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Bauer SB, Saunders RA, Masoom SN, Choung K, Hayes LC, Price DE, Keays M, Sable PE, Shimmel A. The art of introducing clean intermittent catheterization: How families respond and adapt: A qualitative study. Neurourol Urodyn 2023; 42:309-321. [PMID: 36352775 DOI: 10.1002/nau.25085] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/12/2022] [Accepted: 09/22/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Since its inception >50 years ago, clean intermittent catheterization (CIC) has become ubiquitous in managing lower urinary tract dysfunction in children. Emphasis has been on its impact on daily life, but little on its implementation and adjustment in families. The aim of the current study was to discover how families learned to implement and manage their child's CIC needs by interviewing caregivers, adolescents, and young adults about their experiences. Interviews were designed to uncover facilitators and barriers to beginning CIC to initiate potential improvements in a multidisciplinary approach. METHODS A semi-structured interview guide was developed and piloted initially to 12 families for validation. Between August 2018 and October 2019, 40 families (52 interviews of caregivers and patients >12 years) were then interviewed with open-ended questions interspersed with more specific ones to generate discussion. Transcripts were coded using Dedoose software to create a base list with emergent codes. Inductive and deductive methods were employed to generate themes. Consensus was reached during successive team meetings. RESULTS Five major and several subthemes emerged regarding implementation of CIC by caregivers and patients learning CIC for the first time. THEME 1: Parental reaction to CIC: Caregivers described benefits of an adjustment period on learning their child's need for CIC. Prenatal information to caregivers of spina bifida children gave them time to mentally process the need for CIC. THEME 2: Ease of learning CIC: impact of age and gender: caregivers identified advantages of initiating CIC in infancy. Caregivers speculated CIC was physically easier in boys than girls due to meatus location. Developmentally ready children expressed a desire for independence and privacy as they learned to initiate CIC. THEME 3: The impact of additional caregiver support in learning and performing CIC: presence of multiple caregivers optimized learning and implementation of CIC. Having secondary caregivers available provided peace of mind and more flexibility in maintaining reliable CIC care. Patients learning CIC found it helpful to have a parent present at the teaching session. Occasionally, female caregivers reported feelings of anger and frustration when male caregivers were reluctant to be involved in catheterization, irrespective of their child's gender. THEME 4: Satisfaction with healthcare team's approach: The healthcare team's responsiveness to their learning needs affected how they mastered CIC. The healthcare team's teaching and reassurance helped build caregiver confidence. Developmentally appropriate children were able to learn self-catheterization when supported by the healthcare team. Patients learning self-CIC articulated having a supportive healthcare team was helpful with implementation. THEME 5: Effect of CIC on employment status relative to job changes, insurance, and daycare: implementing and performing CIC presented a spectrum of issues related to employment. Educating employers regarding CIC facilitated a caregiver's ability to both remain at work and administer to their child. Caregivers underscored the importance of adequate insurance when considering employment choices. Concerns about daycare availability affected caregivers' work schedules. CONCLUSIONS It is anticipated this information will aid healthcare personnel to more effectively teach and initiate CIC in families, and in individuals learning for the first time. The findings should serve as the basis for conducting future patient satisfaction studies, which would determine the effectiveness and reproducibility of these approaches.
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Affiliation(s)
- Stuart B Bauer
- Department of Urology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Rachel A Saunders
- Department of Urology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Saafia N Masoom
- Department of Urology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Kennary Choung
- Department of Urology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Lillian C Hayes
- Department of Urology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Diane E Price
- Department of Urology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Mélise Keays
- Department of Urology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Paige E Sable
- Department of Urology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Ashley Shimmel
- Department of Urology, Boston Children's Hospital, Boston, Massachusetts, USA
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Kukafka R, van Haasteren A, Hug A, Elayan S, Sykora M, Albanese E, Naslund J, Wolf M, Fadda M, von Rhein M. Digital Platform Uses for Help and Support Seeking of Parents With Children Affected by Disabilities: Scoping Review. J Med Internet Res 2022; 24:e37972. [PMID: 36472896 PMCID: PMC9768636 DOI: 10.2196/37972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 09/23/2022] [Accepted: 10/25/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Receiving a diagnosis that leads to severe disability in childhood can cause a traumatic experience with long-lasting emotional stress for patients and family members. In recent decades, emerging digital technologies have transformed how patients or caregivers of persons with disabilities manage their health conditions. As a result, information (eg, on treatment and resources) has become widely available to patients and their families. Parents and other caregivers can use digital platforms such as websites or social media to derive social support, usually from other patients and caregivers who share their lived experiences, challenges, and successes on these platforms. However, gaps remain in our understanding of platforms that are most frequently used or preferred among parents and caregivers of children with disabilities. In particular, it is not clear what factors primarily drive or discourage engagement with these digital tools and what the main ethical considerations are in relation to these tools. OBJECTIVE We aimed to (1) identify prominent digital platforms used by parents or caregivers of children with disabilities; (2) explore the theoretical contexts and reasons for digital platform use, as well as the experiences made with using these platforms reported in the included studies; and (3) identify any privacy and ethical concerns emerging in the available literature in relation to the use of these platforms. METHODS We conducted a scoping review of 5 academic databases of English-language articles published within the last 10 years for diseases with childhood onset disability and self-help or parent/caregiver-led digital platforms. RESULTS We identified 17 papers in which digital platforms used by parents of affected children predominantly included social media elements but also search engines, health-related apps, and medical websites. Information retrieval and social support were the main reasons for their utilization. Nearly all studies were exploratory and applied either quantitative, qualitative, or mixed methods. The main ethical concerns for digital platform users included hampered access due to language barriers, privacy issues, and perceived suboptimal advice (eg, due to missing empathy of medical professionals). Older and non-college-educated individuals and ethnic minorities appeared less likely to access information online. CONCLUSIONS This review showed that limited scientifically sound knowledge exists on digital platform use and needs in the context of disabling conditions in children, as the evidence consists mostly of exploratory studies. We could highlight that affected families seek information and support from digital platforms, as health care systems seem to be insufficient for satisfying knowledge and support needs through traditional channels.
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Affiliation(s)
| | - Afua van Haasteren
- Institute of Public Health, Università della Svizzera italiana, Lugano, Switzerland
| | - Anna Hug
- Department of Geography, University of Zurich, Zurich, Switzerland
| | - Suzanne Elayan
- Centre for Information Management, Loughborough University, Loughborough, United Kingdom
| | - Martin Sykora
- Centre for Information Management, Loughborough University, Loughborough, United Kingdom
| | - Emiliano Albanese
- Institute of Public Health, Università della Svizzera italiana, Lugano, Switzerland
| | - John Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
| | - Markus Wolf
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Marta Fadda
- Institute of Public Health, Università della Svizzera italiana, Lugano, Switzerland
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Chow WK, Hetherington K, McGill BC, Sansom-Daly UM, Daly R, Miles G, Cohn RJ, Wakefield CE. 'Like ships in the night': A qualitative investigation of the impact of childhood cancer on parents' emotional and sexual intimacy. Pediatr Blood Cancer 2022; 69:e30015. [PMID: 36200485 DOI: 10.1002/pbc.30015] [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: 04/04/2022] [Revised: 08/19/2022] [Accepted: 08/29/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Childhood cancer is highly distressing for families and can place strain on parents' relationships. Parental functioning and cohesiveness are important predictors of family functioning and adaptation to stress. This qualitative study investigated the perceived impact of childhood cancer on parents' relationship with their partner, with a focus on emotional and sexual intimacy. METHODS We conducted semi-structured interviews with 48 parents (42 mothers, six fathers) of children under the age of 18 who had completed curative cancer treatment. We analysed the interviews using thematic analysis. RESULTS At interview, parents were on average 40.7 years old (SD = 5.5, range: 29-55 years), and had a child who had completed cancer treatment between 3 months and 10.8 years previously (M = 22.1 months). All participants were living with their partner in a married/de facto relationship. Most parents reported that their child's cancer treatment had a negative impact on emotional and sexual intimacy with their partner, with some impacts extending to the post-treatment period. Reasons for compromised intimacy included exhaustion and physical constraints, having a shifted focus, and discord arising from different coping styles. Some parents reported that their relationship strengthened. Parents also discussed the impact of additional stressors unrelated to the child's cancer experience. CONCLUSIONS Parents reported that childhood cancer had a negative impact on aspects of emotional and sexual intimacy, although relationship strengthening was also evident. It is important to identify and offer support to couples who experience ongoing relationship stress, which may have adverse effects on family functioning and psychological wellbeing into survivorship.
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Affiliation(s)
- Wan Ka Chow
- School of Clinical Medicine, Discipline of Paediatrics, UNSW Medicine and Health, UNSW Sydney, Kensington, New South Wales, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Kate Hetherington
- School of Clinical Medicine, Discipline of Paediatrics, UNSW Medicine and Health, UNSW Sydney, Kensington, New South Wales, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Brittany C McGill
- School of Clinical Medicine, Discipline of Paediatrics, UNSW Medicine and Health, UNSW Sydney, Kensington, New South Wales, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Ursula M Sansom-Daly
- School of Clinical Medicine, Discipline of Paediatrics, UNSW Medicine and Health, UNSW Sydney, Kensington, New South Wales, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Rebecca Daly
- School of Clinical Medicine, Discipline of Paediatrics, UNSW Medicine and Health, UNSW Sydney, Kensington, New South Wales, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Gordon Miles
- Acute Services: Paediatric Consultation Liaison, Princess Margaret Hospital, Subiaco, Western Australia, Australia
| | - Richard J Cohn
- School of Clinical Medicine, Discipline of Paediatrics, UNSW Medicine and Health, UNSW Sydney, Kensington, New South Wales, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Claire E Wakefield
- School of Clinical Medicine, Discipline of Paediatrics, UNSW Medicine and Health, UNSW Sydney, Kensington, New South Wales, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
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Pruette CS, Ranch D, Shih WV, Ferris MDG. Health Care Transition in Adolescents and Young Adults With Chronic Kidney Disease: Focus on the Individual and Family Support Systems. Adv Chronic Kidney Dis 2022; 29:318-326. [PMID: 36084978 DOI: 10.1053/j.ackd.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 02/03/2022] [Accepted: 02/15/2022] [Indexed: 11/11/2022]
Abstract
Health care transition (HCT) from pediatric to adult-focused services is a longitudinal process driven by the collaboration and interactions of adolescent/young adult patients, their families, providers, health care agencies, and environment. Health care providers in both pediatric and adult-focused settings must collaborate, as patients' health self-management skills are acquired in the mid-20s, after they have transferred to adult-focused care. Our manuscript discusses the individual and family support systems as they relate to adolescents and young adults with chronic or end-stage kidney disease. In the individual domain, we discuss demographic/socioeconomic characteristics, disease complexity/course, cognitive capabilities, and self-management/self-advocacy. In the family domain, we discuss family composition/culture factors, family function, parenting style, and family unit factors. We provide a section dedicated to patients with cognitive and developmental disability. Furthermore, we discuss barriers for HCT preparation and offer solutions as well as activities for HCT preparation.
