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Davis KA, Mazzenga M, Hall PB, Buchbinder D, Alderfer MA, Oberoi AR, Sharkey CM, Blakey AO, Long KA. Development of a blueprint for sibling psychosocial services: A nationwide study. Pediatr Blood Cancer 2024:e30993. [PMID: 38605546 DOI: 10.1002/pbc.30993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/19/2024] [Accepted: 03/20/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Siblings of youth with cancer have heightened risk for poor long-term psychosocial outcomes. Although sibling psychosocial care is a standard in pediatric oncology, this standard is among those least likely to be met. To address barriers to providing sibling services, a blueprint for systematic psychosocial screening and support of siblings was developed based on feedback from a national sample of psychosocial providers. PROCEDURE Semi-structured interviews were conducted with a purposive sample of psychosocial care providers (N = 27) of various disciplines working in US pediatric cancer centers, varied in size, type, and extent of sibling support. Interviews queried providers' suggestions for the future of sibling psychosocial care and impressions of a blueprint for sibling service delivery, which was iteratively refined based on respondents' feedback. Interviews were analyzed using applied thematic analysis. RESULTS Based on existing literature and refined according to providers' recommendations, the Sibling Services Blueprint was developed to provide a comprehensive guide for systematizing sibling psychosocial care. The blueprint content includes: (i) a timeline for repeated sibling screening and assessment; (ii) a stepped model of psychosocial support; (iii) strategies for circumventing barriers to sibling care; and (iv) recommendations for how centers with varying resources might accomplish sibling-focused care. The blueprint is available online, allowing providers to easily access and individualize the content. Providers indicated enthusiasm and high potential utility and usability of the blueprint. CONCLUSIONS The Sibling Services Blueprint may be a useful tool for systematizing sibling psychosocial care, promoting wider availability of sibling-focused services, and addressing siblings' unmet needs.
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Affiliation(s)
- Kathryn A Davis
- Department of Psychological & Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Marcella Mazzenga
- Department of Psychological & Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Phoebe Brosnan Hall
- Department of Psychological & Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - David Buchbinder
- Division of Hematology, Children's Hospital of Orange County, Orange, California, USA
| | - Melissa A Alderfer
- Center for Healthcare Delivery Science, Nemours Children's Health, Wilmington, Delaware, USA
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Anjali R Oberoi
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Christina M Sharkey
- Department of Psychology, The Catholic University of America, Columbia, Washington, USA
| | - Ariel O Blakey
- Department of Psychological & Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Kristin A Long
- Department of Psychological & Brain Sciences, Boston University, Boston, Massachusetts, USA
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Romagnoli BR, Phan TLT, Lewis AM, Alderfer MA, Kazak AE, Arasteh K, Enlow PT. The Psychosocial Impact of the COVID-19 Pandemic on Families of Youth of Color: A Prospective Cohort Study. J Pediatr Psychol 2024; 49:98-106. [PMID: 37930074 PMCID: PMC10874214 DOI: 10.1093/jpepsy/jsad078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 10/18/2023] [Accepted: 10/18/2023] [Indexed: 11/07/2023] Open
Abstract
OBJECTIVE Prospectively examine racial and ethnic disparities in exposure to COVID-19-related stressors and their impact on families. METHODS A racially, ethnically, and socioeconomically diverse cohort of caregivers of youth (n = 1,581) representative of the population served by a pediatric healthcare system completed the COVID-19 Exposure and Family Impact Scales in Oct/Nov 2020 and March/April 2021. Linear mixed-effects models were used to examine exposure to COVID-19-related events (Exposure), impact of the pandemic on family functioning and well-being (Impact), and child and parent distress (Distress) across time and as a function of race and ethnicity, adjusting for other sociodemographic variables. RESULTS Exposure and Distress increased over time for all participants. After adjusting for sociodemographic factors, caregivers of Black and Hispanic youth reported greater Exposure than caregivers of White youth and caregivers of Black youth had a greater increase in Exposure over time than caregivers of White youth. Caregivers of White youth reported greater Impact than caregivers of Black and Other race youth. CONCLUSIONS Exposure to and impact of the COVID-19 pandemic on family psychosocial functioning varied by race and ethnicity. Although exposure to COVID-19-related events was greater among Hispanic and non-Hispanic Black families, those of marginalized races reported less family impact than non-Hispanic White families, suggesting resiliency to the pandemic. Research should examine such responses to public health crises in communities of color, with a focus on understanding protective factors. These findings suggest the importance of culturally tailored interventions and policies that support universal psychosocial screenings during times of public health crises.
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Affiliation(s)
| | - Thao-Ly T Phan
- Center for Healthcare Delivery Science, Nemours Children’s Health, USA
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, USA
| | - Amanda M Lewis
- Center for Healthcare Delivery Science, Nemours Children’s Health, USA
| | - Melissa A Alderfer
- Center for Healthcare Delivery Science, Nemours Children’s Health, USA
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, USA
| | - Anne E Kazak
- Center for Healthcare Delivery Science, Nemours Children’s Health, USA
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, USA
| | - Kamyar Arasteh
- Center for Healthcare Delivery Science, Nemours Children’s Health, USA
| | - Paul T Enlow
- Division of Behavioral Health, Nemours Children’s Health, USA
- Center for Healthcare Delivery Science, Nemours Children’s Health, USA
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, USA
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3
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Kazak A, Ramirez AP, Scialla MA, Alderfer MA, Sewell-Roberts C, Treadwell-Deering D. Adaptation and pilot implementation of the Psychosocial Assessment Tool for Autism Spectrum Disorders (PAT-ASD). J Autism Dev Disord 2023; 53:4308-4317. [PMID: 36001195 PMCID: PMC9399998 DOI: 10.1007/s10803-022-05713-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 08/04/2022] [Indexed: 11/29/2022]
Abstract
Recognizing the multifaceted and chronic demands on families of children with Autism Spectrum Disorder (ASD) and challenges in providing care matched to need, we adapted the Psychosocial Assessment Tool (PAT), a brief caregiver-report screener of family psychosocial risk, for this population. Study methods included literature review, focus groups with providers, and feedback from caregivers. The PAT-ASD is consistent with the original PAT, with new items reflecting core behavioral manifestations of ASD and parent and family challenges associated with chronicity. The PAT-ASD was implemented in a four-month pilot and was completed online by 59% of families. Although further testing of its validity is necessary, the PAT-ASD is a promising means of assessing family psychosocial risk for families of children with ASD.
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Affiliation(s)
- Anne Kazak
- Nemours Children's Health, Wilmington, DE, United States.
- Sidney Kimmel Medical School of Thomas Jefferson University, Philadelphia, PA, United States.
| | | | | | - Melissa A Alderfer
- Nemours Children's Health, Wilmington, DE, United States
- Sidney Kimmel Medical School of Thomas Jefferson University, Philadelphia, PA, United States
| | | | - Diane Treadwell-Deering
- Nemours Children's Health, Wilmington, DE, United States
- Sidney Kimmel Medical School of Thomas Jefferson University, Philadelphia, PA, United States
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Wawrzynski SE, Cloyes KG, Arasteh K, Guo JW, Linder L, Reblin M, Alderfer MA. Online Experiences, Internet-Fostered Connection, Resilience, and Adjustment Among Adolescent Siblings of Children With Cancer. Cancer Nurs 2023:00002820-990000000-00172. [PMID: 37862436 PMCID: PMC11031615 DOI: 10.1097/ncc.0000000000001284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
BACKGROUND Pediatric cancer disrupts the lives of siblings in many ways, including physical separations from family and friends that increase risk for distress. Research suggests that siblings use technology and social media to connect with friends and family and seek social support and interaction. However, this may expose siblings to negative online experiences that can erode self-esteem, reducing resilience. OBJECTIVE This study explored the relationship between online experiences, internet-fostered connection, resilience, and psychosocial health among siblings of children with cancer. METHODS Participants included adolescent siblings (N = 81; aged 12-17 years) of children with cancer. Most were female (56.8%), and 50.6% represented racially or ethnically minoritized groups. Online experiences, social media use, resilience, and psychosocial health were self-reported and analyzed using structural equation modeling. RESULTS A majority of siblings reported moderate to severe posttraumatic stress symptoms (PTSSs) (59%) and elevated emotional and behavioral difficulties (EBDs) (53%). Experiencing more positive online experiences was associated with greater perceived connection to family and friends online, but not resilience, PTSSs, or EBDs. In contrast, higher negative online experience scores were significantly associated with more PTSSs and EBDs. In addition, the association between negative online experiences and EBDs was significantly mediated by a negative association between negative online experiences and resilience. CONCLUSIONS Although social media may be a valuable tool for helping siblings of children with cancer garner social support, negative online experiences may be detrimental to their adjustment. IMPLICATIONS FOR PRACTICE Efforts should be made to preserve and foster resilience among siblings who use social media for support.
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Affiliation(s)
- Sarah E Wawrzynski
- Author Affiliations: Center for Healthcare Delivery Science, Nemours Children's Hospital, Wilmington, Delaware (Drs Wawrzynski, Alderfer and Arasteh); Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania (Dr Alderfer); College of Nursing, University of Utah (Drs Guo and Linder); and Primary Children's Hospital, Intermountain Health (Dr Linder); and Cancer Control and Population Sciences Research Program, Huntsman Cancer Institute, University of Utah (Dr Linder), Salt Lake City; College of Medicine, University of Vermont, Burlington (Dr Reblin); and School of Nursing, Oregon Health and Sciences University, Portland (Dr Cloyes)
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Wawrzynski SE, Alderfer MA, Waters AR, Linder L, Reblin M, Guo JW, Litchman M, Cloyes KG. Technology-Mediated Support Among Siblings of Children with Cancer. J Adolesc Young Adult Oncol 2023; 12:685-691. [PMID: 36787472 PMCID: PMC10611953 DOI: 10.1089/jayao.2022.0151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
Purpose: A diagnosis of pediatric cancer can leave healthy siblings with limited access to support. Technology-mediated interpersonal interactions have been noted among adolescent and young adults with cancer and may be an effective source of support for adolescent siblings of children with cancer. In this study, we understand how adolescent siblings use technology to connect with their support network and how their technology use changes after their sibling's cancer diagnosis. Methods: Participants included a national sample (N = 24) of adolescents aged 12-17 who had a sibling diagnosed with cancer in the last 2 years (up to 3 years if still receiving curative-focused treatment). Ecomaps were cocreated with participants to identify sources of social support and modality of interactions. Interviews were transcribed, coded, content analyzed, and descriptively summarized. Results: Adolescent siblings (mean = 14.2 years) perceived technology as a tool to maintain support from their established personal network, rather than a way to expand sources of social support. Most did not seek support or information about cancer outside their known network, preferring information to come from parents or trusted network members. Siblings identified video calls as an important resource for connecting with parents, their sick brother or sister, and others to receive emotional support and companionship. Conclusions: Findings suggest that adolescent siblings of children use technology to connect with their established network for support, an important finding for designing assessments and interventions for this population. Future inquiry should explore these differences, identify unmet needs, and inform acceptable, effective interventions to augment support.
