental health, and examined the moderating role of resilience. (2) Methods: The main variables were measured using standard tools administered via an online survey. A one-sample t-test, ANOVA, Pearson correlation analysis, and multiple regression were performed with SPSS. A simple slope test was conducted based on the multiple regression results. (3) Results: The analysis revealed that the mental health level of the surveyed female healthcare workers was significantly lower than the national norm (t = 16.36, p < 0.001). Work-family conflict had a significant negative impact on mental health (β = 0.39, p < 0.001), while the interaction effect of resilience and work-family conflict was significant (β = -0.13, p < 0.05), suggesting a moderating effect. (4) Conclusions: Female healthcare workers exhibited poor mental health during the COVID-19 pandemic, but resilience remained a protective factor, mitigating the negative impact of work-family conflict on female healthcare workers' mental health.
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Affiliation(s)
- Zixiao Liu
- School of Humanities, Tongji University, Shanghai 200092, China
| | - Liu Hong
- School of Social Development and Public Policy, Fudan University, Shanghai 200433, China
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13
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O'Daffer A, Comiskey L, Scott SR, Zhou C, Bradford MC, Yi-Frazier JP, Rosenberg AR. Protocol for the promoting resilience in stress management (PRISM) intervention: a multi-site randomized controlled trial for adolescents and young adults with advanced cancer. BMC Palliat Care 2023; 22:60. [PMID: 37189149 DOI: 10.1186/s12904-023-01179-4] [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: 03/28/2023] [Accepted: 05/03/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Adolescents and young adults (AYAs) with cancer are at high risk of poor psychosocial outcomes, and evidence-based interventions designed to meet their psychosocial and communication needs are lacking. The main objective of this project is to test the efficacy of a new adaptation of the Promoting Resilience in Stress Management intervention for AYAs with Advanced Cancer (PRISM-AC). METHODS/DESIGN The PRISM-AC trial is a 2-arm, parallel, non-blinded, multisite, randomized controlled trial. 144 participants with advanced cancer will be enrolled and randomized to either usual, non-directive, supportive care without PRISM-AC ("control" arm) or with PRISM-AC ("experimental" arm). PRISM is a manualized, skills-based training program comprised of four 30-60 min, one-on-one sessions targeting AYA-endorsed resilience resources (stress-management, goal-setting, cognitive-reframing, and meaning-making). It also includes a facilitated family meeting and a fully equipped smartphone app. The current adaptation includes an embedded advance care planning module. English- or Spanish-speaking individuals 12-24 years old with advanced cancer (defined as progressive, recurrent, or refractory disease, or any diagnosis associated with < 50% survival) receiving care at 4 academic medical centers are eligible. Patients' caregivers are also eligible to participate in this study if they are able to speak and read English or Spanish, and are cognitively and physically able to participate. Participants in all groups complete surveys querying patient-reported outcomes at the time of enrollment and 3-, 6-, 9-, and 12-months post-enrollment. The primary outcome of interest is patient-reported health-related quality of life (HRQOL) and secondary outcomes of interest include patient anxiety, depression, resilience, hope and symptom burden, parent/caregiver anxiety, depression and health-related quality of life, and family palliative care activation. We will conduct intention-to-treat analysis to compare the group means of primary and secondary outcomes between PRISM-AC arm and control arm with regression models. DISCUSSION This study will provide methodologically rigorous data and evidence regarding a novel intervention to promote resilience and reduce distress among AYAs with advanced cancer. This research has the potential to offer a practical, skills-based curriculum designed to improve outcomes for this high-risk group. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT03668223, September 12, 2018.
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Affiliation(s)
| | - Liam Comiskey
- Seattle Children's Research Institute, Seattle, WA, USA
| | - Samantha R Scott
- Seattle Children's Research Institute, Seattle, WA, USA
- University of Denver, Denver, CO, USA
| | - Chuan Zhou
- Seattle Children's Research Institute, Seattle, WA, USA
- University of Washington, Seattle, WA, USA
| | | | | | - Abby R Rosenberg
- Dana-Farber Cancer Institute, 450 Brookline Ave, JF7, Boston, MA, 02215, USA.
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Sihvola SP, Kiwanuka F, Kvist TA. Promoting resilience among adult cancer patients: An integrative review of patient education methods. Eur J Oncol Nurs 2023; 64:102342. [PMID: 37290158 DOI: 10.1016/j.ejon.2023.102342] [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: 09/05/2022] [Revised: 04/12/2023] [Accepted: 04/29/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE To explore the essential elements of patient education methods for promoting resilience among adult cancer patients. METHODS The PubMed, Scopus, CINAHL and PsycInfo databases were searched fromJanuary 2010 to April 2021. The outcome of interest was resilience. The integrative review applied the PRISMA statement guidelines. RESULTS Nine studies were identified, which formed three main patient education strategies that fell under categories: 1. Provision of illness-related information 2. Learning self-management skills 3. Provision of emotional support and the adjustment process. The key elements include promotion of positive factors, easing patients' mental burden, highlighting the importance of illness-related information, developing self-management skills, and emotional support. Interventions prepared patients for the future, enhanced their understanding of illness and recovery process, and comfort in physical and mental aspects of life, and improved their resilience. CONCLUSIONS Resilience among cancer patients is a process that helps them adjust to live with cancer. The provision of psychosocial support and illness-related information, as well as learning self-management skills, are essential elements of patient education interventions that aim to improve resilience among adult cancer patients.
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Affiliation(s)
| | - Frank Kiwanuka
- University of Eastern Finland, Department of Nursing Science, Kuopio, Finland.
| | - Tarja Anneli Kvist
- University of Eastern Finland, Department of Nursing Science, Kuopio, Finland.
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15
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Miyamoto R(R, Ono C, Faustina K, Miyamoto K, Nakamatsu P, Lew D. Resilience among racially diverse adolescent patients with chronic orthopedic conditions. CURRENT PSYCHOLOGY 2023:1-18. [PMID: 37359616 PMCID: PMC10127162 DOI: 10.1007/s12144-023-04543-y] [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] [Accepted: 03/12/2023] [Indexed: 06/28/2023]
Abstract
The theoretical literature on resilience shows there is no consensus regarding whether resilience is an ability; interactive process involving the individual, group, and community; both ability and process; or favorable outcome. A definitive part of the research on children's resilience featured the assessment of an indicator of resilience (e.g., health-related quality of life) and involved pediatric patients with prolonged illnesses. The present study examined resilience directly as an ability and process, and related protective or risk variables, with validated instruments among adolescent patients with chronic orthopedic conditions. One-hundred fifteen adolescent patients assented (parents/legally authorized representatives consented), with 73 completing the study questionnaire. Fifteen, 47, and 10 scored low, normal, or high, respectively, on resilience-ability (one with missing data). These three groups differed significantly on the number of years living with family, individual personal skills, self-esteem, negative affect, anxiety, and depression. Resilience-ability positively correlated with number of years living with family, individual personal skills, and self-esteem, but negatively with duration of chronic orthopedic condition, negative affect, anxiety, and depression. Duration of chronic orthopedic condition negatively correlated with individual peer support among those scoring high on resilience-ability. For girls, duration of chronic orthopedic condition negatively correlated with resilience-ability, educational context, and self-esteem, but positively correlated with caregiver physical and psychological caregiving for boys. Findings underscored the consequence of resilience for these adolescent patients, with their chronic orthopedic conditions affecting daily function and life quality. Implementation of best practices to nurture and enhance their health-related resilience will promote a lifetime of well-being.
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Affiliation(s)
| | - Craig Ono
- Shriners Children’s Hawaii, 1310 Punahou Street, Honolulu, HI 96826 USA
| | - Kalani Faustina
- Shriners Children’s Hawaii, 1310 Punahou Street, Honolulu, HI 96826 USA
| | | | | | - Daphne Lew
- Washington University School of Medicine, St. Louis, 660 S Euclid Avenue, St. Louis, MO 63110 USA
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16
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van der Laan SEI, Berkelbach van der Sprenkel EE, Lenters VC, Finkenauer C, van der Ent CK, Nijhof SL. Defining and Measuring Resilience in Children with a Chronic Disease: a Scoping Review. ADVERSITY AND RESILIENCE SCIENCE 2023; 4:105-123. [PMID: 37139096 PMCID: PMC10088629 DOI: 10.1007/s42844-023-00092-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/03/2023] [Indexed: 05/05/2023]
Abstract
More than 25% of all children grow up with a chronic disease. They are at higher risk for developmental and psychosocial problems. However, children who function resiliently manage to adapt positively to these challenges. We aim to systematically review how resilience is defined and measured in children with a chronic disease. A search of PubMed, Cochrane, Embase, and PsycINFO was performed on December 9, 2022, using resilience, disease, and child/adolescent as search terms. Two reviewers independently screened articles for inclusion according to predefined criteria. Extraction domains included study characteristics, definition, and instruments assessing resilience outcomes, and resilience factors. Fifty-five out of 8766 articles were identified as relevant. In general, resilience was characterized as positive adaptation to adversity. The included studies assessed resilience by the outcomes of positive adaptation, or by resilience factors, or both. We categorized the assessed resilience outcomes into three groups: personal traits, psychosocial functioning, and disease-related outcomes. Moreover, myriad of resilience factors were measured, which were grouped into internal resilience factors (cognitive, social, and emotional competence factors), disease-related factors, and external factors (caregiver factors, social factors, and contextual factors). Our scoping review provides insight into the definitions and instruments used to measure resilience in children with a chronic disease. More knowledge is needed on which resilience factors are related to positive adaptation in specific illness-related challenges, which underlying mechanisms are responsible for this positive adaptation, and how these underlying mechanisms interact with one another. Supplementary Information The online version contains supplementary material available at 10.1007/s42844-023-00092-2.
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Affiliation(s)
- Sabine E. I. van der Laan
- Department of Pediatric Pulmonology,Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - Virissa C. Lenters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Catrin Finkenauer
- Department of Interdisciplinary Social Sciences, Utrecht University, Utrecht, The Netherlands
| | - Cornelis K. van der Ent
- Department of Pediatric Pulmonology,Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Sanne L. Nijhof
- Department of Pediatrics, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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17
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Hill DL, Boyden JY, Feudtner C. Hope in the context of life-threatening illness and the end of life. Curr Opin Psychol 2023; 49:101513. [PMID: 36481600 DOI: 10.1016/j.copsyc.2022.101513] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 11/13/2022]
Abstract
Recent research shows the importance of hope in the context of life-threatening illness and the end of life for patients and their families. While some patients and family members continue to hope for a cure or extending life, others may develop more complex hopes related to quality of life and making the most of the time left. Clinicians often worry about taking hope away with bad news about the patient's prognosis, but patients and family members often appreciate honesty without losing hope. Clinicians should recognize that hopes in the context of serious, progressive illness may be complex, contradictory, culturally based, and evolve over time. Recent interventions have been developed to support hope for these patients, caregivers, and parents.
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Affiliation(s)
- Douglas L Hill
- Justin Ingerman Center for Palliative Care, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Jackelyn Y Boyden
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Chris Feudtner
- Justin Ingerman Center for Palliative Care, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Division of General Pediatrics, Department of Pediatrics, Medical Ethics and Health Policy, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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18
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Enabling flourishing: novel approaches in palliative medicine for children with advanced kidney disease. Curr Opin Nephrol Hypertens 2023; 32:41-48. [PMID: 36250456 DOI: 10.1097/mnh.0000000000000839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Paediatric kidney disease results in considerable burden on children and their families. Paediatric palliative care is a holistic, family-centred care approach intended to enable flourishing and address the many impediments to life participation which advanced kidney disease can impose. To date, palliative care resources have been underutilized in paediatric nephrology. This review will highlight recent literature targeting the engagement and life participation of children with advanced kidney disease through implementation of novel palliative care approaches and propose directions for future research. RECENT FINDINGS Children with advanced kidney disease and their families highly value incorporation of their perspectives, particularly on life participation, within care plan development; but what it means to participate in life can be variable, and clinicians need improved tools to ascertain and incorporate these perspectives. Novel palliative care interventions developed for application in comparable disease states offer potential opportunities for paediatric nephrologists to support this goal. SUMMARY Children with advanced kidney disease and their families will benefit from incorporation of their perspectives and values, facilitated by palliative interventions.
