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Khalil D, Alyoussef R, Al Hosni H, Idriss S, Ahmad A, Al Rooh S, Ghanem KM. The Psychosocial Impact of the COVID-19 Pandemic on Families of Children With Cancer in the Low-income Setting. J Pediatr Hematol Oncol 2023; 45:e857-e860. [PMID: 37526410 DOI: 10.1097/mph.0000000000002726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 06/09/2023] [Indexed: 08/02/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has had a profound effect on families' psychosocial well-being worldwide. This study aimed to investigate the pandemic's impact on families of children with cancer in a low-income setting in Syria. The study conducted a cross-sectional survey of 50 families of children with cancer receiving treatment at a nongovernmental organization-based pediatric oncology unit in Syria. The survey used the Corona Anxiety Scale (CAS) to assess the pandemic's impact on families' anxiety, and other items to evaluate the financial toxicity of the strict measures implemented during the pandemic's first months. The study's results revealed that the COVID-19 pandemic significantly negatively impacted the psychosocial well-being of families of children with cancer in Syria. Specifically, 22% of families reported a major increase in anxiety levels (CAS of >9), and the majority of families (84%) reported excessive indirect financial costs, including travel and living expenses. The study emphasizes the significant social and psychological impact of the COVID-19 pandemic on families of children with cancer in Syria, highlighting the need for additional psychosocial interventions to mitigate future global health crises or pandemics' impact on this vulnerable population. The interventions should prioritize promoting resilience and adaptive coping strategies.
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Affiliation(s)
- Dima Khalil
- BASMA Pediatric Oncology Unit, Damascus, Syria
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2
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Howard Sharp KM, Li C, Lu Z, Clark ME, Jurbergs N, Ouma A, Harrison L, Gerhardt E, Taylor L, Hamilton KV, McGee RB, Nuccio R, Hines-Dowell S, Gattuso JS, Pritchard M, Mandrell BN, Tercyak KP, Nichols KE, Johnson LM. Parent Quality of Life After Disclosure of Pediatric Oncology Germline Sequencing Results. JCO Precis Oncol 2023; 7:e2300159. [PMID: 37944075 DOI: 10.1200/po.23.00159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/06/2023] [Accepted: 08/22/2023] [Indexed: 11/12/2023] Open
Abstract
PURPOSE To characterize parents' quality of life (QoL) after germline genomic sequencing for their children with cancer. METHODS Participants were n = 104 parents of children with cancer enrolled in a prospective study of clinical tumor and germline genomic sequencing. Parents completed surveys at study consent (T0), before disclosure of their child's germline results (T1), and again ≥5 weeks after results disclosure (T2). Bivariate associations with QoL were examined, followed by a multivariable regression model predicting parents' psychological distress. RESULTS At T2, parental distress significantly differed by their children's germline result type (positive, uncertain, negative; P = .038), parent relationship status (P = .04), predisclosure genetics knowledge (P = .006), and predisclosure worry about sequencing (P < .001). Specifically, parents of children with positive (ie, pathogenic or likely pathogenic) results experienced greater distress than those of children with negative results (P = .029), as did parents who were single, more knowledgeable about genetics, and with greater worry. In the adjusted regression model, a positive germline result remained significantly associated with parents' lower QoL at T2 follow-up (F [4,92] = 9.95; P < .001; R2 = .30; β = .19; P = .031). CONCLUSION Germline genomic sequencing for children with cancer is associated with distress among parents when revealing an underlying cancer predisposition among their affected children. Genetic education and counseling before and after germline sequencing may help attenuate this impact on QoL by addressing parents' concerns about test results and their health implications. Assessing parents' worry early in the testing process may also aid in identifying those most likely in need of psychosocial support.
