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Joosten MMH, Maurice-Stam H, van Gorp M, Beek LR, Stremler-van Holten D, Scholten L, Grootenhuis MA. Efficacy of Op Koers Online, an online group intervention for parents of children with cancer: Results of a randomized controlled trial. Psychooncology 2024; 33:e6284. [PMID: 38282215 DOI: 10.1002/pon.6284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/29/2023] [Accepted: 12/19/2023] [Indexed: 01/30/2024]
Abstract
OBJECTIVE Parents of children with cancer are at risk for developing psychosocial problems. The present study aims to evaluate the effect of an online group intervention (Op Koers Online, in English: On Track Online) on psychosocial wellbeing and coping skills. METHODS Parents of a child with cancer (diagnosis <5 years ago) participated in a randomized controlled trial. In six consecutive (and one booster-) protocolled sessions in an online chatroom, trained psychologists and social workers taught coping skills using cognitive behavioral and acceptance and commitment techniques. Questionnaires assessed anxiety, depression, distress, situation-specific emotional reactions and coping skills (Op Koers Questionnaire/Cognitive Coping Strategies Scale Parent Form) and evaluated the intervention. Linear mixed-model analyses were performed to detect differences between the conditions in changes over time; T0-T1 and T0-T2 (6-week and 6-month follow-up), and to detect changes in scores T2-T3 (12-month follow-up) for the intervention group only. RESULTS 89 parents were included in analyses (mean age 41.9 years, 86% female, 62%/38% post/during treatment of their child). Beneficial intervention effects (p < 0.05) were found at T1 for anxiety, depression, distress, loneliness and relaxation, and at T2 for anxiety, uncertainty and relaxation. In the intervention condition, scores did not change from T2 to T3, except loneliness that decreased and relaxation that improved. All effect sizes were small to medium (β = -0.21 to 0.46). Parents were generally positive about the intervention. CONCLUSIONS Op Koers Online for parents of children with cancer has a positive effect on psychosocial wellbeing and the coping skill relaxation. Implementation is recommended to prevent psychosocial problems. CLINICAL TRIAL REGISTRATION Dutch Trial Register https://onderzoekmetmensen.nl/en NL73763.041.20.
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Affiliation(s)
- M M H Joosten
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - H Maurice-Stam
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - M van Gorp
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - L R Beek
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | | | - L Scholten
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - M A Grootenhuis
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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2
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Liu Q, László KD, Wei D, Yang F, Fall K, Valdimarsdóttir U, Feychting M, Li J, Fang F. Suicide attempt and death by suicide among parents of young individuals with cancer: A population-based study in Denmark and Sweden. PLoS Med 2024; 21:e1004322. [PMID: 38227561 PMCID: PMC10791002 DOI: 10.1371/journal.pmed.1004322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 11/14/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND The psychological toll on parents of a child receiving a cancer diagnosis is known to be high, but there is a knowledge gap regarding suicidal behavior among these parents. The aim of this study was to investigate the risk of suicide attempt and death by suicide in relation to having a child with cancer. METHODS AND FINDINGS We performed a binational population-based and sibling-controlled cohort study, including all parents with a child diagnosed with cancer in Denmark (1978 to 2016) or Sweden (1973 to 2014), 10 matched unexposed parents per exposed parent (population comparison), and unaffected full siblings of the exposed parents (sibling comparison). Suicide attempt was identified through the Patient Register and the Psychiatric Central Register in Denmark and the Patient Register in Sweden, whereas death by suicide was identified through the Danish Causes of Death Register and the Swedish Causes of Death Register. In population comparison, we used Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of suicide attempt and death by suicide associated with cancer diagnosis of a child, adjusting for sex, age, country of residence, calendar year, marital status, highest attained educational level, household income, history of cancer, history of psychiatric disorder, and family history of psychiatric disorder. The sibling comparison was performed to assess the role of familial confounding in the studied associations. The population comparison consisted of 106,005 exposed parents and 1,060,050 matched unexposed parents, with a median age of 56 at cohort entry and 46.9% male. During the median follow-up of 7.3 and 7.2 years, we observed 613 (incidence rate [IR], 58.8 per 100,000 person-years) and 5,888 (IR, 57.1 per 100,000 person-years) cases of first-onset suicide attempt among the exposed and unexposed parents, respectively. There was an increased risk of parental suicide attempt during the first years after a child's cancer diagnosis (HR, 1.15; 95% CI, [1.03, 1.28]; p = 0.01), particularly when the child was 18 or younger at diagnosis (HR, 1.25; 95% CI, [1.08, 1.46]; p = 0.004), when the child was diagnosed with a highly aggressive cancer (HR, 1.60; 95% CI, [1.05, 2.43]; p = 0.03), or when the child died due to cancer (HR, 1.63; 95% CI, [1.29, 2.06]; p < 0.001). The increased risk did not, however, maintain thereafter (HR, 0.86; 95% CI: [0.75, 0.98]; p = 0.03), and there was no altered risk of parental death by suicide any time after the child's cancer diagnosis. Sibling comparison corroborated these findings. The main limitation of the study is the potential residual confounding by factors not shared between full siblings. CONCLUSIONS In this study, we observed an increased risk of parental suicide attempt during the first years after a child's cancer diagnosis, especially when the child was diagnosed during childhood, or with an aggressive or fatal form of cancer. There was, however, no altered risk of parental death by suicide at any time after a child's cancer diagnosis. Our findings suggest extended clinical awareness of suicide attempt among parents of children with cancer, especially during the first few years after cancer diagnosis.
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Affiliation(s)
- Qianwei Liu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Krisztina D. László
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- The Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Dang Wei
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Fen Yang
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Katja Fall
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Unnur Valdimarsdóttir
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Center of Public Health Sciences, School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Maria Feychting
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jiong Li
- Department of Clinical Medicine-Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Fang Fang
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Howard Sharp KM, Tillery Webster R, Cook J, Okado Y, Long A, Phipps S. Profiles of Resilience, Distress, and Posttraumatic Growth in Parents of Children with Cancer and the Relation to Subsequent Parenting and Family Functioning. J Pediatr Psychol 2023; 48:375-385. [PMID: 36668686 PMCID: PMC10118855 DOI: 10.1093/jpepsy/jsac097] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 12/16/2022] [Accepted: 12/22/2022] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE The aim of this study was to identify patterns of distress and growth in parents of children with cancer and examine associations with subsequent parenting, parent-child relationship, and family environment. METHODS Participants included children with cancer history (8-17 years) stratified by time since diagnosis and their parent. At enrollment, parents (n = 254) reported depression and anxiety, and post-traumatic stress symptoms, posttraumatic growth (PTG), and benefit finding in relation to their child's cancer. Three years later, children (n = 214) reported parenting behavior, parent reactions to their distress, and family environment. Parents reported their reaction to children's distress and qualities of the parent-child relationship. RESULTS Latent profile analysis empirically identified 3 cross-sectional profiles using baseline data: "Resilience, High Growth" (50%), characterized by the lowest distress and the highest PTG/benefit finding; "Moderate Distress with Growth" (33%), characterized by relatively high levels of all indicators; and "Resilience, Low Growth" (17%), characterized by relatively low distress with low PTG/benefit finding. Membership in profiles was associated with parent gender; parents' stressful life events; socioeconomic status; and child diagnosis, on versus off treatment status, and treatment intensity. Parent membership in the Moderate Distress with Growth profile was generally linked with poorer parenting behavior, parent-child relationship quality, and family functioning. CONCLUSION The majority of parents exhibited resilience and growth. However, a subset of parents displaying moderate distress may be at risk for subsequent parenting and family functioning challenges. Findings further highlight the importance of screening for even moderate parent distress and the possible impact of parent psychosocial interventions indirectly on parenting and family functioning.
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Affiliation(s)
| | | | - Jessica Cook
- Department of Psychology, St. Jude Children’s Research Hospital, USA
- Department of Psychology, The University of Memphis, USA
| | - Yuko Okado
- Department of Psychology, California State University, USA
| | - Alanna Long
- Department of Psychology, St. Jude Children’s Research Hospital, USA
| | - Sean Phipps
- Department of Psychology, St. Jude Children’s Research Hospital, USA
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4
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Sherief ST, Girma E, Wu F, O'Banion J, Wondimagegn D, Teshome T, Dimaras H. Caring for a child with retinoblastoma: Experience of Ethiopian parents. Pediatr Blood Cancer 2023; 70:e30163. [PMID: 36545916 DOI: 10.1002/pbc.30163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 11/05/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE This study explored the lived experience of parents of children with retinoblastoma. DESIGN AND METHOD A phenomenological qualitative study design was used, and a purposive sampling technique to recruit parents of children with retinoblastoma. Semi-structured interviews were conducted to document the lived experience of participants, who were asked to narrate their experiences caring for a child with retinoblastoma, thinking back to the day they learned about their child's condition, as well as their thoughts about the future. The interviews were conducted in Amharic and Oromo language, and audio recordings were transcribed and translated to English. Data were analyzed using thematic analysis. RESULTS Thirteen parents (seven mothers, six fathers) participated in the study. Collectively, the children of the participants represented all the stages of the retinoblastoma journey (i.e., diagnosis, treatment, remission, and recurrence). Five major themes emerged from the thematic data analysis: (a) reactions when learning the child's condition; (b) receiving health care; (c) costs of caregiving; (d) support; and (e) uncertainties. CONCLUSION The lived experiences of parents of children with retinoblastoma revealed a significant mental health and psychosocial burden. The sources of mental distress were found to be complex and varied. Holistic care for retinoblastoma should include programs that address the biopsychosocial needs of caregivers.
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Affiliation(s)
- Sadik Taju Sherief
- Department of Ophthalmology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Engida Girma
- Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia
| | - Fran Wu
- Department of Ophthalmology, Emory University, Atlanta, Georgia, USA
| | | | - Dawit Wondimagegn
- Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tiliksew Teshome
- Department of Ophthalmology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Helen Dimaras
- Department of Ophthalmology and Vision Science, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.,Child Health Evaluative Sciences Program and Centre for Global Child Health, SickKids Research Institute, Toronto, Ontario, Canada.,Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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5
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Park M, Choi EK, Lee HJ, Park HE, Chinbayar A. Resilience-Promoting Programs in Families of Children With Cancer: A Systematic Review. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2022; 39:185-201. [PMID: 35467437 DOI: 10.1177/27527530211055997] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Purpose: Pediatric cancer is a difficult experience for children and their families. It is thus necessary to promote family resilience for the effective treatment and quality of life improvement among children with cancer. The aim of this systematic review was to identify the components of a resilience-promoting program for children with cancer and their families and to synthesize the literature findings on the outcomes of the resilience-promoting program. Method: A systematic search of the literature was conducted using five databases (PubMed, CHIAHL, PsycINFO, Web of Science, and Research Information Sharing Service) up to July 22, 2020. The search was limited to studies published in English and Korean, and to grey literature published in Korea. Studies were critically appraised using the Mixed Methods Appraisal Tool and Cochrane Risk of Bias tool. Extracted data were summarized as tables. Results: Eight studies were selected. The main components of the resilience-promoting program were providing information (on strategies, medical and psychoeducation, and community resources) and emotional coping (expressing feeling, reappraising cognition about adversity, and stress management). The main outcomes of these programs were reinforced outcomes (resilience, benefit finding, coping, positive affect, problem-solving skills, family adaptation, and self-concept) and improved outcomes (in depression, posttraumatic stress, anxiety, impact of illness of the family, and mood). Conclusion: As the components and outcomes of family resilience-promoting programs vary, it is necessary to consistently use valid tools to effectively identify interventions. Additionally, various methodological studies are required to further analyze the effect of these programs.
