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McLachlan LM, Engster S, Winger JG, Haupt A, Levin-Decanini T, Decker M, Noll RB, Yu JA. Self-Reported Well-Being of Family Caregivers of Children with Medical Complexity. Acad Pediatr 2024:S1876-2859(24)00145-1. [PMID: 38609015 DOI: 10.1016/j.acap.2024.04.002] [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: 11/08/2023] [Revised: 03/08/2024] [Accepted: 04/06/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVE Provide an in-depth and psychometrically rigorous profile of the emotional well-being and sleep-related health of family caregivers of children with medical complexity (CMC). METHODS Cross-sectional survey study of family caregivers of CMC receiving care from a pediatric complex care center between May 2021 and March 2022. Patient Reported Outcomes Measurement Information System Short-Forms (PROMIS-SF) assessed global mental health, emotional distress (anxiety, depression, anger), psychological strengths (self-efficacy, emotional regulation, meaning and purpose), and sleep-related health (fatigue, sleep-related impairment). Student's t-tests compared the sample's mean T-scores to US population norms. Pearson's correlation coefficient (ρ) examined associations between measures of psychological strengths and emotional distress. Unadjusted linear regression analyses explored relationships between well-being outcomes and child and caregiver characteristics. RESULTS Compared to US population norms, caregivers of CMC (n = 143) reported significantly lower global mental health and emotional regulation ability as well as elevated symptoms of anxiety, depression, anger, fatigue, and sleep-related impairment (all P < .01). Whereas participants reported a significantly higher sense of meaning and purpose (P < .05), levels of self-efficacy were not significantly different from population norms. We observed moderate-to-strong inverse relationships between psychological strengths and emotional distress (ρ range, -0.39 to -0.69); with the strongest inverse associations found between emotional regulation ability and emotional distress. In exploratory analyses, caregiver race and ethnicity, socioeconomic status, and child health insurance type were significantly associated with caregiver well-being. CONCLUSION Family caregivers of CMC report poor well-being, most notably, increased symptoms of anxiety and reduced global mental health and sleep-related health.
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Affiliation(s)
| | - Stacey Engster
- Jose F. Alvarado and Associates (S Engster), Salisbury, Md
| | - Joseph G Winger
- Department of Psychiatry and Behavioral Sciences (JG Winger), Duke University School of Medicine, Durham, NC; Duke Cancer Institute (JG Winger), Duke University Health System, Durham, NC
| | - Alicia Haupt
- Complex Care Center (A Haupt and M Decker), UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Pediatrics (A Haupt, M Decker, and RB Noll), University of Pittsburgh School of Medicine, Pittsburgh, Pa
| | - Tal Levin-Decanini
- Complex Care Center (T Levin-Decanini), General Academic Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa
| | - Michael Decker
- Complex Care Center (A Haupt and M Decker), UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Pediatrics (A Haupt, M Decker, and RB Noll), University of Pittsburgh School of Medicine, Pittsburgh, Pa
| | - Robert B Noll
- Department of Pediatrics (A Haupt, M Decker, and RB Noll), University of Pittsburgh School of Medicine, Pittsburgh, Pa
| | - Justin A Yu
- Divisions of Pediatric Supportive and Palliative Care and Hospital Medicine (JA Yu), University of Pittsburgh School of Medicine and UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa.
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Bishop L, McLean KJ, Harris AB, Rabidoux PC, Laughlin SF, Noll RB. Measuring LEND Core Competencies Using Trainee Follow-Up Surveys. Matern Child Health J 2023; 27:2147-2155. [PMID: 37452893 PMCID: PMC10896113 DOI: 10.1007/s10995-023-03759-5] [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] [Accepted: 07/09/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVES Measuring the value-added impact of Leadership Education in Neurodevelopmental Disabilities and Related Disorders (LEND) training on trainees' leadership and career trajectories is necessary to understand program efficacy. In the current study, we leveraged an existing ex post facto design to develop and test a new measure of LEND competencies and compare outcomes of LEND trainees and comparison peers. METHODS We developed the LEND Outcomes Follow-Up Survey using a multi-step, mixed methods process. A series of focus groups and consultations with key stakeholders identified eight important LEND leadership outcomes: (1) interdisciplinary work; (2) advocacy; (3) intersectional approach; (4) systems perspective; (5) life course perspective; (6) leadership; (7) engagement with maternal and child health populations; and (8) research experience. We developed and piloted this novel survey to measure these LEND leadership outcomes. We used data collected from this novel measure and an existing survey that is used nationally by LEND, to compare the outcomes of 43 LEND trainees and 30 comparison peers at two years post completion of LEND training. RESULTS We found that, compared to comparison peers, LEND trainees: (1) worked with a greater number of disciplines; (2) were more likely to be engaged in advocacy; (3) were more likely to utilize a systems perspective in their work; (4) were more likely to work with maternal and child health populations; and (5) were more likely to have experience conducting research. CONCLUSIONS Our findings suggested that LEND training improves LEND leadership outcomes at two years post-completion of LEND training.
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Affiliation(s)
- Lauren Bishop
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Ave, Madison, WI, 53706, USA.
- Sandra Rosenbaum School of Social Work, University of Wisconsin-Madison, Madison, USA.
| | - Kiley J McLean
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Ave, Madison, WI, 53706, USA
- Sandra Rosenbaum School of Social Work, University of Wisconsin-Madison, Madison, USA
| | - Anne Bradford Harris
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Ave, Madison, WI, 53706, USA
| | | | - Sarah F Laughlin
- University of Pittsburgh School of Medicine, Pittsburgh, USA
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, USA
| | - Robert B Noll
- University of Pittsburgh School of Medicine, Pittsburgh, USA
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Schepers SA, Phipps S, Devine KA, Noll RB, Fairclough DL, Dolgin MJ, Ingman KA, Schneider NM, Voll ME, Askins MA, Sahler OJ. Psychometric properties of the 52-, 25-, and 10-item English and Spanish versions of the Social Problem-Solving Inventory-Revised. Front Psychol 2023; 14:1213784. [PMID: 37809313 PMCID: PMC10551167 DOI: 10.3389/fpsyg.2023.1213784] [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: 04/28/2023] [Accepted: 08/29/2023] [Indexed: 10/10/2023] Open
Abstract
Objective The Social Problem-Solving Inventory-Revised (SPSI-R) is a widely used instrument to assess problem-solving ability. This study examined the factor structure of the 52-, 25-, and 10-item versions of the SPSI-R and assessed factorial invariance across English- and Spanish-speaking participants. In addition, the internal consistency, test-retest reliability and sensitivity to detect change in problem-solving skills over time were assessed across the three different versions of the SPSI-R. Methods Data from three randomized controlled trials, in which caregivers of children with cancer (N = 1,069) were assigned to either a problem-solving skills intervention (N = 728) or a control condition (N = 341), were combined. The SPSI-R was administered at baseline (T1) and immediately post intervention (T2). Reliability and multigroup analyses were performed with confirmatory factor analysis (CFA). Sensitivity to change analyses were performed using repeated measures ANOVA. Results Confirmatory factor analysis at T1 showed good fit statistics and internal consistency for the 52- and the 25-item versions, but not for the 10-item version. Factorial invariance was demonstrated across time (T1-T2) and language (Spanish-English) for both the 52- and 25-item versions. Adequate sensitivity to change over time was shown. Conclusion The 52- and 25-item versions of the SPSI-R appear reliable and valid for assessment of problem-solving skills in English- and Spanish-speaking caregivers of children with newly diagnosed cancer. The 25-item SPSI-R can be used as a short version measuring problem-solving ability; the 10-item version cannot be considered a reliable measure for this population.
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Affiliation(s)
| | - Sean Phipps
- St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Katie A. Devine
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
| | - Robert B. Noll
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | | | | | | | | | - Megan E. Voll
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Martha A. Askins
- The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Olle Jane Sahler
- University of Rochester Medical Center, Rochester, NY, United States
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Hardy KK, Kairalla JA, Gioia AR, Weisman HS, Gurung M, Noll RB, Hinds PS, Hibbitts E, Salzer WL, Burke MJ, Winick NJ, Embry L. Impaired neurocognitive functioning 3 months following diagnosis of high-risk acute lymphoblastic leukemia: A report from the Children's Oncology Group. Pediatr Blood Cancer 2023; 70:e30350. [PMID: 37129114 PMCID: PMC10205681 DOI: 10.1002/pbc.30350] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 03/01/2023] [Accepted: 03/20/2023] [Indexed: 05/03/2023]
Abstract
PURPOSE Acute lymphoblastic leukemia (ALL) is the most common pediatric cancer diagnosis. Cognitive late effects develop in 20%-40% of ALL survivors, but the course of declines is unclear. The aim of this paper is to characterize cognitive functioning, and its association with patient-reported outcomes, early in treatment. PATIENTS AND METHODS A total of 483 children with high-risk ALL, aged 6-12 years at diagnosis, consented to the neurocognitive study embedded in a prospective therapeutic trial, Children's Oncology Group (COG) AALL1131. A computerized neurocognitive battery (Cogstate) was administered 3 months post diagnosis assessing reaction time, visual attention, working memory, visual learning, and executive functioning. Parent-reported executive functioning and patient-reported physical symptoms were also collected. RESULTS Data from 390 participants (mean age at diagnosis = 9.2 years, 55.4% male) were obtained. Relatively few patients reported pain (16.0%) or nausea (22.6%), but a majority (68.5%) reported feeling at least some fatigue at testing. Mean Cogstate Z-scores were within normal limits across tasks; however, rates of impairment (Z-scores ≤ -1.5) for reaction time, working memory, visual learning, and visual attention were all higher than expected compared to the standardization sample. Patients reporting fatigue were significantly more likely to have impaired reaction time and visual attention compared to those reporting no fatigue. CONCLUSION Findings support feasibility of computerized cognitive assessments and suggest higher-than-expected rates of impaired cognitive performance early during treatment for pediatric ALL, notably within 3 months of diagnosis, suggesting intervention efforts may be indicated. These results also highlight acute factors that may impact reliability of "baseline" assessments conducted soon after diagnosis.
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Affiliation(s)
- Kristina K Hardy
- Children's National Hospital, Washington, District of Columbia, USA
- The George Washington University School of Medicine, Washington, District of Columbia, USA
| | | | | | | | - Meera Gurung
- University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Robert B Noll
- University of Pittsburgh Department of Pediatrics, Pittsburgh, Pennsylvania, USA
| | - Pamela S Hinds
- Children's National Hospital, Washington, District of Columbia, USA
- The George Washington University School of Medicine, Washington, District of Columbia, USA
| | | | - Wanda L Salzer
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | | | - Naomi J Winick
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Leanne Embry
- University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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Brown KL, Fairclough D, Noll RB, Barrera M, Kupst MJ, Gartstein MA, Egan AM, Bates CR, Gerhardt CA, Vannatta K. Emotional Well-Being of Pediatric Brain Tumor Survivors and Comparison Peers: Perspectives From Children and Their Parents. J Pediatr Psychol 2023; 48:166-175. [PMID: 36190446 PMCID: PMC9941833 DOI: 10.1093/jpepsy/jsac077] [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: 02/03/2022] [Revised: 08/13/2022] [Accepted: 09/18/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The aim of this study was to examine the emotional well-being of pediatric brain tumor survivors (PBTS) from the perspective of children's self-reports and parents' reports relative to matched comparison peers (COMP) and their parents. It was hypothesized that PBTS would self-report more depression symptoms, loneliness, and lower self-concept than COMP. We also hypothesized that mothers and fathers of PBTS would report more internalizing symptoms and lower total competence for their children. Age and sex effects were examined in exploratory analyses. METHODS Families of 187 PBTS and 186 COMP participated across 5 sites. Eligible children in the PBTS group were 8-15 years of age and 1-5 years post-treatment for a primary intracranial tumor without progressive disease. COMP were classmates matched for sex, race, and age. RESULTS PBTS self-reported lower scholastic, athletic, and social competence, but not more depression, loneliness, or lower global self-worth than COMP. Parents of PBTS reported more internalizing symptoms and lower total competence than parents of COMP. With few exceptions, group differences did not vary as a function of child age and sex. CONCLUSION PBTS reported diminished self-concept in scholastic, athletic, and social domains, while their parents reported broader challenges with internalizing symptoms and total competence. Discrepancies between self-report and parent report require further study to inform targeted interventions for PBTS. Screening survivors for emotional challenges in follow-up clinic or in school setting may help with the allocation of psychosocial support and services for PBTS and their families.
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Affiliation(s)
- Kara L Brown
- Department of Psychology, Washington State University, USA
| | - Diane Fairclough
- Department of Biostatistics and Informatics, Colorado School of Public Health, USA
| | - Robert B Noll
- Department of Pediatrics, University of Pittsburgh Medical Center, USA
| | - Maru Barrera
- Psychology Department, The Hospital for Sick Children, USA
| | - Mary Jo Kupst
- Department of Pediatrics, Medical College of Wisconsin, USA
| | | | - Anna M Egan
- Division of Developmental and Behavioral Sciences, Children's Mercy Kansas City, USA
- University of Missouri Kansas City School of Medicine, USA
| | - Carolyn R Bates
- Department of Pediatrics, The University of Kansas Medical Center, USA
| | - Cynthia A Gerhardt
- Center for Biobehavioral Health, Nationwide Children’s Hospital, USA
- Department of Pediatrics, The Ohio State University, USA
| | - Kathryn Vannatta
- Center for Biobehavioral Health, Nationwide Children’s Hospital, USA
- Department of Pediatrics, The Ohio State University, USA
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McNeal DM, Sahler OJZ, Noll RB, Fairclough DL, Voll ME, Bhat S, Morrato EH. Core functions and forms of Bright IDEAS: A multi-methods evaluation of the adoption of an evidence-based psychosocial training program through iterative adaptation. Front Health Serv 2022; 2:928580. [PMID: 36925829 PMCID: PMC10012676 DOI: 10.3389/frhs.2022.928580] [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] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022]
Abstract
Background Despite efforts to widely disseminate interventions designed to increase access to quality supportive care to pediatric cancer patients and their families, many of these interventions fail to meet expectations once deployed in real-life clinical settings. This study identifies the functions and forms of Bright IDEAS: Problem-Solving Skills Training, an evidence based psychosocial intervention for caregivers of children recently diagnosed with cancer, to identify pragmatic program adaptations in its real-world clinical implementation. We compare intervention adoption before and after adaptations to the Bright IDEAS training program as part of a national training program designed to disseminate the intervention. Methods 209 pediatric psychosocial oncology practitioners representing 134 unique institutions were trained during 10 in-person 8-hour workshops (2015-2019). Functions and forms of Bright IDEAS were identified, and adaptations made to the training agenda and curriculum based on practitioner feedback following implementation in local institutions. Mixed method evaluation included longitudinal surveys at 6- and 12-months post training; and qualitative interviews among a subgroup of practitioners (N = 47) to understand and compare perspectives on intervention adoption and barriers to implementation before and after adaptations to the Bright IDEAS training program. The RE-AIM framework was used to guide dissemination evaluation. Results A total of four adaptations were tailored to the identified forms of the intervention: case studies; pre-training reading materials; training videos; and letters of institutional support from primary supervisor. Pre- and post-training adaptations to the Bright IDEAS training program were mapped to RE-AIM constructs. Quantitative findings demonstrate that adaptations appeared to improve adoption and usage overall. Conclusion This study provides insight into how contextual factors influence psychosocial practitioners' capacity to adopt, implement, and maintain Bright IDEAS in the clinical setting. This study demonstrates the use of real-time stakeholder feedback to guide intervention translation from research to practice settings.