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O'Donnell MB, Scott SR, Ellisor BM, Cao VT, Zhou C, Bradford MC, Pihoker C, DeSalvo DJ, Malik FS, Hilliard ME, Rosenberg AR, Yi-Frazier JP. Protocol for the Promoting Resilience in Stress Management (PRISM) intervention: A multi-site randomized controlled trial for adolescents with type 1 diabetes. Contemp Clin Trials 2023; 124:107017. [PMID: 36410689 PMCID: PMC9839528 DOI: 10.1016/j.cct.2022.107017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/14/2022] [Accepted: 11/16/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Adolescents with type 1 diabetes (T1D) are at high risk for elevated diabetes distress, which greatly impacts diabetes management, glycemic outcomes and overall quality of life. Developing protective skills and "resilience resources" to navigate adversity and manage diabetes distress has high potential to help adolescents with T1D achieve optimal behavioral, psychological, and health outcomes. The "Promoting Resilience in Stress Management" (PRISM) program is a manualized, brief, skills-based intervention delivered over 6 months via two 45-60 min one-on-one sessions and a family meeting with a PRISM coach, and supplemented by booster calls and a digital app. This trial (PRISM versus usual care)is designed to:: (1) assess PRISM's impact on glycemic outcomes and diabetes distress among adolescents with T1D, and (2) explor PRISM's impact on resilience, self-reported adherence, and quality of life. METHODS We describe the protocol for a multi-site randomized controlled trial designed for adolescents ages 13-18 with elevated diabetes distress. The primary trial outcomes are glycemic outcomes and diabetes distress 6 months post-randomization. Secondary outcomes include resilience, self-reported adherence, and QOL 6 months post-randomization. Our hypothesis is that youth in the PRISM group will demonstrate better glycemic outcomes and improved diabetes distress, adherence, resilience, and QOL compared to usual care. CONCLUSIONS This study will provide methodologically rigorous data and evidence regarding a novel intervention to promote resilience among adolescents with T1D and elevated diabetes distress. This research has the potential to offer a practical, skills-based curriculum designed to improve outcomes for this high-risk group. TRIAL REGISTRATION Prospectively registered at Clinicaltrials.gov (NCT03847194).
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Affiliation(s)
- Maeve B O'Donnell
- Palliative Care and Resilience Lab, Seattle Children's Research Institute, Center for Clinical & Translational Research, Seattle, WA, United States of America; University of Washington School of Medicine, Department of Pediatrics, Division of Diabetes/Endocrinology, Seattle, WA, United States of America; Cambia Palliative Care Center of Excellence, University of Washington School of Medicine, Seattle, WA, United States of America
| | - Samantha R Scott
- Palliative Care and Resilience Lab, Seattle Children's Research Institute, Center for Clinical & Translational Research, Seattle, WA, United States of America; Department of Psychology, University of Denver, Denver, CO, United States of America
| | - Britney M Ellisor
- Palliative Care and Resilience Lab, Seattle Children's Research Institute, Center for Clinical & Translational Research, Seattle, WA, United States of America
| | - Viena T Cao
- Texas Children's Hospital and Baylor College of Medicine, Department of Pediatrics, Houston, TX, United States of America
| | - Chuan Zhou
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, United States of America; University of Washington, School of Medicine, Department of Pediatrics, Division of General Pediatrics, Seattle, WA, United States of America
| | - Miranda C Bradford
- Core for Biostatistics, Epidemiology and Analytics for Research (BEAR) Core, Seattle Children's Research Institute, Seattle, WA, United States of America
| | - Catherine Pihoker
- University of Washington School of Medicine, Department of Pediatrics, Division of Diabetes/Endocrinology, Seattle, WA, United States of America
| | - Daniel J DeSalvo
- Texas Children's Hospital and Baylor College of Medicine, Department of Pediatrics, Houston, TX, United States of America
| | - Faisal S Malik
- University of Washington School of Medicine, Department of Pediatrics, Division of Diabetes/Endocrinology, Seattle, WA, United States of America; Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, United States of America
| | - Marisa E Hilliard
- Texas Children's Hospital and Baylor College of Medicine, Department of Pediatrics, Houston, TX, United States of America
| | - Abby R Rosenberg
- Palliative Care and Resilience Lab, Seattle Children's Research Institute, Center for Clinical & Translational Research, Seattle, WA, United States of America; Cambia Palliative Care Center of Excellence, University of Washington School of Medicine, Seattle, WA, United States of America
| | - Joyce P Yi-Frazier
- Palliative Care and Resilience Lab, Seattle Children's Research Institute, Center for Clinical & Translational Research, Seattle, WA, United States of America.
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20
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Abbott J, Hurley MA, Chadwick H, Peckham D. Ways of coping and survival in Cystic Fibrosis: a 20-year longitudinal study. J Cyst Fibros 2023; 22:112-118. [PMID: 35461783 DOI: 10.1016/j.jcf.2022.04.011] [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] [Received: 01/07/2022] [Revised: 03/14/2022] [Accepted: 04/11/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND The relationship between ways of coping and health outcomes has been a focus of interest for decades. There is increasing recognition that positive psychological functioning can influence health outcomes beneficially. This work investigated the role of coping in predicting survival in CF. METHODS A longitudinal observational cohort study with a 20-year follow-up period was undertaken. At entry to the study, demographic and clinical variables were recorded, and ways of coping were assessed using the Cystic Fibrosis Coping Scale which measures four distinct ways of coping: optimism, hopefulness, distraction and avoidance. Survival outcome was measured as time in days from the date of recruitment to exit from the study, where exit was either death, loss to follow-up or the end of the follow-up period. RESULTS Survival time was modelled using Cox's proportional hazards model. At baseline, 116 people with CF were recruited. By the census date, 54 people had died (14 men had died during 248,565 person-days of observation and 40 women had died during 358,372 person-days of observation). Optimism was the only way of coping that showed any beneficial effect on survival (RR=0.984, p=0.040) after adjustments for age, gender, ppFEV1 and the three other coping variables measured at baseline. CONCLUSION This work suggests that optimistic coping serves as a prognostic measure of survival in CF beyond key clinical and demographic variables. Ways of coping are modifiable, providing a target for clinical intervention; to improve quality of life and clinical outcomes and potentially increase longevity.
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Affiliation(s)
- Janice Abbott
- School of Psychology, University of Central Lancashire, Preston, PR1 2HE, UK.
| | - Margaret A Hurley
- Faculty of Health, University of Central Lancashire, Preston, PR1 2HE, UK
| | - Helen Chadwick
- Adult Cystic Fibrosis Unit, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, United Kingdom; Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, LS2 9JT, UK
| | - Daniel Peckham
- Adult Cystic Fibrosis Unit, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, United Kingdom; Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, LS2 9JT, UK
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21
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Chavan SS, Mendonca TL. Effectiveness of Psychosocial Intervention on Quality of Life of Mothers of Children with Cancer: A Feasibility Study. JOURNAL OF HEALTH AND ALLIED SCIENCES NU 2022. [DOI: 10.1055/s-0042-1758527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Abstract
Background Mothers of children with cancer are reported to experience stress more often. For children with cancer, parents are the primary source of social and emotional support, and they are also in charge of how successfully patients manage their illness. The degree of difficulty parents suffer after learning that their child has cancer significantly influences the child's psychological adjustment.
Aim The study aimed to assess the effectiveness of psychosocial intervention on quality of life (QoL) among mothers of children with cancer.
Materials and Methods Quasi-intervention study design was undertaken, and a purposive sampling technique was used to select the 60 mothers of children with cancer who were assigned randomly to the intervention and control groups. A pretested and validated self-administered questionnaire was used; the sociodemographic, WHOQOL-BREF scale with 26 items was studied.
Statistical Analysis Prevalence, demographic pro forma of mother and child was analyzed in terms of frequency, percentage, mean, and standard deviation. Two-factor repeated measures analysis of variance was used to establish the effectiveness of the psychosocial intervention on QoL. Association was done by using the chi-square test. SPSS package was used for analysis.
Results Psychosocial intervention was found to be effective in improving QoL scores in psychological health domain (p = 0.02*, p < 0.05), social relationship domain (p = 0.04*, p < 0.05), and environmental health domain (p = 0.001**, p < 0.05). A significant association was found between the physical health domain and information on cancer (p = 0.01*), psychological health domain and financial status (p = 0.03*), social relationship domain and cost of treatment (p = 0.04*), Q1 and Q2 with the place of residence (p = 0.004**, p = 0.02*), and Q2 and financial status (p = 0.03*).
Conclusion Mothers of children with cancer undergo a lot of stress and emotional turmoil and are at risk of deteriorating their QoL. Hence, they need to be provided support to address their issues. Thus, health professionals must develop and implement interventions to promote the QoL.
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Affiliation(s)
- Seema S. Chavan
- Department of Pediatric Nursing, Father Muller College of Nursing, Mangaluru, Karnataka, India
- Department of Pediatric Nursing, Laxmi Memorial College of Nursing, Mangaluru, Karnataka, India
- Rajiv Gandhi University of Health Sciences, Bengaluru, Karnataka, India
| | - Theresa L. Mendonca
- Department of Pediatric Nursing, Father Muller College of Nursing, Mangaluru, Karnataka, India
- Department of Pediatric Nursing, Laxmi Memorial College of Nursing, Mangaluru, Karnataka, India
- Rajiv Gandhi University of Health Sciences, Bengaluru, Karnataka, India
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22
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Gmuca S, Weiss PF, McGill M, Xiao R, Ward M, Nelson M, Sherry DD, Cronholm PF, Gerber JS, Palermo TM, Young JF, Rosenberg AR. The Feasibility and Acceptability of Resilience Coaching for Adolescent Chronic Musculoskeletal Pain: A Single-Arm Pilot Trial. CHILDREN 2022; 9:children9101432. [PMID: 36291374 PMCID: PMC9600525 DOI: 10.3390/children9101432] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/14/2022] [Accepted: 09/16/2022] [Indexed: 11/16/2022]
Abstract
Promoting Resilience in Stress Management (PRISM) is a well-established resilience coaching program for youth with chronic illness. It is a one-on-one intervention targeting skills in stress management, goal-setting, cognitive reframing, and meaning-making. We aimed to (i) assess the feasibility and acceptability of PRISM and (ii) explore PRISM’s impact on clinical outcomes among youth with chronic musculoskeletal pain (CMP). This was a single-arm pilot trial of PRISM for youth with CMP aged 12–17 years. Patients completed patient-reported outcome measures (PROs) pre- and post- intervention; patients and caregivers provided qualitative feedback. Twenty-seven patients were enrolled (63% enrollment rate); 82% percent were female. The patients’ median age was 16 years (IQR: 13–16). The intervention completion rate was 81% (n = 22). The mean satisfaction for PRISM overall was 4.3 (SD 0.9), while the mean acceptability of the intervention measure (AIM) was 4.4 (SD 0.89). Participants reported improved resilience (2.2 [SD 5.1]), functional disability (−3.5 [IQR: −6.0, 1.0]), and psychological distress (−1.0 [−5.0, 2.0]) from baseline to immediately post-treatment; pain intensity, pain catastrophizing, and global health were similar at both time points. Feedback was positive and suggested that a group component may be helpful. PRISM is feasible and acceptable among youth with CMP. Exploratory analyses suggest improvements in clinically relevant outcomes, warranting further investigation.