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Affiliation(s)
- Mina Park
- Department of Nursing, Yonsei University Health System, Seoul, Republic of Korea
- Department of Nursing, Yonsei University Graduate School, Seoul, Republic of Korea
| | - Eun Kyoung Choi
- 299347College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Republic of Korea
| | - Hyun Jie Lee
- Department of Nursing, Yonsei University Health System, Seoul, Republic of Korea
- Department of Nursing, Yonsei University Graduate School, Seoul, Republic of Korea
| | - Hyeon Eun Park
- Department of Nursing, Yonsei University Graduate School, Seoul, Republic of Korea
- Department of Nursing, Samsung Medical Center, Seoul, Republic of Korea
| | - Altantuya Chinbayar
- Department of Nursing, Yonsei University Health System, Seoul, Republic of Korea
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Bates CR, Fairclough D, Noll RB, Barrera ME, Kupst MJ, Egan AM, Gartstein MA, Ach EL, Gerhardt CA, Vannatta KA. Psychosocial functioning of caregivers of pediatric brain tumor survivors. Pediatr Blood Cancer 2022; 69:e29565. [PMID: 35044078 PMCID: PMC8860870 DOI: 10.1002/pbc.29565] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 12/06/2021] [Accepted: 12/23/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Assessment of caregiver needs is a recommended standard of care in pediatric oncology. Caregivers of pediatric brain tumor survivors (PBTS) are a subgroup that may be at highest psychosocial risk. This study examined psychosocial functioning of caregivers of PBTS in comparison to caregivers of youth without cancer history. We hypothesized that caregivers of PBTS would exhibit more psychological symptoms, higher caregiver burden, and lower perceptions of social support than caregivers of comparison youth. PROCEDURE As part of a five-site study, we utilized a matched sample design to evaluate psychosocial functioning of 301 caregivers of 189 PBTS (ages 8-15) who were 1-5 years post treatment, and 286 caregivers of 187 comparison youth matched for sex, race, and age. Caregivers completed measures of psychological symptoms, caregiver burden, and perceptions of social support. Repeated measures mixed models compared outcomes between groups and examined differences based on caregiver sex. Socioeconomic status (SES) was examined as a moderator of significant main effects. RESULTS Caregivers of PBTS reported similar levels of psychological symptoms to caregivers of comparison youth. Mothers of PBTS mothers reported higher caregiver burden and lower perceptions of social support than mothers of comparison youth. Low SES exacerbated group differences in caregiver burden. CONCLUSIONS Mothers of PBTS may have more caregiving responsibilities and perceive less social support, but reported similar levels of psychological symptoms to comparison mothers; fathers of PBTS were similar to comparison fathers. The mechanisms involved in this complex psychosocial dynamic require further investigation.
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Affiliation(s)
- Carolyn R. Bates
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, KS
| | - Diane Fairclough
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado, USA
| | - Robert B. Noll
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Maru E. Barrera
- Division of Hematology/Oncology, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mary Jo Kupst
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Anna M. Egan
- Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, MO,University of Missouri Kansas City School of Medicine, Kansas City, Missouri, USA
| | | | - Emily L. Ach
- Department of Psychiatry, Stanford University School of Medicine, Stanford, California, USA
| | - Cynthia A. Gerhardt
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA,Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | - Kathryn A. Vannatta
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA,Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
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7
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Sharp K, Tillery R, Long A, Wang F, Pan H, Phipps S. Trajectories of resilience and posttraumatic stress in childhood cancer: Consistency of child and parent outcomes. Psychol Health 2022; 41:256-267. [PMID: 34855418 PMCID: PMC9809178 DOI: 10.1037/hea0001132] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Childhood cancer represents a potentially traumatic experience for both patients and caregivers. We examined trajectories of posttraumatic stress symptoms (PTSS) across a 5-year period in children with a history of cancer and their parents/caregivers. Medical, demographic, and dispositional variables were examined as predictors of PTSS trajectories. METHOD Using a longitudinal design, children with cancer history (n = 254, age 8-17 years at baseline) and one parent or caregiver (n = 255) completed measures of PTSS at baseline, and 1-, 3-, and 5-years poststudy entry. Children and caregivers completed dispositional measures including optimism, positive or negative affect, and Five-Factor Inventories. Latent class growth analysis (LCGA) was used to identify latent trajectories of PTSS, and univariate logistic regression models were conducted to predict LCGA class membership from medical, demographic, and disposition factors Results: Very similar trajectories were observed in children and caregivers, with two-class solutions providing the best fit: a "resilient" class, with low PTSS at baseline, which declined significantly over time (83.5% in children; 71.5% in parents), and an "elevated PTSS" class, which was moderately high at baseline and increased significantly over time. There was a small, but significant relationship between child and caregiver trajectories. Latent trajectories observed in children and parents were more strongly associated with dispositional variables than medical factors. CONCLUSIONS Resilience, depicted by low PTSS, is by far the most common outcome observed in both children and caregivers. However, the smaller subset with elevated PTSS do not show recovery over time, and are identified as a group in need of targeted interventions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Katianne Sharp
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Rachel Tillery
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Alanna Long
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Fang Wang
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN
| | - Haitao Pan
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN
| | - Sean Phipps
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
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Agbayani CJ, Tucker JA, Nelson EL, Martinez F, Cortes H, Khoury D, Kain ZN, Lin C, Torno L, Fortier MA. Immunological and psychosocial functioning in parents of children with cancer. Support Care Cancer 2022; 30:3379-3388. [PMID: 34994860 PMCID: PMC9833860 DOI: 10.1007/s00520-021-06770-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 12/16/2021] [Indexed: 01/13/2023]
Abstract
PURPOSE Research has shown that parents of children with cancer exhibit an altered immune profile compared to parents of healthy children, reflective of increased susceptibility to illness. These parents are also at risk for poorer psychosocial outcomes and quality of life. The current study compares peripheral blood cell analyses and psychosocial self-reports from parents of children being treated for cancer (n = 21) to parents of healthy children (n = 30). METHODS A blood sample was drawn from parents to analyze immune profiles. Parents also completed the Perceived Stress Scale (PSS), Medical Outcomes Study Short Form-36 (MOS), and Patient-Reported Outcomes Measurement Information System Short Form v1.0 Emotional Distress-Anxiety 8a, and Emotional Distress-Depression 8a (PROMIS). Mann-Whitney U tests and independent samples t-tests were conducted to examine differences in outcomes between parent groups. RESULTS Parents of children with cancer exhibited higher monocyte percentages in their peripheral blood compared to peers with healthy children. Parents of children with cancer also reported poorer psychosocial outcomes: higher perceived stress, higher anxiety and depression symptoms, more role disability resulting from emotional problems, poorer general and mental health, and poorer social functioning. CONCLUSION These findings support research that has shown a direct effect of chronic stress on the immune system. Symptoms reported by parents of children with cancer indicate unmet psychosocial needs that could potentially affect long-term health. Given the central role of parents in their children's cancer care, it is compelling to address and work to improve parent immunological and psychosocial well-being.
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Affiliation(s)
- Crystle-Joie Agbayani
- UCI Center on Stress and Health, School of Medicine, University of California-Irvine, Irvine, CA, USA,Department of Psychological Science, University of California-Irvine, Irvine, CA, USA
| | - Jo A. Tucker
- Department of Medicine, Division of Hematology Oncology, University of California-Irvine, Irvine, CA, USA,Institute for Immunology, University of California-Irvine, Irvine, CA, USA
| | - Edward L. Nelson
- Department of Medicine, Division of Hematology Oncology, University of California-Irvine, Irvine, CA, USA,Institute for Immunology, University of California-Irvine, Irvine, CA, USA,NCI-Designated Chao Family Comprehensive Cancer Center, Irvine, CA, USA
| | - Freddy Martinez
- UCI Center on Stress and Health, School of Medicine, University of California-Irvine, Irvine, CA, USA
| | - Haydee Cortes
- UCI Center on Stress and Health, School of Medicine, University of California-Irvine, Irvine, CA, USA,Department of Anesthesiology & Perioperative Care, University of California-Irvine, Irvine, CA, USA
| | - Dina Khoury
- UCI Center on Stress and Health, School of Medicine, University of California-Irvine, Irvine, CA, USA,Department of Medicine, Division of Hematology Oncology, University of California-Irvine, Irvine, CA, USA
| | - Zeev N. Kain
- UCI Center on Stress and Health, School of Medicine, University of California-Irvine, Irvine, CA, USA,Department of Anesthesiology & Perioperative Care, University of California-Irvine, Irvine, CA, USA,Department of Pediatrics, CHOC, Orange, CA, USA,Child Study Center, School of Medicine, Yale University, New Haven, CT, USA
| | - Carol Lin
- Hyundai Cancer Institute, CHOC, Orange, CA, USA
| | | | - Michelle A Fortier
- UCI Center on Stress and Health, School of Medicine, University of California-Irvine, Irvine, CA, USA,Department of Psychological Science, University of California-Irvine, Irvine, CA, USA,NCI-Designated Chao Family Comprehensive Cancer Center, Irvine, CA, USA,Department of Anesthesiology & Perioperative Care, University of California-Irvine, Irvine, CA, USA,Department of Psychology, CHOC, Orange, CA, USA,Sue & Bill Gross School of Nursing, University of California-Irvine, Irvine, CA, USA
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9
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Yang Y, He X, Chen J, Tan X, Meng J, Cai R, Liang L, Shi L. Posttraumatic stress symptoms in Chinese children with ongoing cancer treatment and their parents: Are they elevated relative to healthy comparisons? Eur J Cancer Care (Engl) 2022; 31:e13554. [PMID: 35129840 DOI: 10.1111/ecc.13554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 01/11/2022] [Accepted: 01/24/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The objective of this work is to compare posttraumatic stress symptoms (PTSS) between families of children on cancer treatment and families of healthy children in China and to analyse the association among child PTSS, parent PTSS, and depression in the cancer group. METHODS Participants were children on cancer treatment (n = 91) and their parents (n = 91), and healthy children (n = 114) and their parents (n = 96). The children were asked to self-report PTSS, and the parents completed self-reported measures of PTSS and depression. RESULTS Although the prevalence of probable PTSD in children on cancer treatment was higher than that in comparisons (8.79% vs. 0.88%, P < 0.01), no statistic differences in PTSS levels were found between the two groups (P > 0.05). However, significant differences in PTSS levels and the prevalence of severe PTSS (21.98% vs. 1.04%) between parents of children with cancer and comparisons were observed (P < 0.001). Parent PTSS and depression were positively associated with child PTSS in the cancer group (P < 0.01). CONCLUSION The prevalence of probable PTSD in Chinese children with cancer was low, but PTSS was remarkably prevalent in their parents. Greater parent PTSS and depression were related to greater child PTSS. Results underline the importance to provide supportive psychological care for Chinese parents of children undergoing cancer treatment.
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Affiliation(s)
- Yiling Yang
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Xiaofeng He
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Jinlu Chen
- PICU, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Xiangyi Tan
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Jiangnan Meng
- Department of Pediatrics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ruiqing Cai
- Department Pediatric Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Lichan Liang
- Department of Pediatric Hematology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Lei Shi
- School of Nursing, Southern Medical University, Guangzhou, China
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10
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Exploring Posttraumatic Stress Symptoms and Posttraumatic Growth among Children Living beyond Cancer and Their Parents Using an Actor–Partner Interdependence Model. Cancers (Basel) 2022; 14:cancers14030704. [PMID: 35158977 PMCID: PMC8833714 DOI: 10.3390/cancers14030704] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 12/04/2022] Open
Abstract
Simple Summary A diagnosis of childhood cancer, and its subsequent treatment, initiates a difficult and long-lasting experience for families which can result in posttraumatic stress symptoms. However, positive change, such as growth, may also occur. The relationship between posttraumatic stress symptoms and growth in the wake of childhood cancer is poorly understood. We sought to better understand the relationships between children’s posttraumatic stress symptoms and growth and those of their parents via a survey. The results from our study showed that the children and parents in our study were faring relatively well, reporting low levels of posttraumatic stress symptoms and moderate levels of growth. The children’s posttraumatic stress symptom score was not related to, nor did it predict their growth. The same was true for their parents wherein their posttraumatic stress symptom score was not related to, nor did it predict their growth. Notably, lower posttraumatic stress symptom scores among children were associated with greater growth in their parents, and vice versa, but the parents’ posttraumatic stress symptom score was not associated with the children’s growth. Abstract There is a growing focus on describing both negative and positive outcomes in the wake of childhood cancer. The purpose of this study was to describe and explore the relationships between posttraumatic stress symptoms (PTSS) and posttraumatic growth (PTG) among children living beyond cancer and one of their parents. As part of a larger online survey, 113 children (Mage at time of study = 15.82 (SD = 4.81); Mage at diagnosis = 5.86 (SD = 4.66)) and one of their parents completed questionnaires assessing PTSS and PTG. Descriptive statistics were used to describe the sample and levels of PTSS and PTG. Data were z-transformed and analyzed using bivariate correlations and t-tests. An actor–partner interdependence model (APIM) was used to test whether children’s and their parents’ PTSS was associated with their own PTG (actor effect) and the others’ PTG (partner effect). PTSS was low and PTG was moderate in this sample relative to scale ranges. There were no significant differences between the children’s and their parents’ PTSS (p = 0.535) or PTG (p = 0.534). Results from the APIM showed no significant actor effects (p = 0.185). A significant overall partner effect (p = 0.020) emerged. Lower PTSS for children was associated with greater PTG for their parents (b = −0.29, p = 0.018), but parent’s PTSS was not associated with children’s PTG (p = 0.434). This sample reported similar levels of PTSS and PTG to that which has been reported in the literature. Children and their parents’ scores on PTSS and PTG measures were not significantly different from one another. Children’s PTSS was negatively associated with their parents PTG, illuminating the ways in which PTSS and PTG may be related in the context of childhood cancer. Exploring family-based strategies to reduce PTSS and enhance PTG may be warranted, though further studies are required.