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Affiliation(s)
| | - Daniel Ranch
- Department of Pediatrics, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health at San Antonio, San Antonio, TX
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Erickson SJ, Dinces S, Kubinec N, Annett RD. Pediatric Cancer Survivorship: Impact Upon Hair Cortisol Concentration and Family Functioning. J Clin Psychol Med Settings 2022; 29:943-953. [PMID: 35150359 DOI: 10.1007/s10880-022-09858-9] [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] [Accepted: 01/25/2022] [Indexed: 12/30/2022]
Abstract
A clearer understanding of the association between a biomarker of long-term stress reactivity and family functioning among pediatric cancer survivors may guide both survivorship research and clinical practice. The current study examined the relationship between a long-term measure of hypothalamic-pituitary-adrenal (HPA) activity (cortisol concentration; CORTHAIR) and parent-reported family functioning (Family Environment Scale; FES) in a cross-sectional sample of survivors (n = 26) and controls (n = 53). Child CORTHAIR was not different in survivors and controls, though treatment severity was significantly related to child survivor CORTHAIR. Child CORTHAIR and parent CORTHAIR were positively correlated. Cancer survivor parents reported greater FES Organization. Child CORTHAIR was inversely associated with FES Independence, while parent CORTHAIR was inversely correlated with FES Organization. Parent CORTHAIR and FES Independence were significant and unique predictors of child CORTHAIR. Our results provide preliminary evidence for a relationship between a stress biomarker, child CORTHAIR, and family functioning among pediatric cancer survivors and controls.
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Affiliation(s)
- Sarah J Erickson
- Department of Psychology, Logan Hall, University of New Mexico, MSC03 2220, Albuquerque, NM, 87131, USA.
| | | | - Nicole Kubinec
- Department of Psychology, Logan Hall, University of New Mexico, MSC03 2220, Albuquerque, NM, 87131, USA
| | - Robert D Annett
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS, USA
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Moscato E, Patronick J, Wade SL. Family functioning and adaptation following pediatric brain tumor: A systematic review. Pediatr Blood Cancer 2022; 69:e29470. [PMID: 34842339 DOI: 10.1002/pbc.29470] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 10/29/2021] [Accepted: 11/02/2021] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Pediatric brain tumor survivors (PBTS) experience psychosocial difficulties and poor quality of life (QOL). Family functioning may be adversely impacted by the stress of diagnosis and associated symptoms, which may, in turn, affect PBTS outcomes. The objective of this study was to complete a systematic review of family functioning and psychosocial outcomes in PBTS. METHODS We conducted systematic searches of PubMed and PsychInfo. Full-text articles (n = 324) were screened and 14 were included. A risk-of-bias assessment was conducted to evaluate the quality of study conclusions. RESULTS Studies examined associations of family functioning with adaptive, social, emotional, and behavioral outcomes, and QOL. More adaptive family functioning (cohesiveness, effective communication, lower conflict) was associated with better PBTS outcomes. Studies were limited by heterogeneous/small samples and cross-sectional designs. CONCLUSIONS Results provide preliminary support for the relationship between family functioning and psychosocial outcomes. Common outcome measures and prospective research designs can further advance understanding.
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Affiliation(s)
- Emily Moscato
- Department of Psychology, University of Cincinnati, Cincinnati, Ohio, USA.,Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jamie Patronick
- Department of Psychology, University of Cincinnati, Cincinnati, Ohio, USA.,Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Shari L Wade
- Department of Psychology, University of Cincinnati, Cincinnati, Ohio, USA.,Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Holt RF, Kronenberger WG, Pisoni DB. Family Environmental Dynamics Differentially Influence Spoken Language Development in Children With and Without Hearing Loss. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:361-377. [PMID: 34818506 PMCID: PMC9150738 DOI: 10.1044/2021_jslhr-21-00220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/16/2021] [Accepted: 09/07/2021] [Indexed: 05/19/2023]
Abstract
PURPOSE The aim of this study was to evaluate whether families of children with sensorineural hearing loss (SNHL) are organized similarly to those of typically developing, typically hearing (TH) children and whether the dimensions of family dynamics and environment are related to spoken language development similarly in children with and without SNHL. METHOD Primary caregivers of children with SNHL (n = 63) or TH (n = 65) completed the Family Environment Scale-Fourth Edition (FES-4) to assess multiple dimensions of family environment. Children's receptive vocabulary was assessed with the Peabody Picture Vocabulary Test-Fourth Edition, and their receptive language was assessed by an age-appropriate version of the Concepts and Following Directions subtest of the Clinical Evaluation of Language Fundamentals and the Sentence Comprehension subscale of the Comprehensive Assessment of Spoken Language-Second Edition. Principal component analysis was used to examine the dimensional structure of the family environment. RESULTS Three higher order components were derived from FES-4 subscales for both families of children with SNHL and with TH: Supportive, Controlling, and Conflicted. However, the composition of the factors themselves differed between the two groups. For the TH group, most family environment measures on the FES-4 were not associated with language outcomes. In contrast, for children with SNHL, families who were more supportive, less controlling, and less conflicted had children with better language skills. CONCLUSIONS Three well-accepted dimensions of family dynamics and functioning apply to families of children with SNHL, but their composition differs from those of families with TH children. Family environmental dynamics were much more strongly associated with language outcomes in children with SNHL than in their TH peers. The spoken language development of children with SNHL, in particular, is better in families that provide high levels of support for each other and, in particular, low levels of control, disorganization, and conflict, reflecting the fragile nature of their spoken language development.
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Affiliation(s)
- Rachael Frush Holt
- Department of Speech and Hearing Science, The Ohio State University, Columbus
| | - William G. Kronenberger
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis
- DeVault Otologic Research Laboratory, Department of Otolaryngology, Indiana University School of Medicine, Indianapolis
| | - David B. Pisoni
- DeVault Otologic Research Laboratory, Department of Otolaryngology, Indiana University School of Medicine, Indianapolis
- Department of Psychological and Brain Sciences, Indiana University, Bloomington
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Desjardins L, Solomon A, Shama W, Mills D, Chung J, Hancock K, Barrera M. The impact of caregiver anxiety/depression symptoms and family functioning on child quality of life during pediatric cancer treatment: From diagnosis to 6 months. J Psychosoc Oncol 2022; 40:790-807. [PMID: 35016592 DOI: 10.1080/07347332.2021.2015646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
A pediatric cancer diagnosis can have a significant impact on the quality of life (QOL) of the child. Diagnosis and treatment impact caregiver anxiety/depression symptoms and family functioning, and these in turn may influence child QOL. However, there has been limited longitudinal examination of the impact of both caregiver anxiety/depression symptoms and family functioning on youth QOL at specific points during the early diagnosis and treatment period. Ninety-six caregivers of youth (diagnosed with leukemia/lymphoma or a solid tumor) reported on their own anxiety/depression symptoms, family functioning, demographic and medical factors, and on their child's generic and cancer-specific QOL shortly after diagnosis (T1) and 6 months later (T2). Caregiver anxiety/depression symptoms were associated with poorer cancer-specific and generic child QOL within and across time points. Family conflict was associated with youth cancer-related QOL at T1. Attendance to caregiver anxiety/depression symptoms and family functioning, beginning early in the cancer trajectory, is an important aspect of family-centered care. Routine psychosocial screening and triage may help identify and intervene to support both caregiver and child psychosocial well-being.
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Affiliation(s)
- Leandra Desjardins
- Charles-Bruneau Cancer Care Centre, Sainte-Justine University Health Centre, Montreal, Canada.,Department of Psychology, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Aden Solomon
- Department of Psychology, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Wendy Shama
- Department of Social Work, Division of Hematology/Oncology, BC Children's Hospital, Vancouver, Canada
| | - Denise Mills
- Department of Nursing, Division of Hematology/Oncology, BC Children's Hospital, Vancouver, Canada
| | - Joanna Chung
- Department of Psychology, Division of Hematology/Oncology, BC Children's Hospital, Vancouver, Canada
| | - Kelly Hancock
- Department of Psychology, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Maru Barrera
- Department of Psychology, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada
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Dover S, Young NL, Blanchette VS, Klaassen RJ, Chan AK, Wakefield C, Bouskill V, Carcao M, Belletrutti M, Bruce AAK, Price VE. Measuring the impact of hemophilia on families: Development of the Hemophilia Family Impact Tool (H-FIT). Res Pract Thromb Haemost 2021; 5:e12519. [PMID: 34013152 PMCID: PMC8114030 DOI: 10.1002/rth2.12519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 04/02/2021] [Accepted: 04/06/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction This study aimed to assess the impact of hemophilia on families, in the context of current and emerging hemostatic therapies, and explore the need for a hemophilia‐specific tool targeted at parents of boys aged <4 years. A secondary aim was to develop and validate the new tool. Methods Focus groups were conducted with parents of boys with hemophilia and hemophilia health care providers at Canadian hemophilia treatment centers (HTCs) to review the relevance of the Pediatric Quality of Life Family Impact Module (PedsQL‐FIM); a novel questionnaire was developed by identifying core themes expressed. This questionnaire, the Hemophilia Family Impact Tool (H‐FIT) was validated in a sample of parents of boys with hemophilia relative to the PedsQL‐FIM. Results Seven focus groups were conducted at four HTCs, generating themes specific to hemophilia not covered by the PedsQL‐FIM, suggesting that a new tool be developed (the H‐FIT). In the validation phase, 54 parents completed the H‐FIT and PedsQL‐FIM. The H‐FIT had a strong correlation with the PedsQL‐FIM across all ages (r = 0.79; P < .0001) and a moderate correlation for parents of boys aged <7 years (r = 0.64; P = .0007). There was a significant difference between the mean H‐FIT scores for parents of boys using extended half‐life factor (68.1; standard deviation [SD]=14.2) compared to standard half‐life factor (54.7; SD=18.4; P = .04). Conclusion A novel, disease‐specific tool, the H‐FIT, has been developed to measure the impact of hemophilia on families. The H‐FIT has good preliminary measurement properties and may be responsive to changes in therapy associated with a decreased burden of administration.