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Affiliation(s)
- Sabrina Gmuca
- Department of Pediatrics, Division of Rheumatology, Children’s Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, 11-121, Philadelphia, PA 19146, USA
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA 19146, USA
- PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA 19146, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Palliative Care and Resilience Program, Seattle Children’s Research Institute, Seattle, WA 98145, USA
- Correspondence: ; Tel.: +1-(718)-614-5251 or +1-(215)-590-2547; Fax: +1-(215)-590-4750
| | - Pamela F. Weiss
- Department of Pediatrics, Division of Rheumatology, Children’s Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, 11-121, Philadelphia, PA 19146, USA
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA 19146, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Mackenzie McGill
- Department of Pediatrics, Division of Rheumatology, Children’s Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, 11-121, Philadelphia, PA 19146, USA
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA 19146, USA
- PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA 19146, USA
| | - Rui Xiao
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA 19146, USA
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Michaela Ward
- Mixed Methods Research Lab, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Maria Nelson
- Mixed Methods Research Lab, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - David D. Sherry
- Department of Pediatrics, Division of Rheumatology, Children’s Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, 11-121, Philadelphia, PA 19146, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Peter F. Cronholm
- Mixed Methods Research Lab, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Family Medicine and Community Health, Center for Public Health Initiatives, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Jeffrey S. Gerber
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA 19146, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Pediatrics, Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, PA 19146, USA
| | - Tonya M. Palermo
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Jami F. Young
- PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA 19146, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, Seattle, WA 98145, USA
- Department of Child and Adolescent Psychiatry and Behavioral Services, Children’s Hospital of Philadelphia, Philadelphia, PA 19146, USA
| | - Abby R. Rosenberg
- Palliative Care and Resilience Program, Seattle Children’s Research Institute, Seattle, WA 98145, USA
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA 98104, USA
- Department of Pediatrics, Division of Hematology/Oncology, University of Washington School of Medicine, Seattle, WA 98195, USA
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23
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Steineck A, Bradford MC, O'Daffer A, Fladeboe KM, O'Donnell MB, Scott S, Yi-Frazier JP, Rosenberg AR. Quality of Life in Adolescents and Young Adults: The Role of Symptom Burden. J Pain Symptom Manage 2022; 64:244-253.e2. [PMID: 35649460 PMCID: PMC9378571 DOI: 10.1016/j.jpainsymman.2022.05.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/21/2022] [Accepted: 05/24/2022] [Indexed: 11/23/2022]
Abstract
CONTEXT Adolescents and young adults (AYAs) with cancer report worse health-related quality of life (HRQOL) than other age groups. Symptom burden is a modifiable predictor of HRQOL. OBJECTIVES The objective of this study was to identify which symptoms are most burdensome to AYAs with advanced cancer. METHODS In this observational study, English-speaking individuals aged 12-25 years undergoing treatment for advanced cancer completed assessments of symptom burden (Memorial Symptom Assessment Scale) and HRQOL (Pediatric Quality of Life Inventory Generic Form and Cancer Module; minimal clinically important difference 4.4). We dichotomized participants as having low (<7) or high (≥7) symptom prevalence. Mixed regression models estimated HRQOL differences between groups. For individual symptoms, unadjusted mixed models estimated HRQOL reductions. RESULTS N = 58 AYAs completed baseline surveys. The median age was 17 years (IQR 15-19), 58% were male, 59% identified as white, and 44% were diagnosed with leukemia/lymphoma. High symptom prevalence was associated with a mean generic HRQOL 7 points lower (95% CI: -11, -3; P < 0.01) and cancer-specific HRQOL score 12 points lower (95% CI: -17, -7; P < 0.01) than low symptom prevalence. The most prevalent symptoms were fatigue (71%), pain (58%), and difficulty sleeping (58%). Fatigue (-8), difficulty concentrating (-7), and mouth sores (-6) were associated with the greatest generic HRQOL score reductions. Dysphagia (-12), difficulty concentrating (-12), and sadness (-11) were associated with the greatest cancer-specific HRQOL score reductions. CONCLUSION The symptom experience among AYAs with advanced cancer is unique. Separate evaluation of AYA's symptoms may optimize management and improve HRQOL.
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Affiliation(s)
- Angela Steineck
- Seattle Children's Hospital (A.S.), Cancer and Blood Disorders Center, Seattle, Washington, USA; Seattle Children's Research Institute (A.S., A.O., K.M.F., M.B.O., J.P.Y-F., A.R.R.), Center for Clinical and Translational Research, Seattle, Washington, USA; University of Washington School of Medicine (A.S.), Department of Pediatrics, Seattle, Washington, USA; University of Washington (A.S., K.M.F., M.B.O., A.R.R.), Cambia Palliative Care Center of Excellence, Seattle, Washington, USA; MACC Fund Center for Cancer and Blood Disorders (A.S.), Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Miranda C Bradford
- Core for Biostatistics (M.C.B.), Epidemiology, and Analytics in Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Alison O'Daffer
- Seattle Children's Research Institute (A.S., A.O., K.M.F., M.B.O., J.P.Y-F., A.R.R.), Center for Clinical and Translational Research, Seattle, Washington, USA
| | - Kaitlyn M Fladeboe
- Seattle Children's Research Institute (A.S., A.O., K.M.F., M.B.O., J.P.Y-F., A.R.R.), Center for Clinical and Translational Research, Seattle, Washington, USA; University of Washington (A.S., K.M.F., M.B.O., A.R.R.), Cambia Palliative Care Center of Excellence, Seattle, Washington, USA
| | - Maeve B O'Donnell
- Seattle Children's Research Institute (A.S., A.O., K.M.F., M.B.O., J.P.Y-F., A.R.R.), Center for Clinical and Translational Research, Seattle, Washington, USA; University of Washington (A.S., K.M.F., M.B.O., A.R.R.), Cambia Palliative Care Center of Excellence, Seattle, Washington, USA
| | - Samantha Scott
- Department of Psychology (S.S.), University of Denver, Denver, Colorado, USA
| | - Joyce P Yi-Frazier
- Seattle Children's Research Institute (A.S., A.O., K.M.F., M.B.O., J.P.Y-F., A.R.R.), Center for Clinical and Translational Research, Seattle, Washington, USA
| | - Abby R Rosenberg
- Seattle Children's Hospital (A.S.), Cancer and Blood Disorders Center, Seattle, Washington, USA; Seattle Children's Research Institute (A.S., A.O., K.M.F., M.B.O., J.P.Y-F., A.R.R.), Center for Clinical and Translational Research, Seattle, Washington, USA; University of Washington School of Medicine (A.S.), Department of Pediatrics, Seattle, Washington, USA; University of Washington (A.S., K.M.F., M.B.O., A.R.R.), Cambia Palliative Care Center of Excellence, Seattle, Washington, USA.
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24
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Yi-Frazier JP, O’Donnell MB, Adhikari EA, Zhou C, Bradford MC, Garcia-Perez S, Shipman KJ, Hurtado SE, Junkins CC, O’Daffer A, Rosenberg AR. Assessment of Resilience Training for Hospital Employees in the Era of COVID-19. JAMA Netw Open 2022; 5:e2220677. [PMID: 35796151 PMCID: PMC9250051 DOI: 10.1001/jamanetworkopen.2022.20677] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IMPORTANCE Health care workers face serious mental health challenges as a result of ongoing work stress. The COVID-19 pandemic exacerbated that stress, resulting in high rates of anxiety, depression, and burnout. To date, few evidence-based programs targeting mental health outcomes in health care workers have been described. OBJECTIVE To assess the feasibility, acceptability, and preliminary outcomes of a skills-based coaching program designed to reduce stress and build resilience. DESIGN, SETTING, AND PARTICIPANTS A pilot cohort study was conducted between September 2020 and April 2021 using preprogram and postprogram assessments and a mixed-methods analysis. Duration of follow-up was 7 weeks. The coaching program was delivered via video conferencing. Participants were health care workers and staff from a large urban health system. INTERVENTION The Promoting Resilience in Stress Management (PRISM) program, a manualized, skills-based coaching program originally developed for adolescents and young adults with serious/chronic illness, was adapted to support health care workers and staff ("PRISM at Work"). It included 6 weekly 1-hour group sessions. MAIN OUTCOMES AND MEASURES Feasibility was defined a priori as 70% completion rates. Acceptability was defined quantitatively (satisfaction scores) and qualitatively (open-ended questions regarding experience with program). Preliminary outcomes were assessed with preprogram and post program assessments of self-reported resilience, stress, anxiety, and burnout using validated instruments. Descriptive statistics summarized demographic variables and feasibility and acceptability. Linear mixed effects regression models examined preliminary outcomes, controlling for relevant covariates. RESULTS A total of 153 participants (median [SD] age, 40.6 [10.1] years; 142 [92%] were female; 128 [84%] identified as having White race; 81 [53%] were in patient-facing roles) enrolled. Of the 132 health care workers who provided follow-up surveys, 120 (91%) had completed the program, and 116 (88%) reported being satisfied. Answers to open-ended questions suggested that participants wanted more PRISM either with longer or additional sessions. Participant-reported resilience (β = 1.74; 95% CI, 1.00-2.48), stress (β = -2.40; 95% CI, -3.28 to -1.51), anxiety (β = -2.04; 95% CI, -2.74 to -1.34), and burnout-exhaustion (β = -0.37; 95% CI, -0.56 to -0.18) improved after the program. CONCLUSIONS AND RELEVANCE Results of this study suggest that PRISM at Work may have utility for health care workers and staff in that the program was found to be feasible, acceptable, and associated with improved outcomes.
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Affiliation(s)
- Joyce P. Yi-Frazier
- Palliative Care and Resilience Lab, Seattle Children’s Research Institute, Seattle, Washington
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle
| | - Maeve B. O’Donnell
- Palliative Care and Resilience Lab, Seattle Children’s Research Institute, Seattle, Washington
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle
| | - Elizabeth A. Adhikari
- Palliative Care and Resilience Lab, Seattle Children’s Research Institute, Seattle, Washington
| | - Chuan Zhou
- Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, Washington
- Division of General Pediatrics, Department of Pediatrics, University of Washington School of Medicine, Seattle
| | - Miranda C. Bradford
- Palliative Care and Resilience Lab, Seattle Children’s Research Institute, Seattle, Washington
- Biostatistics, Epidemiology, and Analytics in Research Program, Seattle Children’s Research Institute, Seattle, Washington
| | - Samantha Garcia-Perez
- Palliative Care and Resilience Lab, Seattle Children’s Research Institute, Seattle, Washington
| | - Kelly J. Shipman
- Palliative Care and Resilience Lab, Seattle Children’s Research Institute, Seattle, Washington
| | - Samantha E. Hurtado
- Palliative Care and Resilience Lab, Seattle Children’s Research Institute, Seattle, Washington
| | - Courtney C. Junkins
- Palliative Care and Resilience Lab, Seattle Children’s Research Institute, Seattle, Washington
| | - Alison O’Daffer
- Palliative Care and Resilience Lab, Seattle Children’s Research Institute, Seattle, Washington
| | - Abby R. Rosenberg
- Palliative Care and Resilience Lab, Seattle Children’s Research Institute, Seattle, Washington
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle
- Division of Hematology/Oncology, Department of Pediatrics, University of Washington School of Medicine, Seattle
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25
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Rea KE, Cousino MK. Commentary: Posttraumatic Growth Following Pediatric Solid Organ Transplantation: Making Meaning Out of the Gift of Life. J Pediatr Psychol 2022; 47:978-980. [PMID: 35768960 PMCID: PMC9801703 DOI: 10.1093/jpepsy/jsac060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 06/10/2022] [Accepted: 06/10/2022] [Indexed: 01/07/2023] Open
Affiliation(s)
- Kelly E Rea
- All correspondence concerning this article should be addressed to Kelly E. Rea, MS, Department of Psychology, University of Georgia, 125 Baldwin Street, Athens, GA 30602, USA. E-mail:
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26
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Scott SR, O’Donnell M, Manczak EM, Fladeboe K, Ellisor B, Rosenberg AR, Malik FS, Yi-Frazier JP. Resilience and Diabetes Distress at 3 Months Following Diagnosis Predict A1C Trajectories in Youth With Type 1 Diabetes: An Argument for Early Intervention. J Pediatr Psychol 2022; 47:1125-1134. [PMID: 35689646 PMCID: PMC9801710 DOI: 10.1093/jpepsy/jsac046] [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: 09/24/2021] [Revised: 05/02/2022] [Accepted: 05/04/2022] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE Youth and adolescents with type 1 diabetes (T1D) are at risk for poor health outcomes. Understanding if psychological factors shortly following diagnosis, such as diabetes distress and resilience, predict glycated hemoglobin (A1C) trajectories may help inform both optimal timing and content of psychosocial interventions for youth with T1D. METHODS Youth and adolescents (N = 34) with newly diagnosed T1D completed distress and resilience measures at baseline and 3 months following diagnosis. Using multilevel modeling, we predicted A1C trajectories up to 3 years following diagnosis. RESULTS We found that in separate models, higher 3-month diabetes distress and lower 3-month resilience predicted larger increases in A1C years 1-3 following diagnosis. CONCLUSIONS Our findings suggest that targeting resilience and diabetes distress within 3 months following diagnosis has implications for the yearly rate of A1C increase up to 3 years later.