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Affiliation(s)
- Demetria M. McNeal
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, United States
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Olle Jane Z. Sahler
- Division of Pediatric Hematology/Oncology, University of Rochester School of Medicine and Dentistry, Golisano Children's Hospital, Rochester, NY, United States
| | - Robert B. Noll
- Department of Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Diane L. Fairclough
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Megan E. Voll
- Department of Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Shubha Bhat
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Elaine H. Morrato
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL, United States
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Voll M, Fairclough DL, Morrato EH, McNeal DM, Embry L, Pelletier W, Noll RB, Sahler OJZ. Dissemination of an evidence-based behavioral intervention to alleviate distress in caregivers of children recently diagnosed with cancer: Bright IDEAS. Pediatr Blood Cancer 2022; 69:e29904. [PMID: 35929012 PMCID: PMC9420785 DOI: 10.1002/pbc.29904] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/06/2022] [Accepted: 07/09/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Four multisite randomized clinical trials of > 1400 caregivers of children newly diagnosed with cancer showed that the Bright IDEAS (BI) paradigm of problem-solving skills training is an acceptable and efficacious approach to alleviating the high levels of distress they experience. To facilitate providing evidence-based caregiver support as recommended in the pediatric oncology standards of care, the project described here was designed to disseminate BI to 200 psychosocial professionals. PROCEDURE We partnered with the Children's Oncology Group (COG), Association of Pediatric Oncology Social Workers (APOSW), Association of Pediatric Hematology/Oncology Nurses (APHON), and special interest group in pediatric hematology/oncology of the Society for Pediatric Psychology (SPP). Membership surveys revealed substantial enthusiasm for training in BI. We structured training to include review of the evidence base for BI, role plays, and strategies for implementation at individual sites. Four conference calls designed to enhance implementation were held one, two, three, and five months after training. RESULTS Ten 1.5-day workshops were held in conjunction with annual meetings of COG, APOSW, APHON, and SPP. A total of 209 psychosocial clinicians from 134 sites were trained. Evaluations were highly favorable. Trainees had provided BI to 545 individuals as of the last conference call. CONCLUSIONS Initial dissemination goals were met. BI is now available at numerous pediatric oncology centers, but it has not become part of routine care. Future work focused on implementation might consider top-down approaches that include direct communication with pediatric oncologists and hospital leaders about the benefits of incorporating this evidence-based intervention systemically.
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Affiliation(s)
- Megan Voll
- University of Pittsburgh, School of Medicine, Department of Pediatrics, Pittsburgh, Pennsylvania
| | - Diane L. Fairclough
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus Aurora, Aurora, Colorado
| | - Elaine H. Morrato
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois
| | - Demetria M. McNeal
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Leanne Embry
- Department of Pediatrics, University of Texas Health Science Center, San Antonio, Texas
| | - Wendy Pelletier
- Pediatric Hematology/Oncology/Transplant Program, Alberta Children’s Hospital, Calgary, Alberta, Canada
| | - Robert B. Noll
- University of Pittsburgh, School of Medicine, Department of Pediatrics, Pittsburgh, Pennsylvania
| | - Olle Jane Z. Sahler
- University of Rochester School of Medicine and Dentistry, Golisano Children’s Hospital, Division of Pediatric Hematology/Oncology, Rochester, New York
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Cesa KT, Cunningham CA, Noll RB, Kim SC. Parental Distress in Pediatric Inflammatory Bowel Diseases: Associations With Time From Diagnosis, Disease Activity, and Demographic Factors. Crohns Colitis 360 2022; 4:otac019. [PMID: 35783219 PMCID: PMC9237933 DOI: 10.1093/crocol/otac019] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Indexed: 11/14/2022] Open
Abstract
Background There are limited studies examining caregiver distress when raising a child with inflammatory bowel disease (IBD). The aim of this study was to investigate the occurrence of symptoms of distress (anxiety, depression, and post-traumatic stress disorder [PTSD]) among parents with children with IBD and associations with disease severity, time from diagnosis, and demographic factors. Methods We conducted a cross-sectional study with parents of children (2-17 years) diagnosed with IBD. There were 2 cohorts: (1) recently diagnosed cohort (<6 months from diagnosis); (2) established diagnosis cohort (>1 year from diagnosis). Parents completed measures of anxiety, depression, and PTSD, while children completed surveys on the symptoms of their IBD. Results Fifty-two parents in the recently diagnosed cohort and 103 parents in the established diagnosis cohort completed surveys. For the entire cohort of parents, we found the mean scores on all measures of distress were within the normal ranges with 20%, 13%, and 8% of parents reporting moderate-to-severe symptoms of anxiety, depression, and PTSD, respectively. Symptoms of anxiety and depression were not significantly associated with time from diagnosis; symptoms of anxiety and PTSD were significantly associated with patients' IBD clinical activity. Conclusions Parents with children with IBD are remarkably resilient to distress even soon after their child's diagnosis. Despite considerable resilience, routine brief caregiver screening for symptoms of anxiety during annual visits seems reasonable and feasible.
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Affiliation(s)
- Kevin T Cesa
- Address correspondence to: Kevin T. Cesa, MD, Department of Pediatrics, University of Pittsburgh School of Medicine, 4401 Penn Avenue, Pittsburgh, PA 15224, USA ()
| | - Catherine A Cunningham
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Robert B Noll
- Department of Child Development, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Sandra C Kim
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Bishop L, Harris AB, Rabidoux PC, Laughlin SF, McLean KJ, Noll RB. A model to evaluate interprofessional training effectiveness: feasibility and five-year outcomes of a multi-site prospective cohort study. Matern Child Health J 2022; 26:1622-1631. [PMID: 35583590 PMCID: PMC9513993 DOI: 10.1007/s10995-022-03421-6] [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: 01/06/2021] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Assessing the impact of interdisciplinary training programs is highly desirable and needed. However, there are currently no established methods to prospectively assess long-term outcomes of trainees compared to individuals who did not receive training. Our objective was to test the feasibility of a longitudinal, prospective cohort design to evaluate training outcomes, and to use this method to evaluate Leadership Education in Neurodevelopmental Disabilities and Related Disorders (LEND) training outcomes. METHODS LEND trainees were matched to comparison peers and followed annually for up to five years using a pre-existing outcomes survey. We assessed study feasibility using recruitment and retention data over five years. We then looked at preliminary efficacy of LEND training in LEND trainees compared to comparison peers using the pre-existing outcomes survey. RESULTS Overall, 68.3% of eligible trainees participated in the Outcomes Study across five years, and 66.0% were matched to comparison peers. On average, 84.4% of LEND trainees and 79.9% of comparison peers completed the outcomes survey annually. Attrition was low at 0.9% for LEND trainees and 2.6% for comparison peers over five years. LEND training demonstrated preliminary efficacy in promoting leadership development: LEND trainees began their careers engaged in more leadership activities than comparison peers, and the rate of growth in their participation in leadership activities was greater. CONCLUSIONS The design used to assess outcomes is a feasible approach that can be widely used to assess training program outcomes. Analyses suggest that LEND training is efficacious in increasing involvement in leadership activities over time after graduation.
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Affiliation(s)
- Lauren Bishop
- Waisman Center, University of Wisconsin-Madison, Madison, United States.
- Sandra Rosenbaum School of Social Work, University of Wisconsin-Madison, Madison, United States.
| | | | - Paula C Rabidoux
- Nisonger Center, The Ohio State University, Columbus, United States
| | - Sarah F Laughlin
- University of Pittsburgh School of Medicine, Pittsburgh, United States
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, United States
| | - Kiley J McLean
- Waisman Center, University of Wisconsin-Madison, Madison, United States
- Sandra Rosenbaum School of Social Work, University of Wisconsin-Madison, Madison, United States
| | - Robert B Noll
- University of Pittsburgh School of Medicine, Pittsburgh, United States
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10
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Bates CR, Fairclough D, Noll RB, Barrera ME, Kupst MJ, Egan AM, Gartstein MA, Ach EL, Gerhardt CA, Vannatta KA. Psychosocial functioning of caregivers of pediatric brain tumor survivors. Pediatr Blood Cancer 2022; 69:e29565. [PMID: 35044078 PMCID: PMC8860870 DOI: 10.1002/pbc.29565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 07/23/2021] [Revised: 12/06/2021] [Accepted: 12/23/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Assessment of caregiver needs is a recommended standard of care in pediatric oncology. Caregivers of pediatric brain tumor survivors (PBTS) are a subgroup that may be at highest psychosocial risk. This study examined psychosocial functioning of caregivers of PBTS in comparison to caregivers of youth without cancer history. We hypothesized that caregivers of PBTS would exhibit more psychological symptoms, higher caregiver burden, and lower perceptions of social support than caregivers of comparison youth. PROCEDURE As part of a five-site study, we utilized a matched sample design to evaluate psychosocial functioning of 301 caregivers of 189 PBTS (ages 8-15) who were 1-5 years post treatment, and 286 caregivers of 187 comparison youth matched for sex, race, and age. Caregivers completed measures of psychological symptoms, caregiver burden, and perceptions of social support. Repeated measures mixed models compared outcomes between groups and examined differences based on caregiver sex. Socioeconomic status (SES) was examined as a moderator of significant main effects. RESULTS Caregivers of PBTS reported similar levels of psychological symptoms to caregivers of comparison youth. Mothers of PBTS mothers reported higher caregiver burden and lower perceptions of social support than mothers of comparison youth. Low SES exacerbated group differences in caregiver burden. CONCLUSIONS Mothers of PBTS may have more caregiving responsibilities and perceive less social support, but reported similar levels of psychological symptoms to comparison mothers; fathers of PBTS were similar to comparison fathers. The mechanisms involved in this complex psychosocial dynamic require further investigation.
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Affiliation(s)
- Carolyn R. Bates
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, KS
| | - Diane Fairclough
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado, USA
| | - Robert B. Noll
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Maru E. Barrera
- Division of Hematology/Oncology, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mary Jo Kupst
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Anna M. Egan
- Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, MO,University of Missouri Kansas City School of Medicine, Kansas City, Missouri, USA
| | | | - Emily L. Ach
- Department of Psychiatry, Stanford University School of Medicine, Stanford, California, USA
| | - Cynthia A. Gerhardt
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA,Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | - Kathryn A. Vannatta
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA,Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
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11
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Dolgin MJ, Devine KA, Tzur-Bitan D, Askins MA, Fairclough DL, Katz ER, Noll RB, Phipps S, Sahler OJZ. Responsivity to Problem-Solving Skills Training in Mothers of Children With Cancer. J Pediatr Psychol 2021; 46:413-421. [PMID: 33367833 DOI: 10.1093/jpepsy/jsaa117] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/08/2020] [Accepted: 11/09/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Bright IDEAS (BI) is a problem-solving skills training (PSST) program that has been demonstrated in earlier randomized controlled trials (RCTs) to be an effective and specific intervention for improving problem-solving skills and reducing negative affect in caregivers of children with cancer. The objectives of this study were to (a) offer an approach to defining meaningful treatment response and to determine the rates of responsivity to PSST; and (b) identify characteristics of PSST responders and nonresponders. METHODS Data from 154 mothers receiving the BI intervention were analyzed. Drawing on the literature on minimal clinically important differences, two criteria for determining responsivity were calculated for the primary outcome of problem-solving skills: (a) The reliable change index (RCI) based on group data, and; (b) The effect size (ES) of each participant's pre/postintervention change score as a function of the group's baseline SD. RESULTS Thirty-three percent of the sample met both responsivity criteria immediately posttreatment (39% at follow-up) and 38% (39% at follow-up) met neither. An additional 29% demonstrated a small or greater ES (≥ 0.2) but did not meet the RCI criteria, suggesting possible benefit. The single consistent predictor of responsivity was participants' pretreatment problem-solving skills, with lower skills at baseline predicting greater improvement (p < .001). CONCLUSIONS These findings highlight the need to go beyond group data in interpreting RCTs and to incorporate measures of meaningful treatment response. Our ability to predict and screen for meaningful treatment response is critical to more precise targeting, enhanced outcomes, and better resource allocation.
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Affiliation(s)
| | - Katie A Devine
- Cancer Control and Prevention Program, Rutgers Cancer Institute of New Jersey
| | | | | | - Diane L Fairclough
- Department of Biometrics and Informatics, Colorado School of Public Health
| | - Ernest R Katz
- Department of Pediatrics, Children's Hospital Los Angeles
| | - Robert B Noll
- Department of Child Development, School of Medicine, University of Pittsburgh
| | - Sean Phipps
- Department of Behavioral Medicine, St. Jude children's Research Hospital
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12
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Jacola LM, Baran J, Noll RB, Willard VW, Hardy KK, Embry L, Hullmann SE, Larsen EC, Winick N, Kairalla JA. Adaptive functioning and academic achievement in survivors of childhood acute lymphoblastic leukemia: A report from the Children's Oncology Group. Pediatr Blood Cancer 2021; 68:e28913. [PMID: 33522102 PMCID: PMC8212574 DOI: 10.1002/pbc.28913] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 01/04/2021] [Accepted: 01/05/2021] [Indexed: 11/12/2022]
Abstract
PURPOSE To characterize academic and adaptive skill outcomes in survivors of high-risk B-lineage acute lymphoblastic leukemia (HR B-ALL). METHODS Participants were 178 patients enrolled on a nontherapeutic clinical trial that aimed to characterize neurocognitive and functional outcomes (ie, academic achievement and adaptive skills) following treatment for childhood HR B-ALL. Eligible patients were treated on Children's Oncology Group AALL0232 clinical trial that included two treatment randomizations: methotrexate delivery (high or escalating dose) and corticosteroid (dexamethasone or prednisone). Academic achievement and adaptive skills were evaluated at one time point, 8-24 months after completing treatment. RESULTS Multivariable logistic regression showed no significant association between treatment variables and outcomes after accounting for age at diagnosis, sex, and insurance status. In multivariable analyses accounting for sex and insurance status, survivors <10 years old at diagnosis had significantly lower scores in Math (P = .02). In multivariable analyses accounting for sex and age at diagnosis, scores for children with US public health insurance were significantly lower than those with US private or military insurance across all academic and adaptive skills (all P-values ≤.04). Results from univariate analyses showed that boys had significantly lower scores than girls across all adaptive skill domains (all P-values ≤.04). CONCLUSION Regardless of treatment randomization, survivors of HR B-ALL <10 years at diagnosis are at risk for deficits in Math and overall adaptive functioning; overall adaptive skills for boys were significantly poorer. Screening and early intervention for patients at highest risk, particularly young patients and lower resourced families, should be prioritized.