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Affiliation(s)
- Saunya Dover
- Child Health Evaluative Sciences The Hospital for Sick Children Research Institute Toronto ON Canada
| | - Nancy L Young
- School of Rural and Northern Health Laurentian University Sudbury ON Canada
| | - Victor S Blanchette
- Child Health Evaluative Sciences The Hospital for Sick Children Research Institute Toronto ON Canada.,Division of Hematology/Oncology The Hospital for Sick Children Toronto ON Canada.,Department of Pediatrics University of Toronto Toronto ON Canada
| | - Robert J Klaassen
- Division of Pediatric Hematology/Oncology University of Ottawa Children's Hospital of Eastern Ontario Ottawa ON Canada
| | - Anthony K Chan
- Department of Pediatrics McMaster Children's Hospital McMaster University Hamilton ON Canada
| | - Cindy Wakefield
- Department of Nursing The Hospital for Sick Children Toronto ON Canada
| | - Vanessa Bouskill
- Division of Hematology/Oncology The Hospital for Sick Children Toronto ON Canada.,Department of Nursing The Hospital for Sick Children Toronto ON Canada
| | - Manuel Carcao
- Child Health Evaluative Sciences The Hospital for Sick Children Research Institute Toronto ON Canada.,Division of Hematology/Oncology The Hospital for Sick Children Toronto ON Canada.,Department of Pediatrics University of Toronto Toronto ON Canada
| | - Mark Belletrutti
- Pediatric Hematology Department of Pediatrics University of Alberta Edmonton AB Canada
| | - Aisha A K Bruce
- Pediatric Hematology Department of Pediatrics University of Alberta Edmonton AB Canada
| | - Victoria E Price
- Division of Pediatric Hematology/Oncology Department of Pediatrics IWK Health Centre Dalhousie University Halifax NS Canada
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Patton M, Stokoe M, Forbes C, Nwaroh C, Noel M, Reynolds K, Schulte F. The Intergenerational Transmission of Chronic Pain from Parents to Survivors of Childhood Cancer. CHILDREN (BASEL, SWITZERLAND) 2020; 7:E246. [PMID: 33233437 PMCID: PMC7700439 DOI: 10.3390/children7110246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 11/16/2020] [Accepted: 11/19/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Among youth with chronic non-cancer pain, 50% have parents with chronic pain. These youth report significantly more pain interference and posttraumatic stress symptoms (PTSS), and worse health-related quality of life (HRQL) than youth whose parents do not have chronic pain. Additionally, parent chronic pain is linked to increased child anxiety and depressive symptoms. Survivors of childhood cancer (SCCs) are at risk of pain and negative psychosocial outcomes and therefore may be especially vulnerable if their parents have chronic pain. Thus, the aims of the current study were to (1) identify rates of chronic pain among parents of SCCs, (2) test group differences in psychological symptoms in parents with chronic pain versus without, and (3) test group differences in pain interference, HRQL, anxiety, depression, and PTSS in SCCs with parents with chronic pain versus without. METHODS 122 SCCs (Mean age = 15.8, SD = 4.8, 45.7% male, Mean age at diagnosis = 5.9, SD = 4.7) and their parents were recruited from across Canada to complete online questionnaires. Parents were asked if they have had pain for at least three consecutive months and completed the brief symptom inventory (BSI) as a measure of psychological symptomatology. Survivors completed the pain questionnaire, patient reported outcomes measurement information system (PROMIS)-pain interference, anxiety, and depression measures, child posttraumatic stress scale, posttraumatic stress disorder checklist for the Diagnostic and Statistical Manual of Mental Disorders, and the pediatric quality of life inventory. RESULTS Forty-three (39%) parents of SCCs reported having chronic pain. Of the 29 survivors who had chronic pain, 14 (48%) also had parents with chronic pain. Parents with chronic pain reported significantly higher scores on the BSI than parents without chronic pain, F(1, 116) = 5.07, p = 0.026. SCCs with parents with versus without chronic pain reported significantly higher PTSS F(1, 105) = 10.53, p = 0.002 and depressive symptoms F(1, 102) = 6.68, p = 0.011. No significant differences were found across the other variables tested. CONCLUSIONS Findings suggest that survivors' parents' own pain is prevalent and is related to survivors' increased depressive symptoms and PTSS, but not anxiety, pain interference, or HRQL. Future research should explore whether parents may benefit from psychological intervention after their child has been diagnosed with cancer and how this could improve outcomes for their child.
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Affiliation(s)
- Michaela Patton
- Department of Psychology, University of Calgary, Calgary, AB T2N 1N4, Canada; (M.P.); (M.N.)
| | - Mehak Stokoe
- Hematology, Oncology, and Bone Marrow Transplant Program, Alberta Children’s Hospital, Calgary, AB T3B 6A8, Canada; (M.S.); (C.F.); (K.R.)
| | - Caitlin Forbes
- Hematology, Oncology, and Bone Marrow Transplant Program, Alberta Children’s Hospital, Calgary, AB T3B 6A8, Canada; (M.S.); (C.F.); (K.R.)
| | - Chidera Nwaroh
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada;
| | - Melanie Noel
- Department of Psychology, University of Calgary, Calgary, AB T2N 1N4, Canada; (M.P.); (M.N.)
| | - Kathleen Reynolds
- Hematology, Oncology, and Bone Marrow Transplant Program, Alberta Children’s Hospital, Calgary, AB T3B 6A8, Canada; (M.S.); (C.F.); (K.R.)
| | - Fiona Schulte
- Department of Psychology, University of Calgary, Calgary, AB T2N 1N4, Canada; (M.P.); (M.N.)
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada;
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Schulte F, Russell KB, Pelletier W, Scott-Lane L, Guilcher GMT, Strother D, Dewey D. Screening for psychosocial distress in pediatric cancer patients: An examination of feasibility in a single institution. Pediatr Hematol Oncol 2019; 36:125-137. [PMID: 30983467 DOI: 10.1080/08880018.2019.1600082] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Despite the availability of tools to assess psychosocial screening in pediatric oncology, little is known about the feasibility and acceptability of systematic screening. We aimed to assess the feasibility of implementing a tool, or set of tools, capable of screening for psychosocial distress in pediatric cancer patients across the cancer continuum (on treatment, off treatment). Psychometric criteria were also evaluated. Patients 8-18 years were recruited from a pediatric oncology program. Patients completed self-report measures of the Distress Thermometer (DT) and Pediatric Quality of Life Inventory (PedsQL). One parent of each patient completed three screening tools: DT (proxy-report); PedsQL (proxy-report), and the Psychosocial Assessment Tool adapted for the Canadian context (PATrev), as well as a measure of patient psychological functioning (Behavioral Assessment System for Children-2), and an assessment of screening tool acceptability. Recruitment rates and acceptability informed feasibility of implementation. Ninety-five patients (58 men) with a mean age of 11.47 participated in the study (on treatment, n = 43; off treatment, n = 52). Recruitment rates were on treatment: 56.6% and off treatment: 47.3%. Mean acceptability scores of tools ranged from 3.41 to 4.97 out of 7. Screening tools were comparable with respect to their psychometric properties. The DT took the least amount of time to complete, while the PATrev offered the most robust data with respect to psychometrics. Feasibility of screening for psychosocial distress with our tool was moderate and may be enhanced when administered by a known health-care provider. Future research exploring how to further enhance feasibility of implementation for pediatric cancer patients is warranted.
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Affiliation(s)
- Fiona Schulte
- a Department of Oncology , Cumming School of Medicine, University of Calgary , Alberta , Canada.,b Haematology, Oncology and Transplant Program , Alberta Children's Hospital , Alberta , Canada
| | - K Brooke Russell
- c Department of Psychology , Faculty of Arts, University of Calgary , Alberta , Canada
| | - Wendy Pelletier
- b Haematology, Oncology and Transplant Program , Alberta Children's Hospital , Alberta , Canada
| | - Laura Scott-Lane
- b Haematology, Oncology and Transplant Program , Alberta Children's Hospital , Alberta , Canada
| | - Gregory M T Guilcher
- a Department of Oncology , Cumming School of Medicine, University of Calgary , Alberta , Canada.,b Haematology, Oncology and Transplant Program , Alberta Children's Hospital , Alberta , Canada.,d Department of Pediatrics , Cumming School of Medicine, University of Calgary , Alberta , Canada
| | - Douglas Strother
- a Department of Oncology , Cumming School of Medicine, University of Calgary , Alberta , Canada.,b Haematology, Oncology and Transplant Program , Alberta Children's Hospital , Alberta , Canada.,d Department of Pediatrics , Cumming School of Medicine, University of Calgary , Alberta , Canada
| | - Deborah Dewey
- d Department of Pediatrics , Cumming School of Medicine, University of Calgary , Alberta , Canada.,e Department of Community Health Sciences , Cumming School of Medicine, University of Calgary , Alberta , Canada
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Ogez D, Bourque CJ, Péloquin K, Ribeiro R, Bertout L, Curnier D, Drouin S, Laverdière C, Marcil V, Rondeau É, Sinnett D, Sultan S. Definition and improvement of the concept and tools of a psychosocial intervention program for parents in pediatric oncology: a mixed-methods feasibility study conducted with parents and healthcare professionals. Pilot Feasibility Stud 2019; 5:20. [PMID: 30774970 PMCID: PMC6366012 DOI: 10.1186/s40814-019-0407-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 01/24/2019] [Indexed: 12/17/2022] Open
Abstract
Background Studies have shown that supporting parents in pediatric oncology reduces family distress following a cancer diagnosis. Manualized programs for parents have therefore been developed to reduce family distress. However, these programs have limitations that need to be improved, such as better defining programs’ procedures, developing interventions focusing on parents’ conjugal relationship, conducting rigorous evaluations of implementation, and proposing adaptations to various cultural dimensions. According to the Obesity-Related Behavioral Intervention Trials (ORBIT) model for the development of behavioral intervention, we improved these limitations and developed TAKING BACK CONTROL TOGETHER, a six in-person intervention sessions to support parents of children with cancer by taking the active components of two programs: Bright IDEAS and SCCIP. Referring to the redesign phase of the ORBIT model, this study aims to refine the definition of this program’s design by interviewing parents and healthcare professionals. Methods In order to refine the program, we used a sequential mixed-methods study. Parents and healthcare professionals first completed questionnaires assessing the program, and then discussed its limitations, benefits, and areas for improvement in group and/or individual interviews. We performed a descriptive thematic content analysis of the qualitative data from the open-ended questions (questionnaires and interviews) with NVivo 11 to categorize recommendations for the program refinement. Results The results showed that components seemed pertinent to final users. The main areas needing improvement were the level of complexity and understandability of the parent manual, the possibility to choose the place and time of the intervention, and the lack of ethnic/cultural diversity. Changes to the program were made accordingly. Conclusions It is necessary to include end-users when developing complex intervention programs designed for vulnerable populations and sensitive clinical contexts. Following the present refinement, we now have a treatment package, which is safe and acceptable for the target population and has a better chance of yielding a clinically significant benefit for users in a future pilot study.