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Affiliation(s)
- Katianne M Howard Sharp
- Department of Psychology and Biobehavioral Sciences, St Jude Children's Research Hospital, Memphis, TN
| | - Chen Li
- Department of Biostatistics, St Jude Children's Research Hospital, Memphis, TN
| | - Zhaohua Lu
- Department of Biostatistics, St Jude Children's Research Hospital, Memphis, TN
| | - Mary Egan Clark
- Division of Cancer Predisposition, St Jude Children's Research Hospital, Memphis, TN
| | - Niki Jurbergs
- Department of Psychology and Biobehavioral Sciences, St Jude Children's Research Hospital, Memphis, TN
| | - Annastasia Ouma
- Division of Cancer Predisposition, St Jude Children's Research Hospital, Memphis, TN
| | - Lynn Harrison
- Division of Cancer Predisposition, St Jude Children's Research Hospital, Memphis, TN
| | - Elsie Gerhardt
- Division of Cancer Predisposition, St Jude Children's Research Hospital, Memphis, TN
| | - Leslie Taylor
- Division of Cancer Predisposition, St Jude Children's Research Hospital, Memphis, TN
| | - Kayla V Hamilton
- Division of Cancer Predisposition, St Jude Children's Research Hospital, Memphis, TN
| | - Rose B McGee
- Division of Cancer Predisposition, St Jude Children's Research Hospital, Memphis, TN
| | - Regina Nuccio
- Division of Cancer Predisposition, St Jude Children's Research Hospital, Memphis, TN
| | - Stacy Hines-Dowell
- Division of Cancer Predisposition, St Jude Children's Research Hospital, Memphis, TN
| | - Jami S Gattuso
- Division of Nursing Research, St Jude Children's Research Hospital, Memphis, TN
| | - Michelle Pritchard
- Division of Nursing Research, St Jude Children's Research Hospital, Memphis, TN
| | - Belinda N Mandrell
- Division of Nursing Research, St Jude Children's Research Hospital, Memphis, TN
| | - Kenneth P Tercyak
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Kim E Nichols
- Division of Cancer Predisposition, St Jude Children's Research Hospital, Memphis, TN
| | - Liza-Marie Johnson
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
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3
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Ritter J, Allen S, Cohen PD, Fajardo AF, Marx K, Loggetto P, Auste C, Lewis H, de Sá Rodrigues KE, Hussain S, Omotola A, Bolous NS, Thirumurthy H, Essue BM, Steliarova-Foucher E, Huang IC, Meheus F, Bhakta N. Financial hardship in families of children or adolescents with cancer: a systematic literature review. Lancet Oncol 2023; 24:e364-e375. [PMID: 37657477 PMCID: PMC10775706 DOI: 10.1016/s1470-2045(23)00320-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 09/03/2023]
Abstract
Financial hardship in childhood cancer contributes to poor health outcomes and global disparities in survival, but the extent of the financial burden on families is not yet fully understood. We systematically reviewed financial hardship prevalence and individual components characterising financial hardship across six domains (medical, non-medical, and indirect costs, financial strategies, psychosocial responses, and behavioural responses) and compared characteristics across country income levels using an established theory of human needs. We included 123 studies with data spanning 47 countries. Extensive heterogeneity in study methodologies and measures resulted in incomparable prevalence estimates and limited analysis. Components characterising financial hardship spanned the six domains and showed variation across country income contexts, yet a synthesis of existing literature cannot establish whether these are true differences in characterisation or burden. Our findings emphasise a crucial need to implement a data-driven methodological framework with validated measures to inform effective policies and interventions to address financial hardship in childhood cancer.
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Affiliation(s)
- Julie Ritter
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA.
| | | | | | | | - Kelsey Marx
- Prometheus Federal Services, Washington, DC, USA
| | - Patrícia Loggetto
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Hedley Lewis
- CHOC Childhood Cancer Foundation South Africa, Rivonia, South Africa
| | | | | | - Ayomide Omotola
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Nancy S Bolous
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Harsha Thirumurthy
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Beverley M Essue
- Institute of Health Policy, Management and Evaluation, University of Toronto, ON, Canada
| | | | - I-Chan Huang
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Filip Meheus
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Nickhill Bhakta
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA; Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
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4
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The Influence of Socioeconomic Status (SES) and Processing Speed on the Psychological Adjustment and Wellbeing of Pediatric Brain Tumor Survivors. Cancers (Basel) 2022; 14:cancers14133075. [PMID: 35804846 PMCID: PMC9264789 DOI: 10.3390/cancers14133075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/20/2022] [Accepted: 06/21/2022] [Indexed: 01/27/2023] Open
Abstract
Simple Summary Processing speed (PS) is one of the most impaired functions in pediatric brain tumor survivors (PBTSs) and it has been linked to difficulties in their psychological functioning, together with other non-insult-related risk factors, such as socio-economic status (SES). Given the psychological adjustment difficulties observed in PBTS, the aim of the current study was to explore the relationship between SES and psychological functioning, measured with the Child Behavioral Checklist (CBCL) and the Strengths and Difficulties Questionnaire, and considering the contribution of PS as a mediator. The results demonstrated that the influence of SES on the CBCL total index was mediated by PS. Furthermore, PS was found to have a mediating effect on the SES–internalizing problems relationship but not on the SES–externalizing problems relationship. These findings suggest that PS may be a rehabilitation target to prevent psychological distress and should be addressed, especially for PBTSs who live in a disadvantaged situation. Abstract (1) Background: The relationship between processing speed (PS) and psychological adjustment in the healthy population is well established, as is that between low socio-economic status (SES) and psychological distress. While PS is one of the most impaired functions in pediatric brain tumor survivors (PBTSs), previous research has demonstrated that low SES may be a predictor of increased psychosocial risk in PBTSs. Given the psychological adjustment difficulties observed in PBTS, in the current study we aimed to explore the relationship between SES and psychological functioning, considering the contribution of PS as a mediator. (2) Methods: demographic and clinical data of 80 children (age range: 4–17 y.o.) were retrospectively collected. Psychological measures were the parent-compiled versions of the Child Behavioral Checklist (CBCL) and the Strengths and Difficulties Questionnaire (SDQ). Mediation analysis models were performed on psychological measures with and without the inclusion of covariates. (3) Results: The influence of SES on the CBCL total index was mediated by PS. Furthermore, PS was found to have a mediating effect on the relationship between SES and internalizing problems but not on the relationship between SES and externalizing problems. (4) Conclusions: The results suggest that PS may be a rehabilitation target for the prevention of psychological distress and should be addressed especially for PBTSs who live in a disadvantaged situation.
