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Yan Q, Li X, Chen Y, Li L, Hu X. Efficacy of Supportive Care Interventions for Improving Posttraumatic Stress Symptoms and Resilience in Family Caregivers of Cancer-Affected Children: A Meta-Analysis of Randomized Controlled Trials. Worldviews Evid Based Nurs 2025; 22:e12764. [PMID: 39828279 DOI: 10.1111/wvn.12764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 12/10/2024] [Accepted: 12/15/2024] [Indexed: 01/22/2025]
Abstract
BACKGROUND The diagnosis of pediatric cancer is a major shock to family caregivers, and posttraumatic stress symptoms (PTSSs) emerge as the most prevalent adverse psychological outcomes. However, not all family caregivers have sufficient resilience to cope with these challenges; thus, supportive care interventions are necessary. These interventions, which include psychosocial support, education, and other forms of assistance, are designed to enhance the well-being of those affected by disease. In the past few years, more research has been delving into supportive care interventions for family caregivers of cancer-affected children, yet there is still a variance in the results. OBJECTIVE To investigate the impacts of supportive care interventions on PTSSs and resilience in family caregivers of cancer-affected children, also focusing on the impacts of prerecruitment time to diagnosis, duration, type of intervention, and recruitment area on the outcomes. METHODS Nine databases (Cochrane Library, Ovid MEDLINE, CINAHL Plus with Full Text, Embase, CNKI, Sinomed, WANFANG, VIP, and Web of Science) were searched from their inception to February 21, 2024. The revised Cochrane Risk of Bias tool and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method were used to evaluate the quality of evidence. To gauge the effectiveness of the interventions, we computed the standard mean difference (SMD) and the 95% confidence interval (CI) utilizing StataCorp (version 16.0). Sensitivity analysis and Egger's test were also conducted. RESULTS Supportive care interventions significantly improved the PTSSs (SMD = -0.86, 95% CI [-1.39, -0.33], p < 0.01, I2 = 94.95%) and resilience (SMD = 0.85, 95% CI [0.26, 1.44], p < 0.01, I2 = 88.3%) among family caregivers of cancer-affected children. Subgroup analyses revealed that early interventions for family caregivers after the diagnosis of children and the short-term interventions were associated with improvements in their PTSS and resilience. Moreover, cognitive behavioral interventions were the most common type of interventions and were effective in supporting family caregivers. Additionally, supportive care interventions did not improve PTSSs among family caregivers in middle-income countries. LINKING EVIDENCE TO ACTION Supportive care interventions have demonstrated efficacy in improving PTSSs and resilience among family caregivers of cancer-affected children. This research proved the imperative of providing prompt supportive care to family caregivers early after the pediatric cancer diagnosis. Additionally, it is also necessary to further study and explore the optimal way to combine different intervention components based on caregivers' need and to develop regionally adapted and culturally sensitive supportive care interventions to better improve health outcomes for family caregivers.
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Affiliation(s)
- Qianwen Yan
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Xia Li
- General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Yang Chen
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Linna Li
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Xiaolin Hu
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, P.R. China
- Tianfu Jincheng Laboratory, City of Future Medicine, Chengdu, Sichuan, P.R. China
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Harman E, Stegenga K, Robb SL. Attributes of Pediatric Music Therapists: A Qualitative Analysis of Parent Descriptions. J Music Ther 2025; 62:thae024. [PMID: 39791492 PMCID: PMC11718509 DOI: 10.1093/jmt/thae024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2024] [Revised: 12/05/2024] [Accepted: 12/19/2024] [Indexed: 01/12/2025]
Abstract
Therapist attributes are known to contribute to positive therapeutic outcomes and are important to effective training and clinical practice. Although well researched in psychology and play therapy, few studies have directly explored music therapist attributes. To explore and understand these descriptions, we conducted a secondary analysis of parent interview data from a multisite trial investigating a music therapist-delivered intervention for young children with cancer and their parents. We used qualitative descriptive analysis to identify music therapists' attributes as described by parents who participated in the intervention. Our inductive analysis of 28 interviews revealed 135 descriptors of music therapists. We discovered that these descriptions grouped naturally using essential therapist attributes of supportive, attuned, and nonjudgemental, as identified in the extant literature. This analysis highlights music therapists' attributes perceived as central to their work with parents and young children in cancer settings.