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Affiliation(s)
- David Ogez
- Sainte-Justine University Health Center, Chaussée de la Côte-Sainte-Catherine, 3175, Montréal, Québec H3T 1C5 Canada.,2Department of Psychology, Université de Montréal, Québec, Canada
| | - Claude-Julie Bourque
- Sainte-Justine University Health Center, Chaussée de la Côte-Sainte-Catherine, 3175, Montréal, Québec H3T 1C5 Canada.,3Department of Pediatrics, Université de Montréal, Québec, Canada
| | | | - Rebeca Ribeiro
- 2Department of Psychology, Université de Montréal, Québec, Canada
| | - Laurence Bertout
- Sainte-Justine University Health Center, Chaussée de la Côte-Sainte-Catherine, 3175, Montréal, Québec H3T 1C5 Canada
| | - Daniel Curnier
- Sainte-Justine University Health Center, Chaussée de la Côte-Sainte-Catherine, 3175, Montréal, Québec H3T 1C5 Canada.,4Department of Kinesiology, Université de Montréal, Québec, Canada
| | - Simon Drouin
- Sainte-Justine University Health Center, Chaussée de la Côte-Sainte-Catherine, 3175, Montréal, Québec H3T 1C5 Canada
| | - Caroline Laverdière
- Sainte-Justine University Health Center, Chaussée de la Côte-Sainte-Catherine, 3175, Montréal, Québec H3T 1C5 Canada.,3Department of Pediatrics, Université de Montréal, Québec, Canada
| | - Valérie Marcil
- Sainte-Justine University Health Center, Chaussée de la Côte-Sainte-Catherine, 3175, Montréal, Québec H3T 1C5 Canada.,5Department of Nutrition, Université de Montréal, Québec, Canada
| | - Émélie Rondeau
- Sainte-Justine University Health Center, Chaussée de la Côte-Sainte-Catherine, 3175, Montréal, Québec H3T 1C5 Canada
| | - Daniel Sinnett
- Sainte-Justine University Health Center, Chaussée de la Côte-Sainte-Catherine, 3175, Montréal, Québec H3T 1C5 Canada.,3Department of Pediatrics, Université de Montréal, Québec, Canada
| | - Serge Sultan
- Sainte-Justine University Health Center, Chaussée de la Côte-Sainte-Catherine, 3175, Montréal, Québec H3T 1C5 Canada.,2Department of Psychology, Université de Montréal, Québec, Canada.,3Department of Pediatrics, Université de Montréal, Québec, Canada
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14
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Janin MMH, Ellis SJ, Wakefield CE, Fardell JE. Talking About Cancer Among Adolescent and Young Adult Cancer Patients and Survivors: A Systematic Review. J Adolesc Young Adult Oncol 2018; 7:515-524. [PMID: 29851370 DOI: 10.1089/jayao.2017.0131] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Communication plays an essential role in social relationships. Yet it is unclear how young cancer patients and survivors communicate with peers, and whether this contributes to increased rates of social difficulties. We aimed to analyze how childhood cancer patients and survivors communicate about their cancer with family and peers. We systematically searched Medline, Embase and PsycINFO for peer-reviewed studies on cancer-related communication among patients and survivors (any cancer, <25 years at diagnosis). We screened 309 articles, and included 6 qualitative studies. Studies were assessed using a standardized quality assessment tool. Participants were adolescents and young adults, 16-34 years of age at the time of study. Included studies related to different forms of cancer-related communication, benefits, and challenges. We found that cancer-related communication was an individual, complex process, addressing medical, existential, and emotional aspects of cancer. Communication occurred on a spectrum with variation in who information was shared with, as well as differences in the frequency at which information was shared, and the amount and type of information shared. Communication often occurred at uncertain or significant times for participants, or was initiated by others. Communicating about cancer yielded benefits as a coping strategy, prompted social support, and appeared central to significant relationships. Barriers to communication, including fear of stigma and poor peer reactions, hindered willingness to disclose. The number of studies analyzing this topic was limited. Communicating about cancer is a significant yet complex process for young patients and survivors. Further research is needed to complement the existing literature and to establish the evidence base for the development of future effective interventions promoting social and communication skills.
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Affiliation(s)
- Madeleine Marie Hortense Janin
- 1 Kids Cancer Center, Sydney Children's Hospital , Randwick, Australia .,2 School of Women's and Children's Health, Discipline of Pediatrics, UNSW Medicine, University of New South Wales , Sydney, Australia
| | - Sarah Jane Ellis
- 1 Kids Cancer Center, Sydney Children's Hospital , Randwick, Australia .,2 School of Women's and Children's Health, Discipline of Pediatrics, UNSW Medicine, University of New South Wales , Sydney, Australia
| | - Claire Elizabeth Wakefield
- 1 Kids Cancer Center, Sydney Children's Hospital , Randwick, Australia .,2 School of Women's and Children's Health, Discipline of Pediatrics, UNSW Medicine, University of New South Wales , Sydney, Australia
| | - Joanna Elizabeth Fardell
- 1 Kids Cancer Center, Sydney Children's Hospital , Randwick, Australia .,2 School of Women's and Children's Health, Discipline of Pediatrics, UNSW Medicine, University of New South Wales , Sydney, Australia
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15
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Psychosocial Issues in Children with Cancer: The Role of Patient Advocacy and Its Impact on Care. Sarcoma 2017. [DOI: 10.1007/978-3-319-43121-5_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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16
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Santos S, Crespo C, Canavarro MC, Kazak AE. Parents' Romantic Attachment Predicts Family Ritual Meaning and Family Cohesion Among Parents and Their Children With Cancer. J Pediatr Psychol 2017; 42:114-124. [PMID: 28173184 DOI: 10.1093/jpepsy/jsw043] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 03/28/2016] [Accepted: 04/22/2016] [Indexed: 11/15/2022] Open
Abstract
Objective Family functioning is associated with adaptation in pediatric illness. This study examines the role of parents’ relationships (specifically romantic attachment) as a predictor of family ritual meaning and family cohesion for parents and their children with cancer. Methods The dyads, 58 partnered Portuguese parents and their children in treatment, reported on family ritual meaning and family cohesion at Time 1 (T1) and after 6 months (T2). Parents also completed the questionnaire assessing romantic attachment at T1. Results Parents’ avoidant attachment, but not anxious attachment, predicted lower family ritual meaning and family cohesion after 6 months. T2 family ritual meaning mediated the relationship between T1 avoidant attachment and T2 family cohesion. Conclusions Parents’ avoidant attachment may have a negative effect on family functioning in parents and children. Clinical intervention to address avoidant attachment or/and to promote family ritual meaning may help strengthen family ties.
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Affiliation(s)
- Susana Santos
- Faculty of Psychology and Education Sciences, University of Coimbra, Portugal
| | - Carla Crespo
- Faculdade de Psicologia, Universidade de Lisboa, Lisboa, Portugal
| | | | - Anne E Kazak
- Center for Healthcare Delivery Science, Nemours Children’s Health System, Philadelphia, PA, USA.,Department of Pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
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Van Schoors M, Caes L, Knoble NB, Goubert L, Verhofstadt LL, Alderfer MA. Systematic Review: Associations Between Family Functioning and Child Adjustment After Pediatric Cancer Diagnosis: A Meta-Analysis. J Pediatr Psychol 2016; 42:6-18. [DOI: 10.1093/jpepsy/jsw070] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 07/20/2016] [Accepted: 07/27/2016] [Indexed: 11/12/2022] Open
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Suzuki LK, Kato PM. Psychosocial Support for Patients in Pediatric Oncology: The Influences of Parents, Schools, Peers, and Technology. J Pediatr Oncol Nurs 2016; 20:159-74. [PMID: 14567564 DOI: 10.1177/1043454203254039] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The diagnosis and treatment of pediatric cancer can be associated with profound psychosocial changes in the life of young patients. Although nurses, physicians, and other health care professionals are important sources of support, psychosocial support is also available through parents, schools, and peers. This article presents a review of the literature on how parents, schools, and peers affect the coping and adjustment of young patients with cancer and critically reviews interventions directed at improving functioning in these areas. Special attention is paid to recent interventions that exploit technology such as video games, CD-ROMs, and the Internet to provide creative new forms of support for patients in pediatric oncology. Existing research on both technological and interpersonal forms of intervention and support shows promising results, and suggestions for further study are provided.