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Affiliation(s)
- Samantha R Scott
- Department of Psychology, University of Denver, USA,Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children’s Research Institute, USA
| | - Maeve O’Donnell
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children’s Research Institute, USA
| | | | - Kaitlyn Fladeboe
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children’s Research Institute, USA
| | - Britney Ellisor
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children’s Research Institute, USA
| | - Abby R Rosenberg
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children’s Research Institute, USA,Department of Pediatrics, University of Washington School of Medicine, USA,Fred Hutchinson Cancer Research Center, USA
| | - Faisal S Malik
- Department of Pediatrics, University of Washington School of Medicine, USA
| | - Joyce P Yi-Frazier
- All correspondence concerning this article should be addressed to Joyce P. Yi-Frazier, PhD, Palliative Care and Resilience Research Lab, Seattle Children’s Research Institute, 1920 Terry Ave, Cure 4, Seattle, WA 98101, USA. E-mail:
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27
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Fladeboe KM, Scott S, Comiskey L, Zhou C, Yi-Frazier JP, Rosenberg AR. The Promoting Resilience in Stress Management (PRISM) intervention for adolescents and young adults receiving hematopoietic cell transplantation: a randomized controlled trial protocol. BMC Palliat Care 2022; 21:82. [PMID: 35585525 PMCID: PMC9117082 DOI: 10.1186/s12904-022-00966-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 05/04/2022] [Indexed: 11/14/2022] Open
Abstract
Background Psychological distress is prevalent among adolescents and young adults (AYAs) receiving hematopoietic cell transplantation (HCT). The Promoting Resilience in Stress Management (PRISM) intervention is a resilience-coaching program that has been shown to mitigate distress and improve quality of life among AYAs receiving chemotherapy for newly diagnosed or advanced cancer. This article describes the protocol of an ongoing randomized-controlled trial (RCT) examining the efficacy of PRISM among AYAs receiving HCT for cancer and/or blood disorders. Methods/design The goal of this multi-site, parallel, RCT is to evaluate the effect of PRISM compared to psychosocial usual care (UC) among AYAs receiving HCT. Our primary hypothesis is that AYAs who receive PRISM will report lower depression and anxiety 6-months following enrollment compared to those who receive UC. The PRISM program includes four scripted coaching sessions targeting skills in stress-management, goal setting, cognitive-restructuring, and meaning-making, followed by a facilitated family meeting. Sessions are delivered one on one, 1–2 weeks apart, in-person or via videoconference. We aim to recruit 90 AYAs from 4 US pediatric AYA oncology centers. Eligible AYAs are aged 12–24 years; receiving HCT for malignancy or a bone marrow failure syndrome associated with cancer predisposition; < 4 weeks from their HCT date; able to speak English and read in English or Spanish; and cognitively able to complete sessions. Enrolled AYAs are randomized 1:1 within each site to receive PRISM+UC or UC alone. AYAs on both study-arms complete patient-reported outcome surveys at baseline, 3- and 6-months. Age-valid instruments assess depression and anxiety, overall and cancer-specific health-related quality of life, symptom burden, resilience, and hope. Covariate-adjusted regression models will compare AYA-reported depression and anxiety at 6-months in the PRISM versus UC groups. Secondary and exploratory objectives include assessments of PRISM’s cost-effectiveness and its impact on (i) parent and caregiver quality of life and mental health, (ii) pharmaco-adherence to oral graft-versus-host disease (GVHD) prophylaxis, (iii) biologic outcomes such as transplant engraftment and graft-versus-host disease, and (iv) biomarkers of stress such as heart rate variability and the Conserved Transcriptional Response to Adversity (CTRA) gene expression profile. Discussion If successful, this study has the potential to address a critical gap in whole-patient care for AYAs receiving HCT. Trial registration ClinicalTrials.gov Identifier NCT03640325, August 21, 2018.
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Affiliation(s)
- Kaitlyn M Fladeboe
- Department of Pediatrics, Division of Hematology/Oncology, University of Washington School of Medicine, Seattle, WA, USA.,Palliative Care and Resilience Lab, Center for Clinical & Translational Research, Seattle Children's Research Institute, M/S CURE-4, PO Box 5371, Seattle, WA, 98145-5005, USA
| | - Samantha Scott
- Palliative Care and Resilience Lab, Center for Clinical & Translational Research, Seattle Children's Research Institute, M/S CURE-4, PO Box 5371, Seattle, WA, 98145-5005, USA.,Department of Psychology, University of Denver, Denver, CO, USA
| | - Liam Comiskey
- Palliative Care and Resilience Lab, Center for Clinical & Translational Research, Seattle Children's Research Institute, M/S CURE-4, PO Box 5371, Seattle, WA, 98145-5005, USA
| | - Chuan Zhou
- Department of Pediatrics, Division of General Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.,Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Joyce P Yi-Frazier
- Palliative Care and Resilience Lab, Center for Clinical & Translational Research, Seattle Children's Research Institute, M/S CURE-4, PO Box 5371, Seattle, WA, 98145-5005, USA
| | - Abby R Rosenberg
- Department of Pediatrics, Division of Hematology/Oncology, University of Washington School of Medicine, Seattle, WA, USA. .,Palliative Care and Resilience Lab, Center for Clinical & Translational Research, Seattle Children's Research Institute, M/S CURE-4, PO Box 5371, Seattle, WA, 98145-5005, USA. .,Cambia Palliative Care Center of Excellence, University of Washington School of Medicine, Seattle, WA, USA.
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State of the science and future research directions in palliative and end-of-life care in paediatric cardiology: a report from the Harvard Radcliffe Accelerator Workshop. Cardiol Young 2022; 32:431-436. [PMID: 34162454 PMCID: PMC8702572 DOI: 10.1017/s104795112100233x] [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] [Indexed: 12/14/2022]
Abstract
Workshop proceedings, priorities, and recommendations from the "State of the Science and Future Directions in Palliative and End-of-Life Care in Pediatric Cardiology," a Harvard Radcliffe Accelerator Workshop, are detailed. Eight priorities for research were identified, including patient and family decision making, communication, patient and family experience, patient symptom measurement and management, training and curriculum development, teamwork, family hardships and bereavement, and ethical considerations. Barriers to research in this area were also identified: lack of outcome/measurement tools, lack of research funding, small population sizes, lack of effort/protected time for research, undervalued research topic by field and colleagues, and heterogeneous research participant diversity. Priorities and barriers were mostly consistent with those reported by the field of paediatric palliative care at large. These collective, consensus-based findings from diverse, multidisciplinary leaders in the field, as well as parent representatives, provide a catalyst for scientific advancement specific to paediatric and end-of-life care in paediatric cardiology.
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Psychosocial Distress Due to Interference of Normal Developmental Milestones in AYAs with Cancer. CHILDREN 2022; 9:children9030309. [PMID: 35327680 PMCID: PMC8947616 DOI: 10.3390/children9030309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/18/2022] [Accepted: 02/19/2022] [Indexed: 01/19/2023]
Abstract
Cancer in the adolescent and young adult phase poses additional challenges to this period of development that is crucial to the transition to independence. This report provides a brief review of normal developmental milestones in this age range while highlighting the disruptive effects of cancer. We focus on the psychological burden of cancer in patients aged 15–39 years and explore the application of the total pain model to highlight the psychological/emotional, social, and spiritual aspects of non-physical pain. We also briefly review posttraumatic growth and resilience. Lastly, we provide a review of areas for possible development and future research.
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30
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O’Donnell MB, Hilliard ME, Cao VT, Bradford MC, Barton KS, Hurtado S, Duran B, Perez SG, Rahman KS, Scott S, Malik FS, DeSalvo DJ, Pihoker C, Zhou C, Rosenberg AR, Yi-Frazier JP. “It Just Kind of Feels Like a Different World Now:” Stress and Resilience for Adolescents With Type 1 Diabetes in the Era of COVID-19. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2022; 3:835739. [PMID: 36992786 PMCID: PMC10012077 DOI: 10.3389/fcdhc.2022.835739] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 01/24/2022] [Indexed: 12/16/2022]
Abstract
PurposeThe COVID-19 pandemic has been a major stressor for adolescents. Given the unique implications of the pandemic for youth with type 1 diabetes (T1D), who already navigate multiple stressors as a function of their chronic condition, we aimed to describe the impact of the pandemic on adolescents with T1D and describe their coping strategies and resilience resources.Research MethodIn a 2-site (Seattle WA, Houston TX) clinical trial of a psychosocial intervention targeting stress/resilience, adolescents 13-18 years old with T1D ≥ 1 year and elevated diabetes distress were enrolled August 2020 – June 2021. Participants completed a baseline survey about the pandemic, including open-ended questions about the effects of the pandemic, what was helping them navigate, and how it impacted T1D management. Hemoglobin A1c (A1c) was extracted from clinical records. Free text responses were analyzed using an inductive content approach. Survey responses and A1c were summarized using descriptive statistics and associations were assessed by Chi-squared tests.ResultsAdolescents (n=122) were 56% female. 11% of adolescents reported diagnosis of COVID-19 and 12% had a family member/other important person die from COVID-19 complications. Adolescents described Social Relationships, Personal Health/Safety Practices, Mental Health, Family Relationships, and School to be primary areas affected by COVID-19. Helpful resources included: Learned Skills/Behaviors, Social Support/Community, and Meaning-Making/Faith. Among participants indicating that the pandemic had an impact on their T1D management (n=35), the most commonly described areas were: Food, Self-Care, Health/Safety, Diabetes Appointments, and Exercise. Compared to adolescents who reported minimal difficulty managing T1D during the pandemic (71%), those reporting moderate to extreme difficulty (29%) were more likely to have A1C ≥ 8% (80% vs. 43%, p<.01).ConclusionsResults underscore the pervasive impact of COVID-19 on teens with T1D across multiple major life domains. Their coping strategies aligned with stress, coping, and resilience theories and suggest resilient responses in the face of stress. Despite experiencing pandemic-related stressors in many areas, diabetes-related functioning was relatively protected for most teens, highlighting their diabetes-specific resilience. Discussing the pandemic impact on T1D management may be an important focus for clinicians, especially for adolescents with diabetes distress and above-target A1C.
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Affiliation(s)
- Maeve B. O’Donnell
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, WA, United States
- Department of Pediatrics, Division of Diabetes/Endocrinology, University of Washington School of Medicine, Seattle, WA, United States
- Cambia Palliative Care Center of Excellence, University of Washington School of Medicine, Seattle, WA, United States
| | - Marisa E. Hilliard
- Department of Pediatrics, Texas Children’s Hospital and Baylor College of Medicine, Houston, TX, United States
| | - Viena T. Cao
- Department of Pediatrics, Texas Children’s Hospital and Baylor College of Medicine, Houston, TX, United States
| | - Miranda C. Bradford
- Core for Biostatistics, Epidemiology and Analytics for Research (BEAR) Core, Seattle Children’s Research Institute, Seattle, WA, United States
| | - Krysta S. Barton
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, WA, United States
- Core for Biostatistics, Epidemiology and Analytics for Research (BEAR) Core, Seattle Children’s Research Institute, Seattle, WA, United States
| | - Samantha Hurtado
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, WA, United States
| | - Brenda Duran
- Department of Pediatrics, Texas Children’s Hospital and Baylor College of Medicine, Houston, TX, United States
| | - Samantha Garcia Perez
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, WA, United States
| | - Kiswa S. Rahman
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, WA, United States
| | - Samantha Scott
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, WA, United States
- Department of Psychology, University of Denver, Denver, CO, United States
| | - Faisal S. Malik
- Department of Pediatrics, Division of Diabetes/Endocrinology, University of Washington School of Medicine, Seattle, WA, United States
- Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, WA, United States
| | - Daniel J. DeSalvo
- Department of Pediatrics, Texas Children’s Hospital and Baylor College of Medicine, Houston, TX, United States
| | - Catherine Pihoker
- Department of Pediatrics, Division of Diabetes/Endocrinology, University of Washington School of Medicine, Seattle, WA, United States
| | - Chuan Zhou
- Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, WA, United States
- Department of Pediatrics, Division of General Pediatrics, School of Medicine, University of Washington, Seattle, WA, United States
| | - Abby R. Rosenberg
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, WA, United States
- Cambia Palliative Care Center of Excellence, University of Washington School of Medicine, Seattle, WA, United States
| | - Joyce P. Yi-Frazier
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, WA, United States
- *Correspondence: Joyce P. Yi-Frazier,
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Hill RM, Gallagher KAS, Eshtehardi SS, Uysal S, Hilliard ME. Suicide Risk in Youth and Young Adults with Type 1 Diabetes: a Review of the Literature and Clinical Recommendations for Prevention. Curr Diab Rep 2021; 21:51. [PMID: 34902071 PMCID: PMC8666467 DOI: 10.1007/s11892-021-01427-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/28/2021] [Indexed: 10/30/2022]
Abstract
PURPOSE OF REVIEW The manuscript reviews the extant literature on suicide-related thoughts and behaviors among youth and young adults with pediatric diabetes. This evidence is presented within the context of current theories of the etiology of suicidal behavior to highlight how diabetes may contribute to suicide risk, and to support providers in understanding the interplay between pediatric diabetes and suicide risk. The manuscript also reviews evidence-based approaches to suicide prevention suitable for use in pediatric healthcare settings, with suggestions for their application to this unique population. RECENT FINDINGS Several recent studies identify heightened rates of suicidal ideation, suicide attempts, and suicide among youth and young adults with pediatric diabetes, as compared with their peers without diabetes. Evidence-based suicide prevention approaches frequently emphasize the importance of reducing suicidal youths' access to potentially lethal means for suicidal behavior. This approach may require special considerations for youth with pediatric diabetes, due to their need to carry sufficient quantities of insulin and the dangers of inaccurate insulin dosing and/or overdose. Suggestions for suicide prevention for this population include risk screening as part of routine diabetes care, early prevention, education for youth and families, and provider awareness of risk factors, warning signs, and implications for diabetes care. Youth and young adults with diabetes reported elevated rates of suicide-related behaviors as compared with their peers without diabetes. Existing suicide prevention approaches may require substantial adaptation for use with youth and young adults with diabetes. Further research is needed to examine how to best prevent suicidal behaviors among this population.