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Psychosocial risk, symptom burden, and concerns in families affected by childhood cancer. Support Care Cancer 2021; 30:2283-2292. [PMID: 34719739 DOI: 10.1007/s00520-021-06646-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/18/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE The revised Psychosocial Assessment Tool (PATrev) is a common family-level risk-based screening tool for pediatric oncology that has gained support for its ability to predict, at diagnosis, the degree of psychosocial support a family may require throughout the treatment trajectory. However, ongoing screening for symptoms and concerns (e.g., feeling alone, understanding treatment) remains underutilized. Resource limitations necessitate triaging and intervention based on need and risk. Given the widespread use of the PATrev, we sought to explore the association between family psychosocial risk, symptom burden (as measured by the revised Edmonton Symptom Assessment System (ESAS-r)), and concerns (as measured by the Canadian Problem Checklist (CPC)). METHODS Families (n = 87) with children ≤ 18 years of age (M = 11.72, male: 62.1%) on or off treatment for cancer were recruited from the Alberta Children's Hospital. One parent from each family completed the PATrev and the CPC. Participants 8-18 years of age completed the ESAS-r. RESULTS Risk category (universal/low risk = 67.8%, targeted/intermediate risk = 26.4%, clinical/high risk = 5.7%) predicted symptom burden (F[2, 63.07] = 4.57, p = .014) and concerns (F[2, 82.06] = 16.79, p < .001), such that universal risk was associated with significantly lower symptom burden and fewer concerns. CONCLUSION Family psychosocial risk is associated with cross-sectionally identified concerns and symptom burden, suggesting that resources might be prioritized for families with the greatest predicted need. Future research should evaluate the predictive validity of the PATrev to identify longitudinal concerns and symptom burden throughout the cancer trajectory.
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6
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Kazak AE, Deatrick JA, Scialla MA, Sandler E, Madden RE, Barakat LP. Implementation of family psychosocial risk assessment in pediatric cancer with the Psychosocial Assessment Tool (PAT): study protocol for a cluster-randomized comparative effectiveness trial. Implement Sci 2020; 15:60. [PMID: 32727493 PMCID: PMC7391817 DOI: 10.1186/s13012-020-01023-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 07/14/2020] [Indexed: 01/07/2023] Open
Abstract
Background Childhood cancer affects and is affected by multiple levels of the social ecology, including social and relational determinants of health (e.g., economic stability, housing, childcare, healthcare access, child and family problems). The 2015 Standards of Psychosocial Care in Pediatric Cancer outline optimal psychosocial care sensitive to these ecological factors, starting with assessment of psychosocial healthcare needs to promote medical and psychosocial outcomes across all children with cancer. To address the first standard of family psychosocial assessment, the Psychosocial Assessment Tool (PAT) is a validated screener ready for broad implementation. Method The PAT will be implemented across a national sample of 18 pediatric cancer programs ranging in size (annual new patients) in a mixed methods, comparative effectiveness study, guided by the Interactive Systems Framework for Dissemination and Implementation, comparing two implementation strategies. It is hypothesized that implementation will be more successful at the patient/family, provider, and institutional level when training (strategy I) is combined with implementation expanded resources (strategy II). There are three aims: (1) Refine the two implementation strategies using semi-structured qualitative interviews with 19 stakeholders including parent advocates, providers, pediatric oncology organization representatives, healthcare industry leaders; (2) Compare the two theoretically based and empirically informed strategies to implement the PAT in English and Spanish using a cluster-randomized controlled trial across 18 sites. Stratified by size, sites will be randomized to cohort (3) and strategy (2). Outcomes include adoption and penetration of screening (patient/family), staff job satisfaction/burnout (provider), and cost-effective use of resources consistent with family risk (institution); (3) Based on the results of the trial and feedback from the first and second aim, we will develop and disseminate a web-based PAT Implementation Toolkit. Discussion Use of the PAT across children’s cancer programs nationally can achieve the assessment standard and inform equitable delivery of psychosocial care matched to family need for all patients. Trial Registration ClinicalTrials.gov, NCT04446728, registered 23 June 2020
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Affiliation(s)
- Anne E Kazak
- Nemours Children's Health System, Wilmington, DE, USA. .,Sidney Kimmel Medical School of Thomas Jefferson University, Philadelphia, PA, USA.