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Van Schoors M, Caes L, Verhofstadt LL, Goubert L, Alderfer MA. Systematic Review: Family Resilience After Pediatric Cancer Diagnosis: Figure 1. J Pediatr Psychol 2015; 40:856-68. [DOI: 10.1093/jpepsy/jsv055] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 05/18/2015] [Indexed: 11/12/2022] Open
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20
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Lau S, Lu X, Balsamo L, Devidas M, Winick N, Hunger SP, Carroll W, Stork L, Maloney K, Kadan-Lottick N. Family life events in the first year of acute lymphoblastic leukemia therapy: a children's oncology group report. Pediatr Blood Cancer 2014; 61:2277-84. [PMID: 25175168 PMCID: PMC4282930 DOI: 10.1002/pbc.25195] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 06/24/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND Despite higher cure rates, childhood acute lymphoblastic leukemia (ALL) may continue to result in considerable family strain. We sought to (i) measure incidence of divorce, reduced career opportunities, changes to work hours, home relocation, and changes to family planning at one year after ALL diagnosis; and (ii) Identify family and patient factors associated with these events. PROCEDURE We conducted a prospective cohort study of 159 children with average risk-ALL enrolled and treated on COG protocol AALL0331 at 31 selected sites. Eligibility criteria included age ≥2 years and English or Spanish comprehension. Parents completed surveys at three time points during the first 12 months of therapy. RESULTS Parents were at significantly increased risk of loss of employment (46% vs. 9.1%, P ≤ 0.001) than peers nationally. 13% divorced/separated, 27% relocated homes, 22% decided not to have more children, 51% declined occupational opportunities, and 68% decreased work hours. In adjusted analyses, relocation correlated with less maternal education (OR: 4.27 [95% CI: 1.43-12.82]). Declining parental opportunities associated with family income <$50,000 (OR: 4.25 [95% CI: 1.50-12.02]) and child <5 years old (OR: 4.21 [95% CI: 1.73-10.25]). Deciding not to have more children correlated with smaller family size 2-3 versus 4-5 (OR: 3.62 [95% CI: 1.10-11.96]). CONCLUSION Families experience a high incidence of major life changes in the first year of ALL treatment. Understanding these burdens helps health care providers to provide appropriate anticipatory guidance and support. No unifying factor was associated with the different family events. Ongoing follow-up is planned to measure long-term outcomes.
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Affiliation(s)
| | - Xiaomin Lu
- University of Florida, Gainesville, Florida
| | - Lyn Balsamo
- Yale School of Medicine, New Haven, Connecticut
| | | | | | - Stephen P. Hunger
- University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Connecticut
| | | | - Linda Stork
- Oregon Health and Science University, Portland, Oregon
| | - Kelly Maloney
- University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Connecticut
| | - Nina Kadan-Lottick
- Yale School of Medicine, New Haven, Connecticut,Yale Cancer Center, New Haven, Connecticut,Correspondence to: Nina Kadan-Lottick, Section of Pediatric Hematology-Oncology Yale University School of Medicine 333 Cedar St LMP 2073 New Haven, CT 06510.
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Abstract
Childhood cancer accounts for less than 2% of all cancers diagnosed each year. About 12-14,000 children will be diagnosed in a given year with any type of cancer. Over the past fifty years, treatments and cure rates have improved from 10-20% five-year survival rates to between 80-85% five-year survival rates. Psychosocial support of children with cancer and their families has grown and has been more fully integrated into paediatric care over the past five decades. Increasing acceptance of the importance of addressing mental health has led to oncologists referring patients to specific resources and services. This paper provides updated information on psychosocial issues for those who treat children and adolescents with cancer and focuses on unique challenges for the paediatric psycho-oncologist. PubMed and PsycINFO databases were searched from January 2000 through June 2013 using key words: pediatrics, oncology, psychosocial care, family, siblings, cancer, psycho-oncology, psychosocial issues, depression, anxiety, survivorship, and end of life.
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Affiliation(s)
- Nicole Mavrides
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - Maryland Pao
- Office of the Clinical Director, National Institutes of Mental Health, National Institutes of Health, Bethesda, MD
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Impact of functional constipation on health-related quality of life in preschool children and their families in Xi'an, China. PLoS One 2013; 8:e77273. [PMID: 24130872 PMCID: PMC3795078 DOI: 10.1371/journal.pone.0077273] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 08/31/2013] [Indexed: 02/07/2023] Open
Abstract
Aim Functional constipation (FC) is one of the common diseases among children. The aim of this study was to investigate the health-related quality of life (HRQOL) in preschool children diagnosed with FC and the impact of the condition on affected families. Methods In this cross-sectional, case-control study, 152 children aged 3–6 years with FC, 176 healthy children aged 3–6 years without FC, and their primary caregivers were selected. Chinese versions of the PedsQLTM 4.0 Generic Core Scale and the Family Impact Module (FIM) were used to assess childhood HRQOL and the impact of FC on family members, respectively. HRQOL scores were compared between children with FC and healthy children. In addition, a multiple step-wise regression with demographic variables of children and their caregivers, family economic status, duration and symptoms of FC, as independent variables, was used to determine factors that influenced HRQOL in children and had impacted caregivers. Results Scores of physical, emotional, social and school functions, and summary scales were significantly lower in children with FC than in healthy children (p < 0.05). Physical, emotional, social, cognitive, and communication scores for caregivers, as well as daily activities and relationships for families of children with FC, were significantly lower than those of caregivers and families with healthy children (p < 0.05). Children’s ages, duration of FC, symptoms of FC, the child-caregiver relationship, family economic status, and caregiver education level emerged as the main factors influencing HRQOL in children, caregivers, and family members. Conclusions FC had a significant impact on HRQOL of affected children and their caregivers, as well as their family functions. Social characteristics of children and caregivers, duration and symptoms of FC and family economic status significantly affected HRQOL of children and caregivers, as well as family functions of children with FC.
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Long KA, Marsland AL, Alderfer MA. Cumulative family risk predicts sibling adjustment to childhood cancer. Cancer 2013; 119:2503-10. [PMID: 23576115 DOI: 10.1002/cncr.28077] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 02/07/2013] [Accepted: 02/22/2013] [Indexed: 11/06/2022]
Abstract
BACKGROUND Prolonged, intensive treatment regimens often disrupt families of children with cancer. Siblings are at increased risk for distress, but factors underlying this risk have received limited empirical attention. In this study, the authors examined associations between the family context and sibling distress. METHODS Siblings of children with cancer (ages 8-18 years; N = 209) and parents (186 mothers and 70 fathers) completed measures of sibling distress, family functioning, parenting, and parent post-traumatic stress. Associations between sibling distress and each family risk factor were evaluated. Then, family risks were considered simultaneously by calculating cumulative family risk index scores. RESULTS After controlling for sociodemographic covariates, greater sibling distress was associated with more sibling-reported problems with family functioning and parental psychological control, lower sibling-reported maternal acceptance, and lower paternal self-reported acceptance. When risk factors were considered together, the results supported a quadratic model in which associations between family risk and sibling distress were stronger at higher levels of risk. CONCLUSIONS The current findings support a contextual model of sibling adjustment to childhood cancer in which elevated distress is predicted by family risk factors, both alone and in combination.
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Affiliation(s)
- Kristin A Long
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
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Holt RF, Beer J, Kronenberger WG, Pisoni DB. Developmental effects of family environment on outcomes in pediatric cochlear implant recipients. Otol Neurotol 2013; 34:388-95. [PMID: 23151776 PMCID: PMC3594395 DOI: 10.1097/mao.0b013e318277a0af] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine and compare the family environment of preschool- and school-age children with cochlear implants and assess its influence on children's executive function and spoken language skills. STUDY DESIGN Retrospective between-subjects design. SETTING Outpatient research laboratory. PATIENTS Prelingually deaf children with cochlear implants and no additional disabilities and their families. INTERVENTION(S) Cochlear implantation and speech-language therapy. MAIN OUTCOME MEASURES Parents completed the Family Environment Scale and the Behavior Rating Inventory of Executive Function (or the preschool version). Children were tested using the Peabody Picture Vocabulary Test-4 and either the Preschool Language Scales-4 or the Clinical Evaluation of Language Fundamentals-4. RESULTS The family environments of children with cochlear implants differed from normative data obtained from hearing children, but average scores were within 1 standard deviation of norms on all subscales. Families of school-age children reported higher levels of control than those of preschool-age children. Preschool-age children had fewer problems with emotional control when families reported higher levels of support and lower levels of conflict. School-age children had fewer problems with inhibition but more problems with shifting of attention when families reported lower levels of conflict. School-age children's receptive vocabularies were enhanced by families with lower levels of control and higher levels of organization. CONCLUSION Family environment and its relation to language skills and executive function development differed across the age groups in this sample of children with cochlear implants. Because family dynamics is one developmental/environmental factor that can be altered with therapy and education, the present results have important clinical implications for family-based interventions for deaf children with cochlear implants.
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Affiliation(s)
- Rachael Frush Holt
- Department of Speech and Hearing Sciences, Indiana University, Bloomington, Indiana 47405, USA.
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Sahler OJZ, Dolgin MJ, Phipps S, Fairclough DL, Askins MA, Katz ER, Noll RB, Butler RW. Specificity of problem-solving skills training in mothers of children newly diagnosed with cancer: results of a multisite randomized clinical trial. J Clin Oncol 2013; 31:1329-35. [PMID: 23358975 DOI: 10.1200/jco.2011.39.1870] [Citation(s) in RCA: 126] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Diagnosis of cancer in a child can be extremely stressful for parents. Bright IDEAS, a problem-solving skills training (PSST) intervention, has been shown to decrease negative affectivity (anxiety, depression, post-traumatic stress symptoms) in mothers of newly diagnosed patients. This study was designed to determine the specificity of PSST by examining its direct and indirect (eg, social support) effects compared with a nondirective support (NDS) intervention. PATIENTS AND METHODS This randomized clinical trial included 309 English- or Spanish-speaking mothers of children diagnosed 2 to 16 weeks before recruitment. Participants completed assessments prerandomization (T1), immediately postintervention (T2), and at 3-month follow-up (T3). Both PSST and NDS consisted of eight weekly 1-hour individual sessions. Outcomes included measures of problem-solving skill and negative affectivity. RESULTS There were no significant between-group differences at baseline (T1). Except for level of problem-solving skill, which was directly taught in the PSST arm, outcome measures improved equally in both groups immediately postintervention (T2). However, at the 3-month follow-up (T3), mothers in the PSST group continued to show significant improvements in mood, anxiety, and post-traumatic stress; mothers in the NDS group showed no further significant gains. CONCLUSION PSST is an effective and specific intervention whose beneficial effects continue to grow after the intervention ends. In contrast, NDS is an effective intervention while it is being administered, but its benefits plateau when active support is removed. Therefore, teaching coping skills at diagnosis has the potential to facilitate family resilience over the entire course of treatment.
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Fleary SA, Heffer RW. Impact of growing up with a chronically ill sibling on well siblings' late adolescent functioning. ISRN FAMILY MEDICINE 2013; 2013:737356. [PMID: 24959574 PMCID: PMC4041246 DOI: 10.5402/2013/737356] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Accepted: 01/14/2013] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to explore the continuing impact of growing up with an ill sibling on well siblings' late adolescent functioning. Forty late adolescents (M age = 18.78, SD = 0.83), who identified themselves as growing up with an ill sibling, completed a semistructured interview, demographic questionnaire, Personality Assessment Screener, and My Feelings and Concerns Sibling Questionnaire. Participants reported clinically significant problems on some PAS scales, and gender differences were found for acting out and alienation. Significant relationships were reported for communication and social withdrawal and alienation. Both positive and negative themes about the experience were elicited from the responses in the semistructured interview. This study provides evidence for some lingering negative effects of growing up with an ill sibling on well siblings' late adolescent functioning. Additionally, evidence for siblings' development of positive characteristics that may act as protective variables as they face the stressors of late adolescence was also highlighted.