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Affiliation(s)
- Sarah E. Wawrzynski
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
- Primary Children's Hospital, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Melissa A. Alderfer
- Center for Healthcare Delivery Science, Nemours Children's Hospital, Delaware, Wilmington, Delaware, USA
- Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Austin R. Waters
- Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA
- Cancer Control and Population Sciences Research Program, Huntsman Cancer Institute-University of Utah, Salt Lake City, Utah, USA
| | - Lauri Linder
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
- Primary Children's Hospital, Intermountain Healthcare, Salt Lake City, Utah, USA
- Cancer Control and Population Sciences Research Program, Huntsman Cancer Institute-University of Utah, Salt Lake City, Utah, USA
| | - Maija Reblin
- College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Jia-Wen Guo
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | | | - Kristin G. Cloyes
- School of Nursing, Oregon Health and Science University, Portland, Oregon, USA
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Hatchimonji DR, Alderfer MA, Riegel EL, Akins RE. Launching IDeA state early career clinician-scientists with mentored just-in-time grant-writing support. J Clin Transl Sci 2023; 7:e197. [PMID: 37771413 PMCID: PMC10523290 DOI: 10.1017/cts.2023.625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 08/23/2023] [Accepted: 08/25/2023] [Indexed: 09/30/2023] Open
Abstract
Institutional Development Award (IDeA) programs build research infrastructure in regions with historically low access to NIH funds. The Mentored Research Development Award (MRDA), a professional development program embedded in our IDeA-funded center, provides junior investigators with mentorship and effort offset to write a grant. We evaluated outcomes from the first eight years (2013-2021; N = 55) using administrative records, publicly available data, and a self-report survey (n = 46, 84% response rate). Fifteen MRDA recipients (27%) went on to receive NIH funding. Providing just-in-time grant-writing support may launch early career clinician-scientists in an IDeA state context.
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Affiliation(s)
- Danielle R. Hatchimonji
- Center for Healthcare Delivery Science, Nemours Children’s Health, Wilmington, DE, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Melissa A. Alderfer
- Center for Healthcare Delivery Science, Nemours Children’s Health, Wilmington, DE, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Erin L. Riegel
- Center for Pediatric Clinical Research and Development, Nemours Children’s Hospital, Delaware, Wilmington, DE, USA
| | - Robert E. Akins
- Center for Pediatric Clinical Research and Development, Nemours Children’s Hospital, Delaware, Wilmington, DE, USA
- College of Engineering, University of Delaware, Newark, DE, USA
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Alderfer MA, Amaro CM, Kripalani S, Taggi Pinto A, Lewis AM, Arasteh K, Hildenbrand AK, Lown EA, Long KA. Trajectories of Traumatic Stress Symptoms Among Siblings of Children With Cancer: The First Two Years Post-Diagnosis. J Pediatr Psychol 2023; 48:688-699. [PMID: 37354552 DOI: 10.1093/jpepsy/jsad033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 05/03/2023] [Accepted: 05/30/2023] [Indexed: 06/26/2023] Open
Abstract
OBJECTIVE Identify and describe trajectories of cancer-related posttraumatic stress symptoms (PTSS) among siblings of children with cancer within two years of diagnosis. METHOD Siblings (aged 8-18; M = 11.2 years) across the United States, and for each, one caregiver, were recruited for a cohort sequential longitudinal study with three data collection points six months apart beginning at 6- or 12-months after cancer diagnosis. Siblings (N = 229; 42% of eligible/approached; 53% identifying as female; 68% identifying as non-Hispanic White) completed the Child Posttraumatic Stress Disorder Symptom Scale. Caregivers completed the Strengths and Difficulties Questionnaire (SDQ). Latent class growth analysis (LCGA) and growth mixture modeling (GMM) identified PTSS patterns across time. RESULTS Fit statistics supported models with three to five PTSS trajectories. The three-class LCGA model included a large mild PTSS group (61%), a moderate PTSS group (35%), and a small (4%) stable severe PTSS group. The four-class LCGA and three- and four-class GMM included groups improving from moderate to mild PTSS (7-21%) and worsening to moderate PTSS across time (12-17%). Across models, siblings with mild PTSS had fewer caregiver-reported emotional and behavioral difficulties on the SDQ. CONCLUSIONS A large group of siblings of children with cancer demonstrate resiliency, however, substantial subsets experience patterns of PTSS that include levels in the moderate-to-severe range during the first two years post-diagnosis. Future research should examine these patterns in more diverse/representative samples and identify factors associated with increasing and sustained severe PTSS to inform intervention targets and reduce cancer-related burden on families.
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Affiliation(s)
- Melissa A Alderfer
- The Center for Healthcare Delivery Science, Nemours Children's Hospital-Delaware, Wilmington, DE, USA
- Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Christina M Amaro
- The Center for Healthcare Delivery Science, Nemours Children's Hospital-Delaware, Wilmington, DE, USA
- Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Simran Kripalani
- The Center for Healthcare Delivery Science, Nemours Children's Hospital-Delaware, Wilmington, DE, USA
- Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Alison Taggi Pinto
- The Center for Healthcare Delivery Science, Nemours Children's Hospital-Delaware, Wilmington, DE, USA
| | - Amanda M Lewis
- The Center for Healthcare Delivery Science, Nemours Children's Hospital-Delaware, Wilmington, DE, USA
| | - Kamyar Arasteh
- The Center for Healthcare Delivery Science, Nemours Children's Hospital-Delaware, Wilmington, DE, USA
| | - Aimee K Hildenbrand
- The Center for Healthcare Delivery Science, Nemours Children's Hospital-Delaware, Wilmington, DE, USA
- Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - E Anne Lown
- Department of Social and Behavioral Sciences, University of California at San Francisco, San Francisco, CA, USA
| | - Kristin A Long
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
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Davis KA, Alderfer MA, Pariseau E, Lewis AM, Kazak AE, Muriel AC, Long KA. Validation of the Psychosocial Assessment Tool Sibling Module Follow-Up Version. J Pediatr Psychol 2023:7179833. [PMID: 37228163 DOI: 10.1093/jpepsy/jsad028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 03/27/2023] [Accepted: 04/24/2023] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVE Psychosocial screening is recommended to connect siblings of youth with cancer to psychosocial services, but the lack of validated sibling-specific screening tools is a barrier to routine screening. The current study aimed to validate and establish a clinical cutoff for the recently developed Psychosocial Assessment Tool (PAT) Sibling Module follow-up version to address this barrier. METHODS Parents (N = 246) completed the PAT Sibling Module follow-up version for all siblings within their families ages 0-17 years (N = 458) at three time points between 6- and 24-month post-cancer diagnosis. For one target sibling within each family aged 8-17 years, parents also completed the Strengths and Difficulties Questionnaire, and the target sibling completed the Child PTSD Symptom Scale. Cross-sectional and longitudinal analyses examined internal consistency and convergent and predictive validity. Receiver operator characteristic analyses were used to establish a maximally sensitive and specific clinical cutoff. RESULTS Internal consistency was acceptable for all age versions (Kuder-Richardson 20s ≥ 0.79), except for the ages 0-2 version, which had low internal consistency at 18 months post-diagnosis (Kuder-Richardson 20 = 0.57). Convergent (r values >0.7, p values <.001) and predictive (r values >0.6, p values <.001) validity were strong at each time point. An optimal clinical cutoff of 0.32 was identified (range: 0.00-1.00). CONCLUSIONS The PAT Sibling Module follow-up version is a reliable and valid screener for sibling psychosocial risk following cancer diagnosis. Validation of a sibling-specific screener and establishment of a clinical cutoff are necessary first steps to addressing siblings' unmet psychosocial needs and improving trajectories of sibling functioning.
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Affiliation(s)
- Kathryn A Davis
- Department of Psychological & Brain Sciences, Boston University, USA
| | - Melissa A Alderfer
- Center for Healthcare Delivery Science, Nemours Children's Hospital, Delaware, USA
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, USA
| | - Emily Pariseau
- Department of Psychological & Brain Sciences, Boston University, USA
| | - Amanda M Lewis
- Center for Healthcare Delivery Science, Nemours Children's Hospital, Delaware, USA
| | - Anne E Kazak
- Center for Healthcare Delivery Science, Nemours Children's Hospital, Delaware, USA
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, USA
| | - Anna C Muriel
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, USA
- Department of Psychiatry, Harvard Medical School, USA
| | - Kristin A Long
- Department of Psychological & Brain Sciences, Boston University, USA
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9
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Phan TLT, Enlow PT, Lewis AM, Arasteh K, Hildenbrand AK, Price J, Schultz CL, Reynolds V, Kazak AE, Alderfer MA. Persistent Disparities in Pediatric Health Care Engagement During the COVID-19 Pandemic. Public Health Rep 2023:333549231163527. [PMID: 37013845 PMCID: PMC10076159 DOI: 10.1177/00333549231163527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
OBJECTIVE The COVID-19 pandemic has disrupted traditional health care, including pediatric health care. We described the impact of the pandemic on disparities in pediatric health care engagement. METHODS Using a population-based cross-sectional time-series design, we compared monthly ambulatory care visit volume and completion rates (completed vs no-show and cancelled visits) among pediatric patients aged 0-21 years in 4 states in the mid-Atlantic United States during the first year of the COVID-19 pandemic (March 2020-February 2021) with the same period before the pandemic (March 2019-February 2020). We used unadjusted odds ratios, stratified by visit type (telehealth or in-person) and sociodemographic characteristics (child race and ethnicity, caregiver primary language, geocoded Child Opportunity Index, and rurality). RESULTS We examined 1 556 548 scheduled ambulatory care visits for a diverse pediatric patient population. Visit volume and completion rates (mean, 70.1%) decreased during the first months of the pandemic but returned to prepandemic levels by June 2020. Disparities in in-person visit completion rates among non-Hispanic Black versus non-Hispanic White patients (64.9% vs 74.3%), patients from socioeconomically disadvantaged versus advantaged communities as measured by Child Opportunity Index (65.8% vs 76.4%), and patients in rural versus urban neighborhoods (66.0% vs 70.8%) were the same during the remainder of the first year of the pandemic as compared with the previous year. Concurrent with large increases in telehealth (0.5% prepandemic, 19.0% during the pandemic), telehealth completion rates increased. CONCLUSIONS Disparities in pediatric visit completion rates that existed before the pandemic persisted during the pandemic. These findings underscore the need for culturally tailored practices to reduce disparities in pediatric health care engagement.
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Affiliation(s)
- Thao-Ly T Phan
- Department of Pediatrics, Nemours Children's Hospital, Wilmington, DE, USA
- Nemours Center for Healthcare Delivery Science, Wilmington, DE, USA
- Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Paul T Enlow
- Department of Pediatrics, Nemours Children's Hospital, Wilmington, DE, USA
- Nemours Center for Healthcare Delivery Science, Wilmington, DE, USA
- Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Amanda M Lewis
- Department of Pediatrics, Nemours Children's Hospital, Wilmington, DE, USA
- Nemours Center for Healthcare Delivery Science, Wilmington, DE, USA
| | - Kamyar Arasteh
- Department of Pediatrics, Nemours Children's Hospital, Wilmington, DE, USA
- Nemours Center for Healthcare Delivery Science, Wilmington, DE, USA
| | - Aimee K Hildenbrand
- Department of Pediatrics, Nemours Children's Hospital, Wilmington, DE, USA
- Nemours Center for Healthcare Delivery Science, Wilmington, DE, USA
- Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Julia Price
- Department of Pediatrics, Nemours Children's Hospital, Wilmington, DE, USA
- Nemours Center for Healthcare Delivery Science, Wilmington, DE, USA
- Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Corinna L Schultz
- Department of Pediatrics, Nemours Children's Hospital, Wilmington, DE, USA
- Nemours Center for Healthcare Delivery Science, Wilmington, DE, USA
- Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Anne E Kazak
- Department of Pediatrics, Nemours Children's Hospital, Wilmington, DE, USA
- Nemours Center for Healthcare Delivery Science, Wilmington, DE, USA
- Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Melissa A Alderfer
- Department of Pediatrics, Nemours Children's Hospital, Wilmington, DE, USA
- Nemours Center for Healthcare Delivery Science, Wilmington, DE, USA
- Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
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10
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Thomas C, Ramirez AP, Alderfer MA, Patton SR, Carakushansky M, Enlow PT. Telehealth and Type 1 Diabetes Care During COVID-19: Perceptions From Youth of Color, Caregivers, and Health Care Providers. Diabetes Spectr 2023; 36:245-252. [PMID: 37583556 PMCID: PMC10425226 DOI: 10.2337/ds22-0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Objective At the outset of the coronavirus disease 2019 (COVID-19) pandemic, health care systems rapidly implemented telehealth services to maintain continuity of type 1 diabetes care. Youth of color are more likely to have suboptimal glycemic control and may benefit most from efforts to ensure continuity of care. However, research examining the perspectives of families of youth of color regarding telehealth for pediatric type 1 diabetes care is limited. We gathered perspectives from youth of color, their caregivers, and health care providers (HCPs) on telehealth for type 1 diabetes care during COVID-19. Methods Fifty participants (22 caregivers, 19 youth, and nine HCPs) completed semi-structured interviews conducted in English (n = 44) or Spanish (n = 6). Transcripts containing mentions of telehealth (n = 33) were included for qualitative analysis to extract themes pertaining to perceptions of type 1 diabetes care and telehealth use during COVID-19. Results Themes related to perceptions, feasibility, and quality of telehealth diabetes care were obtained. Most families had positive perceptions of telehealth. Families and HCPs described logistical and technical challenges and noted the potential for disparities in telehealth access and use. Furthermore, caregivers and HCPs felt that the lack of in-person interaction and limited access to clinical data affected the quality of care. Conclusion Families of youth of color with type 1 diabetes mostly had positive perceptions of telehealth but also identified issues with feasibility and quality of care. Our findings highlight a need for interventions promoting equal access to telehealth and quality care for all youth with type 1 diabetes to minimize disruptions in care.
