The Effects of Psychological Interventions on Fostering Resilience in Family Members of Pediatric Cancer Patients: A Systematic Review and Meta-analysis

BACKGROUND

Interventions to foster resilience may promote mental health recovery after exposure to stressors. However, comprehensive systematic syntheses of such evidence in family members of pediatric cancer patients are lacking.

OBJECTIVE

To systematically review and meta-analyze the evidence for the effects of psychological interventions at fostering resilience in family members of pediatric cancer patients.

METHODS

PubMed, Cumulative Index to Nursing and Allied Health Literature, and 9 other databases were searched for articles published until March 2023. Empirical studies on psychological interventions to improve resilience in family members of pediatric cancer patients were included. Full-text and quality appraisals were performed independently by 2 reviewers. Pooled effect sizes were calculated using random-effects meta-analyses.

RESULTS

Seventeen studies were included, of which 10 were included in the meta-analyses. There was a positive effect of interventions on resilience at postintervention time points, but no effects on depressive symptoms, stress, or well-being. The improvement in resilience was sustained in the short term (≤3 months) and medium term (>3 to ≤6 months), with delayed effects on depressive symptoms and stress. In the 6 studies that reported moderate effect sizes, the interventions comprised problem-solving skills, cognitive strategies, promotion of personal strength, and social resources.

CONCLUSION

The findings indicated that psychological interventions targeting resilience have the potential to positively affect the resilience and mental health outcomes of family members, particularly parents.

IMPLICATIONS FOR PRACTICE

Psychological interventions targeting resilience hold promise in improving the mental health of family members. Future interventions should clearly specify the characteristics of the intervention, such as mode of delivery, format, and duration.

Palliative Care and Care Partner Support in Neuro-oncology

ABSTRACT

The journey for a patient with a brain tumor and their loved ones can be extremely challenging due to the high burden of physical symptoms and the emotional distress caused by the diagnosis. Optimizing quality of life by addressing symptoms and reducing this emotional distress can improve treatment tolerance and outcomes and alleviate care partner distress and burden. Symptoms in patients with central nervous system (CNS) tumors can vary in onset and intensity, ranging from headaches, seizures, and focal weakness to emotional distress and cognitive dysfunction. Additionally, care partners may demonstrate distress due to the high burden of care and need appropriate support structures and access to resources to alleviate this stress. Evidence-based recommendations are unfortunately limited given the lack of high-quality research in this area, but patients living with CNS tumors and their loved ones can benefit from early and routine symptom identification and management, compassionate and transparent communication, and practical guidance for the future. These principles are part of palliative care, a field of medicine focused on alleviating suffering in patients with serious, chronic illness. Clinicians involved in the care of patients with CNS tumors must be educated in these important primary palliative care principles. This article focuses on key symptom management, strategies for high-quality communication, a discussion of advance care planning, and an overview of end-of-life care.

The Disease Experience of Women with Granulomatous Lobular Mastitis. A Qualitative Interview Study

Background

The incidence of granulomatous lobular mastitis (GLM) is increasing year by year, and the breast wounds of women patients with GLM can develop into abscesses, fistulas, sinuses, and sometimes orange-like degeneration similar to malignant tumors, which seriously affects the quality of life of women patients with GLM. In China, breast wounds in women patients with GLM have not been better managed. Therefore, the purpose of this study is to explore the disease experience of women patients with GLM, to provide a basis for the development of precise intervention and support strategies for women patients with GLM, and to further improve the quality of nursing management and enrich the research types of GLM.

Methods

In this study, 10 cases of GLM women patients from a tertiary hospital in Hangzhou, Zhejiang Province were selected by purposive sampling. After obtaining the informed consent of GLM women patients, semi-structured interviews were conducted with GLM women patients using the interview outline to collect qualitative data. The interview was recorded, transcribed verbatim in the local language, and then translated into English, and the content analysis method was used to analyze the data. The Consolidated Criteria for Reporting Qualitative Research (CORE-Q) checklist follows the report 's findings.