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Affiliation(s)
- Sasha A. Fleary
- Department of Psychology, Texas A&M University, MS 4235, College Station, TX 77843, USA
| | - Robert W. Heffer
- Department of Psychology, Texas A&M University, MS 4235, College Station, TX 77843, USA
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Funk M, Seem J. A Mother's Perspective on Chronic Childhood Illness: Parenting a Child with Cystic Fibrosis. ACTA ACUST UNITED AC 2012. [DOI: 10.2190/il6.2.b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This article includes a personal narrative about the first author's experience surrounding the diagnosis of her youngest child with cystic fibrosis, a fatal genetic disease. Sociological research on chronic illness is analyzed in the light of lived experience. Through personal sharing, the reader is invited to develop a greater depth of understanding of the coping experience of a mother and her family who are caring for a child with a life-threatening chronic illness.
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McCarthy MC, Ashley DM, Lee KJ, Anderson VA. Predictors of acute and posttraumatic stress symptoms in parents following their child's cancer diagnosis. J Trauma Stress 2012; 25:558-66. [PMID: 23055298 DOI: 10.1002/jts.21745] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This longitudinal study aimed to examine acute and posttraumatic stress symptoms and predictors of traumatic stress symptoms in parents of children recently diagnosed with cancer. The sample comprised 220 parents of 143 children who completed questionnaires at diagnosis (T1) focused on acute stress disorder (ASD); of these, 145 parents of 97 children completed questionnaires 6-8 months later (T2) focused on posttraumatic stress disorder (PTSD). Demographic, psychosocial, and treatment and illness variables were predictors. Results were that 63% of mothers and 60% of fathers met criteria for ASD at T1. At T2, 21% of mothers and 16% of fathers met criteria for PTSD, with 40% of parents reporting significant subthreshold symptoms. Predictors of ASD symptoms were female gender, presence of psychosocial risk factors, trait anxiety, family functioning, and central nervous system tumor diagnosis. Risk factors for PTSD symptoms were younger maternal age, severity of ASD symptoms, and trait anxiety at T1, and parent-reported quality of life of the child at T2. The results suggest that screening for ASD may help identify parents at increased risk of persistent traumatic stress symptoms who could benefit from preventative, evidence-based psychosocial interventions.
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Affiliation(s)
- Maria C McCarthy
- Children's Cancer Centre, Royal Children's Hospital, Melbourne, Victoria, Australia.
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Guyard A, Michelsen SI, Arnaud C, Lyons A, Cans C, Fauconnier J. Measuring the concept of impact of childhood disability on parents: validation of a multidimensional measurement in a cerebral palsy population. RESEARCH IN DEVELOPMENTAL DISABILITIES 2012; 33:1594-1604. [PMID: 22534397 DOI: 10.1016/j.ridd.2012.03.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Revised: 03/30/2012] [Accepted: 03/30/2012] [Indexed: 05/31/2023]
Abstract
Living with a child with a disability can affect family life in various domains. Impacts on time, expenses, work, relationships within the family, social relationships and physical and psychological health can be observed. The Family Impact of Childhood Disability (FICD) is a specific instrument designed to assess this situation. Used in a cross-sectional survey, this questionnaire was extended to consider two missing aspects: impact on work and health (FICD+4). This paper addresses the psychometric qualities of the FICD in Europe among parents living with an adolescent with cerebral palsy. Expecting the FICD+4 could assess detailed impact dimensions, an exploratory analysis was conducted. We interviewed 242 families of 13- to 17-year-old adolescents with cerebral palsy living in Europe. Good psychometric properties were found in negative and positive FICD scales and in six underlying factors extracted from exploratory factor analysis on FICD+4. These results support the psychometric validity of the FICD in the assessment of the impact of disability in European families who live with an adolescent with cerebral palsy. They also highlight the multifaceted aspects of the impact of childhood disability on the family and suggest that the FICD+4 is a good tool for assessing specific negative impacts on time, finances, work, social relationships and positive impacts on parental feeling and family attitude. This scale needs further validation and could be helpful for research and clinical interventions.
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Affiliation(s)
- Audrey Guyard
- ThEMAS TIMC-IMAG, UMR CNRS 5525, Joseph Fourier University, Grenoble F-38041, France.
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Holt RF, Beer J, Kronenberger WG, Pisoni DB, Lalonde K. Contribution of family environment to pediatric cochlear implant users' speech and language outcomes: some preliminary findings. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2012; 55:848-64. [PMID: 22232387 PMCID: PMC3370076 DOI: 10.1044/1092-4388(2011/11-0143)] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
PURPOSE To evaluate the family environments of children with cochlear implants and to examine relationships between family environment and postimplant language development and executive function. METHOD Forty-five families of children with cochlear implants completed a self-report family environment questionnaire (Family Environment Scale--Fourth Edition; Moos & Moos, 2009) and an inventory of executive function (Behavior Rating Inventory of Executive Function [Gioia, Isquith, Guy, & Kenworthy, 2000] or Behavior Rating Inventory of Executive Function--Preschool Version [Gioia, Espy, & Isquith, 2003]). The authors also evaluated children's receptive vocabulary (Peabody Picture Vocabulary Test--Fourth Edition; Dunn & Dunn, 2007) and global language skills (Preschool Language Scale--Fourth Edition [Zimmerman, Steiner, & Pond, 2002] and Clinical Evaluation of Language Fundamentals--Fourth Edition [Semel, Wiig, & Secord, 2003]). RESULTS The family environments of children with cochlear implants differed from those of normal-hearing children but not in clinically significant ways. Language development and executive function were found to be atypical but not uncharacteristic of this clinical population. Families with higher levels of self-reported control had children with smaller vocabularies. Families reporting a higher emphasis on achievement had children with fewer executive function and working memory problems. Finally, families reporting a higher emphasis on organization had children with fewer problems related to inhibition. CONCLUSION Some of the variability in cochlear implantation outcomes that have protracted periods of development is related to family environment. Because family environment can be modified and enhanced by therapy or education, these preliminary findings hold promise for future work in helping families to create robust language-learning environments that can maximize their child's potential with a cochlear implant.
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Abstract
The diagnosis and treatment of children and adolescents with cancer has a tremendous and lasting effect on the patients, their families, and other individuals in their social network. It carries a host of psychological and behavioral ramifications, from questions of mortality to changes in levels of functioning in multiple domains. In this review the authors address the psychosocial and treatment-related issues that arise in children with cancer, with attention to the adjustment to cancer at different developmental stages, mood and anxiety issues, treatment-related psychiatric sequelae, and the challenges faced by childhood cancer survivors.
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Affiliation(s)
- Brian P Kurtz
- Department of Psychiatry, Division of Pediatric Psychiatry, Tufts Medical Center and Floating Hospital for Children at Tufts Medical Center, 800 Washington Street #1007, Boston, MA 02111, USA
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Abstract
This systematic review integrates qualitative and quantitative research findings regarding family changes in the context of childhood cancer. Twenty-eight quantitative, 42 qualitative, and one mixed-method studies were reviewed. Included studies focused on family functioning, marital quality, and/or parenting in the context of pediatric cancer, were written in English, and were published between 1996 and 2009. Overall, qualitative findings show that families alter roles, responsibilities, and day-to-day functioning to accommodate the needs of children with cancer. Although some degree of family reorganization is normative, the extent and impact of these changes varies. Quantitative work shows that mean levels of family functioning (e.g., cohesion, flexibility) are similar between families facing cancer and normative or comparison samples. However, families follow different trajectories of improvement, decline, or stability in family closeness and marital quality. Parenting has received limited quantitative research attention, but qualitative work suggests that parents perceive deeper bonds with ill children and may spoil or overprotect them. Conclusions support future work examining the influence of family-level variables on the adjustment of individual family members.
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Penn A, Shortman RI, Lowis SP, Stevens MCG, Hunt LP, McCarter RJ, Curran AL, Sharples PM. Child-related determinants of health-related quality of life in children with brain tumours 1 year after diagnosis. Pediatr Blood Cancer 2010; 55:1377-85. [PMID: 20981692 DOI: 10.1002/pbc.22743] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Infratentorial tumour site and health-related quality of life (HRQL) 1 month after diagnosis have been shown to predict HRQL 1 year after diagnosis in children with brain tumours. This study aimed to identify additional early child-related determinants of parent- and child-report HRQL. METHODS Longitudinal prospective study. Semi-structured interviews took place approximately 1 and 12 months after diagnosis. HRQL was measured using the self- and parent-report Pediatric Quality of Life Scales (PedsQL 4.0) Total Scale Score and Health Utilities Index Mark 3 (HUI3) multi-attribute utility function. Child variables included performance and verbal IQ, general memory, selective attention executive function, behaviour problems, adaptive behaviour, symptoms of depression and anxiety and event related anxiety. Univariate analyses were used to identify potential early predictors of HRQL. Regression analysis was then used to identify the most important determinants of HRQL at 1 year. RESULTS Thirty-five patients completed the 12-month interviews. Multivariate analysis showed infratentorial tumour site remained an important determinant of HRQL 1 year after diagnosis. Infratentorial tumour site and selective attention at 1 month generally best predicted poor self- and parent-report HRQL at 12 months. Adaptive behaviour and performance IQ may be important. CONCLUSION Selective attention and infratentorial tumour site are most important in predicting both parent- and self-report HRQL at 1 year after diagnosis. Larger prospective studies are needed to confirm these findings. Cognitive remediation or/and pharmacological intervention, particularly aimed at children with infratentorial tumours may improve attention and subsequently HRQL and both merit further investigation.
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Affiliation(s)
- Anthony Penn
- Department of Paediatric Neurology, Frenchay Hospital, Bristol, UK.