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Affiliation(s)
- Courtney Thomas
- Center for Healthcare Delivery Science, Nemours Children’s Hospital, Delaware, Wilmington, DE
| | - Alejandra Perez Ramirez
- Center for Healthcare Delivery Science, Nemours Children’s Hospital, Delaware, Wilmington, DE
| | - Melissa A. Alderfer
- Center for Healthcare Delivery Science, Nemours Children’s Hospital, Delaware, Wilmington, DE
- Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Susana R. Patton
- Center for Healthcare Delivery Science, Nemours Children’s Health, Jacksonville, FL
| | - Mauri Carakushansky
- Division of Endocrinology, Nemours Children’s Hospital, Florida, Orlando, FL
- Department of Pediatrics, University of Central Florida College of Medicine, Orlando, FL
| | - Paul T. Enlow
- Center for Healthcare Delivery Science, Nemours Children’s Hospital, Delaware, Wilmington, DE
- Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
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11
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Davis KA, Brosnan P, Mazzenga M, Buchbinder D, Alderfer MA, Sharkey CM, Long KA. Inconsistent, uncoordinated, and reactive: The current state of sibling psychosocial care. Pediatr Blood Cancer 2023; 70:e30103. [PMID: 36385588 DOI: 10.1002/pbc.30103] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/21/2022] [Accepted: 10/22/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Although providing sibling psychosocial services is a standard of care in pediatric oncology, initial survey research suggests that this standard is rarely achieved and siblings' support needs remain unmet. Which sibling psychosocial services are available and how centers provide such services is unknown. To identify targetable services gaps, this qualitative study characterizes current sibling psychosocial care practices at select pediatric cancer centers across the United States. PROCEDURE Semi-structured interviews were conducted with a purposive sample of psychosocial care providers (N = 27) working across the United States in pediatric oncology centers of varied sizes. Interviews queried providers regarding sibling-focused parent psychoeducation, psychosocial screening, comprehensive assessment, and psychosocial support offerings. Interview data were analyzed using Applied Thematic Analysis. RESULTS Across cancer centers, sibling care practices did not align with consensus-based recommendations. The nature and availability of sibling-focused psychoeducation, screening, assessment, and support were variable between and within centers. Siblings themselves were largely absent from sibling psychosocial care, and care was rarely sibling-specific. The flow of information about siblings was discontinuous and uncoordinated across the care continuum, resulting in psychosocial care provided reactively, typically in response to parental concerns. CONCLUSIONS Sibling psychosocial care provision falls short of established care recommendations, leaving sibling psychosocial needs unmet. Findings highlight the need for tools and strategies to facilitate the implementation of sibling psychosocial care across the care continuum, to support siblings' psychosocial functioning across the life course.
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Affiliation(s)
- Kathryn A Davis
- Department of Psychological & Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Phoebe Brosnan
- Department of Psychological & Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Marcella Mazzenga
- Department of Psychological & Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - David Buchbinder
- Division of Hematology, Children's Hospital of Orange County, Orange, California, USA
| | - Melissa A Alderfer
- Center for Healthcare Delivery Science, Nemours Children's Hospital, Wilmington, Delaware, USA.,Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Christina M Sharkey
- Department of Neurology, Children's National Hospital, Washington, District of Columbia, USA
| | - Kristin A Long
- Department of Psychological & Brain Sciences, Boston University, Boston, Massachusetts, USA
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12
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Amaro CM, Alderfer MA, Gerhardt CA, Wawrzynski SE, Goldish M, Long KA. Bringing Together a Transdisciplinary Team to Create and Advance a Shared Vision for Research and Support for Siblings of Youth With Cancer. J Pediatr Hematol Oncol Nurs 2023; 40:34-42. [PMID: 36245365 PMCID: PMC9900248 DOI: 10.1177/27527530221121727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background: Siblings of youth with cancer are at risk for psychosocial difficulties and report unmet needs. Supporting siblings is a psychosocial standard of care; however, many barriers prevent this standard from being fully achieved. Transdisciplinary team science has potential to generate novel, real-world solutions to complex research problems and can be beneficial to addressing sibling needs within pediatric hematology/oncology nursing. This process paper aims to present a guiding framework for transdisciplinary team science using the experiences of the Sibling Partnership for Advocacy, Research, and Care in Childhood Cancer (SPARCCC) as an exemplar. Methods: SPARCCC employed an established model of transdisciplinary team-based research, which consisted of four phases: development, consultation, implementation, and translation. This transdisciplinary team was comprised of international experts from a variety of disciplines, as well as siblings and families impacted by cancer. Results: SPARCCC held two summits, and team members developed ongoing collaborative efforts to advance advocacy, research, and support for siblings of youth with cancer. The team implemented the four phases of the transdisciplinary team-based framework and used an iterative process to build a shared perspective of the needs of siblings and take action. For instance, we completed a grant application, several manuscripts, and conference presentations to disseminate our findings and begin to advance a focused research agenda for sibling supportive care. Discussion: Transdisciplinary team science holds promise for tackling complex issues within pediatric hematology/oncology nursing research, particularly areas that are not well aligned with more traditional models and can be used to generate novel solutions.
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Affiliation(s)
- Christina M. Amaro
- Department of Psychological and Brain Sciences, Boston University, MA, USA
- Division of Behavioral Health, Department of Pediatrics, Nemours Children’s Hospital, Wilmington, DE, USA
- Center for Healthcare Delivery Science, Nemours Children’s Health,
Wilmington, DE, USA
| | - Melissa A. Alderfer
- Center for Healthcare Delivery Science, Nemours Children’s Health,
Wilmington, DE, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Cynthia A. Gerhardt
- Abigail Wexner Research Institute at
Nationwide Children’s Hospital and The Ohio State University, OH, USA
| | - Sarah E. Wawrzynski
- Intermountain Primary Children’s
Hospital, Salt Lake City, UT, USA
- College of Nursing, University of Utah, UT, USA
| | | | - Kristin A. Long
- Department of Psychological and Brain Sciences, Boston University, MA, USA
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13
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Carlson MM, Bear B, Alderfer MA, Schultz CL, Monroe DP, Crosby LE, Hildenbrand AK. Family-centered communication in pediatric sickle cell disease. Pediatr Blood Cancer 2022; 69:e30016. [PMID: 36152000 DOI: 10.1002/pbc.30016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 08/17/2022] [Accepted: 09/03/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Individuals with sickle cell disease (SCD) experience systemic barriers in accessing high-quality care. Research suggests that patient/family-provider relationships are an important indicator of healthcare quality and can influence disease self-management and outcomes. The Patient Centered Communication (PCC) framework holds that patient/family-centered communication (e.g., eliciting, understanding, and validating patients' perspectives within their unique psychosocial contexts) contributes to improved family-provider relationships, as well as self-efficacy for disease management, adherence, and health outcomes. While the PCC framework has been useful in guiding the evaluation of patient/family-provider communication in other pediatric populations, it has not yet been applied in the context of pediatric SCD. This study aimed to use this framework to examine patient and family perceptions of communication with pediatric SCD healthcare providers. PROCEDURE Total 17 caregivers (82% mothers, 94% Black/African American) and eight patients (62% female, aged 13-19 years, M = 16.50) completed semi-structured interviews. The PCC framework informed the development of a preliminary codebook. Thematic content analysis summarized family perspectives regarding communication with providers. RESULTS For youth with SCD and their caregivers, specific themes related to family-centered communication included: reducing patient/family distress, supporting disease self-management efforts, facilitating information exchange and decision-making, and fostering positive and trusting relationships with providers. CONCLUSIONS This study helps to address gaps in the literature related to patient/family-provider communication within pediatric SCD. Results underscore the importance of patient- and family-centered communication across pediatric SCD care. These findings can inform future research and clinical care initiatives to improve patient/family-provider interactions and health outcomes for this underserved population.
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Affiliation(s)
- Megan M Carlson
- Division of Developmental and Behavioral Sciences, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Benjamin Bear
- Center for Healthcare Delivery Science, Nemours Children's Health, Wilmington, Delaware, USA
| | - Melissa A Alderfer
- Center for Healthcare Delivery Science, Nemours Children's Health, Wilmington, Delaware, USA.,Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Corinna L Schultz
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Center for Cancer and Blood Disorders, Nemours Children's Health, Wilmington, Delaware, USA
| | | | - Lori E Crosby
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Aimee K Hildenbrand
- Center for Healthcare Delivery Science, Nemours Children's Health, Wilmington, Delaware, USA.,Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Division of Behavioral Health, Department of Pediatrics, Nemours Children's Hospital, Wilmington, Delaware, USA
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14
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Long KA, Davis KA, Pariseau E, Murie AC, Kazak AE, Alderfer MA. Initial Validation of a New Psychosocial Screener for Siblings of Youth with Cancer The Psychosocial Assessment Tool (PAT) Sibling Modules. Psychooncology 2022; 31:1774-1781. [PMID: 36029137 DOI: 10.1002/pon.6024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/15/2022] [Accepted: 08/23/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Psychosocial screening can facilitate the identification of families who have difficulty adjusting to and managing serious pediatric illness. Despite siblings' roles within the family and increased psychosocial risk, a systematic approach to screening siblings of youth with cancer remains rare. One barrier to systematic sibling screening is the lack of a validated screener. We aimed to establish initial validity of the new parent-reported Psychosocial Assessment Tool (PAT) Sibling Modules for siblings ages 0-2, 3-4, 5-9, and 10+. METHODS Families (N=64) completed the PAT Sibling Modules and the Strengths and Difficulties Questionnaire (SDQ) regarding siblings' functioning at cancer diagnosis (13-23 items, depending on age version) and 6-months later (17-42 items). Cross-sectional and longitudinal analyses examined internal consistency and convergent and predictive validity of the PAT Sibling Modules. RESULTS Baseline and follow-up versions of the modules have strong internal consistency (Kuder-Richardson 20 range: 0.82-0.93) and convergent validity at diagnosis (r-values ≥0.4, p-values <0.01) and follow-up (r-values >0.4, p-values <0.05). Predictive validity was supported by significant correlations between baseline PAT Sibling Module scores and 6-month SDQ scores (r=0.86, p<0.001). CONCLUSIONS Findings provide initial evidence that the PAT Sibling Modules are valid measures of sibling psychosocial risk. Availability of a validated screener is a first step toward addressing siblings' unmet psychosocial needs. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | | | | | | | | | - Melissa A Alderfer
- Nemours Children's Hospital, Delaware, Boston, United States.,Sidney Kimmel Medical College at Thomas Jefferson University, Boston, United States
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15
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Schwartz LA, Lewis AM, Alderfer MA, Vega G, Barakat LP, King-Dowling S, Psihogios AM, Canter KS, Crosby L, Arasteh K, Enlow P, Hildenbrand AK, Kassam-Adams N, Pai A, Phan TL, Price J, Schultz CL, Sood E, Wood J, Kazak A. COVID-19 Exposure and Family Impact Scales for Adolescents and Young Adults. J Pediatr Psychol 2022; 47:631-640. [PMID: 35459946 PMCID: PMC9425841 DOI: 10.1093/jpepsy/jsac036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 03/20/2022] [Accepted: 03/22/2022] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE To understand the impact of the coronavirus disease 2019 (COVID-19) pandemic on adolescents and young adults (AYAs), we adapted the COVID-19 Exposure and Family Impact Scales (CEFIS; Kazak et al., 2021) for AYAs. Here, we report on the development, structure, and psychometric properties of the CEFIS-AYA. METHODS The CEFIS-AYA was developed by a multidisciplinary, multi-institutional team using a rapid iterative process. Data from 3,912 AYAs from 21 programs at 16 institutions across the United States were collected from May 2020 to April 2021. We examined the underlying structure of the CEFIS-AYA using principal component analysis (PCA), calculated internal consistencies, and explored differences in scores by gender and age. RESULTS Participants reported exposure to a range of COVID-19-related events (M = 9.08 events, of 28). On the bidirectional 4-point Impact scale, mean item scores were mostly above the midpoint, indicating a slightly negative impact. Kuder-Richardson 20/Cronbach's Alpha was good for Exposure (α = .76) and excellent for Impact (α = .93). PCA identified seven factors for Exposure (Severe COVID-19, Loss of Income, Limited Access to Essentials, COVID-19 Exposure, Disruptions to Activities, Disruptions to Living Conditions, and Designation as an Essential Worker) and five for Impact (Self and Family Relationships, Physical Well-Being, Emotional Well-Being, Social Well-Being, and Distress). Gender and age differences in CEFIS-AYA scores were identified. DISCUSSION Initial reliability data are strong and support use of the CEFIS-AYA for measuring the effect of the COVID-19 pandemic on AYAs in research and clinical care.