| | - Janet A Deatrick
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | | | - Eric Sandler
- Nemours Children's Clinic, Jacksonville, FL, USA
| | | | - Lamia P Barakat
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
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7
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The Relationship between Health Disparities, Psychosocial Functioning and Health Outcomes in Pediatric Hematology-Oncology and Stem Cell Transplant Populations: Recommendations for Clinical Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072218. [PMID: 32224963 PMCID: PMC7178256 DOI: 10.3390/ijerph17072218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/20/2020] [Accepted: 03/22/2020] [Indexed: 01/09/2023]
Abstract
Not only do racial and ethnic minority children and adolescents with chronic illness experience disparities in health status and health outcomes, they also experience significant healthcare disparities, including differences in healthcare coverage, access to care, and quality of care. It is well known that the interaction between psychosocial functioning, health behaviors and ethnic and racial disparities, ultimately leads to worse health and psychosocial outcomes in pediatric and AYA chronic illness patient populations, including increased rates of morbidity and mortality. Investigating the impact of racial and ethnic factors on health outcomes, and strategies for reducing these disparities, is of the utmost importance, specifically in life-threatening conditions like cancer and sickle cell disease. This commentary underscores the relative importance of identifying factors that could reduce disparities between minority and non-minority populations. This present paper will focus on the dynamic relationships between health disparities, psychosocial factors and health outcomes within pediatric cancer, sickle cell disease and bone marrow transplant populations, and will offer recommendations for healthcare professionals working with these vulnerable patient populations. The primary goal of this commentary is to provide recommendations for enhancing cultural competency and humility for those working with highly vulnerable patient populations.
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What's past is prologue: Recalled parenting styles are associated with childhood cancer survivors' mental health outcomes more than 25 years after diagnosis. Soc Sci Med 2020; 252:112916. [PMID: 32200184 DOI: 10.1016/j.socscimed.2020.112916] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 12/23/2019] [Accepted: 03/08/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND With the increased survival rates of childhood cancer, long-term survivors' well-being over the life span has come into focus. A better understanding of the determinants of childhood cancer survivors' (CCS) mental health outcomes contributes to the identification of vulnerable individuals as well as to the development of evidence-based prevention and intervention efforts. It has been noted that psychosocial factors such as parental rearing behavior shape individual differences in mental health. There is also evidence that parents show altered parenting behavior in the face of childhood cancer, e. g. that they express more emotional support, but also more worries. However, little is known about the relevance of different parenting styles for CCS' mental health decades after diagnosis and treatment. METHODS We examined the associations of recalled parenting styles and disease-related factors with lifetime diagnoses of depression and anxiety disorders in a German, registry-based sample of adult CCS (N = 948, 44.50% women) with survival times >25 years. We conducted logistic regression analyses of lifetime diagnoses of depression and anxiety disorders, respectively, on dimensions of recalled parental rearing behavior (measured with a validated German short version of the EMBU) controlling for relevant adjustment variables such as the presence of physical illnesses. RESULTS Recalled parenting styles of both parents had statistically relevant associations with CCS' lifetime depression and anxiety diagnoses. Maternal emotional warmth was related to fewer lifetime diagnoses of depression and fewer lifetime diagnoses of anxiety. Memories of paternal control and overprotection were positively associated with lifetime diagnoses of anxiety. CONCLUSION The results indicate that mental representations of one's caregivers are associated with psychological long-term outcomes. Thus, medical professionals should involve the parents and support them in accompanying their child through the difficult times of treatment and survivorship. Interventions aimed at fostering survivors' quality of life should consider the sustained relevance of early relationships.