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Affiliation(s)
- Lisa M Jacola
- St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Julie Baran
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Robert B Noll
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - Kristina K Hardy
- Children's National Hospital and the George Washington University School of Medicine, Washington, District of Columbia
| | - Leanne Embry
- University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | | | | | - Naomi Winick
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - John A Kairalla
- University of Florida Colleges of Medicine, Public Health and Health Professions, Gainesville, Florida
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13
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Young M, Voll M, Noll RB, Fairclough DL, Flanagan-Priore C. Bright IDEAS problem-solving skills training for caregivers of children with sickle cell disease: A two-site pilot feasibility trial. Pediatr Blood Cancer 2021; 68:e28822. [PMID: 33355983 PMCID: PMC8665732 DOI: 10.1002/pbc.28822] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND Bright IDEAS problem-solving skills training (BI) is an evidence-based behavioral intervention that has been utilized extensively with caregivers of children recently diagnosed with cancer. Considerable evidence has shown that BI is acceptable to caregivers of children recently diagnosed with cancer, and improvements in problem-solving skills mediate reduced symptoms of distress. PROCEDURES A slightly modified version of BI was offered to caregivers of children with sickle cell disease (SCD) in a two-site pilot feasibility trial. BI was modified to reduce barriers to care, logistical challenges, and stigma associated with receiving behavioral health services. Our goal was to establish high rates of recruitment and retention among caregivers of children with SCD. Recruitment was acceptable (94%; N = 72) and retention reasonable (49%) across both sites with 35 caregivers successfully completing the BI program. RESULTS Results showed that caregivers of children with SCD, who successfully completed the BI program reported, significant improvements in problem-solving skills immediately and three months after intervention completion. Interestingly, initial levels of distress were low with few caregivers reporting clinically significant levels of distress; distress remained low over time. CONCLUSIONS Findings are discussed in the context of psychosocial screening and resilience of caregivers of children with SCD.
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Affiliation(s)
- Melissa Young
- Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital, Cincinnati, Ohio
| | - Megan Voll
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Robert B. Noll
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Diane L. Fairclough
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado
| | - Cate Flanagan-Priore
- Joint Division of Hematology/Oncology, Oishei Childrens Hospital and Roswell Park Comprehensive Cancer Center, Buffalo, New York
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14
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Hocking MC, Noll RB, Kazak AE, Brodsky C, Phillips P, Barakat LP. Friendships in Pediatric Brain Tumor Survivors and Non-Central Nervous System Tumor Survivors. J Pediatr Psychol 2020; 45:194-202. [PMID: 31925436 DOI: 10.1093/jpepsy/jsz101] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 12/06/2019] [Accepted: 12/09/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Brain tumors during childhood may disrupt the development and maintenance of friendships due to the impact of disease- and treatment-related factors on functioning. The goal of this study was to determine if children treated for either a brain tumor or a non-central nervous system (CNS) solid tumor could name a friend and to evaluate the social information processes associated with the ability to name a friend. METHOD Youth (ages 7-14) treated for either a brain tumor (n = 47; mean age = 10.51 years) or a non-CNS solid tumor (n = 34; mean age = 11.29) completed an assessment within 6 months of the conclusion of treatment that included asking participants to name a friend and completing measures of social information processing (SIP). Rates of self-reported friendship were compared between groups and correlates of being able to name a friend were evaluated. RESULTS Youth treated for a brain tumor (61.7%) were significantly less likely to name a friend compared with youth treated for a non-CNS solid tumor (85.3%). Diagnosis type (brain vs. non-CNS), relapse status, attribution style, and facial affect recognition were significant predictors of being able to name a friend or not in a logistic regression model. CONCLUSIONS Youth treated for a brain tumor and those who experienced a disease relapse are at risk for impairments in friendships; difficulties with SIP may increase this risk. Targeted screening and intervention efforts for children diagnosed with brain tumors and those who have relapsed could address difficulties with peers.
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Affiliation(s)
| | | | - Anne E Kazak
- Nemours Children's Health System.,Thomas Jefferson University
| | | | - Peter Phillips
- Children's Hospital of Philadelphia.,The University of Pennsylvania
| | - Lamia P Barakat
- Children's Hospital of Philadelphia.,The University of Pennsylvania
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15
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Michel HK, Kim SC, Siripong N, Noll RB. Gaps Exist in the Comprehensive Care of Children with Inflammatory Bowel Diseases. J Pediatr 2020; 224:94-101. [PMID: 32482390 PMCID: PMC7483573 DOI: 10.1016/j.jpeds.2020.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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] [Received: 10/31/2019] [Revised: 02/18/2020] [Accepted: 04/01/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To describe patterns of primary and specialty care delivery in pediatric patients with inflammatory bowel diseases (IBD), delineate which members of the healthcare team provided services, and identify gaps in care. STUDY DESIGN Cross-sectional survey of parents of children (2-17 years) with IBD and adolescents with IBD (13-17 years) at a free-standing, quaternary children's hospital regarding healthcare receipt. RESULTS There were 161 parents and 84 adolescents who responded to the survey (75% and 60% response, respectively). The mean patient age was 14 ± 3 years, 51% were male, 80% had Crohn's disease, 16% ulcerative colitis, and 4% IBD-unspecified. Most parents were white (94%), living in a suburban setting (57%). Sixty-nine percent of households had ≥1 parent with a bachelor's degree or higher. Most had private insurance (43%) or private primary with public secondary insurance (34%). Most patients received annual check-ups (70%), vaccinations (78%), and care for minor illnesses (74%) from their primary care provider. Check-ups for gastrointestinal symptoms, IBD monitoring, and changes in type/dosing of IBD treatment were provided by their gastroenterology provider (77%, 93%, and 86% of patients, respectively). Discussions about family/peer relationships, school/extracurricular activities, and mood were not addressed in 30%-40% of participants. Adolescents frequently reported that no one had talked to them about substance use (40%), sexual health (50%), or body image (60%); 75% of adolescents and 76% of their parents reported that no one had discussed transitioning to an adult provider. CONCLUSIONS There were gaps in the psychosocial care of pediatric patients with IBD. Coordinated, comprehensive care delivery models are needed.
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Affiliation(s)
- Hilary K. Michel
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center (UPMC) Children’s Hospital of Pittsburgh, Pittsburgh, PA, United States,Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children’s Hospital and The Ohio State University College of Medicine, Columbus, OH, United States
| | - Sandra C. Kim
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center (UPMC) Children’s Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Nalyn Siripong
- Clinical Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, United States
| | - Robert B. Noll
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, United States
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16
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Michel HK, Siripong N, Noll RB, Kim SC. Caregiver and Adolescent Patient Perspectives on Comprehensive Care for Inflammatory Bowel Diseases: Building a Family-Centered Care Delivery Model. Crohns Colitis 360 2020; 2:otaa055. [PMID: 32851385 PMCID: PMC7437716 DOI: 10.1093/crocol/otaa055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Children with inflammatory bowel diseases (IBDs) require primary and gastrointestinal (GI) care, but little is known about patient and family preferences for care receipt. We aimed to understand caregiver perceptions of current healthcare quality, describe barriers to receiving healthcare, and elicit caregiver and adolescent preferences for how comprehensive care ideally would be delivered. METHODS This was an anonymous survey of caregivers of 2- to 17-year olds with IBD and adolescents with IBD aged 13-17 years at a large, free-standing children's hospital. Surveys assessed patient medical history, family demographics, perceptions of health care quality and delivery, barriers to primary and GI care, and preferences for optimal care delivery. RESULTS Two hundred and seventeen caregivers and 140 adolescents were recruited, 214 caregivers and 133 adolescents consented/assented, and 160 caregivers and 84 adolescents completed the survey (75% and 60% response rate, respectively). Mean patient age was 14 years (SD = 3); 51% male; 79% Crohn's disease, 16% ulcerative colitis, and 4% indeterminate colitis. Caregivers were primarily female (86%), Caucasian (94%), and living in a 2-caregiver household (79%). Most caregivers reported that their child's primary care physician (PCP) and GI doctor oversaw their primary care (71%) and their IBD care (94%), respectively. Caregivers were satisfied with communication with their PCP and GI providers (>90%) but did not know how well they communicated with one another (54%). Barriers to primary and GI care varied, and few caregivers (6%) reported unmet healthcare needs. Caregivers and adolescents saw PCPs and GI doctors having important roles in comprehensive care, though specific preferences for care delivery differed. CONCLUSION Caregivers and adolescent perspectives are essential to developing family-centered care models for children with IBD.
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Affiliation(s)
- Hilary K Michel
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center (UPMC) Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Nalyn Siripong
- Clinical Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Robert B Noll
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sandra C Kim
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center (UPMC) Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
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17
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Phipps S, Fairclough DL, Noll RB, Devine KA, Dolgin MJ, Schepers SA, Askins MA, Schneider NM, Ingman K, Voll M, Katz ER, McLaughlin J, Sahler OJZ. In-person vs. web-based administration of a problem-solving skills intervention for parents of children with cancer: Report of a randomized noninferiority trial. EClinicalMedicine 2020; 24:100428. [PMID: 32637901 PMCID: PMC7327899 DOI: 10.1016/j.eclinm.2020.100428] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 04/06/2020] [Accepted: 06/05/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Bright IDEAS (BI) problem-solving skills training is an evidence-based intervention designed to help parents manage the demands of caring for a child with cancer. However, the resource intensiveness of this in-person intervention has limited its widespread delivery. We conducted a multicenter, randomized trial with a noninferiority design to evaluate whether a web-based version of BI requiring fewer resources is noninferior to in-person administration. METHODS 621 caregivers of children with newly diagnosed cancer were randomly assigned to standard BI delivered face-to-face or a web-based version delivered via mobile device. The primary outcome was caregiver-reported problem-solving skills. The noninferiority margin was defined as 0.2 standard deviation units of the change from baseline to end of intervention. Secondary outcomes included caregiver-reported mood disturbance, depression, and posttraumatic stress symptoms. The study was registered with ClinicalTrials.gov Identifier: NCT01711944. FINDINGS The effect of the standard treatment was preserved; parents in the standard BI arm improved their problem-solving (effect size = 0.53, t = 8.88, p < .001). Parents in the web-based BI group also improved their problem-solving (effect size = 0.32, t = 5.32, p < .001). Although the web-based intervention preserved 60% of the standard treatment effect, the test of noninferiority was non-significant (effect size = -0.21, p = 0.55). Similarly, the web-based intervention preserved > 60% of the standard intervention effect on all secondary outcomes; however, tests of noninferiority were non-significant. INTERPRETATION Noninferiority of web-based BI relative to standard face-to-face administration was not established. Further development of the web-based BI is needed before it can be recommended as a stand-alone intervention. However, the documented benefits of the web-based intervention as well as the advantages of low resource utilization and ease of delivery suggest that further development of web-based BI is indicated, and that it may play a valuable role in alleviating distress in caregivers of children with serious or chronic illness. FUNDING National Institutes of Health (U.S.), R01 CA159013 (P.I. Sahler).
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Affiliation(s)
- Sean Phipps
- Department of Psychology, St. Jude children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105-3678, United States
- Corresponding author.
| | | | - Robert B. Noll
- University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States
| | - Katie A. Devine
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
| | | | - Sasja A. Schepers
- Department of Psychology, St. Jude children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105-3678, United States
| | | | - Nicole M. Schneider
- Baylor College of Medicine/Texas Children's Hospital, Houston, TX, United States
| | - Kathleen Ingman
- Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Megan Voll
- University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States
| | - Ernest R. Katz
- Children's Hospital Los Angeles, Los Angeles, CA, United States
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18
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Nugent BD, Davis PJ, Noll RB, Tersak JM. Sedation practices in pediatric patients with acute lymphoblastic leukemia. Pediatr Blood Cancer 2020; 67:e28037. [PMID: 31625677 DOI: 10.1002/pbc.28037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 07/25/2019] [Revised: 09/20/2019] [Accepted: 09/24/2019] [Indexed: 11/11/2022]
Abstract
BACKGROUND The 5-year survival for pediatric acute lymphoblastic leukemia (ALL) is greater than 90%. One late effect of pediatric ALL associated with numerous long-term difficulties is neurocognitive deficits. The experience at our institution, as well as conversations with oncologists at other institutions, suggests an increase in the use of sedation during lumbar punctures (LPs) for treatment of pediatric ALL. Among the most common Children's Oncology Group (COG) ALL protocols, approximately 30 LPs are performed over 2-3 years. Studies in animals reveal that sedation drugs may harm the developing brain. Gaps in knowledge exist regarding their use in children, particularly repeated exposures. The purpose of this study is to summarize sedation practices for LPs related to the treatment of ALL at COG institutions. METHODS Responsible Individuals (RIs) of the Cancer Control Committee of COG were invited to complete an internet-based survey about sedation practices at their institutions. RESULTS Surveys were sent to 103 RIs with a 62% response rate (N = 64). A combined 2018 new patients with ALL were seen each year (mean = 31.5, range = 3-110) at the participating institutions. The majority (96%) of children with ALL received sedation for LPs. While there was considerable variability across institutions in the type of sedation given, the most common was propofol alone (n = 36, 56%). CONCLUSIONS A substantial number of children with ALL receive sedation for LPs; however, there is variation in the medication used. Better understanding of sedation practices in children with ALL may inform future research to investigate which methods are the safest, with an emphasis on long-term neurocognitive late effects.
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Affiliation(s)
- Bethany D Nugent
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Peter J Davis
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.,UPMC Children's Hospital of Pittsburgh, Department of Anesthesiology, Pittsburgh, Pennsylvania
| | - Robert B Noll
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jean M Tersak
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.,UPMC Children's Hospital of Pittsburgh, Division of Pediatric Hematology/Oncology, Pittsburgh, Pennsylvania
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19
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Devine KA, Willard VW, Hocking MC, Stapleton JL, Rotter D, Bukowski WM, Noll RB. PROMIS Peer Relationships Short Form: How Well Does Self-Report Correlate With Data From Peers? J Pediatr Psychol 2019; 43:1059-1067. [PMID: 29800306 DOI: 10.1093/jpepsy/jsy038] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 05/01/2018] [Indexed: 11/13/2022] Open
Abstract
Objective To examine the psychometric properties of the Patient-Reported Outcomes Measurement Information System (PROMIS®) peer relationships short form (PR-SF), including association with peer-reported friendships, likeability, and social reputation. Method 203 children (Mage = 10.12 years, SD = 2.37, range = 6-14) in Grades 1-8 completed the 8-item PR-SF and friendship nominations, like ratings, and social reputation measures about their peers during 2 classroom visits approximately 4 months apart, as part of a larger study. A confirmatory factor analysis, followed by an exploratory factor analysis, was conducted to examine the factor structure of the PR-SF. Spearman correlations between the PR-SF and peer-reported outcomes evaluated construct validity. Results For the PR-SF, a 2-factor solution demonstrated better fit than a 1-factor solution. The 2 factors appear to assess friendship quality (3 items) and peer acceptance (5 items). Reliability was marginal for the friendship quality factor (.66) but adequate for the acceptance factor (.85); stability was .34 for the PR-SF over 4 months. The PR-SF (8 items) and acceptance factor (5 items) both had modest but significant correlations with measures of friendship (rs = .25-.27), likeability (rs = .21-.22), and social reputation (rs = .29-.44). Conclusions The PR-SF appears to be measuring two distinct aspects of social functioning. The 5-item peer acceptance scale is modestly associated with peer-reported friendship, likeability, and social reputation. Although not a replacement for peer-reported outcomes, the PR-SF is a promising patient-reported outcome for peer relationships in youth.