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Affiliation(s)
- Ryan M Hill
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
- College for Health, Community and Policy, University of Texas at San Antonio, San Antonio, TX, USA
| | - Katherine A S Gallagher
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Sahar S Eshtehardi
- Department of Psychological, Health, & Learning Sciences, University of Houston, Houston, TX, USA
| | - Serife Uysal
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Marisa E Hilliard
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
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Wilson B, Weeks L, Morris P, Innocente S, Rothfus M. Coping experiences of young adults diagnosed with a chronic illness: a qualitative systematic review protocol. JBI Evid Synth 2021; 19:3315-3323. [PMID: 34410231 DOI: 10.11124/jbies-21-00017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The objective of this review is to gain insight about the experience of emerging adults who are coping with a chronic illness diagnosis. INTRODUCTION Receiving a chronic illness diagnosis is filled with challenges and changes to a person's life. Coping is not an easy or linear process, and is particularly complex for emerging adults. The emerging adult stage is important to consider, as this is a stage characterized by identity exploration, transition to adulthood, and future planning. A chronic illness diagnosis interrupts these processes and affects the coping process in emerging adults. INCLUSION CRITERIA The population included will be persons between 18 and 25 years of age living in the community. Sources will focus on the experience of being diagnosed with a chronic illness, including its impacts on the individual's life. METHODS This qualitative review will be conducted following JBI qualitative review methodology. An initial search was conducted in order to identify relevant articles on the topic. Databases to be searched include CINAHL, PubMed, PsycINFO, and Nursing and Allied Health Database. A gray literature search will also be conducted. There will be no date or language limits on the search. The titles and abstracts will be screened by two independent reviewers, followed by an assessment of the full-text articles. Any disagreements will be resolved through discussion or in consultation with a third reviewer. Critical appraisal of included articles and data extraction will be conducted independently by two reviewers. Meta-aggregation of the articles will be completed and textually pooled in tabular format. Where that is not possible, results will be presented in a narrative format. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42021224772.
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Affiliation(s)
- Beth Wilson
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada.,Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, Halifax, NS, Canada
| | - Lori Weeks
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada.,Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, Halifax, NS, Canada
| | - Patricia Morris
- Faculty of Nursing, University of New Brunswick, Saint John, NB, Canada
| | - Sarah Innocente
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Melissa Rothfus
- Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, Halifax, NS, Canada.,WK Kellogg Health Sciences Library, Dalhousie University, Halifax, NS, Canada
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Rosenberg AR, Zhou C, Bradford MC, Salsman JM, Sexton K, O’Daffer A, Yi-Frazier JP. Assessment of the Promoting Resilience in Stress Management Intervention for Adolescent and Young Adult Survivors of Cancer at 2 Years: Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2136039. [PMID: 34817581 PMCID: PMC8613597 DOI: 10.1001/jamanetworkopen.2021.36039] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Adolescents and young adults (AYAs) with cancer have a high risk of poor psychosocial outcomes. The Promoting Resilience in Stress Management (PRISM) intervention is one of few psychosocial interventions targeting younger people with cancer that has demonstrated efficacy in a randomized clinical trial. OBJECTIVE To explore 2-year trajectories of patient-reported well-being among AYA cancer survivors. The hypothesis was that AYAs who initially responded to PRISM would report sustained positive changes. DESIGN, SETTING, AND PARTICIPANTS This secondary analysis of data from a single-center, parallel, phase 2 randomized clinical trial was conducted from January 2015 to October 2016. Eligible participants were English-speaking AYAs between ages 13 and 25 years with cancer treated at a single, quaternary children's hospital in the US. Participants were randomly assigned (1:1) to PRISM or usual care. Data were analyzed between March 2021 and June 2021. INTERVENTION PRISM is a brief, skills-based coaching program targeting 4 resilience resources (stress management, goal setting, cognitive reframing, and meaning making). MAIN OUTCOMES AND MEASURES Patient-reported cancer-related quality of life (QoL) (PedsQL scale), hope (Hope scale), resilience (Connor-Davidson Resilience scale), and psychological distress (Kessler-6 scale) were collected at baseline, 6, 12, and 24 months. Data from AYAs who remained alive at 24 months were analyzed. Improvement was defined as a positive change in instrument scores between baseline and 6 months (ie, the end of the PRISM program) and used linear mixed effects regression to assess changes over time. RESULTS A total of 57 AYAs were included in analysis at 24 months (62% of 92 randomized). Twenty-six participants (46%) were female; 36 (63%) were between ages 13 and 17 years; and 20 (35%) identified as part of a racial or ethnic minority group (4 [7%] Asian, 11 [19%] Hispanic or Latino, 16 [28%] mixed race or other). PRISM was associated with improved QoL, hope, resilience, and distress between baseline and 6 months, and these associations were sustained for QoL over 12 months (β = 7.4; 95% CI, 0.8 to 14; P = .03) and hope throughout the study period (12 months: β = 6.2; 95% CI, 2.7 to 9.6; P < .001; 24 months: β = 4.6; 95% CI, 1 to 8.3; P = .01). Of those whose scores improved between baseline and 6 months, PRISM participants more commonly reported sustained improvements in QoL (16 of 21 participants [76%] vs 8 of 17 [47%]), hope (14 of 24 participants [58%] vs 6 of 14 [43%]), resilience (9 of 18 participants [50%] vs 4 of 14 [29%]), and distress (14 of 19 participants [74%] vs 6 of 19 [32%]) at 24 months compared with usual care. CONCLUSIONS AND RELEVANCE These results suggest that PRISM was associated with sustained improvements in psychosocial outcomes as reported by adolescents and young adults. Those who responded to PRISM in the first 6 months reported continued well-being 2 years later. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02340884.
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Affiliation(s)
- Abby R. Rosenberg
- Palliative Care and Resilience Lab, Seattle Children’s Research Institute, Seattle, Washington
- Division of Hematology/Oncology, Department of Pediatrics, University of Washington School of Medicine, Seattle
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle
| | - Chuan Zhou
- Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, Washington
- Division of General Pediatrics, Department of Pediatrics, University of Washington School of Medicine, Seattle
| | - Miranda C. Bradford
- Palliative Care and Resilience Lab, Seattle Children’s Research Institute, Seattle, Washington
- Biostatistics, Epidemiology, and Analytics in Research Program, Seattle Children’s Research Institute, Seattle, Washington
| | - John M. Salsman
- Wake Forest School of Medicine and Wake Forest Baptist Comprehensive Cancer Center, Winston Salem, North Carolina
| | - Katie Sexton
- Department of Medical Education, University of Washington School of Medicine, Seattle
| | - Alison O’Daffer
- Palliative Care and Resilience Lab, Seattle Children’s Research Institute, Seattle, Washington
| | - Joyce P. Yi-Frazier
- Palliative Care and Resilience Lab, Seattle Children’s Research Institute, Seattle, Washington
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle
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The biology of stress in cancer: Applying the biobehavioral framework to adolescent and young adult oncology research. Brain Behav Immun Health 2021; 17:100321. [PMID: 34589815 PMCID: PMC8474169 DOI: 10.1016/j.bbih.2021.100321] [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: 05/12/2021] [Revised: 07/28/2021] [Accepted: 08/07/2021] [Indexed: 12/19/2022] Open
Abstract
The stress response influences the development and trajectory of cancer through a host of complex neuroimmune mechanisms. Basic, translational, and clinical research has elucidated these biobehavioral connections and offers a new paradigm for scientific investigation and patient care. Using a biobehavioral approach could offer new diagnostic and therapeutic opportunities in oncology, and this approach will be particularly impactful for adolescent and young adult (AYA) patients with cancer. To date, nearly all biobehavioral oncology research has been done in the adult population. And yet, AYAs have traditionally poorer mental health and cancer-related outcomes, and thus represent a population that could benefit from parallel psychosocial and biomedical intervention. Future biobehavioral work in oncology should focus on the AYA population, integrating new cancer therapies and technology into the next generation of research. Translational research efforts are clarifying the role of stress in cancer biology and patient outcomes. AYAs have poorer cancer-related and mental health outcomes, but nearly all biobehavioral oncology studies are in adults. Future work in immunotherapy, digital health technology, and interdisciplinary cooperation will advance the field. A translational biobehavioral approach brings the paradigm of precision medicine to psychosocial care in cancer.
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Lidington E, Vlooswijk C, Stallard K, Travis E, Younger E, Edwards P, Nandhabalan M, Hunter N, Sarpal N, Flett D, Din A, Starling N, Larkin J, Stanway S, Nobbenhuis M, Banerjee S, Szucs Z, Darlington AS, Gonzalez M, Sirohi B, van der Graaf WTA, Husson O. 'This is not part of my life plan': A qualitative study on the psychosocial experiences and practical challenges in young adults with cancer age 25 to 39 years at diagnosis. Eur J Cancer Care (Engl) 2021; 30:e13458. [PMID: 33942418 DOI: 10.1111/ecc.13458] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 02/18/2021] [Accepted: 04/12/2021] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Adolescents and young adults with cancer face unique psychosocial and practical issues. However, patients across this group encounter different life experiences, cancer diagnoses and treatment settings given the tailored services for patients ages 15 to 24. Here, we qualitatively explore the psychosocial experiences and practical challenges of young adults (YAs) with cancer diagnosed between ages 25 and 39 in the United Kingdom. METHODS We invited YAs diagnosed with cancer in the 5 years prior to enrolment at participating sites to take part in semi-structured interviews or focus groups. Transcripts were analysed using inductive thematic analysis. Two YA patients reviewed the results to ensure robustness. RESULTS Sixty-five YAs with varied diagnoses participated. Participants struggled to balance work, childcare and financial solvency with treatment. The halt in family and work life as well as changes in image and ability threatened participants' identity and perceived 'normality' as a YA, however, these also stimulated positive changes. YAs experienced social isolation from friends and family, including children. Many struggled to cope with uncertainty around treatment outcomes and disease recurrence. CONCLUSION The disruption of family and work life can lead to age-specific issues in YAs diagnosed with cancer. Age-tailored psychological and practical services must be considered.
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Affiliation(s)
| | - Carla Vlooswijk
- The Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | | | | | | | | | | | | | | | | | - Amy Din
- University of Southampton, Southampton, UK
| | - Naureen Starling
- Royal Marsden NHS Foundation Trust, London, UK
- Institute of Cancer Research, London, UK
| | - James Larkin
- Royal Marsden NHS Foundation Trust, London, UK
- Institute of Cancer Research, London, UK
| | | | | | - Susana Banerjee
- Royal Marsden NHS Foundation Trust, London, UK
- Institute of Cancer Research, London, UK
| | - Zoltan Szucs
- East Suffolk and North Essex NHS Foundation Trust, Ipswich, UK
| | | | | | - Bhawna Sirohi
- Barts Health NHS Trust, London, UK
- Apollo Proton Cancer Centre, Chennai, India
| | | | - Olga Husson
- Institute of Cancer Research, London, UK
- Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
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Rosenberg AR, Steiner J, Lau N, Fladeboe K, Toprak D, Gmuca S, O'Donnell MB, Smith K, Brown CE, Yi-Frazier JP. From Theory to Patient Care: A Model for the Development, Adaptation, and Testing of Psychosocial Interventions for Patients With Serious Illness. J Pain Symptom Manage 2021; 62:637-646. [PMID: 33677072 PMCID: PMC8418616 DOI: 10.1016/j.jpainsymman.2021.02.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 02/22/2021] [Accepted: 02/25/2021] [Indexed: 10/22/2022]
Abstract
Psychosocial and supportive care interventions are a cornerstone of palliative care science, yet there is little published guidance regarding how to develop, test, adapt, and ultimately disseminate evidence-based interventions. Our objective was to describe the application of a single intervention-development model in multiple populations of patients with serious illness. Specifically, we use the "Promoting Resilience in Stress Management" (PRISM) intervention as an exemplar for how the Obesity Related Behavioral Intervention Trials (ORBIT) intervention-development model may be applied to: 1) create an initial palliative care intervention; 2) adapt an existing intervention for a new patient-population; 3) expand an existing intervention to include new content; and, 4) consider dissemination and implementation of a research-proven intervention. We began by identifying key psychological and social science theories and translating them a testable clinical hypothesis. Next, we conducted observational studies and randomized trials to design, refine, and standardize PRISM within unique patient-populations. We moved backwards in the ORBIT model when necessary to adapt or expand PRISM content and delivery-strategies to meet patient-reported needs. Finally, we began to explore PRISM's effectiveness using Dissemination and Implementation research methods. Key lessons include the need to ground intervention-development in evidence-based theory; involve patient, clinician, and other stakeholders at every phase of development; "meet patients where they are at" with flexible delivery strategies; invest in the time to find the right scientific premise and the right intervention content; and, perhaps most importantly, involve an interdisciplinary research team.