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Affiliation(s)
| | - Kristin Stegenga
- Division of Hematology/Oncology/BMT, Children’s Mercy Hospital, Kansas City, MO, USA
| | - Sheri L Robb
- Schools of Nursing and Medicine, Indiana University, Indianapolis, IN, USA
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Boyde C, Berger B, Längler A, Neugebauer L, Jacobsen SL, Swanick R, Gaebel C, Schneider D, Bernbeck B, Paulussen M, Ostermann T, Hunger-Schoppe C. Interaction-focused music therapy with cancer-affected children and their significant others: a randomized controlled feasibility study with subsequent intervention (INMUT). Pilot Feasibility Stud 2024; 10:86. [PMID: 38807165 PMCID: PMC11131283 DOI: 10.1186/s40814-024-01490-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 03/26/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Paediatric oncology/haematology patients and their families are confronted with a life-threatening situation for which music therapy can be a cross-linguistic field of action. The creative act of making music together offers the possibility to strengthen competences and make conflicts tangible. Besides its complementing of evidence-based biomedical care, there is little research on the feasibility and efficacy of interactive music therapy including the diagnosed child and their significant others. METHODS We conducted an assessor blind, prospective, multicentric feasibility randomized controlled trial (RCT) with subsequent intervention. Including overall 52 child-significant other dyads, INMUT investigates interaction-focused music therapy with cancer-affected children and their significant others (INMUT-KB; n = 21) compared to music therapy only with the child (MUT-K; n = 21) and a wait-list group (WLG; n = 10). The measurement points include the screening for a cancer diagnosis, psychometric baseline (pre-T1), initial assessment (T1/T2), music therapy sessions (T3-T9), final assessment (T10), final psychometric evaluation (post-T10), and 3-month follow-up (cat-T11). Feasibility and acceptability of the (1) research methodology, (2) intervention and (3) estimation of effect sizes will be assessed using qualitative and quantitative data. The proposed primary outcome includes the parent-child interaction (APCI), and the proposed secondary outcomes refer to subjective goal achievement (GAS), quality of life (KINDL), system-related functional level (EXIS), psychosocial stress (BAS), psychosomatic complaints (SCL-9k), and resources (WIRF). We plan to investigate the efficacy of INMUT-KB and MUT-K post-intervention (post-T10) within the RCT design and at 3-month follow-up (cat-T11). DISCUSSION This study will provide insights into the feasibility of INMUT and the final sample needed for a confirmatory RCT. We will reflect on successfully implemented study procedures and, if necessary, provide recommendations for changes considering the design, procedures, measures, and statistical analyses. The discussion will conclude with an evaluation whether a confirmatory RCT is worth the investment of future resources, including the calculated number of child-significant other dyads needed based on the efficacy trends derived from this feasibility study. TRIAL REGISTRATION ClinicalTrials.gov: NCT05534282; date of registration: June 23, 2022.
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Affiliation(s)
- Constance Boyde
- Faculty of Health, Departement of Psychology and Psychotherapy, Chair for Clinical Psychology and Psychotherapy III, Witten/Herdecke University, Alfred-Herrhausen-Strasse 50, Witten, 58455, Germany.
- Department of Paediatrics and Adolescent Medicine, Community Hospital Herdecke, Gerhard-Kienle-Weg 4, Herdecke, 58313, Germany.
- Interprofessional Graduate School of Integrative Medicine and Health Sciences (IGIM), Witten/Herdecke University, Alfred-Herrhausen-Strasse 50, Witten, 58455, Germany.