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Affiliation(s)
- Katie A Devine
- Department of Medicine, Rutgers Cancer Institute of New Jersey; Rutgers, The State University of New Jersey
| | | | - Matthew C Hocking
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania and The Children's Hospital of Philadelphia
| | - Jerod L Stapleton
- Department of Medicine, Rutgers Cancer Institute of New Jersey; Rutgers, The State University of New Jersey
| | - David Rotter
- Department of Medicine, Rutgers Cancer Institute of New Jersey; Rutgers, The State University of New Jersey
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20
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D'Souza AM, Devine KA, Reiter-Purtill J, Gerhardt CA, Vannatta K, Noll RB. Internalizing symptoms in AYA survivors of childhood cancer and matched comparisons. Psychooncology 2019; 28:2009-2016. [PMID: 31325346 DOI: 10.1002/pon.5183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 03/05/2019] [Revised: 07/10/2019] [Accepted: 07/16/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE As the number of pediatric cancer survivors increases, so does our need to understand behavioral late effects. Prior studies show mixed results, with some noting increased emotional distress and psychiatric diagnoses in cancer survivors and others suggesting resilience. The purpose of our study was to evaluate internalizing symptoms such as anxiety and depression in young adult survivors of childhood cancer compared with matched classroom matched peers. METHOD We completed a multisource, cross-sectional examination of internalizing symptoms using a semistructured psychiatric interview with 18-year-olds with a history of pediatric cancer compared with age, race, and gender matched classroom peers who had been identified during the survivor's first year of treatment and their primary caregivers. RESULTS Fifty-seven young adult survivors of childhood cancer and 60 comparison peers participated. There were no significant differences between survivors and their peers on the basis of self- or parent-reported depressive or anxiety symptoms or number of psychiatric diagnoses. CONCLUSIONS Young adult survivors of childhood cancer and their parents did not report increased rates of anxiety or depression compared with their former classroom peers. Despite experiencing a major life challenge, this group of young adults with cancer did not report more current or past symptoms of internalizing psychopathology.
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Affiliation(s)
- Amber M D'Souza
- Cancer and Blood Disease Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Katie A Devine
- Division of Medical Oncology, Rutgers, The State University of New Jersey, New Brunswick, New Jersey
| | - Jennifer Reiter-Purtill
- Department of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Cynthia A Gerhardt
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, The Ohio State University, Columbus, Ohio.,Department of Psychology, The Ohio State University, Columbus, Ohio
| | - Kathryn Vannatta
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, The Ohio State University, Columbus, Ohio.,Department of Psychology, The Ohio State University, Columbus, Ohio
| | - Robert B Noll
- Department of Pediatrics, Division of Neurology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
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21
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Seelisch J, Sung L, Kelly MJ, Raybin JL, Beauchemin M, Dvorak CC, Kelly KP, Nieder ML, Noll RB, Thackray J, Ullrich NJ, Cabral S, Dupuis LL, Robinson PD. Identifying clinical practice guidelines for the supportive care of children with cancer: A report from the Children's Oncology Group. Pediatr Blood Cancer 2019; 66:e27471. [PMID: 30259647 PMCID: PMC6249051 DOI: 10.1002/pbc.27471] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 08/22/2018] [Accepted: 09/04/2018] [Indexed: 11/08/2022]
Abstract
Providing evidence-based supportive care for children with cancer has the potential to optimize treatment outcomes and improve quality of life. The Children's Oncology Group (COG) Supportive Care Guidelines Subcommittee conducted a systematic review to identify current supportive care clinical practice guidelines (CPGs) relevant to childhood cancer or pediatric hematopoietic stem cell transplant. Only 22 papers met the 2011 Institute of Medicine criteria to be considered a CPG. The results highlight the paucity of CPGs available to pediatric oncology healthcare professionals and the pressing need to create CPGs using current methodological standards.
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Affiliation(s)
- Jennifer Seelisch
- Pediatric Oncology Group of Ontario, Toronto, ON
- Division of Hematology/Oncology, Children’s Hospital, London Health Sciences Centre, London, ON
| | - Lillian Sung
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON
| | - Michael J. Kelly
- Pediatric Hematology Oncology, The Floating Hospital for Children at Tufts Medical Center, Boston, MA
| | - Jennifer L. Raybin
- Children’s Hospital Colorado, University of Colorado, School of Medicine, Aurora, CO
| | - Melissa Beauchemin
- CUMC Minority Underserved NCI Community Oncology, Research Program Columbia University Medical Center, New York, NY
| | - Christopher C. Dvorak
- Division of Pediatric Allergy, Immunology & Bone Marrow Transplantation Benioff Children’s Hospital, University of California, San Francisco, CA
| | - Katherine Patterson Kelly
- Department of Nursing Science, Professional Practice, and Quality Children’s National Health System, George Washington University School of Medicine and Health Sciences Washington, DC
| | - Michael L. Nieder
- Department of Blood & Marrow Transplantation and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL
- University of South Florida Morsani College of Medicine, Tampa, FL
| | - Robert B. Noll
- Department of Pediatrics University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Jennifer Thackray
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nicole J. Ullrich
- Dana Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, MA
| | | | - L. Lee Dupuis
- These authors share senior authorship
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON
- Department of Pharmacy, The Hospital for Sick Children; Leslie Dan Faculty of Pharmacy, University of Toronto, The Hospital for Sick Children, Toronto, ON
| | - Paula D. Robinson
- These authors share senior authorship
- Pediatric Oncology Group of Ontario, Toronto, ON
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22
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Shin JY, Kang TI, Noll RB, Choi SW. Supporting Caregivers of Patients With Cancer: A Summary of Technology-Mediated Interventions and Future Directions. Am Soc Clin Oncol Educ Book 2018; 38:838-849. [PMID: 30231412 DOI: 10.1200/edbk_201397] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This paper aims to review literature published on the support of cancer caregivers with health technology. Eighteen articles were reviewed to better understand cancer caregiving and categorized into four different themes: (1) design guidelines, (2) information facilitation, (3) social support, and (4) multicomponent interventions. Analysis of the current articles revealed that there are substantial gaps in knowledge regarding a range of health technologies that facilitate family caregiver support and its distribution to health institutions. Further research is needed in this area, as family caregivers are primary providers of essential elements of care to patients. Future studies should unpack existing barriers that interfere with the development of health technology interventions in cancer care.
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Affiliation(s)
- Ji Youn Shin
- From the University of Michigan, Ann Arbor, MI; Texas Children's Hospital, Baylor College of Medicine, Houston, TX; Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Tammy I Kang
- From the University of Michigan, Ann Arbor, MI; Texas Children's Hospital, Baylor College of Medicine, Houston, TX; Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Robert B Noll
- From the University of Michigan, Ann Arbor, MI; Texas Children's Hospital, Baylor College of Medicine, Houston, TX; Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Sung Won Choi
- From the University of Michigan, Ann Arbor, MI; Texas Children's Hospital, Baylor College of Medicine, Houston, TX; Children's Hospital of Pittsburgh, Pittsburgh, PA
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23
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Affiliation(s)
- Lori Wiener
- Department of Pediatric Oncology, NCI,
Bethesda,Maryland
| | - Robert B. Noll
- Department of Pediatrics, Children’s Hospital of
Pittsburgh, Pittsburgh, Pennsylvania
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24
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Saoji N, Baran J, Gerhardt CA, Vannatta K, Rotter D, Trauth JM, Noll RB. The Psychometrics of the Children’s Depression Inventory When Used With Children Who Are Chronically Ill and Matched Community Comparison Peers. Journal of Psychoeducational Assessment 2018. [DOI: 10.1177/0734282918774963] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The Children’s Depression Inventory (CDI) is used to screen for depression in children aged 7 years to 16 years. The purpose of this study is to examine the psychometrics of the CDI in a sample of children who are chronically ill ( N = 350) and in a sample of matched community comparison peers ( N = 357), and determine if the psychometrics of the scale are similar in both groups. Data were aggregated from previous reports examining social and emotional functioning of children with six chronic diseases and matched comparisons. The CDI was completed in the homes of all participants. No significant differences between groups on CDI scores, distributions, reliability, or validity were observed. Findings suggest that the psychometrics of the CDI are similar for children with chronic diseases compared with typically developing children. The CDI may be an effective screening tool for use with children who have chronic health conditions.
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Affiliation(s)
| | | | - Cynthia A. Gerhardt
- The Ohio State University, Columbus, OH, USA
- Nationwide Children’s Hospital, Columbus, OH, USA
| | - Kathryn Vannatta
- The Ohio State University, Columbus, OH, USA
- Nationwide Children’s Hospital, Columbus, OH, USA
| | - David Rotter
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
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25
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Hardy KK, Embry LM, Kairalla JA, Helian S, Devidas M, Armstrong FD, Hunger S, Carroll WL, Larsen E, Raetz EA, Loh ML, Yang W, Relling MV, Noll RB, Winick N. Reply to I.J. Cohen. J Clin Oncol 2017; 35:3989-3991. [DOI: 10.1200/jco.2017.75.7252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Kristina K. Hardy
- Kristina K. Hardy, Children’s National Medical Center, Washington, DC; Leanne M. Embry, University of Texas at San Antonio, San Antonio, TX; John A. Kairalla, University of Florida, Gainesville, FL; Shanjun Helian, Merck, Upper Gwynedd, PA; Meenakshi Devidas, University of Florida, Gainesville, FL; F. Daniel Armstrong, University of Miami, Miami, FL; Stephen Hunger, Children’s Hospital of Philadelphia, Philadelphia, PA; William L. Carroll, New York University, New York, NY; Eric Larsen, Maine Children’s
| | - Leanne M. Embry
- Kristina K. Hardy, Children’s National Medical Center, Washington, DC; Leanne M. Embry, University of Texas at San Antonio, San Antonio, TX; John A. Kairalla, University of Florida, Gainesville, FL; Shanjun Helian, Merck, Upper Gwynedd, PA; Meenakshi Devidas, University of Florida, Gainesville, FL; F. Daniel Armstrong, University of Miami, Miami, FL; Stephen Hunger, Children’s Hospital of Philadelphia, Philadelphia, PA; William L. Carroll, New York University, New York, NY; Eric Larsen, Maine Children’s
| | - John A. Kairalla
- Kristina K. Hardy, Children’s National Medical Center, Washington, DC; Leanne M. Embry, University of Texas at San Antonio, San Antonio, TX; John A. Kairalla, University of Florida, Gainesville, FL; Shanjun Helian, Merck, Upper Gwynedd, PA; Meenakshi Devidas, University of Florida, Gainesville, FL; F. Daniel Armstrong, University of Miami, Miami, FL; Stephen Hunger, Children’s Hospital of Philadelphia, Philadelphia, PA; William L. Carroll, New York University, New York, NY; Eric Larsen, Maine Children’s
| | - Shanjun Helian
- Kristina K. Hardy, Children’s National Medical Center, Washington, DC; Leanne M. Embry, University of Texas at San Antonio, San Antonio, TX; John A. Kairalla, University of Florida, Gainesville, FL; Shanjun Helian, Merck, Upper Gwynedd, PA; Meenakshi Devidas, University of Florida, Gainesville, FL; F. Daniel Armstrong, University of Miami, Miami, FL; Stephen Hunger, Children’s Hospital of Philadelphia, Philadelphia, PA; William L. Carroll, New York University, New York, NY; Eric Larsen, Maine Children’s
| | - Meenakshi Devidas
- Kristina K. Hardy, Children’s National Medical Center, Washington, DC; Leanne M. Embry, University of Texas at San Antonio, San Antonio, TX; John A. Kairalla, University of Florida, Gainesville, FL; Shanjun Helian, Merck, Upper Gwynedd, PA; Meenakshi Devidas, University of Florida, Gainesville, FL; F. Daniel Armstrong, University of Miami, Miami, FL; Stephen Hunger, Children’s Hospital of Philadelphia, Philadelphia, PA; William L. Carroll, New York University, New York, NY; Eric Larsen, Maine Children’s
| | - F. Daniel Armstrong
- Kristina K. Hardy, Children’s National Medical Center, Washington, DC; Leanne M. Embry, University of Texas at San Antonio, San Antonio, TX; John A. Kairalla, University of Florida, Gainesville, FL; Shanjun Helian, Merck, Upper Gwynedd, PA; Meenakshi Devidas, University of Florida, Gainesville, FL; F. Daniel Armstrong, University of Miami, Miami, FL; Stephen Hunger, Children’s Hospital of Philadelphia, Philadelphia, PA; William L. Carroll, New York University, New York, NY; Eric Larsen, Maine Children’s
| | - Stephen Hunger
- Kristina K. Hardy, Children’s National Medical Center, Washington, DC; Leanne M. Embry, University of Texas at San Antonio, San Antonio, TX; John A. Kairalla, University of Florida, Gainesville, FL; Shanjun Helian, Merck, Upper Gwynedd, PA; Meenakshi Devidas, University of Florida, Gainesville, FL; F. Daniel Armstrong, University of Miami, Miami, FL; Stephen Hunger, Children’s Hospital of Philadelphia, Philadelphia, PA; William L. Carroll, New York University, New York, NY; Eric Larsen, Maine Children’s
| | - William L. Carroll
- Kristina K. Hardy, Children’s National Medical Center, Washington, DC; Leanne M. Embry, University of Texas at San Antonio, San Antonio, TX; John A. Kairalla, University of Florida, Gainesville, FL; Shanjun Helian, Merck, Upper Gwynedd, PA; Meenakshi Devidas, University of Florida, Gainesville, FL; F. Daniel Armstrong, University of Miami, Miami, FL; Stephen Hunger, Children’s Hospital of Philadelphia, Philadelphia, PA; William L. Carroll, New York University, New York, NY; Eric Larsen, Maine Children’s
| | - Eric Larsen
- Kristina K. Hardy, Children’s National Medical Center, Washington, DC; Leanne M. Embry, University of Texas at San Antonio, San Antonio, TX; John A. Kairalla, University of Florida, Gainesville, FL; Shanjun Helian, Merck, Upper Gwynedd, PA; Meenakshi Devidas, University of Florida, Gainesville, FL; F. Daniel Armstrong, University of Miami, Miami, FL; Stephen Hunger, Children’s Hospital of Philadelphia, Philadelphia, PA; William L. Carroll, New York University, New York, NY; Eric Larsen, Maine Children’s
| | - Elizabeth A. Raetz
- Kristina K. Hardy, Children’s National Medical Center, Washington, DC; Leanne M. Embry, University of Texas at San Antonio, San Antonio, TX; John A. Kairalla, University of Florida, Gainesville, FL; Shanjun Helian, Merck, Upper Gwynedd, PA; Meenakshi Devidas, University of Florida, Gainesville, FL; F. Daniel Armstrong, University of Miami, Miami, FL; Stephen Hunger, Children’s Hospital of Philadelphia, Philadelphia, PA; William L. Carroll, New York University, New York, NY; Eric Larsen, Maine Children’s
| | - Mignon L. Loh
- Kristina K. Hardy, Children’s National Medical Center, Washington, DC; Leanne M. Embry, University of Texas at San Antonio, San Antonio, TX; John A. Kairalla, University of Florida, Gainesville, FL; Shanjun Helian, Merck, Upper Gwynedd, PA; Meenakshi Devidas, University of Florida, Gainesville, FL; F. Daniel Armstrong, University of Miami, Miami, FL; Stephen Hunger, Children’s Hospital of Philadelphia, Philadelphia, PA; William L. Carroll, New York University, New York, NY; Eric Larsen, Maine Children’s
| | - Wenjian Yang
- Kristina K. Hardy, Children’s National Medical Center, Washington, DC; Leanne M. Embry, University of Texas at San Antonio, San Antonio, TX; John A. Kairalla, University of Florida, Gainesville, FL; Shanjun Helian, Merck, Upper Gwynedd, PA; Meenakshi Devidas, University of Florida, Gainesville, FL; F. Daniel Armstrong, University of Miami, Miami, FL; Stephen Hunger, Children’s Hospital of Philadelphia, Philadelphia, PA; William L. Carroll, New York University, New York, NY; Eric Larsen, Maine Children’s
| | - Mary V. Relling
- Kristina K. Hardy, Children’s National Medical Center, Washington, DC; Leanne M. Embry, University of Texas at San Antonio, San Antonio, TX; John A. Kairalla, University of Florida, Gainesville, FL; Shanjun Helian, Merck, Upper Gwynedd, PA; Meenakshi Devidas, University of Florida, Gainesville, FL; F. Daniel Armstrong, University of Miami, Miami, FL; Stephen Hunger, Children’s Hospital of Philadelphia, Philadelphia, PA; William L. Carroll, New York University, New York, NY; Eric Larsen, Maine Children’s
| | - Robert B. Noll
- Kristina K. Hardy, Children’s National Medical Center, Washington, DC; Leanne M. Embry, University of Texas at San Antonio, San Antonio, TX; John A. Kairalla, University of Florida, Gainesville, FL; Shanjun Helian, Merck, Upper Gwynedd, PA; Meenakshi Devidas, University of Florida, Gainesville, FL; F. Daniel Armstrong, University of Miami, Miami, FL; Stephen Hunger, Children’s Hospital of Philadelphia, Philadelphia, PA; William L. Carroll, New York University, New York, NY; Eric Larsen, Maine Children’s
| | - Naomi Winick
- Kristina K. Hardy, Children’s National Medical Center, Washington, DC; Leanne M. Embry, University of Texas at San Antonio, San Antonio, TX; John A. Kairalla, University of Florida, Gainesville, FL; Shanjun Helian, Merck, Upper Gwynedd, PA; Meenakshi Devidas, University of Florida, Gainesville, FL; F. Daniel Armstrong, University of Miami, Miami, FL; Stephen Hunger, Children’s Hospital of Philadelphia, Philadelphia, PA; William L. Carroll, New York University, New York, NY; Eric Larsen, Maine Children’s
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26
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Hardy KK, Embry L, Kairalla JA, Helian S, Devidas M, Armstrong D, Hunger S, Carroll WL, Larsen E, Raetz EA, Loh ML, Yang W, Relling MV, Noll RB, Winick N. Neurocognitive Functioning of Children Treated for High-Risk B-Acute Lymphoblastic Leukemia Randomly Assigned to Different Methotrexate and Corticosteroid Treatment Strategies: A Report From the Children's Oncology Group. J Clin Oncol 2017; 35:2700-2707. [PMID: 28671857 DOI: 10.1200/jco.2016.71.7587] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Survivors of childhood acute lymphoblastic leukemia (ALL) are at risk for neurocognitive deficits that are associated with treatment, individual, and environmental factors. This study examined the impact of different methotrexate (MTX) and corticosteroid treatment strategies on neurocognitive functioning in children with high-risk B-lineage ALL. Methods Participants were randomly assigned to receive high-dose MTX with leucovorin rescue or escalating dose MTX with PEG asparaginase without leucovorin rescue. Patients were also randomly assigned to corticosteroid therapy that included either dexamethasone or prednisone. A neurocognitive evaluation of intellectual functioning (IQ), working memory, and processing speed (PS) was conducted 8 to 24 months after treatment completion (n = 192). Results The method of MTX delivery and corticosteroid assignment were unrelated to differences in neurocognitive outcomes after controlling for ethnicity, race, age, gender, insurance status, and time off treatment; however, survivors who were age < 10 years at diagnosis (n = 89) had significantly lower estimated IQ ( P < .001) and PS scores ( P = .02) compared with participants age ≥ 10 years. In addition, participants who were covered by US public health insurance had estimated IQs that were significantly lower ( P < .001) than those with US private or military insurance. Conclusion Children with high-risk B-lineage ALL who were age < 10 years at diagnosis are at risk for deficits in IQ and PS in the absence of cranial radiation, regardless of MTX delivery or corticosteroid type. These data may serve as a basis for developing screening protocols to identify children who are at high risk for deficits so that early intervention can be initiated to mitigate the impact of therapy on neurocognitive outcomes.