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Karlson CW, Sarver DE, Raiker JS, Espil FM, Cox AD, Elkin TD, Annett RD. The contribution of neurocognitive functions to academic and psychological outcomes in pediatric cancer: A latent profile analysis. Child Neuropsychol 2020; 26:881-899. [PMID: 32157961 DOI: 10.1080/09297049.2020.1734553] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
This study aimed to identify the impact of neurocognitive functioning on academic and psychological domains using a novel person-centered latent profile analysis approach. We further examined the contribution of identified risk factors (e.g., age at diagnosis, treatment) on latent class membership. 101 pediatric oncology patients and survivors (M age = 11.2, 35.6% female; 47.5% African American; M time since diagnosis = 3.4 years) completed neuropsychological evaluations at a university medical center between February 2004 and June 2017. Neurocognitive, academic, and emotional-behavioral functioning were examined using validated measures. Discreet, homogenous neurocognitive subgroups (latent classes) were identified using latent profile analysis. Demographic and medical factors were evaluated as predictors of latent class. A 3-class model indicated excellent class separation (range: .00-.04) and homogeneity (range: .94-.99). Classes were distinguished by differential cognitive patterns. Class 2 (52%) and Class 3 (25%) displayed overall normative functioning; however, Class 3 displayed significantly poorer attention than the other two classes. Class 1 (23%) demonstrated Borderline neurocognitive, low average academic, and poorer emotional-behavioral and inhibition/executive control functioning. Class membership was predicted by race and whole brain radiation dose. Latent profile analysis identified discrete groups in neurocognitive functioning in this heterogeneous pediatric cancer population. Class membership was predicted by race, whole brain radiation dose, and referral source. Other medical variables (e.g., diagnosis, age at diagnosis) were not significant predictors of neurocognitive function in our sample.
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Affiliation(s)
- Cynthia W Karlson
- Division of Hematology/Oncology, Department of Pediatrics, University of Mississippi Medical Center , Jackson, MS, USA.,Center for Advancement of Youth, Department of Pediatrics, University of Mississippi Medical Center , Jackson, MS, USA
| | - Dustin E Sarver
- Center for Advancement of Youth, Department of Pediatrics, University of Mississippi Medical Center , Jackson, MS, USA.,Department of Psychiatry and Human Behavior, University of Mississippi Medical Center , Jackson, MS, USA
| | - Joseph S Raiker
- Department of Psychology, Florida International University , Miami, FL, USA
| | - Flint M Espil
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine , Stanford, CA, USA
| | - Amanda D Cox
- Center for Advancement of Youth, Department of Pediatrics, University of Mississippi Medical Center , Jackson, MS, USA
| | - T David Elkin
- Center for Advancement of Youth, Department of Pediatrics, University of Mississippi Medical Center , Jackson, MS, USA.,Department of Psychiatry and Human Behavior, University of Mississippi Medical Center , Jackson, MS, USA
| | - Robert D Annett
- Center for Advancement of Youth, Department of Pediatrics, University of Mississippi Medical Center , Jackson, MS, USA
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Ay Kaatsız MA, Öz F. I'm Here, Too: Being an Adolescent Sibling of a Pediatric Cancer Patient in Turkey. J Pediatr Nurs 2020; 51:e77-e84. [PMID: 31653467 DOI: 10.1016/j.pedn.2019.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 10/07/2019] [Accepted: 10/08/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE This study aimed to determine experiences and needs of Turkish adolescent siblings of children with cancer (SCC) and to identify if there is a country/culture-specific risk factor for these siblings. DESIGN AND METHOD In this qualitative study hermeneutic phenomenological approach was used. Eighteen eligible siblings were selected purposively from two hospitals in Ankara, Turkey. Interviews were conducted with a semi-structured form. Content and thematic analyses were used to analyze the data. RESULTS The data revealed three levels of themes. The main theme was based on "I am here, too". From the first moment of diagnosis, siblings need to be visible and noticed by others. They seek ways to make sense of the disease as they experience dramatic changes in all aspects of their lives (high level themes - first encounter with the disease and changes in life). They expect their parents and relatives to support them (expectations) when they turn to various methods to cope with the changes (coping styles). CONCLUSIONS The lack of protective psychosocial care is a basic risk factor for adolescent SCC in Turkey. Despite its various limitations, the strongest aspect of this study is that it is the first publication that determines the experiences of Turkish SCC in their own words. In addition to supporting recent findings about siblings' experiences, obtaining some country-specific findings is a strength of the present study. PRACTICE IMPLICATIONS Providing psychosocial risk assessment of the siblings' immediately after diagnosis is necessary. It can be helpful to inform parents about the risks.