| | - Bettina Berger
- Interprofessional Graduate School of Integrative Medicine and Health Sciences (IGIM), Witten/Herdecke University, Alfred-Herrhausen-Strasse 50, Witten, 58455, Germany
- Faculty of Health, Department of Human Medicine, Chair for Medical Theory, Integrative and Anthroposophic Medicine, Witten/Herdecke University, Gerhard-Kienle-Weg 4, Herdecke, 58313, Germany
| | - Alfred Längler
- Department of Paediatrics and Adolescent Medicine, Community Hospital Herdecke, Gerhard-Kienle-Weg 4, Herdecke, 58313, Germany
- Faculty of Health, Department of Human Medicine, Chair for Paediatrics, Witten/Herdecke University, Dr. Friedrich-Steiner-Strasse 5, Datteln, 45711, Germany
| | - Lutz Neugebauer
- Nordoff/Robbins Centre for Music Therapy Witten, Ruhrstrasse 70, Witten, 58452, Germany
| | - Stine Lindahl Jacobsen
- Department of Communication and Psychology, Faculty of Sciences and Humanities, Aalborg University, Rendsburggade 14, Aalborg, 9000, Denmark
| | - Rachel Swanick
- Chroma Therapies Ltd., Overross House, Ross Park, Ross-On-Wye, Herefordshire, HR9 7US, UK
| | - Christine Gaebel
- Institute of Medical Psychology, University Hospital Heidelberg, Ruprecht-Karls University Heidelberg, Bergheimer Str. 20, Heidelberg, Germany
| | - Dominik Schneider
- Clinic for Paediatrics and Adolescent Medicine, Clinic Centre Dortmund, Beurhausstrasse 40, Dortmund, 44137, Germany
| | - Benedikt Bernbeck
- Clinic for Paediatrics and Adolescent Medicine, Clinic Centre Dortmund, Beurhausstrasse 40, Dortmund, 44137, Germany
| | - Michael Paulussen
- Faculty of Health, Department of Human Medicine, Chair for Paediatrics, Witten/Herdecke University, Dr. Friedrich-Steiner-Strasse 5, Datteln, 45711, Germany
- Vestic Children's Hospital, Dr. Friedrich-Steiner-Strasse 5, Datteln, 45711, Germany
| | - Thomas Ostermann
- Faculty of Health, Department of Psychology and Psychotherapy, Witten/Herdecke University, Alfred-Herrhausen-Strasse 50, Witten, 58455, Germany
| | - Christina Hunger-Schoppe
- Faculty of Health, Departement of Psychology and Psychotherapy, Chair for Clinical Psychology and Psychotherapy III, Witten/Herdecke University, Alfred-Herrhausen-Strasse 50, Witten, 58455, Germany
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Robb SL, Russ KA, Holochwost SJ, Stegenga K, Perkins SM, Jacob SA, Henley AK, MacLean JA. Protocol and biomarker strategy for a multi-site randomized controlled trial examining biological mechanisms and dosing of active music engagement in children with acute lymphoblastic leukemia and lymphoma and parents. BMC Complement Med Ther 2023; 23:90. [PMID: 36973774 PMCID: PMC10041701 DOI: 10.1186/s12906-023-03909-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/04/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Music therapy is a standard palliative care service in many pediatric and adult hospitals; however, most research has focused on the use of music to improve psychosocial dimensions of health, without considering biological dimensions. This study builds on prior work examining psychosocial mechanisms of action underlying an Active Music Engagement (AME) intervention, designed to help manage emotional distress and improve positive health outcomes in young children with cancer and parents (caregivers), by examining its effects on biomarkers of stress and immune function. METHODS This two-group randomized controlled trial (R01NR019190) is designed to examine biological mechanisms of effect and dose-response relationships of AME on child/parent stress during the consolidation phase of Acute B- or T-cell Lymphoblastic Leukemia (ALL) and T-cell Lymphoblastic Lymphoma (TLyLy) treatment. Child/parent dyads (n = 228) are stratified (by age, site, risk level) and randomized in blocks of four to the AME or attention control condition. Each group receives one session (30-minutes AME; 20-minutes control) during weekly clinic visits (4 weeks standard risk B-cell ALL; 8 weeks high risk B-cell ALL/T-cell ALL/TLyLy). Parents complete questionnaires at baseline and post-intervention. Child/parent salivary cortisol samples are taken pre- and post-session (sessions 1-4). Child blood samples are reserved from routine draws before sessions 1 and 4 (all participants) and session 8 (high risk participants). We will use linear mixed models to estimate AME's effect on child/parent cortisol. Examining child/parent cortisol as mediators of AME effects on child and parent outcomes will be performed in an ANCOVA setting, fitting the appropriate mediation models using MPlus and then testing indirect effects using the percentile bootstrap approach. Graphical plots and non-linear repeated measures models will be used to examine dose-response relationship of AME on child/parent cortisol. DISCUSSION During pediatric cancer treatment there are special challenges that must be considered when measuring cortisol and immune function. In this manuscript we discuss how we addressed three specific challenges through our trial design. Findings from this trial will increase mechanistic understanding of the effects of active music interventions on multiple biomarkers and understanding of dose-response effects, with direct implications for clinical practice. TRIAL REGISTRATION ClinicalTrials.gov: NCT04400071.