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Luo Y, Li HCW, Xia W, Cheung AT, Ho LLK, Chung JOK. The Lived Experience of Resilience in Parents of Children With Cancer: A Phenomenological Study. Front Pediatr 2022; 10:871435. [PMID: 35707743 PMCID: PMC9189362 DOI: 10.3389/fped.2022.871435] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Resilience is vital in parents of children with cancer as it can promote parental well-being and minimize maladaptation in the face of the children's cancer. Although existing quantitative studies investigated the influence factors of resilience in the parents, it has not been fully explored about the factors contributing to the resilience of parents and how they respond to and cope with their children's cancer. OBJECTIVE To investigate the lived experience of resilience in the parents of children with cancer from a qualitative perspective to complement existing findings in quantitative studies. METHODS A phenomenological approach was used. Purposive sampling was performed to recruit parents of children with cancer from two tertiary hospitals in mainland China, followed by one-to-one semi-structured interviews. All of the interviews were audio-recorded and data were analyzed using thematic analysis. RESULTS Twenty-three parents, comprising 15 mothers and eight fathers, of children with cancer participated in the interview. Four themes were identified: positive and negative experiences of their children's disease, going through hardships, perceived competence and perceived social support. The most prominent facilitating factor of resilience was the presence of positive attitudes toward the children's cancer, while low level of confidence was the main obstacle. CONCLUSION This study identified certain factors that affect resilience in parents of children with cancer. The findings of this study provide important implications for the development of targeted resilience training programs to enhance resilience in parents of children with cancer. It is crucial for future interventions to focus on cultivating parental resilience to promote parents' mental well-being and improve their quality of life. CLINICALTRIALSGOV ID NCT03631485; URL: https://clinicaltrials.gov/ct2/show/NCT03631485.
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Affiliation(s)
- Yuanhui Luo
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Ho Cheung William Li
- Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
| | - Wei Xia
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Ankie Tan Cheung
- Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
| | - Laurie Long Kwan Ho
- Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
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Triplett KN, Mayersohn GS, Masood SS, Pickwith K, Mbroh H, Killian M. Posttraumatic Growth in Youth, Young Adults, and Caregivers Who Experienced Solid Organ Transplant. J Pediatr Psychol 2021; 47:965-977. [PMID: 34957509 DOI: 10.1093/jpepsy/jsab134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 12/01/2021] [Accepted: 12/10/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To explore posttraumatic growth (PTG) in pediatric patients who have undergone solid organ transplant (SOT) and their caregivers, and to examine potential correlates of PTG. METHOD Youth and young adults with a history of SOT (heart, kidney, liver) at least 1 month prior to participation and caregivers completed measures of PTG, demographic, and medical factors. In total, 59 youth (M = 12.68 years, SD = 1.91), 21 young adults (M = 19.37, SD = 0.82), and 95 caregivers (M = 37.95 years, SD = 9.37) participated. RESULTS Overall, 67% of youth, 76% of young adults, and 89% of caregivers reported PTG within the medium to very high range. Appreciation of Life was the highest PTG subscale across all groups. Youth and caregiver PTG scores were significantly positively correlated. Religious affiliation and religious coping were positively associated with PTG for caregivers, and the relationship yielded large effect sizes for young adults. Caregivers of children with kidney transplants endorsed lower PTG than other organ types and caregivers of children who had an acute medical condition endorsed greater PTG than caregivers of children who had chronic illness. CONCLUSION Findings suggest the pediatric SOT experience can yield positive changes such as a greater appreciation of life. Although small sample sizes may have led to reduced power for detecting significant findings for some analyses, results suggest religious, medical, and parent-child relationship factors are likely related to PTG in pediatric SOT and warrant future investigation.
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Affiliation(s)
- Kelli N Triplett
- Department of Solid Organ Transplant, Children's Medical Center Dallas, Dallas, TX, USA.,Department of Psychiatry, University of Texas Southwestern, Dallas, TX, USA
| | - Gillian S Mayersohn
- Department of Psychology, St. Louis Children's Hospital, St. Louis, MO, USA.,Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Saba S Masood
- Department of Solid Organ Transplant, Children's Medical Center Dallas, Dallas, TX, USA.,Department of Psychiatry, University of Texas Southwestern, Dallas, TX, USA
| | - Kristine Pickwith
- Department of Solid Organ Transplant, Children's Medical Center Dallas, Dallas, TX, USA
| | - Hayden Mbroh
- Department of Psychiatry, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Department of Psychiatry, University of Southern California, Los Angeles, CA, USA
| | - Michael Killian
- College of Social Work, Florida State University, Tallahassee, FL, USA
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Burgess A, Wilcoxon L, Rushworth I, Meiser‐Stedman R. Meta-analysis found high rates of post-traumatic stress disorder and associated risk factors in parents following paediatric medical events. Acta Paediatr 2021; 110:3227-3236. [PMID: 34534369 DOI: 10.1111/apa.16113] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 08/24/2021] [Accepted: 09/15/2021] [Indexed: 11/30/2022]
Abstract
AIM This meta-analysis identified how prevalent parental post-traumatic stress disorder (PTSD) was after their children's medical events and evaluated the risk factors that increased the likelihood of PTSD. METHODS The MEDLINE, PsycINFO and PTSDpubs databases were searched for papers published in English from 1980 to June 2018. The prevalence of parental PTSD was pooled across the studies and risk factors were extracted whether PTSD symptoms were correlated with other research variables or when the authors had conducted between group analyses of PTSD. We also explored the effects of the assessment method, parental gender and medical events and the risk of bias. RESULTS The 54 studies that were identified had a pooled PTSD prevalence rate of 30.3% (95% confidence interval 25.3%-35.5%). Childhood cancer cases yielded the highest rates of parental PTSD. A total of 33 potential risk factors were identified. The risk factors with medium to large effects were: comorbid parental psychological responses and functioning, acute stress responses, child behavioural functioning, uncertainty about the child's illness and negative coping strategies. The findings are discussed within the context of high heterogeneity. CONCLUSION The prevalence of parental PTSD after paediatric medical events was relatively high, and 33 risk factors were identified.
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Affiliation(s)
- Aaron Burgess
- Department of Clinical Psychology and Psychological Therapies Norwich Medical School University of East AngliaNorwich Research Park Norwich UK
| | - Lucy Wilcoxon
- Department of Clinical Psychology and Psychological Therapies Norwich Medical School University of East AngliaNorwich Research Park Norwich UK
| | - Imogen Rushworth
- Department of Clinical Psychology and Psychological Therapies Norwich Medical School University of East AngliaNorwich Research Park Norwich UK
| | - Richard Meiser‐Stedman
- Department of Clinical Psychology and Psychological Therapies Norwich Medical School University of East AngliaNorwich Research Park Norwich UK
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Steinberg DM, Andresen JA, Pahl DA, Licursi M, Rosenthal SL. "I've Weathered Really Horrible Storms Long Before This…": The Experiences of Parents Caring for Children with Hematological and Oncological Conditions during the Early Months of the COVID-19 Pandemic in the U.S. J Clin Psychol Med Settings 2021; 28:720-727. [PMID: 33492628 PMCID: PMC7831624 DOI: 10.1007/s10880-020-09760-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2020] [Indexed: 11/18/2022]
Abstract
The societal impact of COVID-19 is vast, thus it is imperative to understand how vulnerable groups, such as children with chronic medical conditions are affected. This understanding can prepare psychologists and other healthcare providers to meet their current and future needs. A convenience sample of 11 parents of children with hematological/oncological conditions was recruited. They participated in semi-structured interviews on the effect of the COVID-19 pandemic on their children. Qualitative analysis identified common themes. Parental responses focused on the pandemic's impact on children's general daily life and healthcare. Themes of caution, uncertainty, adaptation, and the role of the healthcare providers and early medical experiences emerged. Concerns about vulnerability, changes in routine, the importance of virtual connections, and the pivotal role of providers have implications for children with and without medical conditions. The adaptation and resilience of the families provide a sense of hope in an uncertain time.
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Affiliation(s)
- Dara M. Steinberg
- Department of Pediatrics, Division of Hematology, Oncology & Stem Cell Transplantation, Columbia University Irving Medical Center, 161 Fort Washington Avenue—IP 7, New York, NY 10032 USA
- Department of Psychiatry, Division of Child & Adolescent Psychiatry, Columbia University Irving Medical Center, 161 Fort Washington Avenue—IP 7, New York, NY 10032 USA
| | - Jane A. Andresen
- Department of Pediatrics, Columbia University Irving Medical Center, New York, USA
| | - Daniel A. Pahl
- Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, USA
| | - Maureen Licursi
- Morgan Stanley Children’s Hospital, NewYork-Presbyterian Hospital, New York, USA
| | - Susan L. Rosenthal
- Department of Psychiatry, Division of Child & Adolescent Psychiatry, Columbia University Irving Medical Center, 161 Fort Washington Avenue—IP 7, New York, NY 10032 USA
- Department of Pediatrics, Columbia University Irving Medical Center, New York, USA
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Gise J, Cohen LL. Social Support in Parents of Children With Cancer: A Systematic Review. J Pediatr Psychol 2021; 47:292-305. [PMID: 34643692 DOI: 10.1093/jpepsy/jsab100] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 09/11/2021] [Accepted: 09/13/2021] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Parents of children with cancer (PCCs) experience stress as they navigate managing their child's illness. Arguably, social support is critical to PCCs' well-being. This review examines the literature on social support in PCCs. METHODS Studies of social support in PCCs were collected from PsycINFO, CINHAL, and MEDLINE. Data were extracted from 37 studies published between January 2010 and May 2021 related to the conceptualization, measurement, and availability of social support in PCCs. Relationships between PCCs' social support, well-being, and unique parent and child factors were also synthesized. Risks of biases were assessed using domains of the Effective Public Health Practice Project. RESULTS Social support in PCCs is conceptualized as (a) perceived availability and satisfaction with social support and (b) social support seeking as a coping strategy. Parents of children with cancer report receiving as much or more support than typical adults, but PCCs engage in less social support seeking. Family and significant others are the most prevalent sources of support, and emotional support is the most received type of social support. Social support is positively related to well-being and negatively related to distress, anxiety, and posttraumatic stress. Findings related to social support differences based on parent and child unique factors were minimal and present opportunities for future research. The risk of bias was generally low, with caution that most studies cannot demonstrate directionality of findings due to cross-sectional study designs. CONCLUSIONS Given the consistent positive association between social support and well-being in PCCs, clinicians should assess and encourage social support for this vulnerable population.
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Affiliation(s)
- Jensi Gise
- Department of Psychology, Georgia State University, USA
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Beckmann NB, Dietrich MS, Hooke MC, Gilmer MJ, Akard TF. Parental Posttraumatic Growth After Pediatric Hematopoietic Stem Cell Transplant. J Hosp Palliat Nurs 2021; 23:331-338. [PMID: 34185727 DOI: 10.1097/njh.0000000000000759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Little is known about the development of posttraumatic growth among parents of children with serious advanced disease. The purpose of this study is to describe parental posttraumatic growth 100 days after pediatric stem cell transplant. This is a cross-sectional, descriptive study of 24 parents, approximately 100 days after their children received stem cell transplant. Participants reported environmental, personal, and disease characteristics and completed measures of distress, coping, rumination, and posttraumatic growth. Evidence of parental posttraumatic growth was described in each of 5 dimensions (relating to others, new possibilities, personal strength, spiritual change, and appreciation of life). Posttraumatic growth was positively associated with parental distress, disengagement coping, and rumination measures (r = 0.44-0.47, P < .05). Appreciation of life demonstrated the strongest associations with distress and rumination (r = 0.53-0.61, P < .01). Curvilinear relationships were observed for the association of distress, disengagement coping, and involuntary engagement with posttraumatic growth (P < .05). Study results highlight opportunities for palliative care nurses and clinicians to facilitate opportunities to support parent posttraumatic growth during treatment for children's advanced disease.