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Affiliation(s)
- Kristina K Hardy
- Kristina K. Hardy, Children's National Medical Center, Washington, DC; Leanne Embry, The University of Texas Health Science Center at San Antonio, San Antonio; Naomi Winick, University of Texas Southwestern Medical Center, Dallas, TX; John A. Kairalla and Meenakshi Devidas, Colleges of Medicine, Public Health and Health Professions, University of Florida, Gainesville; Daniel Armstrong, University of Miami, Sylvester Comprehensive Cancer Center, Miami, FL; Shanjun Helian, Merck, Upper Gwynedd; Stephen Hunger, Children's Hospital of Philadelphia, Philadelphia; Robert B. Noll, University of Pittsburgh School of Medicine, Pittsburgh, PA; William L. Carroll, New York University Medical Center, New York, NY; Eric Larsen, Maine Children's Cancer Program, Scarborough, ME; Elizabeth A. Raetz, University of Utah, Salt Lake City, UT; Mignon L. Loh, University of California, San Francisco, San Francisco, CA; and Wenjian Yang and Mary V. Relling, St Jude Children's Research Hospital; University of Tennessee Health Science Center, Memphis, TN
| | - Leanne Embry
- Kristina K. Hardy, Children's National Medical Center, Washington, DC; Leanne Embry, The University of Texas Health Science Center at San Antonio, San Antonio; Naomi Winick, University of Texas Southwestern Medical Center, Dallas, TX; John A. Kairalla and Meenakshi Devidas, Colleges of Medicine, Public Health and Health Professions, University of Florida, Gainesville; Daniel Armstrong, University of Miami, Sylvester Comprehensive Cancer Center, Miami, FL; Shanjun Helian, Merck, Upper Gwynedd; Stephen Hunger, Children's Hospital of Philadelphia, Philadelphia; Robert B. Noll, University of Pittsburgh School of Medicine, Pittsburgh, PA; William L. Carroll, New York University Medical Center, New York, NY; Eric Larsen, Maine Children's Cancer Program, Scarborough, ME; Elizabeth A. Raetz, University of Utah, Salt Lake City, UT; Mignon L. Loh, University of California, San Francisco, San Francisco, CA; and Wenjian Yang and Mary V. Relling, St Jude Children's Research Hospital; University of Tennessee Health Science Center, Memphis, TN
| | - John A Kairalla
- Kristina K. Hardy, Children's National Medical Center, Washington, DC; Leanne Embry, The University of Texas Health Science Center at San Antonio, San Antonio; Naomi Winick, University of Texas Southwestern Medical Center, Dallas, TX; John A. Kairalla and Meenakshi Devidas, Colleges of Medicine, Public Health and Health Professions, University of Florida, Gainesville; Daniel Armstrong, University of Miami, Sylvester Comprehensive Cancer Center, Miami, FL; Shanjun Helian, Merck, Upper Gwynedd; Stephen Hunger, Children's Hospital of Philadelphia, Philadelphia; Robert B. Noll, University of Pittsburgh School of Medicine, Pittsburgh, PA; William L. Carroll, New York University Medical Center, New York, NY; Eric Larsen, Maine Children's Cancer Program, Scarborough, ME; Elizabeth A. Raetz, University of Utah, Salt Lake City, UT; Mignon L. Loh, University of California, San Francisco, San Francisco, CA; and Wenjian Yang and Mary V. Relling, St Jude Children's Research Hospital; University of Tennessee Health Science Center, Memphis, TN
| | - Shanjun Helian
- Kristina K. Hardy, Children's National Medical Center, Washington, DC; Leanne Embry, The University of Texas Health Science Center at San Antonio, San Antonio; Naomi Winick, University of Texas Southwestern Medical Center, Dallas, TX; John A. Kairalla and Meenakshi Devidas, Colleges of Medicine, Public Health and Health Professions, University of Florida, Gainesville; Daniel Armstrong, University of Miami, Sylvester Comprehensive Cancer Center, Miami, FL; Shanjun Helian, Merck, Upper Gwynedd; Stephen Hunger, Children's Hospital of Philadelphia, Philadelphia; Robert B. Noll, University of Pittsburgh School of Medicine, Pittsburgh, PA; William L. Carroll, New York University Medical Center, New York, NY; Eric Larsen, Maine Children's Cancer Program, Scarborough, ME; Elizabeth A. Raetz, University of Utah, Salt Lake City, UT; Mignon L. Loh, University of California, San Francisco, San Francisco, CA; and Wenjian Yang and Mary V. Relling, St Jude Children's Research Hospital; University of Tennessee Health Science Center, Memphis, TN
| | - Meenakshi Devidas
- Kristina K. Hardy, Children's National Medical Center, Washington, DC; Leanne Embry, The University of Texas Health Science Center at San Antonio, San Antonio; Naomi Winick, University of Texas Southwestern Medical Center, Dallas, TX; John A. Kairalla and Meenakshi Devidas, Colleges of Medicine, Public Health and Health Professions, University of Florida, Gainesville; Daniel Armstrong, University of Miami, Sylvester Comprehensive Cancer Center, Miami, FL; Shanjun Helian, Merck, Upper Gwynedd; Stephen Hunger, Children's Hospital of Philadelphia, Philadelphia; Robert B. Noll, University of Pittsburgh School of Medicine, Pittsburgh, PA; William L. Carroll, New York University Medical Center, New York, NY; Eric Larsen, Maine Children's Cancer Program, Scarborough, ME; Elizabeth A. Raetz, University of Utah, Salt Lake City, UT; Mignon L. Loh, University of California, San Francisco, San Francisco, CA; and Wenjian Yang and Mary V. Relling, St Jude Children's Research Hospital; University of Tennessee Health Science Center, Memphis, TN
| | - Daniel Armstrong
- Kristina K. Hardy, Children's National Medical Center, Washington, DC; Leanne Embry, The University of Texas Health Science Center at San Antonio, San Antonio; Naomi Winick, University of Texas Southwestern Medical Center, Dallas, TX; John A. Kairalla and Meenakshi Devidas, Colleges of Medicine, Public Health and Health Professions, University of Florida, Gainesville; Daniel Armstrong, University of Miami, Sylvester Comprehensive Cancer Center, Miami, FL; Shanjun Helian, Merck, Upper Gwynedd; Stephen Hunger, Children's Hospital of Philadelphia, Philadelphia; Robert B. Noll, University of Pittsburgh School of Medicine, Pittsburgh, PA; William L. Carroll, New York University Medical Center, New York, NY; Eric Larsen, Maine Children's Cancer Program, Scarborough, ME; Elizabeth A. Raetz, University of Utah, Salt Lake City, UT; Mignon L. Loh, University of California, San Francisco, San Francisco, CA; and Wenjian Yang and Mary V. Relling, St Jude Children's Research Hospital; University of Tennessee Health Science Center, Memphis, TN
| | - Stephen Hunger
- Kristina K. Hardy, Children's National Medical Center, Washington, DC; Leanne Embry, The University of Texas Health Science Center at San Antonio, San Antonio; Naomi Winick, University of Texas Southwestern Medical Center, Dallas, TX; John A. Kairalla and Meenakshi Devidas, Colleges of Medicine, Public Health and Health Professions, University of Florida, Gainesville; Daniel Armstrong, University of Miami, Sylvester Comprehensive Cancer Center, Miami, FL; Shanjun Helian, Merck, Upper Gwynedd; Stephen Hunger, Children's Hospital of Philadelphia, Philadelphia; Robert B. Noll, University of Pittsburgh School of Medicine, Pittsburgh, PA; William L. Carroll, New York University Medical Center, New York, NY; Eric Larsen, Maine Children's Cancer Program, Scarborough, ME; Elizabeth A. Raetz, University of Utah, Salt Lake City, UT; Mignon L. Loh, University of California, San Francisco, San Francisco, CA; and Wenjian Yang and Mary V. Relling, St Jude Children's Research Hospital; University of Tennessee Health Science Center, Memphis, TN
| | - William L Carroll
- Kristina K. Hardy, Children's National Medical Center, Washington, DC; Leanne Embry, The University of Texas Health Science Center at San Antonio, San Antonio; Naomi Winick, University of Texas Southwestern Medical Center, Dallas, TX; John A. Kairalla and Meenakshi Devidas, Colleges of Medicine, Public Health and Health Professions, University of Florida, Gainesville; Daniel Armstrong, University of Miami, Sylvester Comprehensive Cancer Center, Miami, FL; Shanjun Helian, Merck, Upper Gwynedd; Stephen Hunger, Children's Hospital of Philadelphia, Philadelphia; Robert B. Noll, University of Pittsburgh School of Medicine, Pittsburgh, PA; William L. Carroll, New York University Medical Center, New York, NY; Eric Larsen, Maine Children's Cancer Program, Scarborough, ME; Elizabeth A. Raetz, University of Utah, Salt Lake City, UT; Mignon L. Loh, University of California, San Francisco, San Francisco, CA; and Wenjian Yang and Mary V. Relling, St Jude Children's Research Hospital; University of Tennessee Health Science Center, Memphis, TN
| | - Eric Larsen
- Kristina K. Hardy, Children's National Medical Center, Washington, DC; Leanne Embry, The University of Texas Health Science Center at San Antonio, San Antonio; Naomi Winick, University of Texas Southwestern Medical Center, Dallas, TX; John A. Kairalla and Meenakshi Devidas, Colleges of Medicine, Public Health and Health Professions, University of Florida, Gainesville; Daniel Armstrong, University of Miami, Sylvester Comprehensive Cancer Center, Miami, FL; Shanjun Helian, Merck, Upper Gwynedd; Stephen Hunger, Children's Hospital of Philadelphia, Philadelphia; Robert B. Noll, University of Pittsburgh School of Medicine, Pittsburgh, PA; William L. Carroll, New York University Medical Center, New York, NY; Eric Larsen, Maine Children's Cancer Program, Scarborough, ME; Elizabeth A. Raetz, University of Utah, Salt Lake City, UT; Mignon L. Loh, University of California, San Francisco, San Francisco, CA; and Wenjian Yang and Mary V. Relling, St Jude Children's Research Hospital; University of Tennessee Health Science Center, Memphis, TN
| | - Elizabeth A Raetz
- Kristina K. Hardy, Children's National Medical Center, Washington, DC; Leanne Embry, The University of Texas Health Science Center at San Antonio, San Antonio; Naomi Winick, University of Texas Southwestern Medical Center, Dallas, TX; John A. Kairalla and Meenakshi Devidas, Colleges of Medicine, Public Health and Health Professions, University of Florida, Gainesville; Daniel Armstrong, University of Miami, Sylvester Comprehensive Cancer Center, Miami, FL; Shanjun Helian, Merck, Upper Gwynedd; Stephen Hunger, Children's Hospital of Philadelphia, Philadelphia; Robert B. Noll, University of Pittsburgh School of Medicine, Pittsburgh, PA; William L. Carroll, New York University Medical Center, New York, NY; Eric Larsen, Maine Children's Cancer Program, Scarborough, ME; Elizabeth A. Raetz, University of Utah, Salt Lake City, UT; Mignon L. Loh, University of California, San Francisco, San Francisco, CA; and Wenjian Yang and Mary V. Relling, St Jude Children's Research Hospital; University of Tennessee Health Science Center, Memphis, TN
| | - Mignon L Loh
- Kristina K. Hardy, Children's National Medical Center, Washington, DC; Leanne Embry, The University of Texas Health Science Center at San Antonio, San Antonio; Naomi Winick, University of Texas Southwestern Medical Center, Dallas, TX; John A. Kairalla and Meenakshi Devidas, Colleges of Medicine, Public Health and Health Professions, University of Florida, Gainesville; Daniel Armstrong, University of Miami, Sylvester Comprehensive Cancer Center, Miami, FL; Shanjun Helian, Merck, Upper Gwynedd; Stephen Hunger, Children's Hospital of Philadelphia, Philadelphia; Robert B. Noll, University of Pittsburgh School of Medicine, Pittsburgh, PA; William L. Carroll, New York University Medical Center, New York, NY; Eric Larsen, Maine Children's Cancer Program, Scarborough, ME; Elizabeth A. Raetz, University of Utah, Salt Lake City, UT; Mignon L. Loh, University of California, San Francisco, San Francisco, CA; and Wenjian Yang and Mary V. Relling, St Jude Children's Research Hospital; University of Tennessee Health Science Center, Memphis, TN
| | - Wenjian Yang
- Kristina K. Hardy, Children's National Medical Center, Washington, DC; Leanne Embry, The University of Texas Health Science Center at San Antonio, San Antonio; Naomi Winick, University of Texas Southwestern Medical Center, Dallas, TX; John A. Kairalla and Meenakshi Devidas, Colleges of Medicine, Public Health and Health Professions, University of Florida, Gainesville; Daniel Armstrong, University of Miami, Sylvester Comprehensive Cancer Center, Miami, FL; Shanjun Helian, Merck, Upper Gwynedd; Stephen Hunger, Children's Hospital of Philadelphia, Philadelphia; Robert B. Noll, University of Pittsburgh School of Medicine, Pittsburgh, PA; William L. Carroll, New York University Medical Center, New York, NY; Eric Larsen, Maine Children's Cancer Program, Scarborough, ME; Elizabeth A. Raetz, University of Utah, Salt Lake City, UT; Mignon L. Loh, University of California, San Francisco, San Francisco, CA; and Wenjian Yang and Mary V. Relling, St Jude Children's Research Hospital; University of Tennessee Health Science Center, Memphis, TN
| | - Mary V Relling
- Kristina K. Hardy, Children's National Medical Center, Washington, DC; Leanne Embry, The University of Texas Health Science Center at San Antonio, San Antonio; Naomi Winick, University of Texas Southwestern Medical Center, Dallas, TX; John A. Kairalla and Meenakshi Devidas, Colleges of Medicine, Public Health and Health Professions, University of Florida, Gainesville; Daniel Armstrong, University of Miami, Sylvester Comprehensive Cancer Center, Miami, FL; Shanjun Helian, Merck, Upper Gwynedd; Stephen Hunger, Children's Hospital of Philadelphia, Philadelphia; Robert B. Noll, University of Pittsburgh School of Medicine, Pittsburgh, PA; William L. Carroll, New York University Medical Center, New York, NY; Eric Larsen, Maine Children's Cancer Program, Scarborough, ME; Elizabeth A. Raetz, University of Utah, Salt Lake City, UT; Mignon L. Loh, University of California, San Francisco, San Francisco, CA; and Wenjian Yang and Mary V. Relling, St Jude Children's Research Hospital; University of Tennessee Health Science Center, Memphis, TN