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Affiliation(s)
- Melike Ayça Ay Kaatsız
- Faculty of Nursing, Psychiatric Nursing Department, Hacettepe University, Ankara, Turkey.
| | - Fatma Öz
- Faculty of Health Sciences, Nursing Department, Lokman Hekim University, Ankara, Turkey
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Kazak AE, Chen FF, Hwang WT, Askins MA, Vega G, Kolb EA, Reilly A, Barakat LP. Stability and change in family psychosocial risk over 6 months in pediatric cancer and its association with medical and psychosocial healthcare utilization. Pediatr Blood Cancer 2020; 67:e28051. [PMID: 31724814 DOI: 10.1002/pbc.28051] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 10/01/2019] [Accepted: 10/04/2019] [Indexed: 12/26/2022]
Abstract
PURPOSE Family psychosocial risk in pediatric oncology can be assessed using the Psychosocial Assessment Tool (PAT), a brief parent report screener based on the Pediatric Psychosocial Preventative Health Model (PPPHM; universal, targeted, and clinical). However, little is known about risk over the course of treatment and its association with medical and psychosocial healthcare utilization. METHODS Primary caregivers of children with cancer participated in this prospective multisite investigation, completing the PAT at diagnosis (T1; n = 396) and 6 months later (T2; n = 304). Healthcare utilization data were extracted from electronic health records. RESULTS The distribution of PPPHM risk levels at T1 and T2 was highly consistent for the samples. Two-thirds of families remained at the same level of risk, 18% decreased and 16% increased risk level. Risk was not related to sociodemographic or treatment variables. The PAT risk score correlated with psychosocial contacts over the 6-month period. CONCLUSIONS Although the majority of families reported universal (low) risk on the PAT and were stable in their risk level over 6 months, reassessing risk is helpful in identifying those families who report higher level of risk during treatment than at diagnosis. PAT scores were related to psychosocial services that are provided to most but not all families and could be tailored more specifically to match risk and delivery of evidence-based care.
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Affiliation(s)
- Anne E Kazak
- Nemours Center for Healthcare Delivery Science, Nemours Children's Health System, Wilmington, Delaware.,Sidney Kimmel Medical School at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Fang Fang Chen
- Nemours Center for Healthcare Delivery Science, Nemours Children's Health System, Wilmington, Delaware.,Sidney Kimmel Medical School at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Wei-Ting Hwang
- Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Martha A Askins
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Gabriela Vega
- Nemours Center for Healthcare Delivery Science, Nemours Children's Health System, Wilmington, Delaware
| | - E Anders Kolb
- Nemours Center for Healthcare Delivery Science, Nemours Children's Health System, Wilmington, Delaware.,Sidney Kimmel Medical School at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Anne Reilly
- Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania.,The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Lamia P Barakat
- Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania.,The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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12
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Kazak AE, Hwang WT, Chen FF, Askins MA, Carlson O, Argueta-Ortiz F, Barakat LP. Screening for Family Psychosocial Risk in Pediatric Cancer: Validation of the Psychosocial Assessment Tool (PAT) Version 3. J Pediatr Psychol 2019; 43:737-748. [PMID: 29509908 DOI: 10.1093/jpepsy/jsy012] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 02/10/2018] [Indexed: 01/09/2023] Open
Abstract
Objective Family psychosocial risk screening is an important initial step in delivering evidence-based care. The Psychosocial Assessment Tool (PAT) is a brief parent report screener based on the trilevel Pediatric Psychosocial Preventative Health Model (PPPHM; Universal, Targeted, Clinical). The current article validates a revised PAT (version 3.0) in pediatric oncology that includes new items (for families of younger patients; clinically relevant risk items) and applicable to broad health literacy levels (a 4th grade reading level). Methods Primary caregivers of 394 children newly diagnosed with cancer participated in this multisite investigation, completing the PAT and validation measures using REDCap. Results The original structure of the PAT, with seven subscales (Family Structure, Social Support, Child Problems, Sibling Problems, Family Problems, Stress Reactions, and Family Beliefs) was supported using a confirmatory factor analysis. Internal consistency for the total score (Kuder-Richardson 20 coefficient [KR20] = 0.81) and the subscales (KR20 = 0.59-0.85) was moderate to strong. Moderate to strong correlations with the criteria measures provided validation for the total and subscale scores. The validation measures varied significantly, as expected, across the three levels of the PPPHM. Receiver operating characteristic (ROC) analyses showed that the PAT total and subscale scores can discriminate families above and below clinical thresholds. Conclusions Results reinforce the psychometric properties of this approach for screening of family psychosocial risk. The PAT provides an evidence-based screener that identifies families at three levels of risk and can provide the basis for further evaluation and treatment of children with cancer and their families.