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Roles of Reexamination of Core Beliefs and Rumination in Posttraumatic Growth Among Parents of Children With Cancer: Comparisons With Parents of Children With Chronic Disease. Cancer Nurs 2021; 44:20-28. [PMID: 31261183 DOI: 10.1097/ncc.0000000000000731] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Studies have indicated that the impact of a traumatic experience can be negative and can provide the opportunity to experience psychological growth, known as posttraumatic growth (PTG). OBJECTIVE To evaluate the role of cognitive processing in PTG among parents of childhood cancer survivors (CCSs) based on the PTG theoretical model. We compared the model between parents of SCC and parents of children with chronic disease (CCDs) to determine how the role of cognitive processing in PTG is different depending on the children's illness. METHODS Final sample consisted of 78 parents of CCSs and 44 parents of CCDs. The survey included standardized measurements assessing reexamination of core beliefs, intrusive and deliberate rumination, posttraumatic stress symptoms, and PTG. The hypothetical relationships among the variables were tested by covariance structure analysis. RESULTS Posttraumatic growth among parents of CCSs had significantly strong association with reexamination of core beliefs, but not with deliberate rumination. Reexamination of core beliefs was significantly more likely to foster PTG among parents of CCSs, whereas deliberate rumination was significantly more likely to be associated with PTG among parents of CCDs. CONCLUSIONS For parents of CCSs, reexamination of core beliefs had a greater impact on PTG than deliberate rumination. Our results suggest that support should focus on the process of reexamining core beliefs in facilitating PTG among parents of CCSs. IMPLICATIONS FOR PRACTICE Nurses should provide parents of CCSs with reassurance regarding their experiences of the reexamination of core beliefs, which will likely lead to PTG.
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Willard VW, Tillery R, Harman JL, Long A, Phipps S. The Influence of Early Childhood Temperament on Later Social-Emotional Functioning in Youth with Cancer. J Pediatr Psychol 2021; 46:433-442. [PMID: 33355354 PMCID: PMC8355438 DOI: 10.1093/jpepsy/jsaa120] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/20/2020] [Accepted: 11/18/2020] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE One of the peak incidences of childhood cancer is during the early childhood years. This is also an important time for psychosocial and personality development, and it is well known that early childhood temperament influences later psychosocial functioning. However, this association has not been examined in young children with cancer. METHODS Parents of children with cancer (N = 39) and healthy comparisons (N = 35) completed an indicator of temperament (Children's Behavior Questionnaire) when children were young (Mage=4.99 ± 1.05 years). Five years later, parents and youth completed measures of psychosocial functioning (Mage=10.15 ± 1.10 years; Behavior Assessment Scale for Children, 2nd edition and Social Emotional Assets and Resilience Scale). RESULTS Parents of healthy comparisons reported that their children demonstrated greater surgency than youth with cancer; there were no differences in negative affect or effortful control. Children with cancer and healthy comparisons were rated similarly on measures of psychosocial functioning. Health status was not a significant predictor of later functioning, but socioeconomic status and temperament were. The influence of temperament was stronger for strengths-based functioning (e.g., social competence, adaptive functioning) versus distress (internalizing and externalizing problems). CONCLUSIONS Early childhood temperament is a strong predictor of later psychosocial functioning, regardless of health status. Findings highlight the need to consider temperament in the clinical assessment of psychosocial functioning in children with cancer. Additional research is needed to specifically assess how a diagnosis of cancer in early childhood influences temperament over time.
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Affiliation(s)
| | - Rachel Tillery
- Department of Psychology, St. Jude Children’s Research Hospital
| | | | - Alanna Long
- Department of Psychology, St. Jude Children’s Research Hospital
| | - Sean Phipps
- Department of Psychology, St. Jude Children’s Research Hospital
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López J, Velasco C, Noriega C. The role of acceptance in parents whose child suffers from cancer. Eur J Cancer Care (Engl) 2021; 30:e13406. [PMID: 33481311 DOI: 10.1111/ecc.13406] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 12/08/2020] [Accepted: 12/23/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Parents are the main caregivers when there is a child diagnosed with cancer. Receiving a diagnosis of childhood cancer is a stressful experience. The objective of this study is to explore the mediating role of emotional avoidance and acceptance in the emotional adjustment of parents throughout the disease. METHODS Using the qualitative methodology Interpretative Phenomenological Analysis (IPA), parent's experiences of having a child with a diagnosis of cancer were explicated. Participants (n = 10) took part in one-on-one semi-structured interviews. RESULTS Acceptance serves to cope with paediatric cancer because parents live day by day, actively taking care of their children. Acceptance and emotional avoidance with oneself, with the sick child and with the others play a key role in emotional adjustment. Differences between acceptance and avoidance were considered. CONCLUSION Three main themes emerged from the analyses. Parents' ability to overcome their emotional struggle provides a non-pathological view of the experience of a child's illness. The results also showed the possibility for parents to access new ways to support their loved ones and to maintain the quality of their relationships. Acceptance has a positive impact on parents' adjustment while avoidance showed a negative effect on parents of children with cancer.
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Affiliation(s)
- Javier López
- Department of Psychology, School of Medicine, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
| | - Cristina Velasco
- Department of Psychology, School of Medicine, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
| | - Cristina Noriega
- Department of Psychology, School of Medicine, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
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Psychological Outcomes, Health-Related Quality of Life, and Neurocognitive Functioning in Survivors of Childhood Cancer and Their Parents. Pediatr Clin North Am 2020; 67:1103-1134. [PMID: 33131537 DOI: 10.1016/j.pcl.2020.07.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Childhood cancer disrupts the lives of patients and their families and affects acute and long-term psychological health. This article summarizes (1) psychological challenges, including depression, anxiety, worries, and posttraumatic stress, as well as positive outcomes such as benefit finding and posttraumatic growth in young survivors and parents; (2) health-related quality of life; (3) interventions to support survivors and parents with psychological difficulties; and (4) neurocognitive problems and interventions to help alleviate them. Although many survivors and parents fare well in the long term, many survivors may benefit from interventions. Interventions should be further evaluated and integrated into routine clinical care.
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Al Ghriwati N, Stevens E, Velázquez-Martin B, Hocking MC, Schwartz LA, Barakat LP. Family factors and health-related quality of life within 6 months of completion of childhood cancer treatment. Psychooncology 2020; 30:408-416. [PMID: 33180350 DOI: 10.1002/pon.5592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 10/19/2020] [Accepted: 11/02/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The transition from active cancer treatment to survivorship represents a period of uncertainty for youth and their families, but factors associated with adaptation during this period are understudied. We evaluated associations among cancer and treatment-related variables, family factors (family functioning, caregiver health-related quality of life [HRQL], and caregiver distress), and patient HRQL after treatment completion. We assessed the indirect effects of neurocognitive difficulties on youth HRQL through family factors. METHODS One hundred fifty-four caregivers (of patients' ages 0-18 years) and 52 youth (ages 7-18 years) completed questionnaires assessing family factors, neurocognitive difficulties, and HRQL for patients within 6 months following treatment completion. Electronic health records were reviewed for cancer and treatment-related information. Bootstrapping analyses assessed whether neurocognitive function had indirect effects on HRQL through family factors. RESULTS Family factors were associated with self- and caregiver reports of children's HRQL. Controlling for demographic, cancer, and treatment covariates, caregiver reports of their child's neurocognitive difficulties had an indirect effect on their reports of child physical HRQL through family functioning. Caregiver reports of their child's neurocognitive difficulties indirectly related to caregiver reports of child psychosocial HRQL through family functioning and caregiver HRQL. Indirect effects for self-reported neurocognitive difficulties and HRQL were not supported. CONCLUSIONS Findings highlight the need for routine psychosocial screening for youth and caregiver reports of family adjustment and HRQL during the transition off treatment. Providers are encouraged to offer interventions matched to specific needs for families at risk for poor family functioning to improve patient outcomes as they transition off treatment.
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Affiliation(s)
| | | | | | - Matthew C Hocking
- The Children's Hospital of Philadelphia.,Perelman School of Medicine at the University of Pennsylvania
| | - Lisa A Schwartz
- The Children's Hospital of Philadelphia.,Perelman School of Medicine at the University of Pennsylvania
| | - Lamia P Barakat
- The Children's Hospital of Philadelphia.,Perelman School of Medicine at the University of Pennsylvania
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Baenziger J, Roser K, Mader L, Harju E, Ansari M, Waespe N, Scheinemann K, Michel G. Post-traumatic stress in parents of long-term childhood cancer survivors compared to parents of the Swiss general population. JOURNAL OF PSYCHOSOCIAL ONCOLOGY RESEARCH AND PRACTICE 2020; 2:e024. [PMID: 32832904 PMCID: PMC7411524 DOI: 10.1097/or9.0000000000000024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 04/27/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND We describe post-traumatic stress symptoms (PTSS) and post-traumatic stress disorder (PTSD) in parents of long-term childhood cancer survivors (CCS-parents) and compare them to parents of similar-aged children (comparison-parents) of the Swiss general population (SGP). We compare type of reported stressful event, prevalence of PTSS and PTSD, and psychosocial and cancer-related characteristics associated with PTSS. We further describe the respective normative data for the SGP. METHODS We conducted a nationwide cross-sectional questionnaire survey in a population-based sample of long-term CCS-parents (survivors aged ≤16 years at diagnosis, ≥20 years at study, >5 years post-diagnosis) and in the SGP. Using the Impact of Event Scale-Revised, we measured PTSS regarding the most stressful event experienced, and computed probable cases of PTSD. RESULTS Participants included 663 CCS-parents (39.4% fathers) and 1035 individuals of the SGP (40.0% male), of which we identified 391 comparison-parents (41.2% fathers). Illness was most often indicated as stressful event (CCS-parents: 49.5%, comparison-parents: 27.6%, SGP: 25.3%). Prevalence of PTSS and PTSD (CCS-parents: 4.8%, comparison-parents: 6.7%, SGP: 5.6%) did not significantly differ. Lower education was associated with higher intrusion, avoidance, and hyperarousal in all samples (all P ≤ .003). Parents of children with a chronic illness reported higher intrusion (all P ≤ .004). We found no associations with cancer-related characteristics. CONCLUSIONS No increased risk for PTSS or PTSD was found among CCS-parents. Individuals with lower education and those with a chronically ill child might benefit from additional support to help manage and resolve the stress symptoms in the long term.
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Affiliation(s)
- Julia Baenziger
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Katharina Roser
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Luzius Mader
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Erika Harju
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Marc Ansari
- Division of Pediatrics, Onco-Hematology Unit, Geneva University Hospitals, Geneva, Switzerland
- CANSEARCH research laboratory, Geneva University Medical School, Geneva, Switzerland
| | - Nicolas Waespe
- CANSEARCH research laboratory, Geneva University Medical School, Geneva, Switzerland
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Katrin Scheinemann
- Division of Hematology/Oncology, University Children's Hospital Basel (UKBB), University of Basel, Basel, Switzerland
- Department of Pediatrics, Kantonsspital Aarau, Aarau, Switzerland
- Department of Pediatrics, McMaster University, Hamilton, Canada
| | - Gisela Michel
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
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Graj E, Muscara F, Anderson V, Hearps S, McCarthy M. Quality of life in parents of seriously Ill/injured children: a prospective longitudinal study. Qual Life Res 2020; 30:193-202. [PMID: 32910402 DOI: 10.1007/s11136-020-02624-0] [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] [Accepted: 08/24/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Parents of children with serious childhood illness or injury (SCII) are at risk of experiencing poor quality of life (QoL). This study investigated the nature of parent QoL at the time of child diagnosis and seven months post-diagnosis, the change in parent QoL over time, and early factors influencing short-term and longer-term parent QoL. METHODS The sample was drawn from a prospective longitudinal cohort study conducted within a paediatric hospital setting. Participants comprised 223 parents of 167 children diagnosed with a life-threatening illness and hospitalised in the cardiology, oncology, or intensive care departments. Examined data included QoL ratings completed by parents within four weeks of diagnosis and seven months post-diagnosis, and demographic, illness-related, and psychosocial predictor measures collected within four weeks of diagnosis, or four months post-diagnosis. RESULTS Generalised Estimating Equations were utilised to analyse data. Results indicated poor parent QoL at diagnosis, and normalised parent QoL at seven months. Improvement occurred most noticeably in the psychosocial domain. Reduced acute stress symptomatology and increased psychological flexibility were associated with higher parent QoL at diagnosis. Increased perceived emotional resources predicted enhanced parent QoL at seven months. CONCLUSION Paediatric medical care teams should consider the challenges to QoL experienced by parents of children with SCII. Parents reporting acute stress symptoms during the acute-illness phase should be prioritised for intervention. Further, parent-dyads presenting at post-acute care settings reporting poor emotional resources would benefit from psychosocial and educative support.