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Affiliation(s)
- Lisa A Schwartz
- Children’s Hospital of Philadelphia, USA
- Perelman School of Medicine, University of Pennsylvania, USA
| | | | - Melissa A Alderfer
- Nemours Children’s Health, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, USA
| | | | - Lamia P Barakat
- Children ’s Hospital of Philadelphia, USA
- Perelman School of Medicine, University of Pennsylvania, USA
| | | | - Alexandra M Psihogios
- Children’s Hospital of Philadelphia , USA
- Perelman School of Medicine, University of Pennsylvania, USA
| | - Kimberly S Canter
- Nemours Children’s Health, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, USA
| | - Lori Crosby
- Cincinnati Children’s Hospital Medical Center, USA
| | | | - Paul Enlow
- Nemours Children’s Heal th, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, USA
| | - Aimee K Hildenbrand
- Nemour s Children’s Health, USA
- Sidney Kimmel Medical College , Thomas Jefferson University, USA
| | - Nancy Kassam-Adams
- Children’s Hospital of Philadelphia, USA
- Perelman School of Medicine, University of Pennsylvania, USA
| | - Ahna Pai
- Cincinnati Children’s Hospital Medical Center, USA
| | - Thao-Ly Phan
- Nemours Children’s Health, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, USA
| | - Julia Price
- Nemours Children’s Health, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, USA
| | - Corinna L Schultz
- Nemours Children’s Health, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, USA
| | - Erica Sood
- Nemour s Children’s Health, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, USA
| | | | - Anne Kazak
- Nemours Ch ildren’s Health, USA
- Sidney Kimmel Medical College, Thomas Jefferson University , USA
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16
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Brosnan P, Davis KA, Mazzenga M, Oberoi AR, Sharkey CM, Buchbinder D, Alderfer MA, Long KA. Psychosocial care providers' perspectives: Barriers to implementing services for siblings of children with cancer. Pediatr Blood Cancer 2022; 69:e29418. [PMID: 34786821 DOI: 10.1002/pbc.29418] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/01/2021] [Accepted: 10/05/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Siblings of children with cancer are at increased risk for poor long-term psychosocial outcomes. The standard of psychosocial care in pediatric oncology calling for sibling support is not routinely implemented, often leaving siblings with unmet psychosocial needs. Barriers to implementing the sibling standard may exist at multiple levels. This study addresses research gaps regarding multilevel barriers to supporting siblings at the health care system, oncology center, and family levels. PROCEDURE Qualitative interviews were conducted with psychosocial care providers (N = 27; 18 psychologists, five social workers, three psychiatrists, and one child life specialist) employed at oncology centers within hospitals across the United States, varying in extent of sibling programming and center size. Interviews included questions about providers' roles, oncology center characteristics, existing psychosocial sibling services, barriers to providing systematic sibling assessment, and ideas about how to overcome barriers. Data were analyzed using applied thematic analysis. RESULTS Qualitative analysis revealed (a) barriers to providing sibling services occur at multiple levels (health care system, oncology center, family); (b) barriers at multiple levels frequently interact with one another; and (c) interacting barriers maintain a cycle: barriers to providing services contribute to limited provision of services, low service provision leads to limited utilization of existing services and underprioritization of siblings, and together this leads to siblings being off the radar, which further limits sibling service provision. CONCLUSION Addressing health care system and oncology center barriers to implementing sibling assessment and support may be important potential targets for interventions to help ensure that siblings receive needed psychosocial assessment and support.
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Affiliation(s)
- Phoebe Brosnan
- Department of Psychological & Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Kathryn A Davis
- Department of Psychological & Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Marcella Mazzenga
- Department of Psychological & Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Anjali R Oberoi
- Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Christina M Sharkey
- Department of Neurology, Children's National Hospital, Washington, District of Columbia, USA
| | - David Buchbinder
- Division of Hematology, CHOC Children's Hospital, Orange, California, USA
| | - Melissa A Alderfer
- Center for Healthcare Delivery Science, Nemours Children's Health, Wilmington, DE & Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Kristin A Long
- Department of Psychological & Brain Sciences, Boston University, Boston, Massachusetts, USA
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17
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Enlow PT, Phan TLT, Lewis AM, Hildenbrand AK, Sood E, Canter KS, Vega G, Alderfer MA, Kazak AE. Validation of the COVID-19 Exposure and Family Impact Scales. J Pediatr Psychol 2021; 47:259-269. [PMID: 34969064 PMCID: PMC8755387 DOI: 10.1093/jpepsy/jsab136] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/30/2021] [Accepted: 12/18/2021] [Indexed: 11/14/2022] Open
Abstract
Objective The COVID-19 Exposure and Family Impact Scales (CEFIS) were developed in Spring 2020 to assess effects of the COVID-19 pandemic on families and caregivers. Initial psychometric properties were promising. The current study examined the factor structure and evaluated convergent and criterion validity of the CEFIS in a new sample. Methods In October and November 2020, caregivers (N = 2,531) of youth (0–21 years) scheduled for an ambulatory care visit at Nemours Children’s Hospital, Delaware completed the CEFIS and measures of convergent (PROMIS Global Mental Health Scale, Family Assessment Device) and criterion validity (PTSD Checklist—Civilian). Confirmatory factor analysis was used to examine the factor structure of the CEFIS. Bivariate correlations and logistic regression were used to examine convergent and criterion validity. Results Factor analysis supported the original six- and three-factor structures for the Exposure and Impact scales, respectively. Second-order factor analyses supported the use of Exposure, Impact, and Distress total scores. Higher scores on the CEFIS Exposure, Impact, and Distress scales were associated with increased mental health concerns and poorer family functioning. Higher scores on all CEFIS scales were also associated with greater odds of having clinically significant posttraumatic stress symptoms. Conclusions The CEFIS is a psychometrically sound measure of the impact of the COVID-19 pandemic on family and caregiver functioning and may also be useful in identifying families who would benefit from psychological supports.
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Affiliation(s)
- Paul T Enlow
- Center for Healthcare Delivery Science, Nemours Children's Health, USA.,Department of Pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University, USA
| | - Thao-Ly T Phan
- Center for Healthcare Delivery Science, Nemours Children's Health, USA.,Department of Pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University, USA
| | - Amanda M Lewis
- Center for Healthcare Delivery Science, Nemours Children's Health, USA
| | - Aimee K Hildenbrand
- Center for Healthcare Delivery Science, Nemours Children's Health, USA.,Department of Pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University, USA
| | - Erica Sood
- Center for Healthcare Delivery Science, Nemours Children's Health, USA.,Department of Pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University, USA
| | - Kimberly S Canter
- Center for Healthcare Delivery Science, Nemours Children's Health, USA.,Department of Pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University, USA
| | - Gaby Vega
- Center for Healthcare Delivery Science, Nemours Children's Health, USA
| | - Melissa A Alderfer
- Center for Healthcare Delivery Science, Nemours Children's Health, USA.,Department of Pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University, USA
| | - Anne E Kazak
- Center for Healthcare Delivery Science, Nemours Children's Health, USA.,Department of Pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University, USA
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18
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Schultz CL, McCahan SM, Lewis AM, Bunnell HT, Alderfer MA. Online patient portal use by caregivers in pediatric oncology: Are we widening sociodemographic disparities? Pediatr Blood Cancer 2021; 68:e29373. [PMID: 34582096 DOI: 10.1002/pbc.29373] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 09/10/2021] [Accepted: 09/11/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Financial and regulatory incentives have encouraged and increased the availability of online patient portals that provide caregivers access to their child's electronic health records (EHR). Such access is believed to promote better engagement and outcomes of care. Little is known about the use of portals by caregivers of children with cancer. This study sought to examine whether sociodemographic and clinical care variables are associated with portal activation in a pediatric oncology sample. METHODS Sociodemographic and clinical characteristics were extracted from the EHR of pediatric oncology patients treated for their first cancer in the Nemours Center for Cancer and Blood Disorders between 2012 and 2017. A Child Opportunity Index (COI) was calculated based on home zip code. Characteristics of children whose caregivers did and did not activate the portal were compared. RESULTS Sixty-six percent of caregivers activated a portal account with a peak within 90 days of diagnosis. In logistic regression, caregivers with a younger aged child, spoke English, lived closer to the hospital, lived in higher COI area, with longer treatment length, and more radiology tests had greater odds of portal activation. Those with private health insurance or White race were overrepresented among those who activated an account in univariate analysis. CONCLUSION The majority of caregivers of children with cancer activate portal accounts; however, differences in sociodemographic and clinical variables across those who did and did not activate accounts emerged. As portals become ubiquitous, we must understand how they are used and mitigate widening inequities caused by disparate portal use.