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Schulte F, Bartels U, Bouffet E, Janzen L, Hamilton J, Barrera M. Body weight, social competence, and cognitive functioning in survivors of childhood brain tumors. Pediatr Blood Cancer 2010; 55:532-9. [PMID: 20658626 DOI: 10.1002/pbc.22543] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND The purpose of the following article was to examine: (a) body mass index (BMI) in survivors of childhood brain tumors; (b) the association of BMI with social competence and cognitive functioning; and (c) congruency in reporting of survivors' social competence by the survivors, parents, and teachers. PROCEDURE Fifty-four survivors of childhood brain tumors (32 males) 8-18 years participated. BMI-for-age percentiles and BMI Z-scores (SDS) were calculated and survivors were categorized as underweight, normal, overweight, or obese, using established criteria. Informants completed measures of social competence and internalizing behaviors. Survivors also completed a test of self-perception and cognitive functioning (IQ). RESULTS Survivors were more underweight (15% vs. 4%), and less overweight (17% vs. 31%) than population norms (chi(2) = 38.62, P < 0.001). Parents perceived lower social competence in survivors that were underweight, had lower verbal IQ, and higher internalizing behaviors (P < 0.05). A significant interaction between BMI-for-age and IQ on self-perception of close friendships suggested that survivors with lower weight and lower IQ perceived having fewer close friendships (P < 0.05). Congruency among the three informants was moderate. CONCLUSIONS Survivors of childhood brain tumors are at increased risk for underweight. Underweight status is related to lower parent reported social competence and survivors' self-perception of fewer close friendships in the presence of low IQ.
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Affiliation(s)
- Fiona Schulte
- Hematology/Oncology/Transplant Program Department of Oncology, Alberta Children's Hospital, Calgary, Alberta, Canada.
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Abstract
The diagnosis and treatment of children and adolescents with cancer has a tremendous and lasting effect on the patients, their families, and other individuals in their social network. It carries a host of psychological and behavioral ramifications, from questions of mortality to changes in levels of functioning in multiple domains. In this review the authors address the psychosocial and treatment-related issues that arise in children with cancer, with attention to the adjustment to cancer at different developmental stages, mood and anxiety issues, treatment-related psychiatric sequelae, and the challenges faced by childhood cancer survivors.
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Affiliation(s)
- Brian P Kurtz
- Massachusetts General Hospital/McLean Hospital Child and Adolescent Psychiatry Residency Training Program, Boston, MA 02114, USA
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Marsac ML, Alderfer MA. Psychometric properties of the FACES-IV in a pediatric oncology population. J Pediatr Psychol 2010; 36:528-38. [PMID: 20147435 DOI: 10.1093/jpepsy/jsq003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The purpose of this study was to examine the psychometric properties of the Family Adaptability and Cohesion Evaluation Scales, version IV (FACES-IV) in families of children with cancer. METHODS As part of a larger program of research, 147 mothers and 40 fathers from 162 families of children with cancer completed the FACES-IV. Parents and one healthy child from each family (77 girls; age M = 12.8, SD = 2.8) completed additional measures of family functioning and parenting. RESULTS Internal consistencies above .70 were found for all subscales except one (Enmeshed, α = .65). Intercorrelations of the subscales were similar to the validation sample but seemed inconsistent with the Circumplex Model on which the measure is based. Analyses raised questions regarding construct validity for the Enmeshed and Rigid subscales. CONCLUSIONS These preliminary findings suggest that more research is needed prior to widespread use of the FACES-IV in pediatric oncology populations.
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Affiliation(s)
- Meghan L Marsac
- The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
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Penn A, Lowis SP, Stevens MCG, Hunt LP, Shortman RI, McCarter RJ, Pauldhas D, Curran AL, Sharples PM. Family, demographic and illness-related determinants of HRQL in children with brain tumours in the first year after diagnosis. Pediatr Blood Cancer 2009; 53:1092-9. [PMID: 19743518 DOI: 10.1002/pbc.22157] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AIMS To evaluate the relationship between parent- and child-report Health-Related Quality of Life (HRQL) and demographic, tumour and family variables in children with a brain tumour in the first year after diagnosis and to identify determinants of HRQL at 12 months. PROCEDURE Longitudinal prospective study: Semi-structured interviews took place approximately 1, 6 and 12 months after diagnosis. HRQL was measured using the self- and parent-report PedsQL 4.0 Total Scale Score. Tumour and treatment variables considered included tumour site and grade, hydrocephalus at diagnosis, chemotherapy and radiotherapy. Family variables included measures of family function, family support and family stress, the primary carer's coping strategies and symptoms of depression and anxiety. Univariate analyses were used at all three time points, and to identify potential early predictors of HRQL at 1 year. Regression analysis was then used to identify the most important determinants of HRQL at 1 year. RESULTS Thirty-five patients completed the 12-month interviews. There were consistent significant negative correlations between concurrent family impact of illness and parent and self-report HRQL, and positive correlations between concurrent family support and parent-report HRQL. Treatment with radio- or chemotherapy correlated with child-report HRQL only at some time points. Multivariate analysis showed infratentorial tumour site, and poor HRQL at 1 month best predicted poor self- and parent-report HRQL at 12 months. CONCLUSION Children with infratentorial tumours and poor HRQL early after diagnosis tend to have poor HRQL at 1 year. While family factors are important modulators of concurrent HRQL, they do not appear important in predicting HRQL.
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Affiliation(s)
- Anthony Penn
- Department of Paediatric Neurology, Frenchay Hospital, Bristol, UK.
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Gazendam-Donofrio S, Hoekstra H, van der Graaf W, van de Wiel H, Visser A, Huizinga G, Hoekstra-Weebers J. Family functioning and adolescents' emotional and behavioral problems: when a parent has cancer. Ann Oncol 2007; 18:1951-6. [DOI: 10.1093/annonc/mdm373] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Alderfer MA, Fiese BH, Gold JI, Cutuli JJ, Holmbeck GN, Goldbeck L, Chambers CT, Abad M, Spetter D, Patterson J. Evidence-based assessment in pediatric psychology: family measures. J Pediatr Psychol 2007; 33:1046-61; discussion 1062-4. [PMID: 17905801 PMCID: PMC2639492 DOI: 10.1093/jpepsy/jsm083] [Citation(s) in RCA: 165] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To provide a review of the evidence base of family measures relevant to pediatric psychology. METHOD Twenty-nine family measures were selected based upon endorsement by Division 54 listserv members, expert judgment, and literature review. Spanning observational and self-report methods, the measures fell into three broad assessment categories: Family functioning, Dyadic family relationships, and Family functioning in the context of childhood chronic health conditions. Measures were categorized as: "Well-established", "Approaching well-established", or "Promising." RESULTS Nineteen measures met "well-established" criteria and the remaining ten were "approaching well-established." "Well-established" measures were documented for each of the broad assessment categories named above. CONCLUSIONS Many measures deemed "well-established" in the general population are proving to be reliable and useful in pediatric samples. More evidence of the validity of family measures is needed in this context. This review should prove helpful to clinicians and researchers as they strive to make evidence-based decisions regarding family measures.
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Affiliation(s)
- Melissa A Alderfer
- The Children's Hospital of Philadelphia, Civic Center Blvd, Philadelphia, PA 19104, USA.
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Piazza-Waggoner C, Adams CD, Muchant D, Wilson N, Hogan MB. Children With Primary Immunodeficiency Disorders: Family Functioning, Coping Strategies, and Behavioral Functioning. CHILDRENS HEALTH CARE 2006. [DOI: 10.1207/s15326888chc3503_1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Piazza-Waggoner C, Adams CD, Cottrell L, Taylor BK, Wilson NW, Hogan MB. Child and caregiver psychosocial functioning in pediatric immunodeficiency disorders. Ann Allergy Asthma Immunol 2006; 96:298-303. [PMID: 16498851 DOI: 10.1016/s1081-1206(10)61239-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Children with chronic illness have been found to be at an increased risk of behavioral and emotional difficulties. To date, children with pediatric immunodeficiency disorders (PIDDs) and their families have not been the focus of extensive published psychosocial research. OBJECTIVE To determine if children with PIDDs and their caregivers have altered psychosocial function and whether the severity of the PIDD was associated with such difficulties. METHODS Twenty children with PIDDs and 20 children with asthma were recruited for this study. Children and their caregivers completed various psychosocial questionnaire forms. Responses were compared with normative data for the appropriate measure and with other variables. RESULTS Higher frequencies of children with PIDDs were found to have a number of elevated psychosocial concerns when contrasted with normative data, particularly from parent report. These concerns included depression, anxiety, somatization, social withdrawal, and social skills. The severity of the PIDDs was significantly associated with a number of behavioral adjustment issues, including receiving psychiatric diagnoses and special education services. Although children with PIDDs had significantly more psychiatric diagnoses than did asthmatic children, these groups did not differ significantly on questionnaire scores regarding child or caregiver psychosocial adjustment. CONCLUSIONS Children with PIDDs have significant behavioral problems. Children receiving intravenous immunoglobulin or immunomodulatory treatments were reported to have more problems than children not receiving them. This study highlights the need for further research in psychosocial functioning of children with PIDDs in an effort to develop interventions to promote their overall adjustment.
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Affiliation(s)
- Carrie Piazza-Waggoner
- Division of Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA.
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Barrera M, Shaw AK, Speechley KN, Maunsell E, Pogany L. Educational and social late effects of childhood cancer and related clinical, personal, and familial characteristics. Cancer 2006; 104:1751-60. [PMID: 16130127 DOI: 10.1002/cncr.21390] [Citation(s) in RCA: 215] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The objectives of this study were to compare educational and social outcomes for young survivors of childhood cancer with a population control group of individuals who were never diagnosed with cancer and to identify risk and protective factors for these outcomes. METHODS In this multicenter, Canadian, retrospective cohort study, 800 survivors age 17 years or younger were matched by age and gender with a group of 923 control participants. Using a mailed survey that was completed by parents, educational outcomes were assessed with questions about the child's enrollment in disability or special-education programs, repeating a grade, and academic or other school problems. Using friendships was the measure of social outcomes. RESULTS Based on parental reports, significantly more survivors than controls repeated a grade (21% vs. 9%), attended learning-disability (19% vs. 7%) or special-education programs (20% vs. 8%), had educational or other school problems (46% vs. 23%), had no close friends (19% vs. 8%), and were less likely to use friends as confidants (58% vs. 67%). Survivors of central nervous system (CNS) tumors reportedly were more likely than controls to have educational problems and no close friends, followed by survivors of leukemia, and survivors of neuroblastoma. Among survivors, cranial radiation increased the likelihood of having educational difficulties and having no close friends compared with survivors who did not receive cranial radiation. Survivors who reportedly had high self-esteem and whose parents had postsecondary education had fewer educational and social problems. CONCLUSIONS Children and adolescents who survived cancer, particularly those who had CNS tumors, leukemia, and neuroblastoma, required close monitoring for early educational and social difficulties, and such children should be offered educational rehabilitation and social skills training to maximize their academic and social success.