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Affiliation(s)
- Ella Graj
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia.
| | - Frank Muscara
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia.,Psychology Services, Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Vicki Anderson
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia.,Psychology Services, Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Stephen Hearps
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Maria McCarthy
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia.,Royal Children's Hospital, Children's Cancer Centre, Melbourne, Australia
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Schepers SA, Okado Y, Russell K, Long AM, Phipps S. Adjustment in Childhood Cancer Survivors, Healthy Peers, and Their Parents: The Mediating Role of the Parent-Child Relationship. J Pediatr Psychol 2020; 44:186-196. [PMID: 30247631 DOI: 10.1093/jpepsy/jsy069] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 08/12/2018] [Indexed: 11/12/2022] Open
Abstract
Objectives Aims were to (1) determine whether the associations between parent psychological functioning and adjustment outcomes of childhood cancer survivors (CCS) were mediated by the parent-child relationship and (2) examine possible differences in pathways for CCS and healthy peers. Method The study included CCS (n = 206), healthy peers (n = 132), and their primary caregivers. Youth (8-21 years) reported on the quality of the parent-child relationship and on their positive and negative adjustment outcomes. Parents reported on their own distress, posttraumatic growth, quality of the parent-child relationship, and their child's positive and negative adjustment outcomes. Two mediation models were tested, first examining youth-reported adjustment as the outcome and second examining parent-reported youth adjustment. Differences between model path coefficients of CCS and healthy peers were assessed by multigroup analyses. Results In the youth-reported model, the parent-child relationship mediated the relation between parental distress and adjustment, with more care leading to better youth-reported adjustment outcomes and more overprotection leading to poorer adjustment outcomes. In the parent-reported model, relational frustration and attachment mediated the link between parental distress/growth and parent-reported youth adjustment, with more relational frustration and less attachment relating to poorer youth adjustment outcomes. Multigroup analyses revealed no differences in model path coefficients between CCS and healthy peers. Conclusions Parental distress and the parent-child relationship likely play an important role in both youth- and parent-reported adjustment, and associations among these constructs do not differ between CCS and healthy peers. Families with less optimal parental functioning may benefit from interventions improving the quality of parent-child interactions.
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Affiliation(s)
| | - Yuko Okado
- Department of Psychology, California State University
| | - Kathryn Russell
- Department of Psychology, St. Jude Children's Research Hospital
| | - Alanna M Long
- Department of Psychology, St. Jude Children's Research Hospital
| | - Sean Phipps
- Department of Psychology, St. Jude Children's Research Hospital
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25
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Annunziato RA, Stuber ML, Supelana CJ, Dunphy C, Anand R, Erinjeri J, Alonso EM, Mazariegos GV, Venick RS, Bucuvalas J, Shemesh E. The impact of caregiver post-traumatic stress and depressive symptoms on pediatric transplant outcomes. Pediatr Transplant 2020; 24:e13642. [PMID: 31880384 DOI: 10.1111/petr.13642] [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] [Received: 08/08/2019] [Revised: 11/27/2019] [Accepted: 12/05/2019] [Indexed: 11/26/2022]
Abstract
PTSS as well as symptoms of depression have been reported in children who experience a serious medical adversity as well as their caretakers. The adverse effects of PTSS, when experienced by the patients, on medical outcomes have been clearly documented. However, the impact of those symptoms, if any, when experienced by the caretakers on child outcomes has not been investigated prospectively. We evaluated whether caregiver PTSS and depression symptoms predict adherence to medications and medical outcomes in a prospective multisite study. Four hundred children participated in MALT. Caretaker PTSS were assessed by the IES and depressive symptoms by CES-D. During 2 years of follow-up, the MLVI was used to determine adherence. Centrally read, biopsy-confirmed organ rejection was the primary medical outcome. IES scores were not associated with either adherence or rejection outcomes. In contrast, there were significant correlations between CES-D (depression) scores and lower adherence, r = .13, P < .001, and a trend toward higher scores on the CES-D among those whose children had experienced rejection, 12.4 (SD = 10.9) versus 9.1 (SD = 8.6), P = .077. Caregivers' PTSS were not a risk factor for poor child outcomes in this cohort, whereas depression symptoms were associated with non-adherence and possibly increased rates of rejection. Further study can validate if caregivers' depression as opposed to PTSS confers greater risk and should be a focus during the clinical care of medically ill children.
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Affiliation(s)
- Rachel A Annunziato
- Icahn School of Medicine at Mount Sinai, New York, New York
- Fordham University, Bronx, New York
| | | | - Christina J Supelana
- Icahn School of Medicine at Mount Sinai, New York, New York
- Fordham University, Bronx, New York
| | - Claire Dunphy
- Icahn School of Medicine at Mount Sinai, New York, New York
- Fordham University, Bronx, New York
| | | | | | - Estella M Alonso
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - George V Mazariegos
- Hillman Center for Pediatric Transplantation, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | | | - John Bucuvalas
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Eyal Shemesh
- Icahn School of Medicine at Mount Sinai, New York, New York
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26
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Quality of life in pediatric oncology patients, caregivers and siblings after psychosocial screening: a randomized controlled trial. Support Care Cancer 2019; 28:3659-3668. [PMID: 31811485 DOI: 10.1007/s00520-019-05160-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 10/30/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE We evaluated whether conducting psychosocial screening using a validated measure (the Psychosocial Assessment Tool, PAT) and providing a summary of PAT results to the patient's treating team improves quality of life (QOL) in newly diagnosed patients with cancer, their caregivers and siblings, in general, and in relation to the initial family psychosocial risk. METHODS Families were randomly allocated to an intervention (IG, treating team received PAT summary describing low, medium, or high psychosocial risk) or control group (CG, no summary provided to treating team) in two Canadian pediatric cancer centers. Caregivers (N = 122) of children newly diagnosed with cancer, patients (n = 36), and siblings (n = 25) completed QOL assessments at 2-4 weeks (T1) and 6 months post-diagnosis (T2). Caregivers also completed PAT and proxy QOL for patient and sibling. RESULTS In general, patient-proxy total QOL improved in IG compared to CG over time but only for high psychosocial risk patients (p < .05). Patient proxy cancer-related QOL improved over time regardless of group allocation; caregiver QOL also improved over time (ps < .05). CONCLUSION This study demonstrated the benefits of psychosocial screening results only on proxy patient QOL outcomes with high psychosocial risk near diagnosis. Evaluating QOL benefits in pediatric oncology patients is critical for establishing the clinical value of psychosocial screening. CLINICAL TRIAL REGISTRATION NUMBER NCT02788604 (REGISTERED WITH HTTPS://CLINICALTRIALS.GOV/CT2/SHOW/NCT02788604 ).
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27
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Howard Sharp KM, Fisher RS, Clark OE, Dunnells ZDO, Murphy LK, Prussien KV, Vannatta K, Compas BE, Gerhardt CA. Long-term trajectories of depression symptoms in mothers of children with cancer. Health Psychol 2019; 39:89-98. [PMID: 31789559 DOI: 10.1037/hea0000826] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To identify trajectories of depression symptoms in mothers of children with cancer from diagnosis/relapse through 5 years and examine maternal factors at diagnosis/relapse predicting membership in these trajectories. METHOD Mothers (n = 327; Mage = 37.6 years, SD = 7.7 years; 85.9% White) reported depression symptoms near the time of their child's diagnosis/relapse and then again at 1-, 3-, and 5-years postdiagnosis/relapse. Mothers also reported perceived stress, coping (primary control, secondary control, and disengagement coping), and spirituality near the time of diagnosis. Latent class growth analysis was used to identify latent trajectories of depression symptoms, and a 3-step multinomial logistic regression tested covariate predictors of membership in the trajectories. RESULTS Three trajectories were identified: "low depression symptoms" (63.3%), "moderate depression symptoms" (31.5%), and "high depression symptoms" (5.2%). Mothers who used more primary and secondary control coping were more likely to be in the low depression symptom trajectory as compared with the moderate (OR = 1.64, p = .024 and OR = 1.38, p = .013, respectively) or high trajectories (OR = 1.99, p = .008 and OR = 1.81, p = .001, respectively). CONCLUSIONS Although mothers of children with cancer generally displayed improved mental health further from diagnosis, mothers with more depression symptoms after diagnosis/relapse displayed substantial stability in depression symptoms over the 5 years. Mothers of children with cancer may benefit from early screening of mental health and coping strategies, as well as interventions to bolster effective coping for those with elevated depression symptoms. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | - Rachel S Fisher
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital
| | - Olivia E Clark
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital
| | - Zackery D O Dunnells
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital
| | - Lexa K Murphy
- Department of Psychology and Human Development, Vanderbilt University
| | - Kemar V Prussien
- Department of Psychology and Human Development, Vanderbilt University
| | - Kathryn Vannatta
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital
| | - Bruce E Compas
- Department of Psychology and Human Development, Vanderbilt University
| | - Cynthia A Gerhardt
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital
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28
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Perez MN, Traino KA, Bakula DM, Sharkey CM, Espeleta HC, Delozier AM, Mayes S, McNall R, Chaney JM, Mullins LL. Barriers to care in pediatric cancer: The role of illness uncertainty in relation to parent psychological distress. Psychooncology 2019; 29:304-310. [DOI: 10.1002/pon.5248] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/27/2019] [Accepted: 10/02/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Megan N. Perez
- Department of Psychology Oklahoma State University Stillwater Oklahoma
| | | | - Dana M. Bakula
- Department of Psychology Oklahoma State University Stillwater Oklahoma
| | | | | | - Alexandria M. Delozier
- Department of Psychology Oklahoma State University Stillwater Oklahoma
- Department of Psychiatry and Human Behavior University of Mississippi Medical Center MI Jackson
| | - Sunnye Mayes
- Department of Pediatrics University of Oklahoma Health Sciences Center Oklahoma City Oklahoma
| | - Rene McNall
- Department of Pediatrics University of Oklahoma Health Sciences Center Oklahoma City Oklahoma
| | - John M. Chaney
- Department of Psychology Oklahoma State University Stillwater Oklahoma
| | - Larry L. Mullins
- Department of Psychology Oklahoma State University Stillwater Oklahoma
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Hu H, Shear D, Thakkar R, Thompson-Lastad A, Pinderhughes H, Hecht FM, Lown EA. Acupressure and Therapeutic Touch in Childhood Cancer to Promote Subjective and Intersubjective Experiences of Well-being During Curative Treatment. Glob Adv Health Med 2019; 8:2164956119880143. [PMID: 31632842 PMCID: PMC6769200 DOI: 10.1177/2164956119880143] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 09/05/2019] [Indexed: 01/29/2023] Open
Abstract
PURPOSE Acupressure and therapeutic touch may be beneficial for symptom management and increasing general well-being for children undergoing cancer treatment. Acupressure has the benefit of stimulating targeted acupuncture points while providing therapeutic touch. We sought to explore the relationship between acupressure and the experience of well-being among children being treated for cancer who received acupressure. METHODS In the Acupressure for Children in Treatment for a Childhood Cancer trial, hospitalized children received acupressure using specified acupressure points for symptom control as well as points for general well-being. Acupressure was delivered by professionals and by caregivers, following training by the professional. Qualitative data were collected through semistructured interviews with a purposive sample of professional acupressure providers (n = 3) and primary caregivers (n = 13), combined with participant observation during the acupressure intervention. Data were analyzed using grounded theory methods. RESULTS Analysis of provider interview, caregiver interview, and participation observation yielded 3 prominent themes: (1) well-being elicited by acupressure, (2) well-being elicited by touch, and (3) well-being experienced as relational and intersubjective. These themes, taken together, illustrate the intricate ways in which an intervention like acupressure can help alleviate the difficulties of a childhood cancer illness experience by promoting well-being in the child as well as the caregiver. Acupressure brought symptom relief, physical relaxation, and comforting touch to the child, allowing the caregiver to also feel relief and relaxation as caregiver-child experience of well-being are closely intertwined. CONCLUSIONS Data from the 3 sources provided distinct and overlapping insights suggesting the versatile benefits of acupressure in promoting well-being during childhood cancer treatment. Professional acupressure combined with training of caregivers for childhood cancer may be a relational intervention that facilitates the experience of well-being for both the caregiver and the child.