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Affiliation(s)
- Abby R Rosenberg
- Palliative Care and Resilience Lab, Center for Clinical and Translational Science, Seattle Children's Research Institute, Seattle, WA, USA; Cambia Palliative Care Center of Excellence at the University of Washington, Seattle, WA, USA; Division of Hematology/Oncology, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.
| | - Jill Steiner
- Palliative Care and Resilience Lab, Center for Clinical and Translational Science, Seattle Children's Research Institute, Seattle, WA, USA; Cambia Palliative Care Center of Excellence at the University of Washington, Seattle, WA, USA; Division of Cardiology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Nancy Lau
- Palliative Care and Resilience Lab, Center for Clinical and Translational Science, Seattle Children's Research Institute, Seattle, WA, USA; Cambia Palliative Care Center of Excellence at the University of Washington, Seattle, WA, USA; Division of Child Psychiatry, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Kaitlyn Fladeboe
- Palliative Care and Resilience Lab, Center for Clinical and Translational Science, Seattle Children's Research Institute, Seattle, WA, USA; Cambia Palliative Care Center of Excellence at the University of Washington, Seattle, WA, USA; Division of Hematology/Oncology, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Demet Toprak
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Sabrina Gmuca
- Palliative Care and Resilience Lab, Center for Clinical and Translational Science, Seattle Children's Research Institute, Seattle, WA, USA; Division of Rheumatology, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania and Center for Pediatric Clinical Effectiveness and PolicyLab at Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Maeve B O'Donnell
- Palliative Care and Resilience Lab, Center for Clinical and Translational Science, Seattle Children's Research Institute, Seattle, WA, USA
| | - Kiska Smith
- Palliative Care and Resilience Lab, Center for Clinical and Translational Science, Seattle Children's Research Institute, Seattle, WA, USA
| | - Crystal E Brown
- Cambia Palliative Care Center of Excellence at the University of Washington, Seattle, WA, USA; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Joyce P Yi-Frazier
- Palliative Care and Resilience Lab, Center for Clinical and Translational Science, Seattle Children's Research Institute, Seattle, WA, USA
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Fladeboe KM, O'Donnell MB, Barton KS, Bradford MC, Steineck A, Junkins CC, Yi-Frazier JP, Rosenberg AR. A novel combined resilience and advance care planning intervention for adolescents and young adults with advanced cancer: A feasibility and acceptability cohort study. Cancer 2021; 127:4504-4511. [PMID: 34358332 DOI: 10.1002/cncr.33830] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 06/03/2021] [Accepted: 07/06/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Few evidence-based psychosocial programs have been tested among adolescents and young adults (AYAs) with advanced cancer (AC), and early advance care planning (ACP) in this population is rare. The authors aimed to determine the feasibility and acceptability of 1) delivering an established resilience-coaching program, and 2) integrating ACP into that program, among AYAs with AC. METHODS Eligible AYAs were 12 to 24 years old, diagnosed with advanced cancer (recurrent/refractory disease or a diagnosis associated with <50% survival) and fluent in English. The Promoting Resilience in Stress Management-Advanced Cancer (PRISM-AC) program included PRISM's standard sessions targeting stress-management, goal-setting, cognitive-restructuring, and meaning-making, delivered 1:1, 1 to 2 weeks apart, plus a new session involving elements of the AYA-specific Voicing My Choices ACP guide. Participants completed surveys at baseline and 12 weeks, and exit interviews following study completion. Feasibility was defined as ≥70% completion of 1) standard 4-session PRISM and 2) the new ACP session among those completing standard PRISM. Acceptability was defined qualitatively. Trajectories of patient-reported anxiety, depression, and hope were examined descriptively. RESULTS Of 50 eligible, approached AYAs, 26 (52%) enrolled and completed baseline surveys. The AYAs had a mean age of 16 years (SD = 2.7 years), and the majority were male (73%) and White/Caucasian (62%). Twenty-two AYAs (85%) completed standard PRISM, and of those, 18 (82%) completed the ACP session. Feedback was highly positive; 100% and 91% described the overall and ACP programs as valuable, respectively. Anxiety, depression, and hope were unchanged after the program. CONCLUSIONS Resilience coaching followed by integrated ACP is feasible and acceptable for AYAs with AC. Participating did not cause distress or decrease hope. LAY SUMMARY Advance care planning (ACP) among adolescents and young adults (AYAs) with advanced cancer can be difficult to introduce. We investigated whether it is feasible and acceptable to integrate ACP into an existing resilience-coaching program for AYAs. In this cohort study of 26 AYAs with advanced cancer, we found the Promoting Resilience in Stress Management-Advanced Cancer program to be feasible (≥70% intervention-completion) and highly acceptable (positive post-participation feedback, no evidence of participant-distress). We conclude that an intervention integrating resilience coaching and ACP is feasible and acceptable among AYAs with advanced cancer.
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Affiliation(s)
- Kaitlyn M Fladeboe
- Division of Hematology/Oncology, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington.,Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington.,Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington
| | - Maeve B O'Donnell
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington
| | - Krysta S Barton
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington
| | - Miranda C Bradford
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington.,Children's Core for Biomedical Statistics, Center for Clinical & Translational Research, Seattle Children's Research Institute, Seattle, Washington
| | - Angela Steineck
- Division of Hematology/Oncology, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington.,Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington.,Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington
| | - Courtney C Junkins
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington
| | - Joyce P Yi-Frazier
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington
| | - Abby R Rosenberg
- Division of Hematology/Oncology, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington.,Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington.,Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington
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Lau N, Parsa AG, Walsh C, Yi-Frazier JP, Weiner BJ, Curtis JR, McCauley E, Rosenberg AR, Barton K. Facilitators and Barriers to Utilization of Psychosocial Care in Adolescents and Young Adults with Advanced Cancer: Integrating Mobile Health Perspectives. J Adolesc Young Adult Oncol 2021; 10:476-482. [PMID: 32985937 PMCID: PMC8418520 DOI: 10.1089/jayao.2020.0129] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Purpose: Although targeted psychosocial programming for adolescents and young adults (AYAs) with advanced cancer is a well-described priority, how best to engage AYAs in that programming is less clear. We aimed to examine AYA perspectives on facilitators and barriers to utilization of psychosocial programs and preferred mode of delivery. Methods: In this nested cohort study, AYAs participated in semistructured 1:1 interviews on communication needs. The present analysis focused on questions regarding psychosocial program delivery. Data were analyzed using directed content analysis followed by thematic content analysis to further organize and refine identified global themes and organizational themes. Results: We interviewed 32 patients (Mage = 18, range 14-25, 41% female). Key facilitators to utilization of psychosocial services by AYAs were to (1) align in importance of coping skills, (2) emphasize AYA self-motivation and agency in approach and introduction to services, and (3) offer services to everyone and at multiple timepoints. Key AYA barriers included (1) considering themselves an exception to the rule when discussing the psychosocial needs of AYAs with cancer, (2) the challenge of starting something new, and (3) reluctance to share emotional problems with psychosocial clinicians. Regarding the mode of delivery, some preferred in-person delivery due to opportunities for developing a close relationship and therapeutic rapport-building. Mobile app-based delivery was universally appealing. Conclusion: We provide a potential framework to increase uptake of psychosocial services in the high needs population of AYAs with advanced cancer. Future research will explore implementation strategies for increasing AYA engagement in psychosocial intervention programs.
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Affiliation(s)
- Nancy Lau
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Arta Gharib Parsa
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA
- UC Davis School of Medicine, Davis, California, USA
| | - Casey Walsh
- Department of Health Services, University of Washington, Seattle, Washington, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Joyce P. Yi-Frazier
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Bryan J. Weiner
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - J. Randall Curtis
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington, USA
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA
| | - Elizabeth McCauley
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Abby R. Rosenberg
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Krysta Barton
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA
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Dolan JG, Hill DL, Faerber JA, Palmer LE, Barakat LP, Feudtner C. Association of psychological distress and religious coping tendencies in parents of children recently diagnosed with cancer: A cross-sectional study. Pediatr Blood Cancer 2021; 68:e28991. [PMID: 33844421 PMCID: PMC8285076 DOI: 10.1002/pbc.28991] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 02/09/2021] [Accepted: 02/11/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE Parents of children with cancer exhibit high levels of psychological distress. Parents of children with serious illness report religion and spirituality are important coping resources. We sought to describe characteristics of religion, religious coping, social support, and resiliency in parents of children newly diagnosed with cancer and examine associations between psychological distress and self-reported religious coping, religiosity, resiliency, and social support. PATIENTS AND METHODS Cross-sectional observational study of 100 parents of 81 unique children recently diagnosed with cancer. Parents provided demographic information and completed measures of psychological distress, importance of religion, religious coping, resiliency, and social support. Patients' type of tumor and intensity of treatment were collected by medical record abstraction. RESULTS Compared to nationally reported data for adults, parents of children with cancer reported high scores for psychological distress but similar levels of religiosity, religious coping, and resiliency. Negative religious coping (feelings of negativity related to the divine) was associated with higher levels of psychological distress. This effect was most prominent in parents who reported the highest levels of religiosity. Positive religious coping, religiosity, and social support were not associated with levels of psychological distress. DISCUSSION Findings confirm high levels of distress for parents of children with cancer. Negative religious coping was associated with higher levels of psychological distress but positive religious coping, religiosity, and other coping factors were not found to be significantly associated with distress. Further assessment of negative religious coping to inform interventions to promote resiliency is warranted as they may impact parental decision-making and care.
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Affiliation(s)
- J. Gregory Dolan
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Douglas L. Hill
- The Justin Michael Ingerman Center for Palliative Care, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jennifer A. Faerber
- Healthcare Analytics Unit, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Laura E. Palmer
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA,Dept of Spiritual Care, Patient and Family Services, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Lamia P. Barakat
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA,Department of Pediatrics, Division of Oncology, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Chris Feudtner
- The Justin Michael Ingerman Center for Palliative Care, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA,Department of Pediatrics, Medical Ethics and Health Policy, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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40
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Kamaladasa DS, Sansom-Daly UM, Hetherington K, McGill BC, Ellis SJ, Kelada L, Donoghoe MW, Evans H, Anazodo A, Patterson P, Cohn RJ, Wakefield CE. How Are Families Faring? Perceived Family Functioning Among Adolescent and Young Adult Cancer Survivors in Comparison to Their Peers. J Adolesc Young Adult Oncol 2021; 10:711-719. [PMID: 33960837 DOI: 10.1089/jayao.2020.0215] [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] [Indexed: 11/12/2022] Open
Abstract
Purpose: Adolescent and young adult (AYA) cancer survivors' families can face ongoing challenges into survivorship. Families' adjustment and functioning as a unit can subsequently impact AYAs' mental health and quality of life. This study examined AYA cancer survivors' perceived family functioning, compared with their peers, and investigated factors associated with family functioning. Methods: Eligible participants were aged between 15 and 40 years, fluent in English, and cancer survivors who had completed treatment. AYA cancer survivors were recruited from hospital clinics, and the comparison group from an affiliated university campus. Participants completed the McMaster Family Assessment Device, Kidcope, and the Depression, Anxiety and Stress Scale-Short Form. We analyzed between-group differences in family functioning using multivariate analysis of covariance and used partial correlations to investigate associations between demographic cancer-related psychological coping variables and family functioning. Results: Ninety-three AYA cancer survivors and 141 comparison peers participated (ages: 15-32 years). AYA cancer survivors reported significantly better family functioning (p = 0.029), lower depression (p = 0.016), and anxiety symptoms (p = 0.008) compared with the comparison group. Approximately one-third of AYA survivors (34.4%) reported clinically significant maladaptive family functioning; however, this was more prevalent in the comparison group (50.4%). After adjusting for covariates, poorer family functioning was associated with AYA survivors using more avoidant escape-oriented coping strategies (p = 0.010). Conclusions: Our cancer survivor cohort reported better family functioning and psychological outcomes compared with their peers. Interventions targeting avoidant coping behaviors may support improved family functioning in some survivors. Further research disentangling the relationship between coping mechanisms and family functioning among AYA cancer survivors is needed.