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Affiliation(s)
- Maru Barrera
- Department of Psychology, Haematology/Oncology Program, Population Health Sciences, Research Institute, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
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Varni JW, Sherman SA, Burwinkle TM, Dickinson PE, Dixon P. The PedsQL Family Impact Module: preliminary reliability and validity. Health Qual Life Outcomes 2004; 2:55. [PMID: 15450120 PMCID: PMC521692 DOI: 10.1186/1477-7525-2-55] [Citation(s) in RCA: 417] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2004] [Accepted: 09/27/2004] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The PedsQL Measurement Model was designed to measure health-related quality of life (HRQOL) in children and adolescents. The PedsQL 4.0 Generic Core Scales were developed to be integrated with the PedsQL Disease-Specific Modules. The newly developed PedsQL Family Impact Module was designed to measure the impact of pediatric chronic health conditions on parents and the family. The PedsQL Family Impact Module measures parent self-reported physical, emotional, social, and cognitive functioning, communication, and worry. The Module also measures parent-reported family daily activities and family relationships. METHODS The 36-item PedsQL Family Impact Module was administered to 23 families of medically fragile children with complex chronic health conditions who either resided in a long-term care convalescent hospital or resided at home with their families. RESULTS Internal consistency reliability was demonstrated for the PedsQL Family Impact Module Total Scale Score (alpha = 0.97), Parent HRQOL Summary Score (alpha = 0.96), Family Functioning Summary Score (alpha = 0.90), and Module Scales (average alpha = 0.90, range = 0.82 - 0.97). The PedsQL Family Impact Module distinguished between families with children in a long-term care facility and families whose children resided at home. CONCLUSIONS The results demonstrate the preliminary reliability and validity of the PedsQL Family Impact Module in families with children with complex chronic health conditions. The PedsQL Family Impact Module will be further field tested to determine the measurement properties of this new instrument with other pediatric chronic health conditions.
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Affiliation(s)
- James W Varni
- Department of Landscape Architecture and Urban Planning, College of Architecture, Texas A&M University, 3137 TAMU, College Station, TX 77843-3137 USA
| | - Sandra A Sherman
- San Diego State University/ University of California, San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA 92120 USA
| | - Tasha M Burwinkle
- Department of Anesthesiology, University of Washington, 1945 NE Pacific Street, Seattle, WA 98195 USA
| | - Paige E Dickinson
- California School of Professional Psychology, 10455 Pomerado Rd., San Diego, CA 92131 USA
| | - Pamela Dixon
- Children's Convalescent Hospital, Children's Hospital and Health Center, 3020 Children's Way, San Diego, CA 92123 USA
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Abstract
OBJECTIVE To evaluate psychopathology and coping mechanisms in parents of children with a chronic illness. METHODS 30 parents whose children had Thalassaemia were randomly selected from the Thalassaemia Day Care Centre of a teaching general hospital. The parents were interviewed on a semi structured proforma and also rated on SCL-90-R and Mechanisms of Coping scales. The data was analyzed using Pearson's correlation coefficient. RESULTS The parents were seen to have high psychopathology on SCL-90-R. Depression was the subscale with the maximum elevation. Somatisation was also significantly elevated The GSI (General Symptomatic Index), a measure of general distress was extremely high in about 86.66% of the parents. Most parents were fatalistic in their approach towards the illness. Fatalism positively correlated with somatisation and depression. Avoidant coping strategies were associated with higher scores on various dimensions of the SCL-90-R. CONCLUSION Chronic illness in children affects the psychological health of the parents. Active coping strategies are associated with fewer distress indices and thus if inculcated may improve the ability to bear the burden of the illness without becoming themselves affected by psychiatric illnesses.
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Affiliation(s)
- Pradeep Rao
- Department of Psychiatry, KEM Hospital, Parel, Mumbai, India.
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Barrera M, Wayland LA, D'Agostino NM, Gibson J, Weksberg R, Malkin D. Developmental Differences in Psychological Adjustment and Health-Related Quality of Life in Pediatric Cancer Patients. CHILDRENS HEALTH CARE 2003. [DOI: 10.1207/s15326888chc3203_3] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Hill J, Kondryn H, Mackie E, McNally R, Eden T. Adult psychosocial functioning following childhood cancer: the different roles of sons' and daughters' relationships with their fathers and mothers. J Child Psychol Psychiatry 2003; 44:752-62. [PMID: 12831119 DOI: 10.1111/1469-7610.00161] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Adult survivors of childhood cancer have impaired psychosocial functioning, but not much is known about the causes. In this study we examined the role of relationships with parents as a possible mediating factor. METHOD One hundred and two adult survivors (82% of those eligible, 35 female and 57 male) of childhood Acute Lymphoblastic Leukaemia and Wilms' Tumour, and 102 matched controls (74% of those eligible) aged 19-30 were interviewed. Interpersonal and social role functioning, and current relationships with each parent were assessed in standardised investigator-based interviews with subjects. RESULTS Adult survivors were more likely than controls to have impaired close relationships (love relationships and friendships), and poorer day-to-day coping. Lower encouragement from fathers and greater involvement with mothers were each independently associated with impaired close relationships outside the family. This association was evident across the sample and in the cancer survivor group. It was much stronger in young adult females. Lower paternal encouragement was also associated with poor day-to-day coping, and this association was stronger in young men. There was, however, little evidence that quality of relationships with parents mediated the link between childhood cancer and adult psychosocial functioning. CONCLUSIONS Within this cross-sectional design we could not determine the direction of influence, nor exclude third variable effects. However, the findings indicate that mothers and fathers have different roles in the transition to adult life, and understanding these may assist the development of interventions designed to improve adult psychosocial functioning.
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Affiliation(s)
- Jonathan Hill
- Department of Psychiatry, University of Liverpool, and Royal Liverpool Children's Hospital, Alder Hey, UK.
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Schmidt S, Petersen C, Bullinger M. Coping with chronic disease from the perspective of children and adolescents--a conceptual framework and its implications for participation. Child Care Health Dev 2003; 29:63-75. [PMID: 12534568 DOI: 10.1046/j.1365-2214.2003.00309.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In medical and health psychology, efforts have increasingly been made to assess coping of children and adolescents with chronic conditions. In contrast to the study of coping in adults, approaches to define and assess adaptational processes in children pose a number of problems because coping and development are inherently connected with each other. Issues arising when applying theoretical concepts from developmental psychology to the area of coping in children and adolescents are highlighted. The most prominent approaches to conceptualize and assess coping with chronic disease in childhood and adolescence are illustrated. In future research, there is a need to focus the situational context and content of coping rather than to assess the effort employed and level of a particular coping strategy. Coping is not only a way of regulating emotions, but has an interpersonal meaning, depending on its interactional context. In the medical field, coping has a mediating function for participation and shared medical decision-making in health care processes.
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Affiliation(s)
- S Schmidt
- Department of Medical Psychology, University Hospital of Hamburg, Eppendorf, Hamburg, Germany.
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48
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Abstract
The child's pediatrician is an important resource for families regarding a host of issues such as infections, complications and side effects of chemotherapy, school issues, and psychosocial stressors that are common in families of children with life-threatening illness. This article provides guidance for caring for children with malignancies in the primary care setting.
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Affiliation(s)
- Eve Golden
- Department of Hematology and Oncology Children's Hospital and Research Center at Oakland, 747 52nd Street, Oakland, CA 94609, USA.
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49
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Moos RH. Life stressors, social resources, and coping skills in youth: applications to adolescents with chronic disorders. J Adolesc Health 2002; 30:22-9. [PMID: 11943571 DOI: 10.1016/s1054-139x(02)00337-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
After setting out a conceptual framework that focuses on how personal and social resources aid adolescents in managing acute and chronic stressors, I describe methods by which to assess adolescents' family environments and specific life stressors and social resources, and the approach and avoidance coping responses adolescents use to manage life stressors. I then review some research that employs these concepts and methods to focus on the families and life contexts, and coping skills, of youth with chronic medical disorders, including juvenile rheumatic disease (JRD). I close by drawing implications for assessment and intervention and describing some fruitful areas for future research, such as examining the reciprocal linkages between parental and youth behavior, how adolescents' personal characteristics shape their life context, and how life crises and transitions enhance adolescents' development and maturation.
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Affiliation(s)
- Rudolf H Moos
- Center for Health Care Evaluation, Department of Veterans Affairs Health Care System and Stanford University Medical Center, Palo Alto, California 94025, USA
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50
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Sahler OJZ, Varni JW, Fairclough DL, Butler RW, Noll RB, Dolgin MJ, Phipps S, Copeland DR, Katz ER, Mulhern RK. Problem-solving skills training for mothers of children with newly diagnosed cancer: a randomized trial. J Dev Behav Pediatr 2002; 23:77-86. [PMID: 11943969 DOI: 10.1097/00004703-200204000-00003] [Citation(s) in RCA: 112] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Mothers of children with serious illnesses have lower levels of well-being than mothers in the general population. Problem-solving therapy (PST), a cognitive-behavioral intervention, has been shown to be effective in treating negative affectivity (depression, anxiety) and other manifestations of reduced well-being. This report describes a problem-solving skills training (PSST) intervention, based on problem-solving therapy, for mothers of newly diagnosed pediatric cancer patients. Ninety-two mothers were randomly assigned to receive PSST or to receive standard psychosocial care (Control Group). After the 8-week intervention, mothers in the PSST Group had significantly enhanced problem-solving skills and significantly decreased negative affectivity compared with controls. Analysis revealed that changes in self-reports of problem-solving behaviors accounted for 40% of the difference in mood scores between the two groups. Interestingly, PSST had the greatest impact on improving constructive problem solving, whereas improvement in mood was most influenced by decreases in dysfunctional problem solving. The implications of these findings for refinement of the PSST intervention and for extension to other groups of children with serious illnesses are discussed.
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Affiliation(s)
- Olle Jane Z Sahler
- Division of Hematology/Oncology, Strong Children's Hospital/University of Rochester Medical Center, New York 14642, USA.
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