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Affiliation(s)
- Sheri L Robb
- School of Nursing, Indiana University, 600 Barnhill Drive, Indianapolis, IN, 46202, USA.
| | - Kristen A Russ
- School of Medicine, Indiana University , 351 W 10th Street, Indianapolis, IN, 46202, USA
| | - Steven J Holochwost
- Department of Psychology, Lehman College, City University of New York, 250 Bedford Park Boulevard, West Bronx, NY, 10468, USA
| | - Kristin Stegenga
- Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Susan M Perkins
- School of Medicine, Indiana University, 340 W 10th Street, Indianapolis, IN, 46202, USA
| | - Seethal A Jacob
- School of Medicine, Indiana University, 410 W 10th Street, Indianapolis, IN, 46202, USA
| | - Amanda K Henley
- Purdue School of Engineering and Technology, IUPUI, 535 W. Michigan Street, Indianapolis, IN, 46202, USA
| | - Jessica A MacLean
- School of Nursing, Indiana University, 600 Barnhill Drive, Indianapolis, IN, 46202, USA
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5
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Bradt J, Dileo C, Myers-Coffman K, Biondo J. Music interventions for improving psychological and physical outcomes in people with cancer. Cochrane Database Syst Rev 2021; 10:CD006911. [PMID: 34637527 PMCID: PMC8510511 DOI: 10.1002/14651858.cd006911.pub4] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND This is an update of the review published on the Cochrane Library in 2016, Issue 8. Having cancer may result in extensive emotional, physical and social suffering. Music interventions have been used to alleviate symptoms and treatment side effects in people with cancer. This review includes music interventions defined as music therapy offered by trained music therapists, as well as music medicine, which was defined as listening to pre-recorded music offered by medical staff. OBJECTIVES To assess and compare the effects of music therapy and music medicine interventions for psychological and physical outcomes in people with cancer. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2020, Issue 3) in the Cochrane Library, MEDLINE via Ovid, Embase via Ovid, CINAHL, PsycINFO, LILACS, Science Citation Index, CancerLit, CAIRSS, Proquest Digital Dissertations, ClinicalTrials.gov, Current Controlled Trials, the RILM Abstracts of Music Literature, http://www.wfmt.info/Musictherapyworld/ and the National Research Register. We searched all databases, except for the last two, from their inception to April 2020; the other two are no longer functional, so we searched them until their termination date. We handsearched music therapy journals, reviewed reference lists and contacted experts. There was no language restriction. SELECTION CRITERIA We included all randomized and quasi-randomized controlled trials of music interventions for improving psychological and physical outcomes in adults and pediatric patients with cancer. We excluded patients undergoing biopsy and aspiration for diagnostic purposes. DATA COLLECTION AND ANALYSIS Two review authors independently extracted the data and assessed the risk of bias. Where possible, we presented results in meta-analyses using mean differences and standardized mean differences. We used post-test scores. In cases of significant baseline difference, we used change scores. We conducted separate meta-analyses for studies with adult participants and those with pediatric participants. Primary outcomes of interest included psychological outcomes and physical symptoms and secondary outcomes included physiological responses, physical functioning, anesthetic and analgesic intake, length of hospitalization, social and spiritual support, communication, and quality of life (QoL) . We used GRADE to assess the certainty of the evidence. MAIN RESULTS We identified 29 new trials for inclusion in this update. In total, the evidence of this review rests on 81 trials with a total of 5576 participants. Of the 81 trials, 74 trials included adult (N = 5306) and seven trials included pediatric (N = 270) oncology patients. We categorized 38 trials as music therapy trials and 43 as music medicine trials. The interventions were compared to standard care. Psychological outcomes The results suggest that music interventions may have a large anxiety-reducing effect in adults with cancer, with a reported average anxiety reduction of 7.73 units (17 studies, 1381 participants; 95% confidence interval (CI) -10.02 to -5.44; very low-certainty evidence) on the Spielberger State Anxiety Inventory scale (range 20 to 80; lower values reflect lower anxiety). Results also suggested a moderately strong, positive impact of music interventions on depression in adults (12 studies, 1021 participants; standardized mean difference (SMD): -0.41, 95% CI -0.67 to -0.15; very low-certainty evidence). We found no support for an effect of music interventions on mood (SMD 0.47, 95% CI -0.02 to 0.97; 5 studies, 236 participants; very low-certainty evidence). Music interventions may increase hope in adults with