Results

Our study identified six themes: (a) Perception of the disease, (b) Emotional discomfort (c) Variety of changes (d) Lack of specific skills (e) Coping strategies adopted to rebuild health, (f) Expectation.

Conclusion

The experience of women with GLM is characterized by diversity and specificity. After experiencing physical trauma, most patients use support systems to change negative attitudes and rebuild physical and mental health. Family, hospital and society should be fully linked to strengthen the prevention of GLM and the popularization of nursing management knowledge; nurses should provide targeted nursing services. Nursing leaders should improve the medical security system, broaden the medical channels, and reduce the pain experience and pressure of patients.

Development and effects of an internet-based family resilience-promoting program for parents of children with cancer: A randomized controlled trial

PURPOSE

The diagnosis of cancer in children can negatively impact their parents, owing to the complex treatment processes. Families with high levels of resilience can overcome these difficulties and thus perform higher family functions. We aimed to develop an internet-based family resilience-promoting program for parents of children with cancer and evaluate its effect on the levels of family resilience, depression, and family function.

METHODS

This prospective, parallel-group, randomized-controlled study that was conducted at Yonsei Cancer Center from June to October 2021 included 41 parents of children with cancer. In total, four sessions of the internet-based family resilience-promoting program, led by a nurse, were conducted individually for parents. Levels of family resilience, depression, and family function were measured before, immediately after, and 4 weeks after the program. The data were analyzed using the linear mixed-effect model, and program satisfaction was evaluated through an internet-based questionnaire and interview.

RESULTS

The experimental group (the family resilience-promoting program participants) differed more significantly from the control group in the level of change in family resilience (β = 13.214, p = 0.003, effect size = 0.374) and family function (β = 1.256, p = 0.018, effect size = 0.394). However, there was no significant difference between the groups in the level of depression (β = 2.133, p = 0.187, effect size = 0.416). All the program participants showed a high program satisfaction score of 4.75 out of 5.00 points overall.

CONCLUSIONS

The applicability of the internet-based family resilience-promoting program as an appropriate nursing intervention was verified. Its application can help the families of children with cancer adapt to the stressful situation of their children's cancer diagnosis and treatment.

Parents of children with congenital heart defects during the COVID-19 pandemic: An examination of mental health variables, risk factors, and protective factors

BACKGROUND

Little is known about the mental health burden or the factors that contribute to mental health variables in parents of children with congenital heart defects (CHD) during the COVID-19 pandemic.

OBJECTIVE

The purpose of this study was to examine risk and protective factors associated with anxiety symptoms, depression symptoms, and perceived stress in parents of young children with CHD during the COVID-19 pandemic.

METHODS

A nonexperimental design was used in this study of 127 parents of children aged newborn to five years with CHD during the COVID-19 pandemic. Regression analyses were conducted to examine associations between COVID-19 stressors, CHD care-related factors, parental resilience, external support, and mental health variables.

RESULTS

Parental resilience, emotional support, and informational support were key protective factors for anxiety, depression, and stress. However, resilience was remarkably low in CHD parents. Increased levels of anxiety symptoms, depression symptoms, and perceived stress were associated with 1) Exposure to a greater number of COVID-19-related stressors, 2) Distress from family visitation restrictions during healthcare encounters, 3) Worry related to the perceived risk of their CHD child's exposure to COVID-19 during healthcare encounters, and 4) Worry about their CHD child's risk of death or serious illness from COVID-19.

CONCLUSIONS

The additive impact of the COVID-19 pandemic plus CHD care-related worries on this parent population's mental health is significant. Interventions that promote resilience, address the effect of healthcare system changes, and support the needs of parents of young children with CHD during this and future pandemics are needed.

Parent-to-parent peer support for children and youth with special health care needs: Preliminary evaluation of a family partner program in a healthcare system

PURPOSE

Children and youth with special health care needs (CYSHCN) have complex care and coordination needs that are often managed by parents or primary caregivers. This study describes a parent-to-parent peer support pilot program for parents of CYSHCN implemented in both outpatient and inpatient settings across a large health system.