| | - Robert B Noll
- Kristina K. Hardy, Children's National Medical Center, Washington, DC; Leanne Embry, The University of Texas Health Science Center at San Antonio, San Antonio; Naomi Winick, University of Texas Southwestern Medical Center, Dallas, TX; John A. Kairalla and Meenakshi Devidas, Colleges of Medicine, Public Health and Health Professions, University of Florida, Gainesville; Daniel Armstrong, University of Miami, Sylvester Comprehensive Cancer Center, Miami, FL; Shanjun Helian, Merck, Upper Gwynedd; Stephen Hunger, Children's Hospital of Philadelphia, Philadelphia; Robert B. Noll, University of Pittsburgh School of Medicine, Pittsburgh, PA; William L. Carroll, New York University Medical Center, New York, NY; Eric Larsen, Maine Children's Cancer Program, Scarborough, ME; Elizabeth A. Raetz, University of Utah, Salt Lake City, UT; Mignon L. Loh, University of California, San Francisco, San Francisco, CA; and Wenjian Yang and Mary V. Relling, St Jude Children's Research Hospital; University of Tennessee Health Science Center, Memphis, TN
| | - Naomi Winick
- Kristina K. Hardy, Children's National Medical Center, Washington, DC; Leanne Embry, The University of Texas Health Science Center at San Antonio, San Antonio; Naomi Winick, University of Texas Southwestern Medical Center, Dallas, TX; John A. Kairalla and Meenakshi Devidas, Colleges of Medicine, Public Health and Health Professions, University of Florida, Gainesville; Daniel Armstrong, University of Miami, Sylvester Comprehensive Cancer Center, Miami, FL; Shanjun Helian, Merck, Upper Gwynedd; Stephen Hunger, Children's Hospital of Philadelphia, Philadelphia; Robert B. Noll, University of Pittsburgh School of Medicine, Pittsburgh, PA; William L. Carroll, New York University Medical Center, New York, NY; Eric Larsen, Maine Children's Cancer Program, Scarborough, ME; Elizabeth A. Raetz, University of Utah, Salt Lake City, UT; Mignon L. Loh, University of California, San Francisco, San Francisco, CA; and Wenjian Yang and Mary V. Relling, St Jude Children's Research Hospital; University of Tennessee Health Science Center, Memphis, TN
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Nelson A, Challinor J, Moore I, Noll RB, White NC, O'Neill JB, Clarke-Steffen L. Consensus Statements: Development and Testing of the School Competency Assessment Scale. J Pediatr Oncol Nurs 2016. [DOI: 10.1053/jpon.2003.28] [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: 11/11/2022] Open
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Oluwole OB, Noll RB, Winger DG, Akinyanju O, Novelli EM. Cognitive functioning in children from Nigeria with sickle cell anemia. Pediatr Blood Cancer 2016; 63:1990-7. [PMID: 27393914 PMCID: PMC7134368 DOI: 10.1002/pbc.26126] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 10/21/2015] [Revised: 05/31/2016] [Accepted: 06/10/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Cognitive impairment is a major neurological complication of sickle cell anemia (SCA) in the United States, but there are limited studies of cognitive impairment in Nigeria, the country with the highest SCA burden. We hypothesized that children from Nigeria with SCA have worse cognitive functioning than comparison children and explored the association between lower cognitive functioning and key laboratory demographic and socioeconomic variables among children with SCA. PROCEDURE We conducted a cross-sectional survey, supplemented by anthropomorphic and laboratory data, among a convenience sample of children from Nigeria with and without SCA. We administered the Wechsler Intelligence Scale for Children, Version IV. Our primary outcome measures included (1) estimated IQ (Est. IQ), (2) working memory (WM), and (3) processing speed (PS). RESULTS The sample included 56 children with SCA (mean age 9.20 [SD 2.75], 46.43% girls) and 44 comparison children (mean age 9.41 [SD 2.49], 40.91% girls). Children with SCA performed worse on Est. IQ (84.58 vs. 96.10, P = 0.006) and PS (86.69 vs 96.91, P = 0.009) than comparison children. There was no significant difference in WM between both groups. Factors associated with lower Est. IQ and PS among children with SCA included age, maternal education, weight-for-age Z scores, and height-for age Z scores. CONCLUSION In this small sample of children from Nigeria, we found worse cognitive functioning in children with SCA than in comparison children, and that sociodemographic and anthropomorphic factors were correlated with cognitive functioning.
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Affiliation(s)
| | - Robert B. Noll
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Daniel G. Winger
- Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Enrico M. Novelli
- Division of Hematology/Oncology, Department of Medicine, Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
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29
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Walsh KS, Noll RB, Annett RD, Patel SK, Patenaude AF, Embry L. Standard of Care for Neuropsychological Monitoring in Pediatric Neuro-Oncology: Lessons From the Children's Oncology Group (COG). Pediatr Blood Cancer 2016; 63:191-5. [PMID: 26451963 PMCID: PMC5222571 DOI: 10.1002/pbc.25759] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [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: 03/17/2015] [Accepted: 08/27/2015] [Indexed: 11/10/2022]
Abstract
As the mortality of pediatric cancers has decreased, focus on neuropsychological morbidities of treatment sequelae have increased. Neuropsychological evaluations are essential diagnostic tools that assess cognitive functioning and neurobiological integrity. These tests provide vital information to support ongoing medical care, documenting cognitive morbidity and response to interventions. We frame standards for neuropsychological monitoring of pediatric patients with CNS malignancy or who received cancer-directed therapies involving the CNS and discuss billing for these services in the United States in the context of clinical research. We describe a cost-effective, efficient model of neuropsychological monitoring that may increases access to neuropsychological care.
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Affiliation(s)
- KS Walsh
- Children’s National Health System & The George Washington University School of Medicine, Washington, DC
| | - RB Noll
- University of Pittsburgh, Pittsburgh, PA
| | - RD Annett
- University of Colorado Denver; Children’s Hospital of Colorado
| | - SK Patel
- City of Hope Medical Center, Duarte, California
| | - AF Patenaude
- Dana-Farber Cancer Institute, Harvard Medical School, Boston MA
| | - L Embry
- University of Texas Health Science Center at San Antonio, San Antonio, TX
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Wiener L, Kazak AE, Noll RB, Patenaude AF, Kupst MJ. Interdisciplinary Collaboration in Standards of Psychosocial Care. Pediatr Blood Cancer 2015; 62 Suppl 5:S425. [PMID: 26700915 PMCID: PMC5191472 DOI: 10.1002/pbc.25718] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 07/28/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Lori Wiener
- Pediatric Oncology Branch, National Cancer Institute, Center for Cancer Research, National Institutes of Health, Bethesda, Maryland,Correspondence to: LoriWiener, Pediatric Oncology Branch, National Cancer Institute, Center for Cancer Research, National Institutes of Health, Bethesda, Maryland 20892.
| | - Anne E. Kazak
- Nemours Children’s Health System, Wilmington, Delaware, Sidney Kimmel Medical School of Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Robert B. Noll
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Mary Jo Kupst
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
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Wiener L, Kazak AE, Noll RB, Patenaude AF, Kupst MJ. Standards for the Psychosocial Care of Children With Cancer and Their Families: An Introduction to the Special Issue. Pediatr Blood Cancer 2015; 62 Suppl 5:S419-24. [PMID: 26397836 PMCID: PMC6397048 DOI: 10.1002/pbc.25675] [Citation(s) in RCA: 249] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 06/26/2015] [Indexed: 01/10/2023]
Abstract
Pediatric oncology psychosocial professionals collaborated with an interdisciplinary group of experts and stakeholders and developed evidence-based standards for pediatric psychosocial care. Given the breadth of research evidence and traditions of clinical care, 15 standards were derived. Each standard is based on a systematic review of relevant literature and used the AGREE II process to evaluate the quality of the evidence. This article describes the methods used to develop the standards and introduces the 15 articles included in this special issue. Established standards help ensure that all children with cancer and their families receive essential psychosocial care.
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Affiliation(s)
- Lori Wiener
- Pediatric Oncology Branch, National Cancer Institute,
Center for Cancer Research, National Institutes of Health, Bethesda, Maryland
| | - Anne E Kazak
- Nemours Children’s Health System, Sidney Kimmel
Medical School of Thomas Jefferson University, Philadelphia, PA
| | | | | | - Mary Jo Kupst
- Department of Pediatrics, Medical College of Wisconsin,
Milwaukee, Wisconsin
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Thompson AL, Christiansen HL, Elam M, Hoag J, Irwin MK, Pao M, Voll M, Noll RB, Kelly KP. Academic Continuity and School Reentry Support as a Standard of Care in Pediatric Oncology. Pediatr Blood Cancer 2015; 62 Suppl 5:S805-17. [PMID: 26700927 PMCID: PMC5198902 DOI: 10.1002/pbc.25760] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 08/20/2015] [Indexed: 11/09/2022]
Abstract
Clinicians agree that return to school after diagnosis promotes the positive adjustment of children and adolescents with cancer; however, the school reentry process can present challenges. The aim of this review was to critically evaluate the literature on school reentry support for youth with cancer. Seventeen publications were identified. School reentry services were well-received by families and educators; increased teacher and peer knowledge about childhood cancer; influenced peer and educator attitudes toward the patient; and improved communication and collaboration between patients/families, school, and the healthcare team. Evidence supports a strong recommendation for school reentry support for youth with cancer.
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Affiliation(s)
- Amanda L. Thompson
- Center for Cancer and Blood Disorders, Children’s National Health System, Washington, DC
| | | | - Megan Elam
- Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Jennifer Hoag
- Department of Pediatric Hematology/Oncology/BMT, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mary Kay Irwin
- School Health Services, Nationwide Children’s Hospital, Columbus, Ohio
| | - Maryland Pao
- National Institute of Mental Health, Bethesda, Maryland
| | - Megan Voll
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Robert B. Noll
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Katherine Patterson Kelly
- Department of Nursing Research and Quality Outcomes, Children’s National Health System, Washington, DC
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Nguyen CT, Fairclough DL, Noll RB. Problem-solving skills training for mothers of children recently diagnosed with autism spectrum disorder: A pilot feasibility study. Autism 2015; 20:55-64. [PMID: 25896269 DOI: 10.1177/1362361314567134] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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: 11/16/2022]
Abstract
Problem-solving skills training is an intervention designed to teach coping skills that has shown to decrease negative affectivity (depressive symptoms, negative mood, and post-traumatic stress symptoms) in mothers of children with cancer. The objective of this study was to see whether mothers of children recently diagnosed with autism spectrum disorder would be receptive to receiving problem-solving skills training (feasibility trial). Participants were recruited from a local outpatient developmental clinic that is part of a university department of pediatrics. Participants were to receive eight 1-h sessions of problem-solving skills training and were asked to complete assessments prior to beginning problem-solving skills training (T1), immediately after intervention (T2), and 3 months after T2 (T3). Outcome measures assessed problem-solving skills and negative affectivity (i.e. distress). In total, 30 mothers were approached and 24 agreed to participate (80.0%). Of them, 17 mothers completed problem-solving skills training (retention rate: 70.8%). Mothers of children with autism spectrum disorder who completed problem-solving skills training had significant decreases in negative affectivity and increases in problem-solving skills. A comparison to mothers of children with cancer shows that mothers of children with autism spectrum disorder displayed similar levels of depressive symptoms but less negative mood and fewer symptoms of post-traumatic stress. Data suggest that problem-solving skills training may be an effective way to alleviate distress in mothers of children recently diagnosed with autism spectrum disorder. Data also suggest that mothers of children with autism spectrum disorder were moderately receptive to receiving problem-solving skills training. Implications are that problem-solving skills training may be beneficial to parents of children with autism spectrum disorder; modifications to improve retention rates are suggested.