cancer, with a reported average increase of 3.19 units (95% CI 0.12 to 6.25) on the Herth Hope Index (range 12 to 48; higher scores reflect greater hope), but this finding was based on only two studies (N = 53 participants; very low-certainty evidence). Physical outcomes We found a moderate pain-reducing effect of music interventions (SMD -0.67, 95% CI -1.07 to -0.26; 12 studies, 632 adult participants; very low-certainty evidence). In addition, music interventions had a small treatment effect on fatigue (SMD -0.28, 95% CI -0.46 to -0.10; 10 studies, 498 adult participants; low-certainty evidence). The results suggest a large effect of music interventions on adult participants' QoL, but the results were highly inconsistent across studies, and the pooled effect size was accompanied by a large confidence interval (SMD 0.88, 95% CI -0.31 to 2.08; 7 studies, 573 participants; evidence is very uncertain). Removal of studies that used improper randomization methods resulted in a moderate effect size that was less heterogeneous (SMD 0.47, 95% CI 0.06 to 0.88, P = 0.02, I2 = 56%). A small number of trials included pediatric oncology participants. The findings suggest that music interventions may reduce anxiety but this finding was based on only two studies (SMD -0.94, 95% CI -1.9 to 0.03; very low-certainty evidence). Due to the small number of studies, we could not draw conclusions regarding the effects of music interventions on mood, depression, QoL, fatigue or pain in pediatric participants with cancer. The majority of studies included in this review update presented a high risk of bias, and therefore the overall certainty of the evidence is low. For several outcomes (i.e. anxiety, depression, pain, fatigue, and QoL) the beneficial treatment effects were consistent across studies for music therapy interventions delivered by music therapists. In contrast, music medicine interventions resulted in inconsistent treatment effects across studies for these outcomes. AUTHORS' CONCLUSIONS This systematic review indicates that music interventions compared to standard care may have beneficial effects on anxiety, depression, hope, pain, and fatigue in adults with cancer. The results of two trials suggest that music interventions may have a beneficial effect on anxiety in children with cancer. Too few trials with pediatric participants were included to draw conclusions about the treatment benefits of music for other outcomes. For several outcomes, music therapy interventions delivered by a trained music therapist led to consistent results across studies and this was not the case for music medicine interventions. Moreover, evidence of effect was found for music therapy interventions for QoL and fatigue but not for music medicine interventions. Most trials were at high risk of bias and low or very low certainty of evidence; therefore, these results need to be interpreted with caution.
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Affiliation(s)
- Joke Bradt
- Department of Creative Arts Therapies, College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
| | - Cheryl Dileo
- Department of Music Therapy and The Arts and Quality of Life Research Center, Boyer College of Music and Dance, Temple University, Philadelphia, PA, USA
| | | | - Jacelyn Biondo
- Department of Creative Arts Therapies, College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
- Department of Expressive Therapies, Graduate School of Arts and Social Sciences, Lesley University, Cambridge, MA, USA
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Holochwost SJ, Robb SL, Henley AK, Stegenga K, Perkins SM, Russ KA, Jacob SA, Delgado D, Haase JE, Krater CM. Active Music Engagement and Cortisol as an Acute Stress Biomarker in Young Hematopoietic Stem Cell Transplant Patients and Caregivers: Results of a Single Case Design Pilot Study. Front Psychol 2020; 11:587871. [PMID: 33224077 PMCID: PMC7667234 DOI: 10.3389/fpsyg.2020.587871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 09/30/2020] [Indexed: 11/13/2022] Open
Abstract
This paper reports the results of a single case design pilot study of a music therapy intervention [the Active Music Engagement (AME)] for young children (age 3.51 to 4.53 years) undergoing hematopoietic stem cell transplantation (HCST) and their caregivers. The primary aims of the study were to determine feasibility/acceptability of the AME intervention protocol and data collection in the context of HCST. Secondary aims were to examine caregivers' perceptions of the benefit of AME and whether there were changes in child and caregiver cortisol levels relative to the AME intervention. Results indicated that the AME could be implemented in this context and that data could be collected, though the collection of salivary cortisol may constitute an additional burden for families. Nevertheless, data that were collected suggest that families derive benefit from the AME, which underscores the need for devising innovative methods to understand the neurophysiological impacts of the AME.