DESIGN & METHODS

Retrospective data from the Family Partner Program documentation in patient health records are described. Descriptions about the encounters and types of support provided are also reviewed using qualitative descriptive analysis.

RESULTS

Three Family Partners conducted 203 encounters with parents of 90 CYSHCN over six months. Family Partners provided both emotional and tangible support. Primary themes discussed included the persistent care, coordination and management needs related to parenting a child with complex care needs, the subsequent worry and stress about their child and family, and the need for stress management and self-care.

CONCLUSION

This study provides early evidence that implementation of a parent-to-parent peer support program for parents of CYSHCN in a large, academic medical center is feasible. Family Partners enhanced their healthcare team's ability to provide patient- and family-centered support for pediatric patients and their families through the provision of emotional and tangible support.

PRACTICE IMPLICATIONS

Family Partners, who are trained in effective use of the shared experience, the health coach model, and healthcare systems, and who are supported by a strong supervisory team, are ideally suited to support families and patients as they address their concerns and unmet needs and navigate complex health circumstances.

Peer Support Perspectives of Parents of Adolescents with Cancer in Pediatrics

Parents of adolescents with cancer (AWC) provide critical support throughout the cancer journey and could offer key insights into support needs. This prospective study aimed to obtain parent perspectives on peer support needs of AWC. Ten individual parents (9 mothers and 1 father) completed a survey and a semistructured interview. Four themes were identified: cancer journey challenges; emotions, reactions, and coping; personal support preferences; and AWC's support needs. Parents recognized that AWC require various support, but lacked insight into their specific peer support desires. Next step interventions should focus on peer support for AWC, while also incorporating peer support for parents.

Resilience-Promoting Programs in Families of Children With Cancer: A Systematic Review

Purpose: Pediatric cancer is a difficult experience for children and their families. It is thus necessary to promote family resilience for the effective treatment and quality of life improvement among children with cancer. The aim of this systematic review was to identify the components of a resilience-promoting program for children with cancer and their families and to synthesize the literature findings on the outcomes of the resilience-promoting program. Method: A systematic search of the literature was conducted using five databases (PubMed, CHIAHL, PsycINFO, Web of Science, and Research Information Sharing Service) up to July 22, 2020. The search was limited to studies published in English and Korean, and to grey literature published in Korea. Studies were critically appraised using the Mixed Methods Appraisal Tool and Cochrane Risk of Bias tool. Extracted data were summarized as tables. Results: Eight studies were selected. The main components of the resilience-promoting program were providing information (on strategies, medical and psychoeducation, and community resources) and emotional coping (expressing feeling, reappraising cognition about adversity, and stress management). The main outcomes of these programs were reinforced outcomes (resilience, benefit finding, coping, positive affect, problem-solving skills, family adaptation, and self-concept) and improved outcomes (in depression, posttraumatic stress, anxiety, impact of illness of the family, and mood). Conclusion: As the components and outcomes of family resilience-promoting programs vary, it is necessary to consistently use valid tools to effectively identify interventions. Additionally, various methodological studies are required to further analyze the effect of these programs.

"You are not alone": Connecting through a bereaved parent mentor program for parents whose child died of cancer

Background

Bereavement after the death of a child is devastating and associated with worse physical and psychosocial well‐being in parents. Evidence suggests that parents desire and benefit from support provided by other bereaved parents. To foster this peer support, an institutional peer‐to‐peer mentorship program for bereaved parents was established, through which trained bereaved parent mentors offer support for newly bereaved parents.

Methods

Using a retrospective cohort design, we describe the characteristics of participants of the Bereaved Parent Mentorship program. Trained bereaved parent mentors documented encounters with newly bereaved parent mentees using a secure internet‐based form. Mentors summarized each encounter including any concerns or need for professional psychosocial support. Descriptive statistics were used to describe mentor and mentee characteristics; free text from encounter summaries was qualitatively analyzed using content analysis.