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Affiliation(s)
- Corinna L Schultz
- Nemours Center for Cancer and Blood Disorders, Nemours Children's Hospital, Wilmington, Delaware, USA.,Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Suzanne M McCahan
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Nemours Biomedical Research Informatics Center, Nemours Children's Hospital, Wilmington, Delaware, USA
| | - Amanda M Lewis
- Center for Healthcare Delivery Science, Nemours Children's Hospital, Wilmington, Delaware, USA
| | - H Timothy Bunnell
- Nemours Biomedical Research Informatics Center, Nemours Children's Hospital, Wilmington, Delaware, USA
| | - Melissa A Alderfer
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Center for Healthcare Delivery Science, Nemours Children's Hospital, Wilmington, Delaware, USA
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19
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Pierce JS, Enlow P, Alderfer MA, Wasserman R, Gurnurkar S, O’Hara E, Pendley JS, Reed M, Welsh K, Brooks K, Taylor A, Wysocki T, Price J. Transdisciplinary Care for Adolescents With Type 1 Diabetes: Development of a Provider Cross-Discipline Training Curriculum. Diabetes Spectr 2021; 34:430-435. [PMID: 34866878 PMCID: PMC8603126 DOI: 10.2337/ds21-0028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Jessica S. Pierce
- Nemours Center for Healthcare Delivery Science, Nemours Children’s Health, Orlando, FL, and Wilmington, DE
- Univeristy of Central Florida College of Medicine, Orlando, FL
- Corresponding author: Jessica S. Pierce,
| | - Paul Enlow
- Nemours Center for Healthcare Delivery Science, Nemours Children’s Health, Orlando, FL, and Wilmington, DE
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Melissa A. Alderfer
- Nemours Center for Healthcare Delivery Science, Nemours Children’s Health, Orlando, FL, and Wilmington, DE
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Rachel Wasserman
- Nemours Center for Healthcare Delivery Science, Nemours Children’s Health, Orlando, FL, and Wilmington, DE
- Univeristy of Central Florida College of Medicine, Orlando, FL
| | - Shilpa Gurnurkar
- Univeristy of Central Florida College of Medicine, Orlando, FL
- Division of Pediatric Endocrinology, Nemours Children’s Hospital, Florida, Orlando, FL
| | - Erin O’Hara
- Division of Pediatric Endocrinology, Nemours Children’s Hospital, Florida, Orlando, FL
| | - Jennifer Shroff Pendley
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
- Division of Psychology, Nemours Children’s Hospital, Delaware, Wilmington, DE
| | - Michelle Reed
- Nemours Children’s Hospital, Delaware, Wilmington, DE
| | | | - Kaley Brooks
- Nemours Children’s Hospital, Florida, Orlando, FL
| | - Alex Taylor
- Nemours Center for Healthcare Delivery Science, Nemours Children’s Health, Orlando, FL, and Wilmington, DE
| | - Tim Wysocki
- Nemours Center for Healthcare Delivery Science, Nemours Children’s Health, Orlando, FL, and Wilmington, DE
| | - Julia Price
- Nemours Center for Healthcare Delivery Science, Nemours Children’s Health, Orlando, FL, and Wilmington, DE
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
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20
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Hildenbrand AK, Amaro CM, Gramszlo C, Alderfer MA, Levy C, Ragsdale L, Wohlheiter K, Marsac ML. Psychologists in pediatric palliative care: Clinical care models within the United States. Clinical Practice in Pediatric Psychology 2021. [DOI: 10.1037/cpp0000402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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21
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Palermo TM, Alderfer MA, Boerner KE, Hilliard ME, Hood AM, Modi AC, Wu YP. Editorial: Diversity, Equity, and Inclusion: Reporting Race and Ethnicity in the Journal of Pediatric Psychology. J Pediatr Psychol 2021; 46:731-733. [PMID: 34270747 PMCID: PMC8502460 DOI: 10.1093/jpepsy/jsab063] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 05/09/2021] [Accepted: 05/10/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Tonya M Palermo
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle Children’s Research Institute
| | - Melissa A Alderfer
- Center for Healthcare Delivery Science, Nemours Children’s Health System and Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University
| | - Katelynn E Boerner
- Department of Pediatrics, University of British Columbia, BC Children’s Hospital Research Institute
| | - Marisa E Hilliard
- Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital
| | - Anna M Hood
- Developmental Neurosciences Unit and Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health
| | - Avani C Modi
- Division of Behavioral Medicine and Clinical Psychology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati-College of Medicine
| | - Yelena P Wu
- Department of Dermatology, University of Utah, Huntsman Cancer Institute
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22
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Wawrzynski SE, Schaefer MR, Schvaneveldt N, Alderfer MA. Social support and siblings of children with cancer: A scoping review. Psychooncology 2021; 30:1232-1245. [PMID: 33851490 PMCID: PMC8363579 DOI: 10.1002/pon.5689] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 03/23/2021] [Accepted: 03/26/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Social support is essential in healthy adjustment to life stressors. This scoping review examines how social support has been conceptualized, operationalized, and studied among siblings of children with cancer. Gaps in the current literature are identified, and future research directions are proposed. METHODS A rigorous systematic scoping review framework guided our process. Medline, Embase, CINAHL, PsycINFO, and Scopus were searched for literature regarding social support and siblings of children with cancer. After screening, 57 articles were identified (n = 26 quantitative, n = 21 qualitative, and n = 10 multi-method) and their content extracted for summarization. RESULTS The majority of studies (n = 43, 75.4%) were descriptive; 14 (24.6%) included interventions, and of those, four were experimental. Few studies used a clearly defined theoretical framework, or validated tools to measure social support. Studies explored perceived social support needs of siblings, the provision and availability of formal support through interventions and related outcomes, and informal family social supports. A variety of support types were found to be helpful to siblings in different ways. CONCLUSIONS Social support is a prevalent topic in the literature regarding siblings of children with cancer. It is unclear what types of support are most important due to how it has been conceptualized and measured. Despite some methodological limitations, greater levels of social support have been linked to better adaptation among siblings of children with cancer. Future work is warranted to identify the most beneficial types of support for siblings based on their age, developmental stage, and the cancer trajectory.
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Affiliation(s)
- Sarah E Wawrzynski
- Intermountain Primary Children's Hospital, Pediatric Critical Care Services, College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | - Megan R Schaefer
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Nena Schvaneveldt
- Eccles Health Science Library, University of Utah, Salt Lake City, Utah, USA
| | - Melissa A Alderfer
- Center for Healthcare Delivery Science, Nemours Children's Health System and Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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23
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Hildenbrand AK, Van Schoors M, Alderfer MA. Survey Research With Families in the Context of Pediatric Chronic Health Conditions: Key Considerations and Future Directions. J Fam Nurs 2021; 27:175-190. [PMID: 34024171 DOI: 10.1177/10748407211014866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Self-report family functioning measures play a critical role in advancing our understanding of how families are impacted by, and adapt to, the demands of childhood health conditions. In this article, we present key considerations when conceptualizing, assessing, and analyzing dynamic family processes in research; discuss related implications for selecting instruments; and provide an update on the evidence base of self-report family functioning measures. Researchers need to consider theory, definitions of the family, informants, instruments, and procedural and data analytic issues when designing family research. Examples of questionnaires assessing general family functioning, dyadic relationships, and family functioning within the context of pediatric health conditions are provided. Additional evidence of validity, reliability, clinical utility, and cultural sensitivity of these measures is needed within pediatric chronic illness populations. Future research should include multiple family members and utilize varied assessment methods to obtain a comprehensive understanding of family functioning in the context of pediatric health conditions.
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Affiliation(s)
- Aimee K Hildenbrand
- Nemours Children's Health System, Wilmington, DE, USA
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
- Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Melissa A Alderfer
- Nemours Children's Health System, Wilmington, DE, USA
- Thomas Jefferson University, Philadelphia, PA, USA
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24
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Morales S, Salehabadi SM, Srivastava D, Gibson TM, Leisenring WM, Alderfer MA, Lown EA, Zeltzer LK, Armstrong GT, Krull KR, Buchbinder D. Health-related and cancer risk concerns among siblings of childhood cancer survivors: a report from the Childhood Cancer Survivor Study (CCSS). J Cancer Surviv 2021; 16:624-637. [PMID: 34075534 DOI: 10.1007/s11764-021-01056-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 05/05/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To characterize the prevalence and predictors of concerns regarding future health and cancer risk among siblings of childhood cancer survivors. METHODS This study reports longitudinal data (baseline and follow-up) from 3969 adult siblings (median age = 29 [range 18-56] years) of long-term survivors of childhood cancer (median time since diagnosis 19.6 [9.6-33.8] years). Self-reported future health and cancer risk concerns (concerned vs not concerned) were assessed. Demographics and health data reported by both the siblings and their matched cancer survivors were examined as risk factors for health concerns using multivariable logistic regression. RESULTS Percentage of siblings reporting future health and cancer risk concerns, respectively, decreased across decade of survivors' diagnosis: 1970s (73.3%; 63.9%), 1980s (67.2%; 62.6%), and 1990s (45.7%; 52.3%). Risk factors associated with future health concerns included sibling chronic health conditions (grade 2 Odds Ratio [OR]=1.57, 95% CI: 1.12-2.20; grades 3-4 OR=1.86, 95% CI: 1.18-2.94; compared to less than grade 2). Risk factors associated with future cancer concerns included sibling chronic health conditions (grade 2 OR=1.43, 95% CI: 1.05-1.94; grades 3-4 OR=1.64, 95% CI: 1.09-2.47; compared to less than grade 2). CONCLUSIONS Sibling concerns regarding future health and cancer have diminished in recent decades. There are subgroups of siblings that are at-risk for future health and cancer risk concerns. IMPLICATIONS FOR CANCER SURVIVORS Routine screening of concerns in at-risk siblings of survivors of childhood cancer may benefit the siblings of cancer survivors. These individuals may benefit from early interventions during diagnosis and treatment of their siblings.
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Affiliation(s)
- Sonia Morales
- Department of Pediatrics, University of California at Irvine, Irvine, CA, USA.,Division of Hematology/Oncology at Children's Hospital of Orange County, 1201 W. La Veta Avenue, Orange, CA, 92868, USA
| | | | - Deokumar Srivastava
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Todd M Gibson
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Wendy M Leisenring
- Cancer Prevention Program at Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Melissa A Alderfer
- Center for Healthcare Delivery Science, Nemours Children's Health System, Wilmington, DE, USA.,Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - E Anne Lown
- Department of Social and Behavioral Sciences and Osher Center for Integrative Medicine, University of California at San Francisco, San Francisco, CA, USA
| | - Lonnie K Zeltzer
- David Geffen School of Medicine at University of California at Los Angeles (UCLA) and UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Kevin R Krull
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA.,Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - David Buchbinder
- Department of Pediatrics, University of California at Irvine, Irvine, CA, USA. .,Division of Hematology/Oncology at Children's Hospital of Orange County, 1201 W. La Veta Avenue, Orange, CA, 92868, USA.
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25
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Sood E, Wysocki T, Alderfer MA, Aroian K, Christofferson J, Karpyn A, Kazak AE, Pierce J. Topical Review: Crowdsourcing as a Novel Approach to Qualitative Research. J Pediatr Psychol 2021; 46:189-196. [PMID: 33236059 DOI: 10.1093/jpepsy/jsaa096] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/18/2020] [Accepted: 09/15/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To describe a novel, five-phase approach to collecting qualitative data from hard-to-reach populations using crowdsourcing methods. METHODS Drawing from experiences across recent studies with type 1 diabetes and congenital heart disease stakeholders, we describe five phases of crowdsourcing methodology, an innovative approach to conducting qualitative research within an online environment, and discuss relevant practical and ethical issues. RESULTS Phases of crowdsourcing methodology are: (I) Preparing; (II) Forming Crowds; (III) Collecting Crowdsourced Data; (IV) Coding and Analyzing Crowdsourced Data; and (V) Generating and Disseminating Findings. Iterative feedback from stakeholders is obtained in all five phases. Practical and ethical issues include accessing diverse stakeholders, emotional engagement of crowd participants, responsiveness and transparency of crowdsourcing methodology, and limited personal contact with crowd participants. CONCLUSIONS Crowdsourcing is an innovative, efficient, feasible, and timely approach to engaging hard-to-reach populations in qualitative research.