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Affiliation(s)
- Hiroe Hu
- Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, California
- College of Osteopathic Medicine, Touro University, Vallejo, California
| | - Deborah Shear
- Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, California
| | - Radhika Thakkar
- Division of Pediatric Allergy, Immunology, & Blood and Marrow Transplantation, University of California, San Francisco, San Francisco, California
| | - Ariana Thompson-Lastad
- Osher Center for Integrative Medicine, University of California, San Francisco, San Francisco, California
| | - Howard Pinderhughes
- Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, California
| | - Frederick M Hecht
- Osher Center for Integrative Medicine, University of California, San Francisco, San Francisco, California
| | - E Anne Lown
- Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, California
- Osher Center for Integrative Medicine, University of California, San Francisco, San Francisco, California
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30
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Tillery R, Willard VW, Long A, Phipps S. Posttraumatic stress in young children with cancer: Risk factors and comparison with healthy peers. Pediatr Blood Cancer 2019; 66:e27775. [PMID: 31038281 PMCID: PMC7417025 DOI: 10.1002/pbc.27775] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 04/03/2019] [Accepted: 04/04/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The most commonly occurring childhood cancers are diagnosed during the preschool years; yet limited psycho-oncology research has focused on this developmental time period. The primary objective was to examine rates of posttraumatic stress symptoms (PTSS) in young children with cancer and compare these findings with those of children without a history of serious illness (comparisons). The secondary aim was to examine risk and modifiable factors associated with PTSS. METHOD Ninety-seven caregivers of patients (n = 50) and comparisons (n = 47) aged three to six years completed diagnostic interviews for the assessment of PTSD. They also completed a survey measure of PTSS adapted from the Child Behavior Checklist (CBCL-PTSD), along with measures of their child's temperament and their own current psychological functioning. RESULTS On the CBCL-PTSD, no differences in PTSS were observed between children with cancer and comparisons, although many in both groups appeared at risk, with approximately 34% of children with cancer and 27% of comparisons meeting threshold scores for probable PTSD. However, using a "gold-standard" clinical-interview assessment, only three children in the patient group and no children in the comparison group met diagnostic criteria for PTSD. Parental distress and child temperament were significantly associated with PTSS scores. CONCLUSION Findings indicate PTSD is relatively infrequent in children with cancer, and survey measures may overestimate rates of PTSD in young children. However, other emotional or behavioral issues may be present. Ultimately, screening for potential emotional/behavioral concerns in young children with cancer is indicated, and interventions should continue to target caregiver distress.
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Affiliation(s)
- Rachel Tillery
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Victoria W. Willard
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Alanna Long
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Sean Phipps
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
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31
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Wiener L, Bluebond-Langner M. Commentary: Treating the Pediatric Cancer Patient: Insights That Have Stood the Test of Time. J Pediatr Psychol 2019; 44:764-767. [PMID: 30990524 PMCID: PMC6655358 DOI: 10.1093/jpepsy/jsz022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 03/12/2019] [Accepted: 03/18/2019] [Indexed: 01/28/2023] Open
Affiliation(s)
- Lori Wiener
- Psychosocial Support and Research Program, Pediatric Oncology Branch, Center for Cancer Research, National Institutes of Health, Bethesda, MD, USA
| | - Myra Bluebond-Langner
- UCL Great Ormond Street Institute of Child Health, Louis Dundas Centre for Children’s Palliative Care, London, England
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Rensen N, Steur LMH, Schepers SA, Merks JHM, Moll AC, Grootenhuis MA, Kaspers GJL, van Litsenburg RRL. Concurrence of sleep problems and distress: prevalence and determinants in parents of children with cancer. Eur J Psychotraumatol 2019; 10:1639312. [PMID: 31448065 PMCID: PMC6691919 DOI: 10.1080/20008198.2019.1639312] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/23/2019] [Accepted: 06/18/2019] [Indexed: 12/20/2022] Open
Abstract
Background: Parents of children with cancer are at risk for sleep problems. If these problems persist, an important perpetuating factor might be ongoing parental distress. Objective: The aim of this study is to assess the prevalence of sleep problems and the concurrence with distress in parents of children treated for cancer, and to identify predictors of this symptom clustering. Method: Parents completed the Medical Outcomes Study (MOS) Sleep Scale and Distress Thermometer for Parents (DT-P). Clinically relevant sleep problems were defined as a score >1SD above the norm and clinical distress as a thermometer score above the established cut-off of 4. Four parent categories were constructed: neither sleep problems nor distress; no distress but sleep problems; no sleep problems but distress; both sleep problems and distress. Predictive determinants (sociodemographic, medical, psychosocial) for each category were assessed with multilevel multinomial logistic regression. Results: Parents (202 mothers and 150 fathers) of 231 children with different cancers participated. Mean time since diagnosis was 3.3 ± 1.4 years (90% off-treatment). The prevalence of sleep problems was 37%. Fifty percent of parents reported neither sleep problems nor distress, 9% had only sleep problems, 13% only distress, and 28% reported both. Compared to parents without sleep problems or distress, parents who reported both were more likely to report parenting problems (OR 4.4, [2.2-9.1]), chronic illness (OR 2.8, [1.2-6.5]), insufficient social support (OR 3.7, [1.5-9.1]), pre-existent sleep problems (OR 6.2, [2.0-18.6]) and be female (OR 1.8, [1.1-4.2]). Conclusions: Sleep problems are common in parents of children treated for cancer, and occur mostly in the presence of clinical distress. Future research must show which interventions are most effective in this group: mainly targeted at sleep improvement or with prominent roles for stress management or trauma processing.
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Affiliation(s)
- Niki Rensen
- Pediatric Oncology-Hematology, Cancer Center Amsterdam, Amsterdam UMC, Emma Children’s Hospital, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Lindsay M. H. Steur
- Pediatric Oncology-Hematology, Cancer Center Amsterdam, Amsterdam UMC, Emma Children’s Hospital, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Sasja A. Schepers
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
- Psychosocial Department, Amsterdam UMC, Emma Children’s Hospital, University of Amsterdam, Amsterdam, Netherlands
| | - Johannes H. M. Merks
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
- Pediatric Oncology-Hematology, Amsterdam UMC, Emma Children’s Hospital, University of Amsterdam, Amsterdam, Netherlands
| | - Annette C. Moll
- Ophthalmology, Amsterdam UMC, Vrije Universiteit, Amsterdam, Netherlands
| | - Martha A. Grootenhuis
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
- Psychosocial Department, Amsterdam UMC, Emma Children’s Hospital, University of Amsterdam, Amsterdam, Netherlands
| | - Gertjan J. L. Kaspers
- Pediatric Oncology-Hematology, Cancer Center Amsterdam, Amsterdam UMC, Emma Children’s Hospital, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Raphaële R. L. van Litsenburg
- Pediatric Oncology-Hematology, Cancer Center Amsterdam, Amsterdam UMC, Emma Children’s Hospital, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
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Psychological distress in parents of children treated for cancer: An explorative study. PLoS One 2019; 14:e0218860. [PMID: 31226159 PMCID: PMC6588250 DOI: 10.1371/journal.pone.0218860] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 06/11/2019] [Indexed: 11/29/2022] Open
Abstract
Objective To explore psychological distress experienced by parents who express a need for psychotherapy after curative treatment for their child’s cancer. Methods 15 parents (eight mothers and seven fathers) of children treated for cancer (median time since end of curative treatment: two years) were recruited via a pediatric oncology center. Each parent was interviewed twice and data was analyzed with inductive latent qualitative content analysis. Results Two overarching themes emerged. One theme, An unfamiliar and frightening situation during treatment, portrayed experiences during the treatment period, and included the sub-themes Initial reactions to the uncontrollable situation, Adjustment to the situation, and Focus on supporting the child. Another theme, Emotional struggles after end of curative treatment, portrayed experiences following curative treatment, and included the sub-themes Transitioning back to life as it was before the diagnosis, Emotional scars, Uncontrollable fears and worries of diseases, and New perspectives on life. Conclusions Parents of children with cancer experience existential, physical, psychological, and social struggles. They describe an unstable situation after diagnosis and having focused their attention towards protecting their child during treatment. After the end of curative treatment, they experience challenges with transitioning back to life as it was before the diagnosis and dealing with their own emotional scars and fears related to the child’s cancer. The findings indicate an unmet need for psychological support among parents of children treated for cancer.
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Salem H, Andersen EW, Dalton SO, Schmiegelow K, Winther JF, Lichtenthal WG, Johansen C, Bidstrup PE. Psychotropic Medication Use in Parents of Children Diagnosed With Cancer. Pediatrics 2019; 143:peds.2018-2605. [PMID: 30944153 PMCID: PMC7548106 DOI: 10.1542/peds.2018-2605] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/29/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Objective measures on parental distress after a child's cancer diagnosis are sparse. We examined the risk for first prescription of psychotropic medicine among parents of children with cancer compared with parents of children who were cancer free. In addition, we examined if sociodemographic and clinical characteristics are associated with risk of first prescription of psychotropic medication in parents of children with cancer. METHODS We followed all parents of children with cancer (N = 6744) from the Danish Cancer Registry (1998-2014) using parents of matched children who were cancer free (N = 65 747) as a comparison. To identify vulnerable subgroups among parents of children with cancer, we followed all parents of children with cancer from the Childhood Cancer Registry (2003-2015; N = 3290 parents). In Cox proportional hazard models, we estimated hazard ratios (HRs) for a first prescription of psychotropic medication according to cancer status of the child and sociodemographic and clinical risk factors. RESULTS Parents of children with cancer were at increased risk for a first prescription of psychotropic medication compared with parents of children who were cancer free up to 2 years after the diagnosis, the risk being highest in the first year (HR, 1.83 [95% confidence interval (CI), 1.66-2.01]). Parents of children with cancer, especially parents who lost their child, had an increased risk for a first prescription of hypnotics (HR, 6.91; 95% CI, 3.50-13.66) and anxiolytics (HR, 4.55, 95% CI, 1.57-13.17) in the first year after diagnosis. CONCLUSIONS Efforts should be made to ensure that medical teams are adequately educated to address stress responses in the parents.
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Affiliation(s)
| | | | - Susanne O. Dalton
- Unit of Survivorship, Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark
| | - Kjeld Schmiegelow
- University Hospital Rigshospitalet; Institute of Clinical Medicine, Medical Faculty, University of Copenhagen, Copenhagen, Denmark
| | - Jeanette Falck Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark;,Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Wendy G. Lichtenthal
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Christoffer Johansen
- Unit of Survivorship, Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark;,Department of Oncology, Finsen Centre, University Hospital Rigshospitalet
| | - Pernille E. Bidstrup
- Unit of Survivorship, Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark
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35
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Salvador Á, Crespo C, Barros L. Parents' psychological well-being when a child has cancer: Contribution of individual and family factors. Psychooncology 2019; 28:1080-1087. [PMID: 30861257 DOI: 10.1002/pon.5057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 03/06/2019] [Accepted: 03/07/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The aim of this study was to examine the contribution of individual (positive reappraisal) and family factors (parenting satisfaction, couple relationship quality, and family life difficulty) to the psychological well-being (PWB) of parents of children/adolescents diagnosed with cancer. METHODS This cross-sectional study was conducted at two pediatric oncology wards in Portugal. Two-hundred and five parents of pediatric patients with cancer completed self-report questionnaires assessing the use of positive reappraisal as a coping strategy, parenting satisfaction, relationship quality, family life difficulty, and PWB. Sociodemographic and clinical data were also assessed. RESULTS Standard multiple regression analysis showed a significant contribution of both individual- and family-level factors to parents' PWB. Specifically, the use of positive reappraisal as a coping strategy, parenting satisfaction, and relationship quality were associated with higher PWB; conversely, family life difficulty was linked to lower PWB. Sociodemographic (child's age and family's socioeconomic status) and clinical variables (time since diagnosis and treatment status) were not associated with PWB. CONCLUSIONS The present study identified potential resources for parents' adaptation to this stressful situation, contributing with insightful conclusions for both research and clinical practice. Screening and addressing both individual- and family-level aspects may be crucial to foster parents' well-being when a child is diagnosed with cancer.