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Affiliation(s)
| | - Sheri L Robb
- School of Nursing, Indiana University, Indianapolis, IN, United States
| | - Amanda K Henley
- School of Nursing, Indiana University, Indianapolis, IN, United States
| | | | - Susan M Perkins
- School of Medicine, Indiana University, Indianapolis, IN, United States.,Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, United States
| | - Kristen A Russ
- Melvin and Bren Simon Comprehensive Cancer Center, Indiana University, Indianapolis, IN, United States
| | - Seethal A Jacob
- School of Medicine, Indiana University, Indianapolis, IN, United States.,Riley Hospital for Children at Indiana University Health, Indianapolis, IN, United States
| | - David Delgado
- Astellas Pharma Global Development, Northbrook, IL, United States
| | - Joan E Haase
- School of Nursing, Indiana University, Indianapolis, IN, United States
| | - Caitlin M Krater
- Riley Hospital for Children at Indiana University Health, Indianapolis, IN, United States
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Russ KA, Holochwost SJ, Perkins SM, Stegenga K, Jacob SA, Delgado D, Henley AK, Haase JE, Robb SL. Cortisol as an Acute Stress Biomarker in Young Hematopoietic Cell Transplant Patients/Caregivers: Active Music Engagement Protocol. J Altern Complement Med 2020; 26:424-434. [PMID: 32073877 PMCID: PMC7232696 DOI: 10.1089/acm.2019.0413] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective: Primary aims of the proposed protocol are to determine the feasibility/acceptability of the active music engagement intervention protocol during hematopoietic stem cell transplantation (HSCT) and clinical feasibility/acceptability of the biological sample collection schedule. Design: The authors propose a single-case, alternating treatment design to compare levels of child and caregiver cortisol in blood and saliva collected on alternating days, when the dyad receives and does not receive AME sessions. Included are the scientific rationale for this design and detailed intervention and sample collection schedules based on transplant type. Setting/Location: Pediatric inpatient HSCT unit. Subjects: Eligible participants are dyads of children 3–8 years old, hospitalized for HSCT, and their caregiver. Children with malignant and nonmalignant conditions will be eligible, regardless of transplant type. Intervention: AME intervention is delivered by a board-certified music therapist who tailors music-based play experiences to encourage active engagement in, and independent use of, music play to manage the inter-related emotional distress experienced by children and their caregivers during HSCT. Dyads will receive two 45-min AME sessions each week during hospitalization. Outcome Measures: Eight collections of blood (child) and saliva (child/caregiver) will be performed for cortisol measurement. The authors will also collect self-report and caregiver proxy measures for dyad emotional distress, quality of life, and family function. At study conclusion, qualitative caregiver interviews will be conducted. Results: Planned analyses will be descriptive and evaluate the feasibility of participant recruitment, cortisol collection, planned evaluations, and AME delivery. Analysis of qualitative interviews will be used to gain an understanding about the ease/burden of biological sample collection and any perceived benefit of AME. Conclusions: Behavioral intervention studies examining biological mechanisms of action in pediatric transplant populations are rare. Findings will provide important information about the feasibility/acceptability of collecting cortisol samples during a high-intensity treatment and advance understanding about the use of active music interventions to mitigate child/caregiver distress during the transplant period.