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Johnson LM, Leek AC, Drotar D, Noll RB, Rheingold SR, Kodish ED, Baker JN. Practical communication guidance to improve phase 1 informed consent conversations and decision-making in pediatric oncology. Cancer 2015; 121:2439-48. [PMID: 25873253 DOI: 10.1002/cncr.29354] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [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: 12/10/2014] [Revised: 02/06/2015] [Accepted: 02/12/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND It can be difficult to explain pediatric phase 1 oncology trials to families of children with refractory cancer. Parents may misunderstand the information presented to them, and physicians may assume that certain topics are covered in the informed consent document and need not be discussed. Communication models can help to ensure effective discussions. METHODS Suggestions for improving the informed consent process were first solicited from phase 1 study clinicians via questionnaire. Eight parents who had enrolled their child on a phase 1 pediatric oncology trial were recruited for an advisory group designed to assess the clinicians' suggestions and make additional recommendations for improving informed consent for pediatric phase 1 trials. RESULTS A phase 1 communication model was designed to incorporate the suggestions of clinicians and families. It focused on educating parents/families about phase 1 trials at specific time points during a child's illness, but specifically at the point of disease recurrence. An informative phase 1 fact sheet that can be distributed to families was also presented. CONCLUSIONS Families who will be offered information regarding phase 1 clinical trials can first receive a standardized fact sheet explaining the general purpose of these early-phase clinical trials. Parental understanding may be enhanced further when oncologists address key themes, beginning at the time of diagnosis and continuing through important decision points during the child's illness. This model should be prospectively evaluated.
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Affiliation(s)
- Liza-Marie Johnson
- Division of Quality of Life and Palliative Care, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Angela C Leek
- Department of Bioethics, Cleveland Clinic, Cleveland, Ohio
| | - Dennis Drotar
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Robert B Noll
- Division of Developmental and Behavioral Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Susan R Rheingold
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Eric D Kodish
- Center for Ethics, Humanities, and Spiritual Care, Cleveland Clinic, Cleveland, Ohio
| | - Justin N Baker
- Division of Quality of Life and Palliative Care, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
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Kelly AD, Egan AM, Reiter-Purtill J, Gerhardt CA, Vannatta K, Noll RB. A controlled study of internalizing symptoms in older adolescents with sickle cell disease. Pediatr Blood Cancer 2015; 62:637-42. [PMID: 25556914 DOI: 10.1002/pbc.25325] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 08/20/2014] [Accepted: 09/30/2014] [Indexed: 11/06/2022]
Abstract
BACKGROUND Due to the ongoing medical challenges we hypothesized that older adolescents with sickle cell disease (SCD) would report greater rates of internalizing symptoms and diagnoses. This study is a follow-up to a previous study [1] that found few differences between the emotional well-being of children ages 8-15 with SCD and comparison peers. Our aim is to re-assess internalizing symptoms of youth with SCD and comparison peers at age 18. PROCEDURE At follow-up, trained staff members administered semi-structured psychiatric interviews and widely use behavioral health questionnaires to adolescents with SCD (n = 48), their comparison peers (COMP; n = 51) and a caregiver. Mood, internalizing symptoms and diagnoses, were evaluated cross-sectionally at the follow-up (age 18). RESULTS Psychiatric interview data showed that COMP reported more phobias relative to adolescents with SCD; no significant differences were reported for any other current symptoms (depression, anxiety, or mania). Questionnaire data showed all scores in the normal range with two significant differences: older adolescents with SCD reported more symptoms of tension-anxiety and fatigue-inertia. Both groups reported significant rates of internalizing disorders with 31% of youth with SCD and 35% of COMP having a DSM-IV diagnosis. CONCLUSIONS Psychiatric interview data for both groups of older adolescents suggested considerable psychopathology; questionnaire data for both groups were in the normal range. We report few significant differences-more phobias in comparisons peers; more tension-anxiety and fatigue-inertia reported by youth with SCD. The overall findings suggest considerable resilience for youth with SCD, but both groups of adolescents report significant rates of psychopathology similar to national rates.
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Affiliation(s)
- Adia D Kelly
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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36
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Hocking MC, McCurdy M, Turner E, Kazak AE, Noll RB, Phillips P, Barakat LP. Social competence in pediatric brain tumor survivors: application of a model from social neuroscience and developmental psychology. Pediatr Blood Cancer 2015; 62:375-84. [PMID: 25382825 PMCID: PMC4304946 DOI: 10.1002/pbc.25300] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 09/16/2014] [Indexed: 12/21/2022]
Abstract
Pediatric brain tumor (BT) survivors are at risk for psychosocial late effects across many domains of functioning, including neurocognitive and social. The literature on the social competence of pediatric BT survivors is still developing and future research is needed that integrates developmental and cognitive neuroscience research methodologies to identify predictors of survivor social adjustment and interventions to ameliorate problems. This review discusses the current literature on survivor social functioning through a model of social competence in childhood brain disorder and suggests future directions based on this model. Interventions pursuing change in survivor social adjustment should consider targeting social ecological factors.
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Affiliation(s)
| | - Mark McCurdy
- Division of Oncology, The Children’s Hospital of Philadelphia
- Department of Psychology, Drexel University
| | - Elise Turner
- Division of Oncology, The Children’s Hospital of Philadelphia
- Department of Psychology, Drexel University
| | - Anne E. Kazak
- Center for Healthcare Delivery Science, Nemours Children’s Health System
- Department of Pediatrics, Sidney Kimmel School of Medicine at Thomas Jefferson University
| | | | - Peter Phillips
- Division of Oncology, The Children’s Hospital of Philadelphia
- Department of Pediatrics, University of Pennsylvania
| | - Lamia P. Barakat
- Division of Oncology, The Children’s Hospital of Philadelphia
- Department of Pediatrics, University of Pennsylvania
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37
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Kazak AE, Noll RB. The integration of psychology in pediatric oncology research and practice: Collaboration to improve care and outcomes for children and families. American Psychologist 2015; 70:146-58. [DOI: 10.1037/a0035695] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [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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38
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Alderfer MA, Stanley C, Conroy R, Long KA, Fairclough DL, Kazak AE, Noll RB. The social functioning of siblings of children with cancer: a multi-informant investigation. J Pediatr Psychol 2014; 40:309-19. [PMID: 25256156 DOI: 10.1093/jpepsy/jsu079] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [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: 11/14/2022] Open
Abstract
OBJECTIVE This study examined social functioning among siblings of children with cancer. METHOD A case-control design was applied to school- and home-based data from multiple informants (peers, teachers, mothers, and self). Social reputation and peer acceptance within the classroom was compared for 87 siblings (aged 8-16 years) and 256 demographically matched peers. Self-perceptions of peer relationships and parent-reported social competence were examined among 67 siblings and 67 matched comparisons. RESULTS Peer reports (N = 1,633) indicated no differences between siblings and comparisons for social reputation, number of friendships, reciprocated friendships, or peer acceptance. Self-reported prosocial behavior and teacher-reported likability were higher for siblings than comparisons. Self-reported loneliness, friendship quality, and perceived social support did not differ between groups. Mothers reported less involvement in activities and poorer school performance for siblings than comparisons. CONCLUSIONS Peer relationships of siblings of children with cancer are similar to classmates, though they experience small decrements in activity participation and school performance.
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Affiliation(s)
- Melissa A Alderfer
- Division of Oncology, The Children's Hospital of Philadelphia & Department of Pediatrics, Perelman School of Medicine, The University of Pennsylvania, Division of Oncology, The Children's Hospital of Philadelphia, Department of Psychology, University of Pittsburgh, Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Denver, and Nemours Center for Healthcare Delivery Science & Department of Pediatrics, Stanley Kimmel Medical College, Thomas Jefferson University
| | - Caroline Stanley
- Division of Oncology, The Children's Hospital of Philadelphia & Department of Pediatrics, Perelman School of Medicine, The University of Pennsylvania, Division of Oncology, The Children's Hospital of Philadelphia, Department of Psychology, University of Pittsburgh, Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Denver, and Nemours Center for Healthcare Delivery Science & Department of Pediatrics, Stanley Kimmel Medical College, Thomas Jefferson University
| | - Rowena Conroy
- Division of Oncology, The Children's Hospital of Philadelphia & Department of Pediatrics, Perelman School of Medicine, The University of Pennsylvania, Division of Oncology, The Children's Hospital of Philadelphia, Department of Psychology, University of Pittsburgh, Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Denver, and Nemours Center for Healthcare Delivery Science & Department of Pediatrics, Stanley Kimmel Medical College, Thomas Jefferson University
| | - Kristin A Long
- Division of Oncology, The Children's Hospital of Philadelphia & Department of Pediatrics, Perelman School of Medicine, The University of Pennsylvania, Division of Oncology, The Children's Hospital of Philadelphia, Department of Psychology, University of Pittsburgh, Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Denver, and Nemours Center for Healthcare Delivery Science & Department of Pediatrics, Stanley Kimmel Medical College, Thomas Jefferson University
| | - Diane L Fairclough
- Division of Oncology, The Children's Hospital of Philadelphia & Department of Pediatrics, Perelman School of Medicine, The University of Pennsylvania, Division of Oncology, The Children's Hospital of Philadelphia, Department of Psychology, University of Pittsburgh, Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Denver, and Nemours Center for Healthcare Delivery Science & Department of Pediatrics, Stanley Kimmel Medical College, Thomas Jefferson University
| | - Anne E Kazak
- Division of Oncology, The Children's Hospital of Philadelphia & Department of Pediatrics, Perelman School of Medicine, The University of Pennsylvania, Division of Oncology, The Children's Hospital of Philadelphia, Department of Psychology, University of Pittsburgh, Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Denver, and Nemours Center for Healthcare Delivery Science & Department of Pediatrics, Stanley Kimmel Medical College, Thomas Jefferson University
| | - Robert B Noll
- Division of Oncology, The Children's Hospital of Philadelphia & Department of Pediatrics, Perelman School of Medicine, The University of Pennsylvania, Division of Oncology, The Children's Hospital of Philadelphia, Department of Psychology, University of Pittsburgh, Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Denver, and Nemours Center for Healthcare Delivery Science & Department of Pediatrics, Stanley Kimmel Medical College, Thomas Jefferson University
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Annett RD, Hile S, Bedrick E, Kunin-Batson AS, Krull KR, Embry L, MacLean WE, Noll RB. Neuropsychological functioning of children treated for acute lymphoblastic leukemia: impact of whole brain radiation therapy. Psychooncology 2014; 24:181-9. [DOI: 10.1002/pon.3586] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 04/22/2014] [Accepted: 05/05/2014] [Indexed: 01/07/2023]
Affiliation(s)
- Robert D. Annett
- University of New Mexico Health Sciences Center, MSC10-5590; 1 University of New Mexico; Albuquerque NM USA
| | - Sarah Hile
- University of New Mexico; Department of Psychology; Logan Hall; Albuquerque NM USA
| | - Edward Bedrick
- University of New Mexico Health Sciences Center, MSC10-5590; 1 University of New Mexico; Albuquerque NM USA
| | | | | | - Leanne Embry
- University of Texas Health Sciences Center at San Antonio; San Antonio TX USA
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Long KA, Keeley L, Reiter-Purtill J, Vannatta K, Gerhardt CA, Noll RB. Child-rearing in the context of childhood cancer: perspectives of parents and professionals. Pediatr Blood Cancer 2014; 61:326-32. [PMID: 24376229 DOI: 10.1002/pbc.24556] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [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: 10/17/2012] [Accepted: 03/11/2013] [Indexed: 11/10/2022]
Abstract
BACKGROUND Elevated distress has been well documented among parents of children with cancer. Family systems theories suggest that cancer-related stressors and parental distress have the potential to affect child-rearing practices, but this topic has received limited empirical attention. The present work examined self-reported child-rearing practices among mothers and fathers of children with cancer and matched comparisons. PROCEDURE Medical and psychosocial professionals with expertise in pediatric oncology selected items from the Child-Rearing Practices Report (CRPR) likely to differentiate parents of children with cancer from matched comparison parents. Then, responses on these targeted items were compared between parents of children with cancer (94 mothers, 67 fathers) and matched comparisons (98 mothers, 75 fathers). Effect sizes of between-group differences were compared for mothers versus fathers. RESULTS Pediatric oncology healthcare providers predicted that 14 items would differentiate child-rearing practices of parents of children with cancer from parents of typically developing children. Differences emerged on six of the 14 CRPR items. Parents of children with cancer reported higher levels of spoiling and concern about their child's health and development than comparison parents. Items assessing overprotection and emotional responsiveness did not distinguish the two groups of parents. The effect size for the group difference between mothers in the cancer versus comparison groups was significantly greater than that for fathers on one item related to worry about the child's health. CONCLUSION Parents of children with cancer report differences in some, but not all, domains of child-rearing, as predicted by healthcare professionals.
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Phipps S, Klosky JL, Long A, Hudson MM, Huang Q, Zhang H, Noll RB. Posttraumatic stress and psychological growth in children with cancer: has the traumatic impact of cancer been overestimated? J Clin Oncol 2014; 32:641-6. [PMID: 24449230 DOI: 10.1200/jco.2013.49.8212] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To examine posttraumatic stress disorder and posttraumatic stress symptoms (PTSD/PTSS) in children with cancer using methods that minimize focusing effects and allow for direct comparison to peers without a history of cancer. PATIENTS AND METHODS Children with cancer (n = 255) stratified by time since diagnosis, and demographically matched peers (n = 101) were assessed for PTSD using structured diagnostic interviews by both child and parent reports, and survey measures of PTSS and psychological benefit/growth by child report. RESULTS Cancer was identified as a traumatic event by 52.6% of children with cancer, declining to 23.8% in those ≥ 5 years from diagnosis. By diagnostic interview, 0.4% of children with cancer met criteria for current PTSD, and 2.8% met lifetime criteria by self-report. By parent report, 1.6% of children with cancer met current criteria and 5.9% met lifetime criteria for PTSD. These rates did not differ from controls (all Ps >.1). PTSS levels were descriptively lower in children with cancer but did not differ from controls when all were referring to their most traumatic event (P = .067). However, when referring specifically to cancer-related events, PTSS in the cancer group were significantly lower than in controls (P = .002). In contrast, perceived growth was significantly higher in the cancer group when referring to cancer (P < .001). CONCLUSION These findings suggest no evidence of increased PTSD or PTSS in youths with cancer. Although childhood cancer remains a significant and challenging event, these findings highlight the capacity of children to adjust, and even thrive, in the face of such challenge.
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Affiliation(s)
- Sean Phipps
- Sean Phipps, James L. Klosky, Alanna Long, Melissa M. Hudson, Qinlei Huang, and Hui Zhang, St Jude Children's Research Hospital, Memphis, TN; and Robert B. Noll, University of Pittsburgh Medical Center, Pittsburgh, PA
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Noll RB, Patel SK, Embry L, Hardy KK, Pelletier W, Annett RD, Patenaude A, Lown EA, Sands SA, Barakat LP. Children's Oncology Group's 2013 blueprint for research: behavioral science. Pediatr Blood Cancer 2013; 60:1048-54. [PMID: 23255478 DOI: 10.1002/pbc.24421] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [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] [Received: 10/15/2012] [Accepted: 11/07/2012] [Indexed: 11/10/2022]
Abstract
Behavioral science has long played a central role in pediatric oncology clinical service and research. Early work focused on symptom relief related to side effects of chemotherapy and pain management related to invasive medical procedures. As survival rates improved, the focused has shifted to examination of the psychosocial impact, during and after treatment, of pediatric cancer and its treatment on children and their families. The success of the clinical trials networks related to survivorship highlights an even more critical role in numerous domains of psychosocial research and care. Within the cooperative group setting, the field of behavioral science includes psychologists, social workers, physicians, nurses, and parent advisors. The research agenda of this group of experts needs to focus on utilization of psychometrically robust measures to evaluate the impact of treatment on children with cancer and their families during and after treatment ends. Over the next 5 years, the field of behavioral science will need to develop and implement initiatives to expand use of standardized neurocognitive and behavior batteries; increase assessment of neurocognition using technology; early identification of at-risk children/families; establish standards for evidence-based psychosocial care; and leverage linkages with the broader behavioral health pediatric oncology community to translate empirically supported research clinical trials care to practice.