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Affiliation(s)
- Dinuli S Kamaladasa
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Kensington, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Ursula M Sansom-Daly
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Kensington, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia.,Sydney Youth Cancer Service, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, Australia
| | - Kate Hetherington
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Kensington, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Brittany C McGill
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Kensington, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Sarah J Ellis
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Kensington, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Lauren Kelada
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Kensington, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Mark W Donoghoe
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Kensington, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia.,Stats Central, Mark Wainwright Analytical Centre, UNSW Sydney, Kensington, Australia
| | - Holly Evans
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Kensington, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia.,School of Psychology, UNSW Sydney, Kensington, Australia
| | - Antoinette Anazodo
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Kensington, Australia.,Sydney Youth Cancer Service, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Pandora Patterson
- Canteen Australia, Newtown, Australia.,Cancer Nursing Research Unit, Sydney Nursing School, The University of Sydney, Sydney, Australia
| | - Richard J Cohn
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Kensington, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Claire E Wakefield
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Kensington, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
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Steineck A, Barton KS, Bradford MC, Yi-Frazier JP, Rosenberg AR. Tincture of Time: The Evolution of Goals in Adolescents and Young Adults with Cancer. J Adolesc Young Adult Oncol 2021; 10:703-710. [PMID: 33960833 DOI: 10.1089/jayao.2020.0223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: A diagnosis of cancer often derails an individual's goals. The purpose of this mixed-methods analysis was to describe the evolution of adolescent and young adult (AYA)-reported goals in the year after a diagnosis of new or advanced cancer. Methods: As part of the Promoting Resilience in Stress Management (PRISM) phase 2 randomized controlled trial, AYAs with cancer (ages 12-25 years) were asked at baseline, 6 months, and 12 months: "Please give an example of a goal you hope to accomplish over the next month/year." We used content analysis to categorize goals as follows: life milestones, physical health, mental/emotional health, cancer specific, and hobbies/interests. We summarized goal categories at each time point: for the entire cohort, by baseline diagnosis status (new vs. advanced cancer), treatment status (on-therapy vs. off-therapy), and baseline health-related quality of life (high vs. low). Results: Eighty-six participants completed the study and were included in the analysis (control: n = 41, PRISM: n = 45); 69 reported their goals at 6 months, and 54 at 12 months. Participants submitted a total of 169 goals at baseline, 148 at 6 months, and 126 at 12 months. At baseline, cancer-specific goals were most common for the short-term (35%), whereas milestone goals were most common for the long-term (46%). At 6 months, milestone goals were most common in both short- (38%) and long-term (51%) categories. A similar pattern was seen at 12 months. Conclusion: AYAs' goals change over the first year of their cancer experience, with a shift in short-term goals from cancer-specific goals at baseline to milestone goals at later time points. ClinicalTrials.gov (NCT02340884).
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Affiliation(s)
- Angela Steineck
- Center for Cancer and Blood Disorders Center, Seattle Children's Hospital, Seattle, Washington, USA.,Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA.,Palliative Care and Resilience Research Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA.,Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA
| | - Krysta S Barton
- Palliative Care and Resilience Research Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA.,Biostatistics Epidemiology and Analytics for Research (BEAR) Core, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Miranda C Bradford
- Palliative Care and Resilience Research Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA.,Biostatistics Epidemiology and Analytics for Research (BEAR) Core, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Joyce P Yi-Frazier
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA.,Palliative Care and Resilience Research Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA.,Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA
| | - Abby R Rosenberg
- Center for Cancer and Blood Disorders Center, Seattle Children's Hospital, Seattle, Washington, USA.,Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA.,Palliative Care and Resilience Research Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA.,Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA
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Rosenberg AR, Zhou C, Bradford MC, Barton K, Junkins CC, Taylor M, Kross EK, Curtis JR, Dionne-Odom JN, Yi-Frazier JP. Parent Perspectives after the PRISM-P Randomized Trial: A Mixed-Methods Analysis. J Palliat Med 2021; 24:1505-1515. [PMID: 33720787 DOI: 10.1089/jpm.2020.0720] [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] [Indexed: 12/23/2022] Open
Abstract
Background: Parents experience high distress following their child's diagnosis of cancer. We previously tested two delivery models (group and one-on-one) of the "Promoting Resilience in Stress Management for Parents" (PRISM-P) intervention in a randomized trial: one-on-one delivery improved resilience and benefit finding at three months when compared to usual care (UC). Objective: The objective of this analysis was to evaluate quantitative and qualitative outcomes at six months. Design: In this single-center, phase 2, parallel, 1:1:1 randomized trial conducted December 2016 to December 2018, English-speaking parents with a 2-24 year-old child diagnosed with new cancer were randomly assigned to UC, one-on-one, or group PRISM-P, a brief, skill-based curriculum targeting stress management, goal setting, cognitive reframing, and meaning making. We collected parent-reported outcomes (resilience, benefit finding, and psychological distress) at baseline and three and six months. We applied linear mixed-effects regression models to examine six-month outcomes among all participants and conducted directed content analyses of exit interviews with the first 12 parents to complete each study arm. Results: The 94 participating parents were median aged 35-38 years and predominantly white, college-educated mothers. At six months, there was no statistically significant difference in parent-reported outcomes. Exit interviews (n = 36) suggested that PRISM-P was highly valued: 100% of interviewed recipients recommended it for other parents. Most suggested more coaching would help them retain skills, and almost all endorsed a combined one-on-one and group program. Conclusions: Although the PRISM-P benefits observed at three months were not sustained for six months, all interviewed parents found it valuable. Additional opportunities to strengthen and sustain resilience resources include longer follow-up, flexible format, and skill reinforcement. Trial Registration: NCT02998086.
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Affiliation(s)
- Abby R Rosenberg
- Palliative Care and Resilience Research Laboratory, Center for Clinical and Translational Research, Epidemiology, and Analytics in Research Program, Seattle Children's Research Institute, Seattle, Washington, USA.,Division of Hematology/Oncology and Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA.,Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA
| | - Chuan Zhou
- Division of General Pediatrics, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA.,Biostatistics, Epidemiology, and Analytics in Research Program, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Miranda C Bradford
- Biostatistics, Epidemiology, and Analytics in Research Program, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Krysta Barton
- Palliative Care and Resilience Research Laboratory, Center for Clinical and Translational Research, Epidemiology, and Analytics in Research Program, Seattle Children's Research Institute, Seattle, Washington, USA.,Biostatistics, Epidemiology, and Analytics in Research Program, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Courtney C Junkins
- Palliative Care and Resilience Research Laboratory, Center for Clinical and Translational Research, Epidemiology, and Analytics in Research Program, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Mallory Taylor
- Palliative Care and Resilience Research Laboratory, Center for Clinical and Translational Research, Epidemiology, and Analytics in Research Program, Seattle Children's Research Institute, Seattle, Washington, USA.,Division of Hematology/Oncology and Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA.,Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA
| | - Erin K Kross
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA.,Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - J Randall Curtis
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA.,Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - J Nicholas Dionne-Odom
- Department of Acute, Chronic, and Continuing Care, University of Alabama at Birmingham School of Nursing, Birmingham, Alabama, USA
| | - Joyce P Yi-Frazier
- Palliative Care and Resilience Research Laboratory, Center for Clinical and Translational Research, Epidemiology, and Analytics in Research Program, Seattle Children's Research Institute, Seattle, Washington, USA
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Shimada S, Aoyanagi M, Sumi N. Components and Related Factors of Nursing Interventions for Improving Resilience in Cancer Patients Undergoing Chemotherapy. Healthcare (Basel) 2021; 9:healthcare9030300. [PMID: 33800524 PMCID: PMC7998617 DOI: 10.3390/healthcare9030300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/19/2021] [Accepted: 02/26/2021] [Indexed: 11/16/2022] Open
Abstract
Resilience is considered an effective concept for cancer patients, but nursing interventions for improving resilience have not been studied adequately yet. We aimed to explore the components and related factors of nursing interventions for promoting resilience among cancer patients receiving chemotherapy (NIPRPC). This cross-sectional study included 68 facilities from 396 cancer hospitals in Japan. Participants were 377 nurses who worked at the outpatient chemotherapy center or cancer ward. They completed self-administered questionnaires including the NIPRPC items and Resilience Scale for Nurses, etc. We conducted factor, correlational, and regression analysis. Based on the exploratory factor analysis, six-dimensional factor components: “Support for patients during the present situation and increasing their self-affirmation”, “Support for self-help”, “Support for utilizing the cancer medical team”, “Support for obtaining family cooperation”, “Support for maintaining regular lifestyle during chemotherapy”, and “Support for interacting with cancer patients and utilizing necessary information”. The strong related factors for all six factors were the resilience of the nurses and the number of collaborations with multiple occupations. Our findings will help nurses improve the psychosocial quality of life of cancer patients and address their needs related to cancer chemotherapy treatment.
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Affiliation(s)
- Shiena Shimada
- Department of Nursing, Hokkaido University Hospital, Sapporo 060-8648, Japan;
| | - Michiko Aoyanagi
- Faculty of Health Sciences, Hokkaido University, Sapporo 060-0812, Japan;
| | - Naomi Sumi
- Faculty of Health Sciences, Hokkaido University, Sapporo 060-0812, Japan;
- Correspondence:
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Eshtehardi SS, Hilliard ME. JPP Student Journal Club Commentary: Advancing Transition Medicine for Adolescents and Young Adults with Chronic Conditions. J Pediatr Psychol 2021; 46:12-14. [PMID: 33306795 DOI: 10.1093/jpepsy/jsaa109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 10/23/2020] [Accepted: 10/24/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Sahar S Eshtehardi
- Department of Psychological, Health, & Learning Sciences, University of Houston
| | - Marisa E Hilliard
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital
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Suicidal risk and resilience in juvenile fibromyalgia syndrome: a cross-sectional cohort study. Pediatr Rheumatol Online J 2021; 19:3. [PMID: 33407630 PMCID: PMC7789563 DOI: 10.1186/s12969-020-00487-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 12/09/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND To characterize suicidality among youth with juvenile fibromyalgia syndrome (JFMS) receiving treatment from pediatric rheumatologists at a tertiary care center in order to determine the prevalence of suicidality in JFMS and to explore risk factors for persistent suicidal ideation. METHODS We performed a cross-sectional cohort study of children 12-17 years old with JFMS seen in a specialty pediatric rheumatology pain clinic from 7/2017-9/2019. All subjects completed patient-reported outcomes measures, complemented by retrospective chart review. Subjects who endorsed item 8 on the Children's Depression Inventory, 2nd Edition (CDI-2) were categorized as endorsing suicidal ideation. We assessed for differences between the suicidal and non-suicidal patients using Wilcoxon-rank sum test. Logistic regression modeling was performed to identify psychosocial factors associated with suicidality. RESULTS Of the 31 subjects, more than one-quarter endorsed suicidality. Nearly 90% of teens with suicidal ideation were established in outpatient counseling. In bivariate analyses, suicidality was associated with lower resilience and greater depression and anxiety (all p < 0.05). Pain intensity trended towards a statistically significant positive association (OR: 1.16 [0.99-1.37]; p = 0.06). Lower resilience was independently associated with suicidality (OR: 0.90 [95% CI: 0.82-0.98]; p < 0.02). CONCLUSIONS Suicidality was prevalent among youth with JFMS and persistent despite concurrent receipt of mental health services. Higher patient-level resilience was independently associated with a reduced odds of suicidality. Future work should examine the role of resilience training on reducing psychological distress and mitigating the risk of suicidality in JFMS.