Results

A total of 1368 documented encounters occurred between 150 mentees and 39 mentors from January 1, 2014 to February 29, 2020. Only seven encounters (0.5%) were flagged as serious concern necessitating professional psychosocial support. Four key themes in the encounters between mentors and mentees emerged, including: descriptions of the grief experience, ways in which a mentor supported their mentee, challenges the mentor experienced in supporting the mentee, and personal benefit gained by the mentor from supporting their mentee.

Conclusion

This structured Bereaved Parent Mentorship program fostered rich interactions between bereaved parent participants, with very few encounters requiring professional assistance. Future research will assess the impact of bereaved mentor programs on resilience and psychosocial, physical, and functional well‐being of parents.

Improving Caregiver Burden by a Peer-Led Mentoring Program for Caregivers of Patients With Chronic Kidney Disease: Randomized Controlled Trial

Chronic kidney disease (CKD) is associated with substantial morbidity, mortality, cost, and increased caregiver burden. Peer mentoring (PM) improves multiple outcomes in various chronic diseases. The effect of PM on caregiver burden among caregivers of patients with CKD has not been studied. We conducted a randomized clinical trial to test the effectiveness of a structured PM program on burden of care among caregivers of patients with CKD. We randomized 86 caregivers to receive 6 months of intervention in 1 of 3 groups: (1) face-to-face PM (n = 29); (2) online PM (n = 29); and (3) usual care: textbook-only (n = 28). Peer mentors were caregivers of patients with CKD, who received 16 h of instruction. All participants received a copy of a textbook, which contains detailed information about kidney disease. Participants in the PM groups received FTF or online PM for 6 months. The outcome was time-related change in the Zarit Burden Interview (ZBI) score. There was a statistically significant decrease in the ZBI score (SE: −3.44; CI: −6.31, −0.57 [p = 0.002]) compared with baseline, among the online PM group. Online PM led to decreased caregiver burden among caregivers of patients with CKD. The study was limited to English-speaking subjects with computer literacy.

Parental stress of Korean immigrants in the U.S.: Meeting Child and Youth's educational needs amid the COVID-19 pandemic

This study investigates Korean immigrants' parental stress amid the COVID-19 pandemic, especially when they experience difficulties trying to meet their children's educational needs. Korean immigrant parents residing in the U.S. were invited to complete an online survey through purposive sampling. The final sample included a total of 341 Korean immigrant parents from 42 U.S. states. Three models of Ordinary Least Squares (OLS) regressions were conducted to examine the associations between parent-reported difficulties meeting the children's educational needs, parental stress, and the immigrant parents' resilience and social support. Findings indicate that parents' difficulties meeting their children's educational needs in general as well as language barriers were associated with increased parental stress. Moreover, parents' resilience and social support also significantly decreased parental stress levels. Implications for practice, policy, and future research are presented.

Development of a Structured Peer Mentoring Program for Support of Parents and Caregivers of Children with Cancer

BACKGROUND

Parents of children newly diagnosed with cancer have increased anxiety, depression, and numerous questions. Many of these concerns can only be answered by parents who have undergone a similar experience.

LOCAL PROBLEM

Our institution lacked a formal parent-to-parent mentoring program for parents of children newly diagnosed with cancer.

METHODS

The Parent Family Advisory Council (PFAC) recommended implementation of a formalized program that would promote a structured approach to mentoring, with a formal referral process and designated parent mentors who had been vetted, trained, and supported by the institution.

INTERVENTION

In 2010, a pilot parent-to-parent mentoring program was initiated.

RESULTS

Since the programs initiation, 4062 encounters have been documented. This represents an annual average of 72 mentees paired with 20 mentors, averaging 677 annual encounters. Parents view the mentoring relationship as positive and report that they feel understood, less anxious, and less isolated.

CONCLUSION

We show that a parent-to-parent mentoring program is feasible and sustainable over time. Our model is now transitioning from a staff referral to self-referral, as well as incorporating real-time mentoring into the new commons area for patients and their families. A formal volunteer mentoring program can assist parents in navigating the trajectory of childhood cancer, decreasing isolation.