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Affiliation(s)
- Ágata Salvador
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Lisbon
| | - Carla Crespo
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Lisbon
| | - Luísa Barros
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Lisbon
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Acceptability and feasibility of a therapeutic board game for children and adolescents with cancer: the Italian version of Shop Talk. Support Care Cancer 2019; 27:4479-4485. [PMID: 30911914 DOI: 10.1007/s00520-019-04755-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 03/18/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Shop Talk is a therapeutic board game for children and adolescents with cancer, aimed at helping them talk about their disease, life, and emotions in a creative way and in a secure setting. The scope of this study was to translate Shop Talk into Italian, evaluating its acceptability, feasibility, and emotional impact. METHODS The game board, question cards, and game instructions were translated into Italian from the original English-Spanish version. A sample of 30 pediatric patients aged 7-18 with cancer were enrolled and assigned to one of the following play settings: individual setting, caregiver setting, group setting. The patients' affectivity was assessed before (T0) and after (T1) the game session using PANAS-C. Acceptability and feasibility were assessed at T1 using a specifically designed questionnaire. RESULTS The patients' acceptability and feasibility perception scores were high. Statistical analyses showed a significant decrease of the negative affect and a significant increase of the positive affect in patients. CONCLUSIONS The results suggest that the patients involved appreciated the game and its content, purpose, and use. In addition, the game session with Shop Talk had a positive impact on the players' affectivity. Therefore, Shop Talk can be considered a useful tool for psychologists working with pediatric cancer patients in Italy.
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Habibpour Z, Mahmoudi H, Nir MS, Areshtanab HN. Resilience and its Predictors among the Parents of Children with Cancer: A Descriptive-Correlational Study. Indian J Palliat Care 2019; 25:79-83. [PMID: 30820107 PMCID: PMC6388604 DOI: 10.4103/ijpc.ijpc_128_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Context: As a common debilitating illness, cancer is among the leading causes of child mortality in developed and developing countries. Cancer diagnosis for children is considerably stressful for their parents. Resilience is a key factor behind effective coping with cancer-related problems. This study evaluated resilience and its predictors among the parents of children with cancer. Aim: This study evaluated resilience and its predictors among the parents of children with cancer. Settings and Design: This cross-sectional descriptive-analytical study was conducted in 2017 on 400 parents of children with cancer in Tabriz Children's Hospital, Iran. Methods: A demographic questionnaire and the Connor-Davidson Resilience Scale were used to collect the data. Parents were conveniently recruited from Tabriz Children's Hospital. Statistical Analysis: Data were analyzed using the SPSS for Windows program (v. 16) via descriptive and inferential statistical methods. Results: The mean score of parents’ resilience was 66.83 ± 14.28. Fathers obtained significantly higher resilience scores than mothers (P < 0.001). The predictors of parents’ resilience were financial status, parents’ gender, fathers’ employment status, and children's gender. Conclusion: The parents of cancer-afflicted children, particularly their mothers, have low resilience and therefore may be at risk for different physical and mental health problems. Health-care providers need to identify at-risk parents and provide them with greater psychological and educational support.
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Affiliation(s)
- Zeinab Habibpour
- Department of Medical-surgical Nursing, Faculty of Nursing, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Hosein Mahmoudi
- Trauma Research Center and Faculty of Nursing, Baqiyatallah University of Medical Sciences, Tehran, IR Iran.,Behavioral Sciences Research Center, Faculty of Nursing, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Masoud Sirati Nir
- Department of Psychiatric Nursing, Faculty of Nursing, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Hossein Namdar Areshtanab
- Department of Psychiatric Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
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Kentor RA, Hilliard ME. JPP Student Journal Club Commentary: Considerations on Depression, Distress, and Resilience in Parents of Children With Chronic Health Conditions. J Pediatr Psychol 2019; 44:150-152. [PMID: 30590517 DOI: 10.1093/jpepsy/jsy096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 11/10/2018] [Indexed: 01/09/2023] Open
Affiliation(s)
- Rachel A Kentor
- Baylor College of Medicine.,Texas Children's Hospital, Houston, TX
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Modanloo S, Rohani C, Shirinabadi Farahani A, Vasli P, Pourhosseingholi A. General Family Functioning as a Predictor of Quality of Life in Parents of Children With Cancer. J Pediatr Nurs 2019; 44:e2-e8. [PMID: 30195919 DOI: 10.1016/j.pedn.2018.08.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 08/18/2018] [Accepted: 08/18/2018] [Indexed: 01/04/2023]
Abstract
PURPOSE The diagnosis of cancer in a child brings about a crisis for the whole family. This study aimed to (1) determine family functioning and parents' quality of life in comparison with groups in relevant studies, (2) assess the correlation between dimensions of family functioning and parents' quality of life domains, and (3) explore the predictive role of general family functioning (GFF) for quality of life domains in a sample of families (mother-father as a dyad) of children with cancer. DESIGN AND METHODS This is a cross-sectional study which was performed on 62 pairs of parents of children with cancer (n = 124). Data were collected using the Demographic-Clinical Information Questionnaire, validated Persian versions of the McMaster Family Assessment Device (FAD) and the World Health Organization's Quality of Life-BREF (WHOQOL-BRFF). The Canonical Correlation Analysis and the Generalized Estimating Equation (GEE) model were used for data analysis. RESULTS All dimensions of the FAD were reported as unhealthy dimensions. Also, a poor quality of life was reported in all domains by parents. Most of the family functioning dimensions were correlated with quality of life domains. Consequently, after controlling for several demographic and clinical variables the GFF was the most important predictor of parents' quality of life and its domains. CONCLUSIONS The GFF should be measured at the first meeting with a family of a child with cancer and during the follow-up meetings to help plan family empowerment interventions.
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Affiliation(s)
- Shokoufeh Modanloo
- University of Ottawa, Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada
| | - Camelia Rohani
- Community Health Nursing Department, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Azam Shirinabadi Farahani
- Department of Pediatric & Neonatal Intensive Care Nursing, School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parvaneh Vasli
- Community Health Nursing Department, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Asma Pourhosseingholi
- Department of Biostatistics, School of Alied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Cederberg JT, Weineland S, Dahl J, Ljungman G. Validation of the Swedish Acceptance and Action Questionnaire (SAAQ) for parents of children with cancer. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2018. [DOI: 10.1016/j.jcbs.2018.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Navea Martín A, Tamayo Hernández JA. Características de la resiliencia familiar en pacientes oncológicos pediátricos: una revisión sistemática. PSICOONCOLOGIA 2018. [DOI: 10.5209/psic.61431] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introducción: la resiliencia familiar consiste en la adaptación positiva a la adversidad, implicando el cambio de su dinámica y su funcionamiento, permitiendo resolver cualquier estresor que se encuentre durante la vida de sus miembros. Objetivo: conocer las características de la resiliencia familiar en el ámbito de la oncología pediátrica. Método: mediante una revisión sistemática, se realiza una búsqueda en las bases de datos Medline, SCOPUS/Sciencedirect, Academic Search complete, Psychology and Behavioral Sciences Collection, CINAHL y E-Journals, para conocer las últimas investigaciones acerca de modelos, variables, instrumentos e intervenciones de resiliencia familiar, obteniéndose 13 artículos. Resultados: un 84,7% de las investigaciones son de tipo cuantitativo y presentan factor de impacto. La mayor parte de los estudios utilizan la Escala Connor-Davidson Resilience y obtienen que la mayoría de las familias de niños con cáncer son resilientes. Dos artículos presentan modelos de resiliencia familiar. Conclusión: El constructo de resiliencia familiar es complejo y es estudiado desde diferentes perspectivas. Un modelo que resuma todos los aspectos que influyen en el mismo, puede ayudar a la intervención del psicólogo con las familias de niños con cáncer.
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Huang IC, Brinkman TM, Mullins L, Pui CH, Robison LL, Hudson MM, Krull KR. Child symptoms, parent behaviors, and family strain in long-term survivors of childhood acute lymphoblastic leukemia. Psychooncology 2018; 27:2031-2038. [PMID: 29772082 DOI: 10.1002/pon.4769] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 05/07/2018] [Accepted: 05/08/2018] [Indexed: 02/01/2023]
Abstract
OBJECTIVE How family environment and parental factors affect health status and symptoms in childhood cancer survivors is understudied. We examined the influence of family cohesion, parent distress, and overprotection on child symptom burden and health-related quality of life (HRQOL) and family strain in survivors of childhood acute lymphoblastic leukemia. METHODS Parents of 213 children treated with chemotherapy only completed a survey when survivors were at least 5-year postdiagnosis. Family Environment Scale, Brief Symptom Inventory-18, Parent Protection Scale, Pediatric Quality of Life Inventory, and Impact on Family were used to assess family cohesion, parental distress, overprotection, child symptom burden and HRQOL, and family strain, respectively. Path analysis was conducted to quantify effects of family cohesion on family strain through parental distress, overprotection, child symptoms, and HRQOL. RESULTS Lower family cohesion (β = 0.06, 95% CI, 0.01-0.13), higher parental distress (β = 0.35, 95% CI, 0.20-0.45), and overprotection (β = 0.17, 95% CI, 0.01-0.32) were associated with more child symptom burden. More symptom burden were associated with poorer child HRQOL (β = 0.66, 95% CI, 0.57-0.75), which in turn was associated with more family strain (β = 0.11, 95% CI, 0.01-0.22). Lower maternal education was associated with overprotection (β = -0.23, 95% CI, -0.33 to -0.12), more child symptoms (β = -0.30, 95% CI, -0.41 to -0.16), poorer child HRQOL (β = -0.36, 95% CI, -0.46 to -0.21), and more family strain (β = -0.15, 95% CI, -0.23 to -0.08). CONCLUSIONS Family and parental factors contributed to health outcomes of childhood acute lymphoblastic leukemia survivors. Interventions to enhance family cohesion, decrease parental distress and overprotection, and ameliorate child symptoms may improve family functioning.
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Affiliation(s)
- I-Chan Huang
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Tara M Brinkman
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Larry Mullins
- Department of Psychology, Oklahoma State University, Stillwater, Oklahoma
| | - Ching-Hon Pui
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Kevin R Krull
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
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43
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Youth and parent perceptions of parenting in childhood cancer survivors and healthy peers. Support Care Cancer 2018; 26:4143-4149. [PMID: 29862451 DOI: 10.1007/s00520-018-4285-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 05/21/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE Having a child diagnosed with cancer may have a long-term impact on parenting practices. The aims of this study were to (a) examine possible differences in youth and parent perceptions of parenting between childhood cancer survivors and healthy comparisons, (b) determine the concordance between youth and parent perceptions of parenting, and (c) explore differences in parent-youth concordance between survivors and healthy comparisons. METHODS Participants were youth aged 8-18 years (N = 170 childhood cancer survivors, N = 114 healthy comparisons) and one of their parents. All patients were ≥ 3 years from diagnosis (M = 6.52, SD = 3.60). Both youth (Parental Bonding Instrument (PBI)) and parents (Parenting Relationship Questionnaire (PRQ)) reported on their perceptions of parenting. Two separate MANCOVA's (PBI and PRQ) were conducted to determine possible differences between childhood cancer survivors and healthy peers. Concordance between youth and parent perceptions of parenting was examined. RESULTS Survivors did not differ from healthy peers in their perception of parental care and overprotection (p = .890). Likewise, parents in the survivor and healthy peer groups did not differ in their perceptions of involvement, attachment, communication, confidence, or relational frustration (p = .360). Youth's report of a caring parent-child relationship was positively associated with parent-reported involvement, attachment, communication, and parenting confidence and negatively associated with parent-reported relational frustration. Youth-perceived overprotection was positively associated with parent-reported relational frustration. No differences were found in parent-youth concordance between survivors and healthy comparisons. CONCLUSION A history of childhood cancer does not appear to adversely influence parenting behavior, as perceived by both youth and their parents.