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Affiliation(s)
- Anne E Kazak
- Nemours Children's Health System.,Sidney Kimmel Medical School, Thomas Jefferson University
| | | | - Fang Fang Chen
- Nemours Children's Health System.,Sidney Kimmel Medical School, Thomas Jefferson University
| | | | | | | | - Lamia P Barakat
- Perelman School of Medicine, University of Pennsylvania.,The Children's Hospital of Philadelphia
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13
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Impact of Race and Socioeconomic Status on Psychologic Outcomes in Childhood Cancer Patients and Caregivers. J Pediatr Hematol Oncol 2019; 41:433-437. [PMID: 30629003 DOI: 10.1097/mph.0000000000001405] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Complex relationships between race and socioeconomic status have a poorly understood influence on psychologic outcomes in pediatric oncology. The Family Symptom Inventory was used to assess symptoms of depression and anxiety in pediatric patients with cancer and their caregivers. Separate hierarchical linear regression models examined the relationship between demographic variables, cancer characteristics, socioeconomic status, and access to care and patient or caregiver depression/anxiety. Participants included 196 pediatric patients with cancer (mean age, 11.21 y; 49% African American) and their caregivers. On average, caregivers reported low levels of depression/anxiety. Symptoms of depression and anxiety in patients were correlated with poorer mental health in caregivers (r=0.62; P<0.01). Self-reported financial difficulty (β=0.49; P<0.001) and brain cancer diagnosis for their child (β=0.42; P=0.008) were significantly associated with depression and anxiety in caregivers. Analysis did not reveal significant associations between race, household income, or access to care and patient or caregiver depression/anxiety. Perception of financial hardship can adversely impact mental health in caregivers of children with cancer. Psychosocial assessment and interventions may be especially important for caregivers of patients with brain tumors and caregivers who report feeling financial difficulty.
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14
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Pai ALH, Swain AM, Chen FF, Hwang WT, Vega G, Carlson O, Ortiz FA, Canter K, Joffe N, Kolb EA, Davies SM, Chewning JH, Deatrick J, Kazak AE. Screening for Family Psychosocial Risk in Pediatric Hematopoietic Stem Cell Transplantation with the Psychosocial Assessment Tool. Biol Blood Marrow Transplant 2019; 25:1374-1381. [PMID: 30878608 DOI: 10.1016/j.bbmt.2019.03.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 03/08/2019] [Indexed: 12/29/2022]
Abstract
Family psychosocial risk screening is an important initial step in delivering evidence-based care in hematopoietic stem cell transplantation (HCT). Establishing an evidence-based screening approach that is acceptable, reliable, and valid is an essential step in psychosocial care delivery. This is a 3-institution multimethod study. In part 1, caregivers of children about to undergo HCT (n = 140) completed the Psychosocial Assessment Tool-Hematopoietic Cell Transplantation (PAT-HCT), a brief parent report screener adapted for HCT, and validating questionnaires. Families received feedback on their risks identified on the PAT-HCT. In part 2, 12 caregivers completed a semistructured interview about their perceptions of the PAT and the feedback process. The reliability and validity of the PAT-HCT total and subscale scores were tested using Kuder-Richardson-20 (KR-20) and Pearson correlations. Thematic content analysis was used to analyze the qualitative interview data. Internal consistency for the total score (KR-20 = .88) and the Child Problems, Sibling Problems, Family Problems, and Stress Reactions subscales were strong (KR-20 >.70). Family Structure, Social Support, and Family Beliefs subscales were adequate (KR-20 = .55 to .63). Moderate to strong correlations with the criteria measures provided validation for the total and subscale scores. Feedback was provided to 97.14% of the families who completed the PAT-HCT, and the mean rating of acceptability was >4.00 (on a 5-point scale). The qualitative data indicate that families appreciate the effort to provide screening and feedback. The PAT-HCT is a psychometrically sound screener for use in HCT. Feedback can be given to families. Both the screener and the feedback process are acceptable to caregivers.