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Affiliation(s)
- Robert B Noll
- Department of Pediatrics, University of Pittsburgh Medical Center, Pittsburgh, PA 15217, USA.
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Butler RW, Fairclough DL, Katz ER, Kazak AE, Noll RB, Thompson RD, Sahler OJZ. Intellectual functioning and multi-dimensional attentional processes in long-term survivors of a central nervous system related pediatric malignancy. Life Sci 2013; 93:611-6. [PMID: 23727455 DOI: 10.1016/j.lfs.2013.05.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [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: 11/13/2012] [Revised: 05/02/2013] [Accepted: 05/20/2013] [Indexed: 10/26/2022]
Abstract
AIMS Central nervous system (CNS) malignancies and/or their treatment in pediatric cancer survivors are known to be associated with deficits in neuropsychological functions. We report findings from a nation-wide study of childhood cancer survivors to investigate intelligence and attention/concentration from a multi-dimensional perspective in a diverse sample from this population. MAIN METHODS Four hundred forty-four pediatric cancer survivors between 6 and 17 years of age, who had suffered CNS involvement associated with their malignancy, were evaluated. All patients completed a measure of general intelligence. Attention was measured by a continuous performance test (CPT) and by parental report using a standardized psychological inventory. KEY FINDINGS Social economic status (SES) was a significant predictor of intellectual functioning and scores on independent measures of attention. After controlling for SES, cranial radiation therapy (CRT) was strongly predictive of impairments in intellectual functioning. Patients who had completed a transplant procedure did not have significant impairments in intellectual functioning when compared to other participants. CPT performance was most clearly influenced by a younger age at diagnosis and the presence of a supratentorial brain tumor. Reaction time was lower in patients who had received CRT. Gender did not correlate with CPT performance, but caregiver reports of deficits in attentional functioning were more prevalent in girls compared to boys. SIGNIFICANCE These findings are important given the large, representative sample and multi-dimensional assessment of attentional functioning. The presence of a very strong SES effect on all dependent variables must be addressed in studies of this nature.
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Affiliation(s)
- Robert W Butler
- Austin Hatcher Foundation for Pediatric Cancer, Chattanooga, TN, USA.
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Devine KA, Heckler CE, Katz ER, Fairclough DL, Phipps S, Sherman-Bien S, Dolgin MJ, Noll RB, Askins MA, Butler RW, Sahler OJZ. Evaluation of the psychometric properties of the Pediatric Parenting Stress Inventory (PPSI). Health Psychol 2013; 33:130-8. [PMID: 23544994 DOI: 10.1037/a0032306] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [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
OBJECTIVE This work evaluated the psychometric properties of the Pediatric Parenting Stress Inventory (PPSI), a new measure of problems and distress experienced by parents of children with chronic illnesses. METHOD This secondary data analysis used baseline data from 1 sample of English-, Spanish-, and Hebrew-speaking mothers of children recently diagnosed with cancer (n = 449) and 1 sample of English- and Spanish-speaking mothers of children recently diagnosed with cancer (n = 399) who participated in 2 problem-solving skills training interventions. The PPSI was administered at baseline with other measures of maternal distress. Factor structure was evaluated using exploratory factor analysis (EFA) on the first sample and confirmatory factor analysis (CFA) on both samples. Internal consistency was evaluated using Cronbach's alpha. Construct validity was assessed via Spearman correlations with measures of maternal distress. RESULTS EFA resulted in a stable four-factor solution with 35 items. CFA indicated that the four-factor solution demonstrated reasonable fit in both samples. Internal consistency of the subscales and full scale was adequate to excellent. Construct validity was supported by moderate to strong correlations with measures of maternal distress, depression, and posttraumatic stress symptoms. CONCLUSIONS The PPSI demonstrated good psychometric properties in assessing current problems and distress experienced by mothers of children newly diagnosed with cancer. This tool may be used to identify individualized targets for intervention in families of children with cancer. Future studies could evaluate the utility and psychometrics of the PPSI with other pediatric populations.
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Affiliation(s)
- Katie A Devine
- Department of Radiation Oncology, University of Rochester Medical Center
| | - Charles E Heckler
- Department of Radiation Oncology, University of Rochester Medical Center
| | - Ernest R Katz
- Children's Center for Cancer and Blood Diseases, Children's Hospital of Los Angeles
| | | | - Sean Phipps
- Department of Psychology, St. Jude Children's Research Hospital
| | | | | | - Robert B Noll
- Department of Pediatrics, Children's Hospital of Pittsburgh
| | - Martha A Askins
- Department of Pediatrics, The Children's Cancer Hospital at MD Anderson Cancer Center
| | | | - Olle Jane Z Sahler
- Division of Hematology/Oncology, Department of Pediatrics, University of Rochester Medical Center
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Shellmer DA, DeVito Dabbs A, Dew MA, Terhorst L, Noll RB, Kosmach-Park B, Mazariegos G. Adaptive functioning and its correlates after intestine and liver transplantation. Pediatr Transplant 2013; 17:48-54. [PMID: 23134290 PMCID: PMC3708469 DOI: 10.1111/petr.12011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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] [Accepted: 08/24/2012] [Indexed: 12/01/2022]
Abstract
In this cross-sectional study, we compared levels of adaptive functioning and examined potential correlates of adaptive functioning in 18 pediatric intestine (ITX) and 22 liver (LTX) recipients transplanted between June 2003 and March 2009. Family caregivers completed the ABAS-II scale and provided socio-demographic information regarding recipients' age at transplantation, gender, ethnicity, time since transplantation, and caregivers' role, ethnicity, education, and family income. Overall adaptive functioning and all three adaptive functioning subdomain scores were significantly lower in ITX patients compared with LTX patients (p ≤ 0.04) and compared with the general population normative mean (p ≤ 0.003). Significant correlates of adaptive functioning after abdominal transplant included type of transplant procedure (r = -0.4, p = 0.02), gender (r = 0.4, p = 0.01), and educational level of caregiver (r = 0.5, p = 0.003) and together explained 45% of the variance in overall adaptive functioning. Findings provide new information regarding everyday functioning outcomes of ITX patients, add to existing data regarding non-medical outcomes for LTX patients, and highlight the need for ongoing monitoring and intervention following transplantation to enhance outcomes.
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Affiliation(s)
- Diana A. Shellmer
- Department of Pediatric Transplant Surgery, School of Medicine University of Pittsburgh, Pittsburgh, PA,Hillman Center for Pediatric Transplantation, The Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA
| | - Annette DeVito Dabbs
- Department of Acute and Tertiary Care Nursing, School of Nursing, University of Pittsburgh, Pittsburgh, PA
| | - Mary Amanda Dew
- Departments of Psychiatry, Psychology, Epidemiology and Biostatistics, School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Lauren Terhorst
- Department of Health and Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, PA
| | - Robert B. Noll
- Department of Pediatrics, School of Medicine, University of Pittsburgh, The Children's Hospital of Pittsburgh of UPMC
| | - Beverly Kosmach-Park
- Hillman Center for Pediatric Transplantation, The Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA
| | - George Mazariegos
- Department of Pediatric Transplant Surgery, School of Medicine University of Pittsburgh, Pittsburgh, PA,Hillman Center for Pediatric Transplantation, The Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA
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Sahler OJZ, Dolgin MJ, Phipps S, Fairclough DL, Askins MA, Katz ER, Noll RB, Butler RW. Specificity of problem-solving skills training in mothers of children newly diagnosed with cancer: results of a multisite randomized clinical trial. J Clin Oncol 2013; 31:1329-35. [PMID: 23358975 DOI: 10.1200/jco.2011.39.1870] [Citation(s) in RCA: 126] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Diagnosis of cancer in a child can be extremely stressful for parents. Bright IDEAS, a problem-solving skills training (PSST) intervention, has been shown to decrease negative affectivity (anxiety, depression, post-traumatic stress symptoms) in mothers of newly diagnosed patients. This study was designed to determine the specificity of PSST by examining its direct and indirect (eg, social support) effects compared with a nondirective support (NDS) intervention. PATIENTS AND METHODS This randomized clinical trial included 309 English- or Spanish-speaking mothers of children diagnosed 2 to 16 weeks before recruitment. Participants completed assessments prerandomization (T1), immediately postintervention (T2), and at 3-month follow-up (T3). Both PSST and NDS consisted of eight weekly 1-hour individual sessions. Outcomes included measures of problem-solving skill and negative affectivity. RESULTS There were no significant between-group differences at baseline (T1). Except for level of problem-solving skill, which was directly taught in the PSST arm, outcome measures improved equally in both groups immediately postintervention (T2). However, at the 3-month follow-up (T3), mothers in the PSST group continued to show significant improvements in mood, anxiety, and post-traumatic stress; mothers in the NDS group showed no further significant gains. CONCLUSION PSST is an effective and specific intervention whose beneficial effects continue to grow after the intervention ends. In contrast, NDS is an effective intervention while it is being administered, but its benefits plateau when active support is removed. Therefore, teaching coping skills at diagnosis has the potential to facilitate family resilience over the entire course of treatment.
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Fernandez CV, Ruccione K, Wells RJ, Long JB, Pelletier W, Hooke MC, Pentz RD, Noll RB, Baker JN, O'Leary M, Reaman G, Adamson PC, Joffe S. Recommendations for the return of research results to study participants and guardians: a report from the Children's Oncology Group. J Clin Oncol 2012; 30:4573-9. [PMID: 23109703 DOI: 10.1200/jco.2012.45.2086] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The Children's Oncology Group (COG) strongly supports the widely recognized principle that research participants should be offered a summary of study results. The mechanism by which to do so in a cooperative research group setting has not been previously described. METHODS On the basis of a review of the available empirical and theoretic literature and on iterative, multidisciplinary discussion, a COG Return of Results Task Force (RRTF) offered detailed recommendations for the return of results to research study participants. RESULTS The RRTF established guidelines for the notification of research participants and/or their parents/guardians about the availability of research results, a mechanism for and timing of sharing results via registration on the COG public Web site, the scope of the research to be shared, the target audience, and a process for creating and vetting lay summaries of study results. The RRTF recognized the challenges in adequately conveying complex scientific results to audiences with varying levels of health literacy and recommended that particularly sensitive or complex results be returned using direct personal contact. The RRTF also recommended evaluation of the cost, effectiveness, and impact of sharing results. CONCLUSION These recommendations provide a framework for the offering and returning of results to participants. They can be used by individual investigators, multi-investigator research collaboratives, and large cooperative groups.
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Affiliation(s)
- Conrad V Fernandez
- Izaak Walton Killam and Steven Joffe Health Centre, Dalhousie University, Halifax, Nova Scotia
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Cousino MK, Zyzanski SJ, Yamokoski AD, Hazen RA, Baker JN, Noll RB, Rheingold SR, Geyer JR, Alexander SC, Drotar D, Kodish ED. Communicating and understanding the purpose of pediatric phase I cancer trials. J Clin Oncol 2012; 30:4367-72. [PMID: 23071225 DOI: 10.1200/jco.2012.42.3004] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Quality informed consent should provide a clear understanding of the purpose of the research. Given the ethical challenges of pediatric phase I cancer trials, it is important to investigate physician-parent communication during informed consent conferences (ICCs) and parental understanding of the purpose of these studies. METHODS In the multisite Informed Consent in Pediatric Phase I Cancer Trials study, 85 ICCs for phase I research between June 2008 and May 2011 were directly observed, and 60 parents were subsequently interviewed. The scientific purpose was defined as composite understanding of drug safety, dose finding, and dose escalation. We determined the frequency with which physicians explained these and other phase I-related concepts during the ICC. Parent interviews were analyzed to determine understanding. RESULTS The child was present at 83 of 85 ICCs. Only 32% of parents demonstrated substantial understanding of the scientific purpose of phase I cancer trials; 35% demonstrated little or no understanding. Parents of higher socioeconomic status and racial majority status were more likely to understand the scientific purpose. Factors associated with understanding included physician explanation of the goal of the applicable phase I protocol offered (explained in 85% of ICCs) and explanation of the dose cohorts (explained in 43% of ICCs). Physicians explained drug safety in 23% of ICCs, dose finding in 52% of ICCs, and dose escalation in 53% of ICCs. CONCLUSION Many parents of children participating in phase I trials do not understand the purpose of these trials. Physician-parent communication about the purpose of phase I research is lacking during ICCs.
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Embry L, Annett RD, Kunin-Batson A, Patel SK, Sands S, Reaman G, Noll RB. Implementation of multi-site neurocognitive assessments within a pediatric cooperative group: can it be done? Pediatr Blood Cancer 2012; 59:536-9. [PMID: 22555997 DOI: 10.1002/pbc.24139] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [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] [Received: 03/30/2011] [Accepted: 02/20/2012] [Indexed: 11/08/2022]
Abstract
BACKGROUND Neurocognitive functioning is an important construct in childhood cancer survivorship, given the potential neurotoxicity of central nervous system (CNS) diseases and treatments and the relevance for important functional outcomes in adulthood. However, within pediatric oncology cooperative groups there have been significant barriers to neurocognitive data collection that have historically resulted in incomplete data (<30% compliance), thereby limiting progress in understanding the neurocognitive functioning of survivors. This paper describes the development, feasibility, and potential efficacy of a brief neurocognitive battery to maximize collection of psychometrically robust neurocognitive data within a pediatric cooperative group. We hypothesized that a novel set of procedures could result in collection of data from over 80% of eligible children. PROCEDURE A novel assessment battery (ALTE07C1) that evaluates a child's cognitive, social, emotional, and behavioral functioning was developed. It included measures that were psychometrically sound, normed, widely available, and could be administered by any licensed psychologist. The battery required approximately 1 hour of administration time. A data monitoring team was developed to ensure prompt data collection. RESULTS Approximately 75% (105 of 140) of institutions with eligible patients opened ALTE07C1; 159 participants have been enrolled. The overall compliance rate for submission of neurocognitive data exceeded 90%. DISCUSSION Our study supports the feasibility and potential efficacy of a brief neurocognitive battery and a data monitoring team to evaluate children participating in multi-site pediatric oncology trials. Future work will utilize ALTE07C1 as a primary or secondary endpoint for pediatric trials when there is risk for neurocognitive impairment.
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Affiliation(s)
- Leanne Embry
- Department of Pediatrics, University of Texas Health Science Center, San Antonio, USA
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Noll RB, Bukowski WB. Commentary: Social Competence in Children With Chronic Illness: The Devil Is in the Details. J Pediatr Psychol 2012; 37:959-66; discussion 867-71. [DOI: 10.1093/jpepsy/jss058] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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