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Affiliation(s)
- Erica Sood
- Center for Healthcare Delivery Science, Nemours Children's Health System.,Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children.,Division of Behavioral Health, Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children.,Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University
| | - Tim Wysocki
- Center for Healthcare Delivery Science, Nemours Children's Health System
| | - Melissa A Alderfer
- Center for Healthcare Delivery Science, Nemours Children's Health System.,Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University
| | - Karen Aroian
- University of Central Florida, College of Nursing
| | | | - Allison Karpyn
- Center for Research in Education and Social Policy, Department of Human Development and Family Sciences, University of Delaware
| | - Anne E Kazak
- Center for Healthcare Delivery Science, Nemours Children's Health System.,Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University
| | - Jessica Pierce
- Center for Healthcare Delivery Science, Nemours Children's Health System.,Division of Behavioral Health, Department of Pediatrics, Nemours Children's Hospital.,Department of Pediatrics, College of Medicine, University of Central Florida
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26
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Tomatsu SC, Stanley C, Conroy R, Alderfer MA. Method Matters: Comparing Cancer-Related Adjustment of Siblings to Norms and Well-matched Peers. J Pediatr Psychol 2021; 46:324-331. [PMID: 33355333 DOI: 10.1093/jpepsy/jsaa110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 10/24/2020] [Accepted: 10/26/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The purpose of this study was to better understand conflicting findings in the literature regarding the adjustment of siblings of children with cancer by examining, in a single sample, differences in patterns of results as a function of reporter and comparator used (i.e., population norms, demographically matched classmates). METHOD Self- and parent-report standardized measures of depression, anxiety, and behavioral problems were collected for 67 siblings and 67 demographically matched classmates. Comparisons were made to norms and controls. RESULTS Siblings consistently demonstrated poorer psychosocial functioning than their demographically matched peers across all measures but their scores did not differ from norms. A significantly greater percentage of siblings fell outside the normal range than that expected in the general population for parent-reported total and internalizing problems, but not for externalizing problems or the self-report measures. CONCLUSIONS Findings regarding the psychological adjustment of siblings of children with cancer differ according to the research methods used. It is important to use rigorous methods such as demographically matched peer comparisons when investigating the impact of childhood cancer on siblings.
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Affiliation(s)
- Saori C Tomatsu
- Nemours Children's Health System/A.I. duPont Hospital for Children.,University of Delaware
| | | | | | - Melissa A Alderfer
- Nemours Children's Health System/A.I. duPont Hospital for Children.,Sidney Kimmel Medical College at Thomas Jefferson University
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27
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Alderfer MA, Logan BA, DiDonato S, Jackson L, Hayes MJ, Sigmon ST. Change Across Time in Cancer-Related Traumatic Stress Symptoms of Siblings of Children with Cancer: A Preliminary Investigation. J Clin Psychol Med Settings 2021; 27:48-53. [PMID: 30993576 DOI: 10.1007/s10880-019-09618-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This pilot study examined changes in cancer-related post-traumatic stress symptoms (PTSS) across time for siblings of children with cancer. Siblings (N = 32; aged 8-18) completed a measure of anxiety, the Child PTSD Symptom Scale (CPSS), and the PTSD section of the Structured Clinical Interview for DSM-IV-TR (SCID) at twelve (SD = .9) and eighteen months (SD = 1.3) post-diagnosis. Moderate-to-severe PTSS was reported by 12 siblings (38%) at T1 and 7 (22%) at T2. Cluster analysis of PTSS data revealed five patterns: Few symptoms, stable across time (31%, n = 10); Mild symptoms, decreasing across time (16%, n = 5); Mild, stable symptoms (28%, n = 9); Moderate/severe symptoms, decreasing across time but remaining moderate (19%, n = 6); and Moderate/severe, stable symptoms (6%, n = 2). SCID data and anxiety scores distinguished siblings in the final two clusters from those with more favorable PTSS levels/trajectories. Additional research with larger samples is needed to validate these trajectories and examine factors that distinguish siblings with consistently elevated cancer-related PTSS from those with mild or significantly improving symptoms.
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Affiliation(s)
- Melissa A Alderfer
- Center for Healthcare Delivery Science, Nemours Children's Health System/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA. .,Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Beth A Logan
- Division of Behavioral Health, Nemours Children's Health System/Alfred I. duPont Hospital for Children, Wilmington, DE, USA.,Hillman Center for Pediatric Transplantation, Children's Hospital of Pittsburgh at UPMC & University of Pittsburgh School of Medicine, Philadelphia, PA, USA
| | - Stephen DiDonato
- Center for Healthcare Delivery Science, Nemours Children's Health System/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA.,Community & Trauma Counseling Program at Thomas Jefferson University, Philadelphia, PA, USA
| | - Leela Jackson
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia & Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Marie J Hayes
- Department of Psychology, University of Maine, Orono, ME, USA
| | - Sandra T Sigmon
- Department of Psychology, University of Maine, Orono, ME, USA
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28
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Buchbinder D, Sidhu S, Alderfer MA, Lown A, Kolarik RC, Wang T. Pediatric resident knowledge, experience, comfort, and perceived competency in providing sibling psychosocial support. Int J Med Educ 2020; 11:73-75. [PMID: 32199019 PMCID: PMC7246124 DOI: 10.5116/ijme.5e63.6a46] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 03/07/2020] [Indexed: 06/10/2023]
Affiliation(s)
- David Buchbinder
- Department of Pediatrics, University of California at Irvine, Orange, CA, USA
| | - Sonam Sidhu
- Department of Pediatrics, University of California at Los Angeles, Los Angeles, CA, USA
| | - Melissa A. Alderfer
- Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Anne Lown
- Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Russ C. Kolarik
- Department of Internal Medicine-Pediatrics, University of South Carolina, Greenville, SC, USA
| | - Tommy Wang
- Department of Pediatrics, University of California at Irvine, Orange, CA, USA
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29
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DeMuth M, Taggi-Pinto A, Miller EG, Alderfer MA. Bereavement Accommodations in the Classroom: Experiences and Opinions of School Staff. J Sch Health 2020; 90:165-171. [PMID: 31957037 DOI: 10.1111/josh.12870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 01/19/2019] [Accepted: 01/24/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Bereaved children often struggle in the school environment and school personnel often feel inadequately prepared to support them. This pilot study explored the experiences and opinions of school staff regarding approaches to addressing the needs of bereaved students in the classroom. METHODS Teachers/school personnel (N = 29) completed written open-ended questions about their experiences with bereaved students and opinions regarding a bereavement-focused accommodation (ie, 504) plan. Responses were summarized using qualitative content analysis. RESULTS Most participants (93%) reported interacting with bereaved students and: (1) providing emotional support; (2) making classroom accommodations; (3) collaborating with the family/community; and (4) referring the student for counseling. Many (72%) expressed interest in a templated bereavement plan (21% did not respond; 7% said no) with education/resources for school personnel and suggested accommodations for students. CONCLUSIONS Teachers encountering grieving students would welcome a templated bereavement plan to help meet students' needs. Such a plan would allow staff to become more knowledgeable about grief and provide guidance for developing specific strategies to accommodate grieving students both emotionally and academically.
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Affiliation(s)
- Michele DeMuth
- Sidney Kimmel Medical College at Thomas Jefferson University, 1025 Walnut Street, Philadelphia, PA, 19107
| | - Alison Taggi-Pinto
- Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803
| | - Elissa G Miller
- Sidney Kimmel Medical College at Thomas Jefferson University, Chief, Division of Palliative Medicine, Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803
| | - Melissa A Alderfer
- Sidney Kimmel Medical College at Thomas Jefferson University, Center Director (Delaware Valley) and Principal Research Scientist, Center for Healthcare Delivery Science, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803
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30
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Christofferson JL, Okonak K, Kazak AE, Pierce J, Kelly C, Schifano E, Sciolla J, Deatrick JA, Alderfer MA. Family consequences of potentially traumatic pediatric medical events: Implications for trauma-informed care. J Fam Psychol 2020; 34:237-246. [PMID: 31647256 DOI: 10.1037/fam0000597] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Extensive research demonstrates that pediatric medical events can be traumatic for patients, caregivers, and siblings, but the aftereffects of these potentially traumatic events for the family and its members are not well documented. Through focus groups with patients, caregivers, and siblings, this qualitative study examined the perceived consequences of potentially traumatic medical events for individual family members and the family as a whole. Sixteen focus groups (6 caregiver, 5 patient, 5 sibling) were conducted. Participants included 44 caregivers, 24 patients, and 14 siblings from 28 families with children treated in cardiology, endocrinology, oncology, orthopedics, or pulmonology. Constant-comparison and directed-content analysis were used to analyze the resulting data. Six themes regarding the family consequences of potentially traumatic medical events emerged: (a) family members experience strong emotional reactions and distressing thoughts, (b) family members experience trauma-related reactions and behaviors, (c) family patterns and routines change, (d) family conflict arises, (e) family members feel different from their peers and strive for normalcy, and (f) family members construct positive narratives about these events and experience positive consequences and emotions. These findings reveal the consequences of potentially traumatic medical events that extend beyond traumatic stress symptoms. Moreover, the impact of these consequences is seen within both individual family member responses and responses within the family system as a whole. Understanding both individual- and family-level consequences of medical events is important in order to provide family-centered, trauma-informed care for children with illness or injury and their family members. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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31
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Oberoi AR, Towry L, Eilenberg JS, Lun P, Lerro G, Alderfer MA, Long KA. Improving support to siblings of children with cancer through a community-academic partnership. Clinical Practice in Pediatric Psychology 2019. [DOI: 10.1037/cpp0000280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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32
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Long KA, Pariseau EM, Muriel AC, Chu A, Kazak AE, Alderfer MA. Development of a Psychosocial Risk Screener for Siblings of Children With Cancer: Incorporating the Perspectives of Parents. J Pediatr Psychol 2019; 43:693-701. [PMID: 29617821 DOI: 10.1093/jpepsy/jsy021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 03/16/2018] [Indexed: 11/13/2022] Open
Abstract
Objective Although many siblings experience distress after a child's cancer diagnosis, their psychosocial functioning is seldom assessed in clinical oncology settings. One barrier to systematic sibling screening is the lack of a validated, sibling-specific screening instrument. Thus, this study developed sibling-specific screening modules in English and Spanish for the Psychosocial Assessment Tool (PAT), a well-validated screener of family psychosocial risk. Methods A purposive sample of English- and Spanish-speaking parents of children with cancer (N = 29) completed cognitive interviews to provide in-depth feedback on the development of the new PAT sibling modules. Interviews were transcribed verbatim, cleaned, and analyzed using applied thematic analysis. Items were updated iteratively according to participants' feedback. Data collection continued until saturation was reached (i.e., all items were clear and valid). Results Two sibling modules were developed to assess siblings' psychosocial risk at diagnosis (preexisting risk factors) and several months thereafter (reactions to cancer). Most prior PAT items were retained; however, parents recommended changes to improve screening format (separately assessing each sibling within the family and expanding response options to include "sometimes"), developmental sensitivity (developing or revising items for ages 0-2, 3-4, 5-9, and 10+ years), and content (adding items related to sibling-specific social support, global assessments of sibling risk, emotional/behavioral reactions to cancer, and social ecological factors such as family and school). Conclusions Psychosocial screening requires sibling-specific screening items that correspond to preexisting risk (at diagnosis) and reactions to cancer (several months after diagnosis). Validated, sibling-specific screeners will facilitate identification of siblings with elevated psychosocial risk.