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Affiliation(s)
- Kristen A Russ
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN, USA
| | | | - Susan M Perkins
- Indiana University School of Medicine, Indianapolis, IN, USA.,Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
| | | | - Seethal A Jacob
- Indiana University School of Medicine, Indianapolis, IN, USA.,Riley Hospital for Children at IU Health, Indianapolis, IN, USA
| | - David Delgado
- Astellas Pharma Global Development, Northbrook, IL, USA
| | | | - Joan E Haase
- Indiana University School of Nursing, Indianapolis, IN, USA
| | - Sheri L Robb
- Indiana University School of Nursing, Indianapolis, IN, USA
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Raybin JL, Barr E, Krajicek M, Jones J. How Does Creative Arts Therapy Reduce Distress for Children With Cancer? A Metasynthesis of Extant Qualitative Literature [Formula: see text]. J Pediatr Oncol Nurs 2019; 37:91-104. [PMID: 31766942 DOI: 10.1177/1043454219888807] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Introduction: As more children survive cancer, attention must be paid to their quality of life (QOL). Integrative therapies are an ideal modality for nurses to advocate for reducing distress and improving QOL for children with cancer. Creative arts therapy is a type of integrative health that may improve QOL in this population. Therefore, the research question was asked, "For children with cancer, what opportunities exist for creative arts therapy to reduce distress?" Method: A metasynthesis of the extant qualitative research was conducted to answer the research question. Seven qualitative studies were identified, which included 162 participants. New themes were identified through rigorous analyzation by the study team of each study as individual data. Results: Four derived analytic themes emerged through the analysis: (a) connection is established through creative expression, (b) coping is facilitated by creative arts, (c) communication is enabled by creative arts interventions, and (d) continuance (the concept of time) is experienced through creative arts. Examples of each theme with subthemes are delineated, including expressive quotes. Summary: Through this qualitative synthesis of studies with creative arts therapy, evocative opportunities to reduce the distress associated with the disease experience are revealed. Nurses are called now to promote creative arts therapy to improve the symptoms in children with cancer.
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Affiliation(s)
- Jennifer L Raybin
- Children's Hospital Colorado, Aurora, CO, USA.,School of Medicine, University of Colorado, Aurora, CO, USA
| | - Emily Barr
- Children's Hospital Colorado, Aurora, CO, USA.,School of Medicine, University of Colorado, Aurora, CO, USA
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Raybin JL, Krajicek M. Creative Arts Therapy in the Context of Children With Cancer: A Concept Analysis. J Pediatr Oncol Nurs 2019; 37:82-90. [PMID: 31592707 DOI: 10.1177/1043454219878397] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Aim: To report an analysis of the concept of creative arts therapy (CAT) in the context of pediatric cancer. Background: Literature supports the intuitive conclusion that creative interventions improve a patient's journey through the cancer trajectory. However, a new definition is needed to encompass CAT and creative expression interventions in order to better understand the concept of creativity in health care, specifically in pediatric oncology. Design: Concept analysis. Data Sources: The scientific databases CINAHL, PsycInfo (Ovid), AMED (Allied and Complementary Medicine), and PubMed were queried for English language research articles published between 2008 and 2018 using the search terms: creative arts therapy and cancer. Method: The Walker and Avant method of concept analysis was implemented. Results: CAT is a broad concept bringing creative arts in a therapeutic manner to children with cancer. Attributes include expression of feelings; creating art, music, or movement; and improvement of symptoms. CAT is frequently measured using quality of life and symptom assessment scales. Antecedents include the diagnosis of cancer, the distress caused by cancer, and a child's willingness to participate in creative activity. Consequences include improved quality of life, improved sense of well-being, decreased psychosocial symptoms, and less cancer pain. Conclusion: The literature supports CAT as a concept that may decrease distress for children with cancer.
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Affiliation(s)
- Jennifer L Raybin
- Children's Hospital Colorado, Aurora, CO, USA.,School of Medicine, University of Colorado, Aurora, CO, USA
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Abstract
PURPOSE OF REVIEW Advances in the field of Pediatric Oncology have led to increased survival rates in children with cancer, and addressing the emotional well-being and quality of life of this specific population is a critical component of care. Mind-body therapies (MBTs) are an adjuvant modality of treatment that appears to have a positive impact on patient quality of life, patient mental health, and family perceptions toward illness. In this review, we describe several evidence-based MBTs, such as art therapy, meditation, prayer, music therapy, hypnosis and relaxation techniques, their use, and our personal experience with MBT in our institution. RECENT FINDINGS Current data suggests that MBTs have been effective in decreasing symptoms related to oncologic pathology in children. Based on experience in our institution, the administration of these therapies can be expanded with the use of technology and also foster family inclusion in care, which can lead to improved quality of life for the patient and family. Further studies are warranted to ascertain the effects of MBTs in childhood cancer. MBTs are increasingly important in the care of youth with oncologic disease. It is necessary to increase the quantity and quality of research for the selection and inclusion of MBT in this population.
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