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46
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Resilience, Hope, and Subjective Happiness Among the Turkish Population: Fear of COVID-19 as a Mediator. Int J Ment Health Addict 2020; 21:803-818. [PMID: 33293904 PMCID: PMC7714252 DOI: 10.1007/s11469-020-00443-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/13/2020] [Indexed: 12/12/2022] Open
Abstract
Psychology deals with not only mental disorders but also psychological strengths within individuals. Psychological strengths will play an important role in struggling with the global novel coronavirus 2019 (COVID-19) pandemic. The present study tested a model concerning the relationship between resilience, hope, and subjective happiness using structural equation modeling to identify the mediating role of fear of COVID-19. A cross-sectional survey was conducted among a convenience sample of 971 Turkish individuals (aged 18 to 74 years) from 75 of 81 cities in Turkey. The survey included the Subjective Happiness Scale, Fear of COVID-19 Scale, Brief Resilience Scale, and the Dispositional Hope Scale, and data were analyzed using structural equation modeling (SEM). The SEM demonstrated an association between resilience-hope and subjective happiness was mediated by fear of COVID-19 (CMIN/df = 2.664, CFI = 0.994, NFI = 0.984, TLI = 0.984, GFI = 0.994, RMSEA = 0.044, SRMR = 0.024, AIC = 81.334, ECVI = 0.084). Resilience had a direct effect and an indirect effect on subjective happiness via fear of COVID-19. Hope also had a direct effect and an indirect effect on subjective happiness via fear of COVID-19. Consequently, in the fight against COVID-19, individuals who are resistant to stress and have a belief that they can find a way to cope can help prevent the fear of COVID-19 and so enhance good mental health.
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47
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Scott SR, O'Daffer AG, Bradford MC, Fladeboe K, Lau N, Steineck A, Taylor M, Yi-Frazier JP, Rosenberg AR. Adverse childhood experiences (ACEs) and medically traumatic events (TEs) in adolescents and young adults (AYAs) with cancer: a report from the Promoting Resilience in Stress Management (PRISM) randomized controlled trial. Support Care Cancer 2020; 29:3773-3781. [PMID: 33219407 DOI: 10.1007/s00520-020-05888-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 11/09/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE In adolescents and young adults (AYAs) with cancer, we examined (1) the distribution and type of traumatic events (TEs) experienced prior to baseline assessment and (2) how a resilience intervention, Promoting Resilience in Stress Management (PRISM), impacted changes in patient-reported outcomes (PROs) for AYAs with and without TEs. METHODS AYAs (12-25 years) within 1-10 weeks of diagnosis of new malignancy or ever diagnosed with advanced cancer were enrolled and randomly assigned to usual care (UC) with or without PRISM. To assess TEs, we screened medical records for traditionally defined adverse childhood experiences (ACEs) and medical traumatic events. Age-validated PROs assessed resilience, benefit-finding, hope, generic health-related quality of life (QoL), cancer-specific QoL, depression, and anxiety at enrollment and 6 months later. We calculated effect sizes (Cohen's d) for PRISM vs. UC effect on PRO score change at 6 months for 1+ TEs and 0 TE groups. RESULTS Ninety-two AYAs enrolled and completed baseline surveys (44-UC, 48-PRISM; N = 74 at 6 months, 38-UC, 36-PRISM); 60% experienced 1+ TEs. PROs at baseline were similar across groups. PRISM's effect on score change was greater (Cohen's d ≥ 0.5) for the 1+ TE group on domains of benefit-finding and hope; and similar (d < 0.5) on domains of resilience, depression, anxiety, and both generic and cancer-specific QoL. CONCLUSIONS In AYAs with cancer, TEs occurred at similar rates as the general population. PRISM may be particularly helpful for improving benefit-finding and hope for those who have experienced TEs.
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Affiliation(s)
- Samantha R Scott
- Palliative Care & Resilience Lab, Seattle Children's Research Institute, Seattle, WA, USA.,Department of Psychology, University of Denver, Denver, CO, USA
| | - Alison G O'Daffer
- Palliative Care & Resilience Lab, Seattle Children's Research Institute, Seattle, WA, USA
| | - Miranda C Bradford
- Children's Core for Biomedical Statistics, Seattle Children's Research Institute, Seattle, WA, USA
| | - Kaitlyn Fladeboe
- Palliative Care & Resilience Lab, Seattle Children's Research Institute, Seattle, WA, USA
| | - Nancy Lau
- Palliative Care & Resilience Lab, Seattle Children's Research Institute, Seattle, WA, USA
| | - Angela Steineck
- Palliative Care & Resilience Lab, Seattle Children's Research Institute, Seattle, WA, USA.,University of Washington School of Medicine, Seattle, WA, USA.,Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Mallory Taylor
- Palliative Care & Resilience Lab, Seattle Children's Research Institute, Seattle, WA, USA.,University of Washington School of Medicine, Seattle, WA, USA.,Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Joyce P Yi-Frazier
- Palliative Care & Resilience Lab, Seattle Children's Research Institute, Seattle, WA, USA
| | - Abby R Rosenberg
- Palliative Care & Resilience Lab, Seattle Children's Research Institute, Seattle, WA, USA. .,University of Washington School of Medicine, Seattle, WA, USA. .,Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
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48
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Hilliard ME, Cao VT, Eshtehardi SS, Minard CG, Saber R, Thompson D, Karaviti LP, Anderson BJ. Type 1 Doing Well: Pilot Feasibility and Acceptability Study of a Strengths-Based mHealth App for Parents of Adolescents with Type 1 Diabetes. Diabetes Technol Ther 2020; 22:835-845. [PMID: 32379496 PMCID: PMC7698853 DOI: 10.1089/dia.2020.0048] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background: We evaluated the feasibility and acceptability of a pilot behavioral intervention delivered to parents of adolescents with type 1 diabetes (T1D) via mobile-friendly web app. The Type 1 Doing Well app aimed to promote supportive family diabetes management by helping parents recognize and reinforce teens' positive diabetes-related behaviors ("strengths"). Methods: Parents (n = 80, 74% recruitment) of adolescents (age range = 12-17 years, M = 15.3 ± 1.5 years, 59% female, 56% insulin pump, M hemoglobin A1c (HbA1c) = 9.0% ± 2.1%) were randomized 2:1 to intervention or control (i.e., usual medical care with or without app) for 3-4 months between diabetes appointments. The app prompted parents daily to track adolescents' strengths and generated weekly summaries of their teen's top strengths. Parents could access a library of text messages to praise their teens. Exploratory pre/post data included questionnaires (98% completed) and HbA1c. Results: Parents used the app for M = 106.1 ± 37.1 days, logging in ≥once/day on 80% of days. Ninety-one percent of parents used the app ≥2 days/week on average. Parents viewed M = 5.6 ± 4.7 weekly summaries and "favorited" 15 praise texts in the library. App acceptability ratings (7-point scale) were high: Satisfaction 5.0 ± 1.5, Usefulness 4.8 ± 1.5, Ease of Use 6.2 ± 0.8, and Ease of Learning 6.5 ± 0.8. Parents (n = 48) and adolescents (n = 47) gave positive feedback and suggestions via qualitative interviews. There were no significant between-group differences for change in exploratory outcomes (HbA1c, questionnaires). Conclusions: Type 1 Doing Well was feasible to deliver and highly acceptable and engaging for parents of adolescents with T1D. It may have a larger impact on behavioral or clinical outcomes as part of a multicomponent intervention protocol. Trial Registration: ClinicalTrials.gov NCT02877680.
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Affiliation(s)
- Marisa E. Hilliard
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
- Address correspondence to: Marisa E. Hilliard, PhD, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, 1102 Bates Avenue, Suite 940, Houston, TX 77030
| | - Viena T. Cao
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Sahar S. Eshtehardi
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
- College of Education, University of Houston, Houston, Texas, USA
| | - Charles G. Minard
- Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas, USA
| | - Rana Saber
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Debbe Thompson
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Lefkothea P. Karaviti
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Barbara J. Anderson
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
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49
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Fladeboe KM, Scott S, Bradford MC, Ketterl TG, Yi-Frazier JP, Rosenberg AR. Sexual Activity and Substance Use Among Adolescents and Young Adults Receiving Cancer Treatment: A Report from the PRISM Randomized Controlled Trial. J Adolesc Young Adult Oncol 2020; 9:594-600. [PMID: 32316824 DOI: 10.1089/jayao.2020.0001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Purpose: Despite health implications, sexual activity and substance use among adolescents and young adults (AYAs) receiving cancer treatment are understudied. Methods: AYAs 12-25 years of age participated in a randomized controlled trial testing the efficacy of a resilience intervention. They were fluent in English and either diagnosed with new cancer (NC) or advanced cancer (AC). At baseline and 6 months, participants self-reported sexual activity and substance use. We describe the percentage of AYAs who endorsed each behavior and a count of total behaviors endorsed by each respondent. We describe frequencies by sex/gender (male/female), age (<18/≥18), and disease status (AC/NC). Results: Participants (N = 92) were majority white/Caucasian (57%), 12-17 years old (73%), and diagnosed with leukemia/lymphoma (62%); 32% had AC. Responses were not associated with the intervention; hence, we summarized data from the whole cohort. At both time points, median behavior endorsed was 2. At baseline and follow-up, 87% and 81% endorsed at least 1 behavior: 13% and 15% were sexually active, 75% and 73% of whom used birth control inconsistently; and 22% and 22% reported drinking alcohol, 31% and 27% using prescription opioids/sedatives, 19% and 22% using other drugs, and 9% and 7% using tobacco. Young adults engaged in most behaviors more frequently than adolescents (e.g., 48% vs. 12% alcohol at baseline); males engaged in sexual activity more frequently than females (e.g., 20% vs. 5% sexually active at baseline); and AYAs with NC engaged in most behaviors more frequently than those with AC (18% vs. 0% sexually active at baseline). Conclusion: AYAs engage in sexual activity and substance use during cancer treatment.
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Affiliation(s)
- Kaitlyn M Fladeboe
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Samantha Scott
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Miranda C Bradford
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Tyler G Ketterl
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA.,Center for Cancer and Blood Disorders, Seattle Children's Hospital, Seattle, Washington, USA
| | - Joyce P Yi-Frazier
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Abby R Rosenberg
- 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.,Division of Bioethics/Palliative Care, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
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50
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Dulude E, Coutu MF, Durand MJ. Promoting resilience in work rehabilitation: development of a transdiagnostic intervention. Disabil Rehabil 2020; 43:3652-3662. [PMID: 32228191 DOI: 10.1080/09638288.2020.1744041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE The aim of this study was to develop an operationalized transdiagnostic resilience-based intervention for workers at risk of long-term work disability. METHODS A sequential mixed method design was used. Expert clinicians (n = 10) first answered a questionnaire including closed and open-ended questions on the clarity, applicability, relevance and exhaustiveness of a preliminary resilience intervention developed from evidenced-informed resilience factors to prompt reflection. Second, proposals from the questionnaire were discussed at a consensus group meeting with the same experts, yielding a final and improved intervention. Third, semi-structured interviews with work-disabled workers (n = 6) explored the intervention's acceptability to them. Thematic analysis of the verbatim was performed. RESULTS Experts identified 15 statements on clarity, applicability, relevance or exhaustiveness in the questionnaire that did not achieve consensus and generated 41 modification proposals. The consensus group adopted 15 modifications. The adapted intervention was well-accepted by the workers who had completed a work rehabilitation program. They perceived the intervention as positive, relevant, coherent, useful and consistent with their values. CONCLUSION A new transdiagnostic resilience intervention in work rehabilitation is available and was on exploratory basis seen acceptable by workers. Next step would be to validate it at a larger scale with more workers and other stakeholders.IMPLICATIONS FOR REHABILITATIONPromoting workers resilience in work rehabilitation fosters a holistic approach in clinical practice.Resilience interventions should be integrated into work rehabilitation programs.A new transdiagnostic resilience intervention designed to complement current work rehabilitation programs is available.
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Affiliation(s)
- Eve Dulude
- Centre de recherche Charles-Le Moyne-Saguenay-Lac-Saint-Jean sur les innovations en santé (CR-CSIS), Université de Sherbrooke ‒ Centre d'action en prévention et réadaptation de l'incapacité au travail (CAPRIT), Longueuil, Canada
| | - Marie-France Coutu
- Centre de recherche Charles-Le Moyne-Saguenay-Lac-Saint-Jean sur les innovations en santé (CR-CSIS), Université de Sherbrooke ‒ Centre d'action en prévention et réadaptation de l'incapacité au travail (CAPRIT), Longueuil, Canada
| | - Marie-José Durand
- Centre de recherche Charles-Le Moyne-Saguenay-Lac-Saint-Jean sur les innovations en santé (CR-CSIS), Université de Sherbrooke ‒ Centre d'action en prévention et réadaptation de l'incapacité au travail (CAPRIT), Longueuil, Canada
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