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Affiliation(s)
| | | | - Anna C Muriel
- Dana Farber Cancer Institute & Harvard Medical School
| | | | - Anne E Kazak
- Nemours Children's Health System.,Sidney Kimmel Medical College at Thomas Jefferson University
| | - Melissa A Alderfer
- Nemours Children's Health System.,Sidney Kimmel Medical College at Thomas Jefferson University
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33
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Abstract
This special issue of Psychological Services includes 18 articles describing efforts to promote and provide trauma-informed care for children and families. Trauma-informed care is an approach to providing services that is sensitive to the possibility that children and families have experienced past or ongoing traumatic situations with implications for their current functioning and response to interventions. Installing and maintaining a trauma-informed approach in organized care settings requires effective planning, initial assessment, implementation, reassessment, and support that reflects an ongoing commitment to recognizing the impact of trauma on those being served. The articles contained in this special issue span a range of efforts in each of these areas, including the development and refinement of models of care and specific interventions, establishing quality assessment tools, and providing illustrations of lessons learned from attempts to implement and sustain trauma-informed initiatives. This introduction to the special issue provides a brief overview of these articles. The purpose of this special issue is to share current data and models of trauma-informed care and to encourage further development of collaborative models, interventions, measurement tools, and implementation efforts that lead to better services and outcomes for children and families who experience trauma. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- J J Cutuli
- Department of Psychology, Rutgers University-Camden
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34
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Stenman K, Christofferson J, Alderfer MA, Pierce J, Kelly C, Schifano E, Klaff S, Sciolla J, Deatrick J, Kazak AE. Integrating play in trauma-informed care: Multidisciplinary pediatric healthcare provider perspectives. Psychol Serv 2018; 16:7-15. [PMID: 30431310 DOI: 10.1037/ser0000294] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Children and their family members may experience potentially traumatic events during medical treatment that can result in pediatric medical traumatic stress reactions. Play is a normative part of childhood that may facilitate engagement in medical care and may be incorporated in trauma-informed care. This qualitative study used semistructured interviews to examine the role of play and its potential use in trauma-informed care. The perspectives of 30 multidisciplinary pediatric healthcare providers representing 5 divisions (Cardiology, Endocrinology, Oncology, Orthopedics, Pulmonology) in 2 children's hospitals were gathered. Constant comparison and directed content analysis were used to analyze the data. Themes and subthemes were derived in 3 areas: (a) aspects of pediatric medical care that are potentially traumatic (specific events; and physical, emotional, and family-level consequences), (b) uses of play in pediatric healthcare settings (general [relieve boredom] and trauma-specific [prevention/alleviation]), and (c) potential barriers to the use of play in trauma-informed care (infection control; lack of provider training). The results document aspects of pediatric medical experiences that providers recognize as potentially traumatic, highlighting the importance of trauma-informed care. They also identify ways to use play to engage with children and families in a trauma-informed way. Additional training and development regarding play may increase the viability of using play in trauma-informed pediatric healthcare. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Katherine Stenman
- Center for Healthcare Delivery Science, Nemours/Alfred I. duPont Hospital for Children
| | | | - Melissa A Alderfer
- Center for Healthcare Delivery Science, Nemours/Alfred I. duPont Hospital for Children
| | - Jessica Pierce
- Center for Healthcare Delivery Science, Nemours Children's Hospital
| | - Carrie Kelly
- Child Life, Nemours/Alfred I. duPont Hospital for Children
| | - Elizabeth Schifano
- Center for Healthcare Delivery Science, Nemours/Alfred I. duPont Hospital for Children
| | | | | | | | - Anne E Kazak
- Center for Healthcare Delivery Science, Nemours Children's Health System
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35
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Schultz CL, Alderfer MA. Are on-line patient portals meeting test result preferences of caregivers of children with cancer? A qualitative exploration. Pediatr Blood Cancer 2018; 65:e27306. [PMID: 30007016 DOI: 10.1002/pbc.27306] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 06/05/2018] [Accepted: 06/07/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND Management of pediatric cancer entails frequent laboratory and radiology testing to monitor response to treatment, side effects, and possible relapse of disease. Little is known about how caregivers of children with cancer would like to receive results of these tests and whether on-line patient portals may meet those preferences. PROCEDURES One-on-one semistructured interviews were conducted with 19 caregivers of children with cancer purposively sampled for breadth on demographic characteristics. Inductive qualitative content coding/analysis was utilized to distill caregiver's preferred methods for test result acquisition and their views of using an on-line patient portal to do so. RESULTS The relative prioritization of speed of information and mode of communication (i.e., "in person," by phone, etc.) revealed three preference styles. Factors including type of testing, type of result, and the time course within their child's care modified these preferences, and the desire to reduce anxiety played a central role. Caregivers recognized advantages of portal use including getting results "fast," being able to visualize trends in results, "keeping a record," and not interfering with clinic flow. Perceived disadvantages included the results being "complicated" or easily misunderstood, and learning results prior to disclosure by care team. CONCLUSION This study provides insight into the importance of understanding of how caregivers want test results and how they utilize the portal. Preferences for result acquisition vary on many factors and include the desire to decrease anxiety. As portal use increases, we have a duty to integrate this technology responsibly.
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Affiliation(s)
- Corinna L Schultz
- Nemours Center for Cancer and Blood Disorders, Wilmington, Delaware.,Nemours/AI duPont Hospital for Children & Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Melissa A Alderfer
- Nemours/AI duPont Hospital for Children & Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania.,Center for Healthcare Delivery Sciences, Wilmington, Delaware
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36
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Valdez JM, Walker B, Ogg S, Gattuso J, Alderfer MA, Zelley K, Ford CA, Baker JN, Mandrell BN, Nichols KE. Parent-child communication surrounding genetic testing for Li-Fraumeni syndrome: Living under the cloud of cancer. Pediatr Blood Cancer 2018; 65:e27350. [PMID: 30009566 DOI: 10.1002/pbc.27350] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 05/23/2018] [Accepted: 06/10/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Advances in the application of genetic technologies reveal a growing number of heritable disorders associated with an increased risk to develop cancer during childhood. As genetic testing is increasingly employed in the clinical setting, it is essential to understand whether parents communicate with their children about test results and to elucidate the factors that influence the content and outcomes of these conversations. METHODS Semistructured interviews were conducted with 14 parents whose children tested positive for Li-Fraumeni syndrome (LFS). Semantic content analysis was performed on transcribed interviews, focusing on questions related to parent-child conversations about the genetic testing process and disclosure of positive test results. RESULTS All parents emphasized the importance of involving children in conversations about LFS. The majority (93%) identified as being part of "cancer families" in which prior experiences with cancer created opportunities for communication. While all had spoken with their children about cancer, only seven (50%) specifically disclosed to their children that they had tested positive for LFS. The most common reason cited for nondisclosure at the time of this study was the young age of the children. CONCLUSION Parents of children with LFS desire open conversations about genetic testing and cancer risk. These conversations are challenging yet essential to enable child understanding of genetic risk status and enhance compliance with health-promoting and cancer surveillance measures. Development of age-appropriate educational materials and novel clinical models to facilitate parent-child conversations about genetic test results and risk status for cancer are needed.
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Affiliation(s)
- Jessica M Valdez
- Division of Cancer Predisposition, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Breya Walker
- Division of Nursing Research, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Susan Ogg
- Division of Nursing Research, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Jami Gattuso
- Division of Nursing Research, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Melissa A Alderfer
- Center for Healthcare Delivery Science, Nemours Children's Health System, Wilmington, Delaware
| | - Kristin Zelley
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Philadelphia
| | - Carol A Ford
- Division of Adolescent Medicine, The Children's Hospital of Philadelphia, Philadelphia, Philadelphia
| | - Justin N Baker
- Division of Quality of Life and Palliative Care, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Belinda N Mandrell
- Division of Nursing Research, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Kim E Nichols
- Division of Cancer Predisposition, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
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Lohani M, Hendershot KA, Pelletier W, Stegenga K, Dixon M, Hinds PS, Alderfer MA, Pentz RD. Potential Benefits to Families, Children, and Adolescents Enrolled in Longitudinal Qualitative Research. IRB 2018; 40:1-7. [PMID: 30387974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Previous research has focused on the risks of research participation but has rarely considered possible benefits. For a study of family decision-making during pediatric bone marrow transplant, we conducted qualitative interviews with 132 family members across 36 families up to three times over the course of a year, before and after transplant. We concluded the study with qualitative interviews of 70 family members from 21 of the original families one year after the transplants, focusing on benefits and concerns regarding their research participation. Participants, including children and adolescents, reported benefits including the opportunity to talk, be altruistic, reflect, have a safe space, gain understanding or perspective, and express emotions. Sixteen percent expressed concerns, mostly finding aspects of the methodology annoying. We encourage institutional review boards to understand that sensitive conversations with adults, children or adolescents may not always increase the risk of the study and may offer benefits to those who agree to be interviewed. We therefore suggest that language describing potential benefits could be included in consent and assent forms for qualitative studies.
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Affiliation(s)
- Minisha Lohani
- Georgia Campus-Philadelphia College of Osteopathic Medicine
| | | | | | | | | | - Pamela S Hinds
- Children's National Health System
- The George Washington University
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38
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Miller EG, Hildenbrand AK, Taggi-Pinto A, Alderfer MA. Let's Work Together: Collaborative Research Is Needed to Overcome Difficulty Enrolling Families for Bereaved Sibling Research. J Pain Symptom Manage 2018; 56:e3-e4. [PMID: 29581036 DOI: 10.1016/j.jpainsymman.2018.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 03/12/2018] [Accepted: 03/13/2018] [Indexed: 11/23/2022]
Affiliation(s)
- Elissa G Miller
- Division of Palliative Medicine, Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA.
| | - Aimee K Hildenbrand
- Nemours Center for Healthcare Delivery Science, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA
| | - Alison Taggi-Pinto
- Nemours Center for Healthcare Delivery Science, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA
| | - Melissa A Alderfer
- Nemours Center for Healthcare Delivery Science, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA; Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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39
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Schultz CL, Alderfer MA, Lindell RB, McClain Z, Zelley K, Nichols KE, Ford CA. The Influence of Adolescence on Parents' Perspectives of Testing and Discussing Inherited Cancer Predisposition. J Genet Couns 2018; 27:10.1007/s10897-018-0267-z. [PMID: 29909594 DOI: 10.1007/s10897-018-0267-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 06/04/2018] [Indexed: 12/28/2022]
Abstract
Li-Fraumeni syndrome (LFS) is a highly penetrant cancer predisposition syndrome that may present with a first cancer before or during adolescence/young adulthood. Families offered LFS genetic testing for their children can inform our understanding of how the unique developmental context of adolescence influences parental perspectives about genetic testing and discussions of cancer risk. In this study, semi-structured interviews were conducted with 46 parents of children at risk for LFS to capture those perspectives. Analysis utilized summary descriptive statistics and inductive qualitative content coding. Most parents (33/46; 72%) expressed beliefs that adolescence influences the importance of LFS testing and/or discussions about genetic risk. Twenty-six parents related this influence to cognitive, physical, and social changes occurring during adolescence. Aspects of adolescence perceived as promoting LFS testing/discussion included developmental appropriateness, risks of cancer in adolescence, need for medical screening decisions, influence on behaviors, transition to adult health care, and reproductive risks. Aspects of adolescence perceived as complicating LFS testing/discussions included potential negative emotional impact, misunderstanding, added burden, and negative impact on self-image or future planning. Parents recognize the complex influence that adolescence has on LFS testing and conversations surrounding results. Further research is needed to understand the actual impact of genetic testing on young people, and how to best support parents and adolescents within the broader context of heritable diseases.
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Affiliation(s)
- Corinna L Schultz
- Nemours Children's Health System/A.I. duPont Hospital for Children, Wilmington, DE, USA
- Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Melissa A Alderfer
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- The Center for Healthcare Delivery Science, Nemours Children's Health System/A.I. duPont Hospital for Children, Wilmington, DE, USA.
- Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA.
| | - Robert B Lindell
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Anesthesia and Critical Care, Division of Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Zachary McClain
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Craig-Dalsimer Division of Adolescent Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kristin Zelley
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kim E Nichols
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Oncology, Division of Cancer Predisposition, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Carol A Ford
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Craig-Dalsimer Division of Adolescent Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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40
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Viola A, Taggi-Pinto A, Sahler OJZ, Alderfer MA, Devine KA. Problem-solving skills, parent-adolescent communication, dyadic functioning, and distress among adolescents with cancer. Pediatr Blood Cancer 2018; 65:e26951. [PMID: 29316232 PMCID: PMC5867217 DOI: 10.1002/pbc.26951] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 11/17/2017] [Accepted: 12/05/2017] [Indexed: 12/20/2022]
Abstract
Some adolescents with cancer report distress and unmet needs. Guided by the disability-stress-coping model, we evaluated associations among problem-solving skills, parent-adolescent cancer-related communication, parent-adolescent dyadic functioning, and distress in adolescents with cancer. Thirty-nine adolescent-parent dyads completed measures of these constructs. Adolescents were 14-20 years old on treatment or within 1 year of completing treatment. Better problem-solving skills were correlated with lower adolescent distress (r = -0.70, P < 0.001). Adolescent-reported cancer-related communication problems and dyadic functioning were not significantly related to adolescent distress (rs < 0.18). Future work should examine use of problem-solving interventions to decrease distress for adolescents with cancer.