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Perez MN, Sharkey CM, Tackett AP, Delozier AM, Bakula DM, Gamwell KL, Mayes S, McNall R, Chaney JM, Clawson AH, Mullins LL. Post traumatic stress symptoms in parents of children with cancer: A mediation model. Pediatr Hematol Oncol 2018; 35:231-244. [PMID: 30395795 DOI: 10.1080/08880018.2018.1524954] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Caregivers of pediatric cancer patients are at risk for posttraumatic stress symptoms (PTSS). Previous literature has identified caregiver illness uncertainty as a predictor of PTSS, yet little is known about the mechanism by which illness uncertainty may affect PTSS. Rumination, or perseverations about the cause and consequences of an event, has been related to posttraumtic stress disorder in other populations. However, limited research of this relationship exists for pediatric cancer caregivers. Further, no studies have evaluated rumination in relation to illness uncertainty. The current study examined rumination in relation to illness uncertainty and PTSS in caregivers with children actively receiving treatment for cancer. It was hypothesized that rumination would be related to illness uncertainty and would mediate the relationship between illness uncertainty and PTSS. METHODS Caregivers (N = 59) completed the Parent Perception of Uncertainty Scale, Ruminative Responses Scale, and the Impact of Event Scale-Revised. RESULTS illness uncertainty was identified as a significant predictor of rumination (B = 0.148, p = .015), and rumination was a significant predictor of PTSS (B = 1.83, p < .001). Biased-corrected bootstrap regression analysis revealed that rumination mediated the relationship between illness uncertainty and PTSS (R2 = 0.53, p < .001). CONCLUSIONS Rumination was identified as a mediator between the relationship of illness uncertainty and PTSS. These findings underscore the importance of rumination in caregivers of children with cancer, as a potential construct for identifying caregivers at risk of PTSS, and as a possible mechanism for targeted intervention.
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Affiliation(s)
- Megan N Perez
- a Department of Psychology , Oklahoma State University , Stillwater , OK , USA
| | - Christina M Sharkey
- a Department of Psychology , Oklahoma State University , Stillwater , OK , USA
| | - Alayna P Tackett
- b Department of Pediatrics , University of Oklahoma Health Sciences Center , Oklahoma City , OK , USA
| | | | - Dana M Bakula
- a Department of Psychology , Oklahoma State University , Stillwater , OK , USA
| | - Kaitlyn L Gamwell
- a Department of Psychology , Oklahoma State University , Stillwater , OK , USA
| | - Sunnye Mayes
- b Department of Pediatrics , University of Oklahoma Health Sciences Center , Oklahoma City , OK , USA
| | - Rene McNall
- b Department of Pediatrics , University of Oklahoma Health Sciences Center , Oklahoma City , OK , USA
| | - John M Chaney
- a Department of Psychology , Oklahoma State University , Stillwater , OK , USA
| | - Ashley H Clawson
- a Department of Psychology , Oklahoma State University , Stillwater , OK , USA
| | - Larry L Mullins
- a Department of Psychology , Oklahoma State University , Stillwater , OK , USA
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Karadeniz Cerit K, Cerit C, Nart Ö, Eker N, Kıyan G, Dağlı T, Ekingen G, Tokuç G, Karaca Ö, Çorapçıoğlu F. Post-traumatic stress disorder in mothers of children who have undergone cancer surgery. Pediatr Int 2017; 59:996-1001. [PMID: 28613013 DOI: 10.1111/ped.13343] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 05/05/2017] [Accepted: 06/08/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND The aim of this study was to investigate the rate of post-traumatic stress disorder (PTSD) and associated risk factors among mothers of children who underwent cancer surgery. METHOD This cross-sectional, multi-center study included a total of 60 mothers whose children underwent major thoraco-abdominal surgery and were under follow up in the outpatient setting between February 2016 and May 2016. Clinical Data Form, Hospital Anxiety and Depression Scale (HADS), and Clinician-Administered PTSD scale were used. RESULTS Of all participants, 13 (21.7%) were diagnosed with PTSD. These mothers had shorter duration of marriage, longer duration of hospital stay after surgery, and higher HADS scores, compared with the others without PTSD. Thoughts of guilt such as "I am being punished or tested" were more frequent in mothers with PTSD. Insomnia, irritability, concentration problems, and psychological reactivity were the most common symptoms. CONCLUSION Post-traumatic stress disorder is a severe disorder that may worsen the daily functioning of mothers and may also have an unfavorable effect on child. It is therefore of utmost importance for clinicians to recognize PTSD and the associated risk factors in order to guide these parents.
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Affiliation(s)
| | - Cem Cerit
- Department of Psychiatry, School of Medicine, Kocaeli University, Izmit, Kocaeli, Turkey
| | - Ömer Nart
- Department of Psychiatry, School of Medicine, Kocaeli University, Izmit, Kocaeli, Turkey
| | - Nurşah Eker
- Department of Pediatric Oncology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Gürsu Kıyan
- Department of Pediatric Surgery, School of Medicine, Marmara University, Istanbul, Turkey
| | - Tolga Dağlı
- Department of Pediatric Surgery, School of Medicine, Marmara University, Istanbul, Turkey
| | - Gülşen Ekingen
- Department of Pediatric Surgery, School of Medicine, Kocaeli University, Izmit, Kocaeli, Turkey
| | - Gülnur Tokuç
- Department of Pediatric Oncology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Ömer Karaca
- Department of Pediatric Oncology, School of Medicine, Kocaeli University, Izmit, Kocaeli, Turkey
| | - Funda Çorapçıoğlu
- Department of Pediatric Oncology, School of Medicine, Kocaeli University, Izmit, Kocaeli, Turkey
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Sharp KMH, Lindwall JJ, Willard VW, Long AM, Martin-Elbahesh KM, Phipps S. Cancer as a stressful life event: Perceptions of children with cancer and their peers. Cancer 2017; 123:3385-3393. [PMID: 28472536 DOI: 10.1002/cncr.30741] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 03/09/2017] [Accepted: 03/20/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND The medical traumatic stress model is commonly applied to childhood cancer, assuming that the diagnosis of cancer is a traumatic event. However, to the authors' knowledge, little is known regarding what specifically children perceive as stressful about cancer or how it compares with other stressful events more often experienced by children. METHODS Children with cancer (254 children) and demographically similar peers without a history of serious illness (202 children) identified their most stressful life event as part of a diagnostic interview assessing for symptoms of posttraumatic stress disorder (PTSD). The events identified as most stressful were categorized thematically, with categories established separately for cancer-related and non-cancer-related events. Events also were examined to assess whether they met Diagnostic and Statistical Manual of Mental Disorders (DSM) A criteria for PTSD. RESULTS In the group of children with cancer, 54% described a cancer-related event as the most stressful event they had experienced. Six distinct categories of cancer-related events and 10 categories of non-cancer-related events were identified. The same noncancer events were identified by children in both groups, and occurred at similar frequencies. The percentage of cancer-related events that met DSM A criteria for PTSD differed dramatically depending on which version of the DSM was applied. CONCLUSIONS Children do not necessarily view their cancer experience as their most stressful life event. The findings of the current study suggest that the diagnosis of cancer might be better viewed as a manageable stressor rather than a major trauma, and are consistent with the change in the fifth edition of the DSM to eliminate the diagnosis of a life-threatening illness as a qualifying trauma for PTSD. Cancer 2017;123:3385-93. © 2017 American Cancer Society.
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Affiliation(s)
- Katianne M Howard Sharp
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee.,Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Jennifer J Lindwall
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Psychiatry, School of Medicine, University of Colorado, Aurora, Colorado
| | - Victoria W Willard
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Alanna M Long
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | | | - Sean Phipps
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
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Willard VW, Qaddoumi I, Zhang H, Huang L, Russell KM, Brennan R, Wilson MW, Rodriguez-Galindo C, Phipps S. A longitudinal investigation of parenting stress in caregivers of children with retinoblastoma. Pediatr Blood Cancer 2017; 64:10.1002/pbc.26279. [PMID: 27808461 PMCID: PMC5584625 DOI: 10.1002/pbc.26279] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 08/17/2016] [Accepted: 09/01/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Retinoblastoma is typically diagnosed in young children and may present unique parenting challenges. Qualitative research suggests that parents experience distress related to the initial diagnosis and treatment that subsequently resolves. The objectives were to systematically assess parenting stress over time in parents of young children with retinoblastoma and to examine associations between parenting stress and child outcomes. PROCEDURES Parents of children with retinoblastoma completed the Parenting Stress Index (PSI) during serial psychological assessments scheduled based on the child's age (6 months to 5 years). Caregivers of 92 patients (85.9% mothers) completed the assessments. Child outcomes included developmental functioning and parent-reported adaptive functioning. RESULTS At baseline and age 5, all subscales on the PSI were within normal limits, and most were significantly below normative means (i.e., demonstrating low levels of stress). All domains remained relatively stable over time. Associations between parenting stress and child outcomes were much stronger at age 5 than at baseline. Child-directed parenting stress was a small but significant contributor to declines in child functioning over time. CONCLUSIONS Parents of children with retinoblastoma report normal levels of parenting stress while their children are young. However, baseline parenting stress appears to contribute to changes in child functioning over time. Future studies should assess illness-related aspects of adjustment to further understand the parenting experience of young children with cancer and/or having a visually impaired child.
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Affiliation(s)
| | | | - Hui Zhang
- Department of Biostatistics, St. Jude Children’s Research Hospital
| | - Lu Huang
- Department of Biostatistics, St. Jude Children’s Research Hospital
| | | | - Rachel Brennan
- Department of Oncology, St. Jude Children’s Research Hospital
| | - Matthew W. Wilson
- Department of Surgery, St. Jude Children’s Research Hospital,Department of Ophthalmology, University of Tennessee
| | | | - Sean Phipps
- Department of Psychology, St. Jude Children’s Research Hospital
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Lamanna J, Bitsko M, Stern M. Effects of a brief problem-solving intervention for parents of children with cancer. CHILDRENS HEALTH CARE 2017. [DOI: 10.1080/02739615.2016.1275638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Jennifer Lamanna
- Department of Psychology, Virginia Commonwealth University, Richmond, VA
| | - Matthew Bitsko
- Department of Psychology, Virginia Commonwealth University, Richmond, VA
- Division of Pediatric Hematology/Oncology, Children’s Hospital of Richmond, Richmond, VA
| | - Marilyn Stern
- Department of Psychology, Virginia Commonwealth University, Richmond, VA
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Willard VW, Hostetter SA, Hutchinson KC, Bonner MJ, Hardy KK. Benefit Finding in Maternal Caregivers of Pediatric Cancer Survivors. J Pediatr Oncol Nurs 2016; 33:353-60. [DOI: 10.1177/1043454215620119] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: Benefit finding has been described as the identification of positive effects resulting from otherwise stressful experiences. In this mixed methods study, we examined the relations between qualitative themes related to benefit finding and quantitative measures of psychosocial adjustment and coping as reported by maternal caregivers of survivors of pediatric cancer. Methods: Female caregivers of survivors of pediatric cancer (n = 40) completed a qualitative questionnaire about their experiences caring for their child, along with several quantitative measures. Qualitative questionnaires were coded for salient themes, including social support and personal growth. Correlation matrices evaluated associations between qualitative themes and quantitative measures of stress and coping. Results: Identified benefits included social support and personal growth, as well as child-specific benefits. Total benefits reported were significantly positively correlated with availability of emotional resources. Coping methods were also associated, with accepting responsibility associated with fewer identified benefits. Conclusion: Despite the stress of their child’s illness, many female caregivers of survivors of pediatric cancer reported finding benefits associated with their experience. Benefit finding in this sample was associated with better adjustment.
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Affiliation(s)
| | | | | | - Melanie J. Bonner
- St. Jude Children’s Research Hospital, Memphis, TN, USA
- Duke University Medical Center, Durham, NC, USA
| | - Kristina K. Hardy
- Children’s National Health System, Washington, DC, USA
- George Washington University School of Medicine, Washington, DC, USA
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Rosenberg AR, Yi-Frazier JP. Commentary: Resilience Defined: An Alternative Perspective. J Pediatr Psychol 2016; 41:506-9. [PMID: 27013701 DOI: 10.1093/jpepsy/jsw018] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 02/24/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
- Abby R Rosenberg
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Department of Pediatrics, University of Washington School of Medicine, Trueman Katz Center for Pediatric Bioethics, and Fred Hutchinson Cancer Research Center
| | - Joyce P Yi-Frazier
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Department of Pediatrics, University of Washington School of Medicine
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