Psychological interventions for enhancing resilience in parents of children with cancer: a systematic review and meta-analysis

PURPOSE

Caring for children with cancer is considerably stressful for parents and may negatively affect their physical and psychological well-being. Resilience plays a pivotal role in maintaining psychological well-being in the face of stress and adversity. The aim of this systematic review was to evaluate the effectiveness of psychological interventions in promoting resilience among parents of children with cancer.

METHODS

Five English databases and two Chinese databases were subjected to a systematic search from inception to March 2020. The methodological quality of the included randomised controlled trials was evaluated using the Cochrane risk of bias tool (RoB 2.0). Meta-analyses and descriptive analyses were used. Subgroup analyses of the intervention modes and time since diagnosis were also conducted.

RESULTS

Five studies involving 308 participants were included. The systematic review identified three types of psychological intervention, namely resilience training, self-disclosure and peer support, which had different essential components and characteristics. The meta-analyses of three randomised controlled trials revealed that the psychological interventions enhanced parents' resilience with a large effect size (Hedges' adjusted g 0.92; 95% CI 0.22, 1.62; p = .01).

CONCLUSION

Evidence supports the effectiveness of psychological interventions for enhancing resilience in the parents of children with cancer. Healthcare professionals can incorporate evidence-based psychological interventions to enhance resilience to help these parents better navigate adversity, adapt to their children's situations and improve their psychological well-being.

Resilience Intervention for Parents of Children with Autism: Findings from a Randomized Controlled Trial of the AMOR Method

Parents of children with autism spectrum disorder (ASD) experience elevated stress, yet parent-specific interventions are sparse. Thirty-five parents of children with ASD were randomized to the novel 8-week AMOR (Acceptance, Mindfulness, Optimism, Resilience) Method parent group or waitlist control group. Significant gains in resilience were reported by AMOR parents only (d = 1.42, p < 0.001, 95% CI [2.152, 10.083]). AMOR parents exhibited significant gains in stress management and reductions in mental health symptoms, along with parent-reported improvements in martial, family, and child functioning. AMOR group follow-up data showed some maintenance of treatment gains. Findings demonstrate promise for resilience interventions in parents of children with ASD. The trial was registered (clinicaltrials.gov; NCT03513419; May 1, 2018) and approved by the Stanford University Institutional Review Board.

Assessing resiliency in paediatric rehabilitation: A critical review of assessment tools and applications

BACKGROUNDS

Resiliency has attracted a growing interest in paediatric rehabilitation as a key capacity for disabled children and their families to thrive. This study aimed to identify measures used to assess resiliency of disabled children/youth and their families and critically appraise the current use of resiliency measures to inform future research and practice.

METHODS

A two-stage search strategy was employed. First, systematic reviews of resiliency measures published since 2000 were searched. Second, full names of measures identified in at least two systematic reviews were searched across four electronic databases. Included studies assessed resiliency among children/youth (0-18 years old) with chronic health conditions and/or disabilities and their families. Identified articles were then analysed to discern the study's definition of resiliency, authors' rationales for measurement selection, and types of perceived adversities facing the study participants.

RESULTS

From an initial yield of 25 measures identified in five systematic reviews, 11 were analysed in two or more reviews. The second stage yielded 41 empirical studies published between 2012 and 2018, which used 8 of the 11 resiliency measures searched by name. Of 41, 17 studies measured resiliency of disabled children/youth, 23 assessed resiliency within family members, and 1 studied both children/youth and their families. Our critical appraisal identified inconsistencies between the studies' definition of resiliency and chosen measures' operationalization, implicit assumption of disabilities as a developmental risk that automatically results in life adversities, and the tendency among family studies to reduce resiliency down to stress coping skills. Research that encompasses contextual factors and developmental influences is lacking.

CONCLUSIONS

There is a need for a situated measurement approach that captures multiple interacting factors shaping resiliency over one's life course. Resiliency measures would benefit from a greater focus on a person-environment transaction and an alternative definition of resiliency that accounts for multiple capacities to navigate through disabling environments.