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Affiliation(s)
- Adrienne Viola
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | | | | | - Melissa A. Alderfer
- Nemours Children’s Health System, Wilmington, Delaware,Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
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41
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Stegenga K, Pentz RD, Alderfer MA, Pelletier W, Fairclough D, Hinds PS. Child and Parent Access to Transplant Information and Involvement in Treatment Decision Making. West J Nurs Res 2018; 41:576-591. [PMID: 29644930 DOI: 10.1177/0193945918770440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Pediatric stem cell transplant processes require information sharing among the patient, family, and clinicians regarding the child's condition, prognosis, and transplant procedures. To learn about perceived access to transplant information and involvement in decision making among child family members (9-22 years old), we completed a secondary analysis of 119 interviews conducted with pediatric patients, sibling donors, nondonor siblings/cousins, and guardians from 27 families prior to transplant. Perceptions of information access and involvement in transplant-related decisions were extracted and summarized. We compared child member perceptions to their guardians' and examined differences by child age and gender. Most child members perceived exclusion from transplant (79%) and donor (63%) information and decisions (63%) although this varied by child role. Gender was unrelated to involvement; older age was associated with less perceived exclusion. Congruence in perspectives across children and guardians was evident for eight (30%) families, most of whom ( n = 7) excluded the children.
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Affiliation(s)
| | | | - Melissa A Alderfer
- 3 Thomas Jefferson University, Philadelphia, PA, USA.,4 Nemours Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | | | | | - Pamela S Hinds
- 7 Children's National Health System, Washington, DC, USA.,8 The George Washington University, Washington, DC, USA
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42
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Long KA, Lehmann V, Gerhardt CA, Carpenter AL, Marsland AL, Alderfer MA. Psychosocial functioning and risk factors among siblings of children with cancer: An updated systematic review. Psychooncology 2018; 27:1467-1479. [DOI: 10.1002/pon.4669] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 01/18/2018] [Accepted: 01/29/2018] [Indexed: 12/23/2022]
Affiliation(s)
| | - Vicky Lehmann
- Department of Pediatrics and Psychology; Ohio State University; Columbus OH USA
- Center for Biobehavioral Health Research Institute at Nationwide Children's Hospital; Columbus OH USA
| | - Cynthia A. Gerhardt
- Department of Pediatrics and Psychology; Ohio State University; Columbus OH USA
- Center for Biobehavioral Health Research Institute at Nationwide Children's Hospital; Columbus OH USA
| | | | | | - Melissa A. Alderfer
- Nemours Children's Health System/A.I. duPont Hospital for Children; Wilmington DE USA
- Sidney Kimmel Medical College; Thomas Jefferson University; Philadelphia PA USA
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43
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Alderfer MA. Introduction to special issue: Improving clinical practices in pediatric psychology through qualitative research. Clinical Practice in Pediatric Psychology 2017. [DOI: 10.1037/cpp0000222] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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44
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Long KA, Pariseau EM, Muriel AC, Chu A, Kazak AE, Leon M, Alderfer MA. Psychosocial screening for siblings of children with cancer: Barriers and preferences. Clinical Practice in Pediatric Psychology 2017. [DOI: 10.1037/cpp0000219] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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45
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Rohan JM, Fukuda T, Alderfer MA, Wetherington Donewar C, Ewing L, Katz ER, Muriel AC, Vinks AA, Drotar D. Measuring Medication Adherence in Pediatric Cancer: An Approach to Validation. J Pediatr Psychol 2017; 42:232-244. [PMID: 27189694 DOI: 10.1093/jpepsy/jsw039] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 04/12/2016] [Indexed: 12/27/2022] Open
Abstract
Objective This study described the prospective relationship between pharmacological and behavioral measures of 6-mercaptopurine (6MP) medication adherence in a multisite cohort of pediatric patients diagnosed with cancer ( N = 139). Methods Pharmacological measures (i.e., metabolite concentrations) assessed 6MP intake. Behavioral measures (e.g., electronic monitoring) described adherence patterns over time. Results Three metabolite profiles were identified across 15 months: one group demonstrated low levels of both metabolites (40.8%) consistent with nonadherence and/or suboptimal therapy; two other groups demonstrated metabolite clusters indicative of adequate adherence (59.2%). Those patients whose metabolite profile demonstrated low levels of both metabolites had consistently lower behavioral adherence rates. Conclusions To our knowledge, this was the first study to prospectively validate a pharmacological measure of medication adherence with a behavioral adherence measure in a relatively large sample of pediatric patients with cancer. Using multiple methods of adherence measurement could inform clinical care and target patients in need of intervention.
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Affiliation(s)
- Jennifer M Rohan
- Department of Psychology, University of Cincinnati, Cincinnati, OH, USA.,Center for Adherence and Self-Management, Cincinnati Children's Hospital Medical Center, OH, USA
| | - Tsuyoshi Fukuda
- Department of Pediatrics, University of Cincinnati School of Medicine, OH, USA.,Division of Clinical Pharmacology, Cincinnati Children's Hospital Medical Cente, OH, USA
| | - Melissa A Alderfer
- Division of Oncology, The Children's Hospital of Philadelphia, PA, USA.,Perelman School of Medicine, University of Pennsylvani, Philadelphia, PA, USA
| | - Crista Wetherington Donewar
- Center for Pediatric Psychiatry, Children's Medical Center Dallas, Texas, USA.,UT Southwestern Medical Center, Dallas, Texas, USA
| | - Linda Ewing
- Department of Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, PA, USA
| | - Ernest R Katz
- Division of General Pediatrics, Children's Hospital Los Angeles, CA, USA.,Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Anna C Muriel
- Division of Psychosocial Oncology, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA, USA
| | - Alexander A Vinks
- Department of Pediatrics, University of Cincinnati School of Medicine, OH, USA.,Division of Clinical Pharmacology, Cincinnati Children's Hospital Medical Cente, OH, USA
| | - Dennis Drotar
- Department of Psychology, University of Cincinnati, Cincinnati, OH, USA
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46
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White TE, Hendershot KA, Dixon MD, Pelletier W, Haight A, Stegenga K, Alderfer MA, Cox L, Switchenko JM, Hinds P, Pentz RD. Family Strategies to Support Siblings of Pediatric Hematopoietic Stem Cell Transplant Patients. Pediatrics 2017; 139:peds.2016-1057. [PMID: 28119426 PMCID: PMC5260146 DOI: 10.1542/peds.2016-1057] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/14/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To describe the strategies families report using to address the needs and concerns of siblings of children, adolescents, and young adults undergoing hematopoietic stem cell transplant (HSCT). METHODS A secondary semantic analysis was conducted of 86 qualitative interviews with family members of children, adolescents, and young adults undergoing HSCT at 4 HSCT centers and supplemented with a primary analysis of 38 additional targeted qualitative interviews (23 family members, 15 health care professionals) conducted at the primary center. Analyses focused on sibling issues and the strategies families use to address these issues. RESULTS The sibling issues identified included: (1) feeling negative effects of separation from the patient and caregiver(s); (2) experiencing difficult emotions; (3) being faced with additional responsibilities or burdens; (4) lacking information; and (5) feeling excluded. Families and health care providers reported the following strategies to support siblings: (1) sharing information; (2) using social support and help offered by family or friends; (3) taking siblings to the hospital; (4) communicating virtually; (5) providing special events or gifts or quality time for siblings; (6) offering siblings a defined role to help the family during the transplant process; (7) switching between parents at the hospital; (8) keeping the sibling's life constant; and, (9) arranging sibling meetings with a certified child life specialist or school counselor. CONCLUSIONS Understanding the above strategies and sharing them with other families in similar situations can begin to address sibling issues during HSCT and can improve hospital-based, family-centered care efforts.
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Affiliation(s)
- Taylor E. White
- East Carolina University School of Medicine, Greenville, North Carolina
| | | | - Margie D. Dixon
- Department of Hematology and Oncology, Emory School of Medicine, and
| | - Wendy Pelletier
- Haemotology/Oncology/Stem Cell Transplant Program, Alberta Children’s Hospital, Calgary, Alberta, Canada
| | - Ann Haight
- Department of Hematology and Oncology, Emory School of Medicine, and,Department of Pediatrics, Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Kristin Stegenga
- Hematology/Oncology/Bone Marrow Transplantation, Children’s Mercy Hospital, Kansas City, Missouri
| | - Melissa A. Alderfer
- Department of Psychology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania;,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lydia Cox
- Winship Cancer Institute, Atlanta, Georgia; and
| | - Jeffrey M. Switchenko
- Department of Biostatistics & Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia;,Winship Cancer Institute, Atlanta, Georgia; and
| | - Pamela Hinds
- Children’s National Medical Center, Nursing Research and Quality Outcomes, Washington, District of Columbia
| | - Rebecca D. Pentz
- Department of Hematology and Oncology, Emory School of Medicine, and,Winship Cancer Institute, Atlanta, Georgia; and
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Alderfer MA. Commentary: Family Processes and Outcomes: Research Advances and Future Directions. J Pediatr Psychol 2017; 42:125-129. [PMID: 28165537 DOI: 10.1093/jpepsy/jsw100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 11/20/2016] [Accepted: 11/22/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
- Melissa A Alderfer
- Nemours Children's Health System/A. I. duPont Hospital for Children and Sidney Kimmel Medical College at Thomas Jefferson University, Wilmington, DE, USA
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48
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Samson K, Rourke MT, Alderfer MA. A qualitative analysis of the impact of childhood cancer on the lives of siblings at school, in extracurricular activities, and with friends. Clinical Practice in Pediatric Psychology 2016. [DOI: 10.1037/cpp0000161] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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49
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Santos S, Crespo C, Canavarro MC, Alderfer MA, Kazak AE. Family rituals, financial burden, and mothers' adjustment in pediatric cancer. J Fam Psychol 2016; 30:1008-1013. [PMID: 27617476 DOI: 10.1037/fam0000246] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The financial burden of childhood cancer may contribute to the distress that parents experience during and after treatment. Inconsistent relationships between financial burden and parental psychological distress highlight the need to identify psychosocial factors that may moderate this relationship. In this study, we aimed to determine if family ritual meaning moderates the relationship between financial burden and anxiety and depression symptoms among mothers of children with cancer. Portuguese mothers of children with cancer on-treatment and off-treatment (N = 244) completed measures of financial burden, anxiety and depression symptoms, and family ritual meaning. Moderating effects were tested using hierarchical multiple regression analyses. Family ritual meaning buffered the effect of financial burden on anxiety, but not on depression symptoms. The relationship between financial burden and anxiety symptoms was not significant when mothers endorsed higher levels of family ritual meaning. Although preliminary, the current findings suggest that high levels of perceived family ritual meaning may constitute a protective factor against the effect of financial burden on mothers' anxiety symptoms. Promoting family ritual meaning might be an effective approach to reducing anxiety symptoms of mothers of children with cancer in the context of financial burden. (PsycINFO Database Record
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Affiliation(s)
| | | | | | - Melissa A Alderfer
- Center for Healthcare Delivery Science, Nemours Children's Health System/Alfred I. DuPont Hospital for Children
| | - Anne E Kazak
- Center for Healthcare Delivery Science, Nemours Children's Health System/Alfred I. DuPont Hospital for Children
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50
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Alderfer MA, Sood E. Using qualitative research methods to improve clinical care in pediatric psychology. Clinical Practice in Pediatric Psychology 2016. [DOI: 10.1037/cpp0000164] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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