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Affiliation(s)
- Ahna L H Pai
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati College of Medicine
| | - Avi Madan Swain
- Division of Pediatric Hematology-Oncology, Children's of Alabama; Department of Pediatrics, University of Alabama at Birmingham
| | - Fang Fang Chen
- Center for Healthcare Delivery Science, Nemours Children's Health System; Sidney Kimmel Medical School at Thomas Jefferson University
| | - Wei-Ting Hwang
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine of the University of Pennsylvania
| | - Gabriela Vega
- Center for Healthcare Delivery Science, Nemours Children's Health System
| | - Olivia Carlson
- Center for Healthcare Delivery Science, Nemours Children's Health System
| | | | - Kimberly Canter
- Center for Healthcare Delivery Science, Nemours Children's Health System; Sidney Kimmel Medical School at Thomas Jefferson University
| | - Naomi Joffe
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati College of Medicine
| | - E Anders Kolb
- Sidney Kimmel Medical School at Thomas Jefferson University; Center for Cancer and Blood Disorders, Nemours Children's Health System
| | - Stella M Davies
- Department of Pediatrics, University of Cincinnati College of Medicine; Cancer and Blood Diseases Institute, Cincinnati Children's Hospital
| | - Joseph H Chewning
- Division of Pediatric Hematology-Oncology, Children's of Alabama; Department of Pediatrics, University of Alabama at Birmingham
| | - Janet Deatrick
- Department of Family and Community Health, University of Pennsylvania School of Nursing
| | - Anne E Kazak
- Center for Healthcare Delivery Science, Nemours Children's Health System; Department of Pediatrics, Sidney Kimmel Medical School at Thomas Jefferson University.
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15
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Long KA, Lehmann V, Gerhardt CA, Carpenter AL, Marsland AL, Alderfer MA. Psychosocial functioning and risk factors among siblings of children with cancer: An updated systematic review. Psychooncology 2018; 27:1467-1479. [DOI: 10.1002/pon.4669] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 01/18/2018] [Accepted: 01/29/2018] [Indexed: 12/23/2022]
Affiliation(s)
| | - Vicky Lehmann
- Department of Pediatrics and Psychology; Ohio State University; Columbus OH USA
- Center for Biobehavioral Health Research Institute at Nationwide Children's Hospital; Columbus OH USA
| | - Cynthia A. Gerhardt
- Department of Pediatrics and Psychology; Ohio State University; Columbus OH USA
- Center for Biobehavioral Health Research Institute at Nationwide Children's Hospital; Columbus OH USA
| | | | | | - Melissa A. Alderfer
- Nemours Children's Health System/A.I. duPont Hospital for Children; Wilmington DE USA
- Sidney Kimmel Medical College; Thomas Jefferson University; Philadelphia PA USA
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16
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Kazak AE, Barakat LP, Askins MA, McCafferty M, Lattomus A, Ruppe N, Deatrick J. Provider Perspectives on the Implementation of Psychosocial Risk Screening in Pediatric Cancer. J Pediatr Psychol 2017; 42:700-710. [DOI: 10.1093/jpepsy/jsw110] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 12/27/2016] [Indexed: 01/24/2023] Open
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17
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Kazak AE, Abrams AN, Banks J, Christofferson J, DiDonato S, Grootenhuis MA, Kabour M, Madan-Swain A, Patel SK, Zadeh S, Kupst MJ. Psychosocial Assessment as a Standard of Care in Pediatric Cancer. Pediatr Blood Cancer 2015; 62 Suppl 5:S426-59. [PMID: 26700916 DOI: 10.1002/pbc.25730] [Citation(s) in RCA: 141] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 08/03/2015] [Indexed: 12/22/2022]
Abstract
This paper presents the evidence for a standard of care for psychosocial assessment in pediatric cancer. An interdisciplinary group of investigators utilized EBSCO, PubMed, PsycINFO, Ovid, and Google Scholar search databases, focusing on five areas: youth/family psychosocial adjustment, family resources, family/social support, previous history/premorbid functioning, and family structure/function. Descriptive quantitative studies, systematic reviews, and meta-analyses (n = 149) were reviewed and evaluated using grading of recommendations, assessment development, and evaluation (GRADE) criteria. There is high quality evidence to support a strong recommendation for multifaceted, systematic assessments of psychosocial health care needs of youth with cancer and their families as a standard of care in pediatric oncology.
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Affiliation(s)
- Anne E Kazak
- Center for Healthcare Delivery Science, Nemours Children's Health System, Wilmington, Delaware.,Center for Pediatric Traumatic Stress, Nemours Children's Health System, Wilmington, Delaware.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Annah N Abrams
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Jennifer Christofferson
- Center for Healthcare Delivery Science, Nemours Children's Health System, Wilmington, Delaware.,Center for Pediatric Traumatic Stress, Nemours Children's Health System, Wilmington, Delaware
| | - Stephen DiDonato
- Center for Healthcare Delivery Science, Nemours Children's Health System, Wilmington, Delaware.,Center for Pediatric Traumatic Stress, Nemours Children's Health System, Wilmington, Delaware
| | | | | | - Avi Madan-Swain
- University of Alabama Birmingham at Children's of Alabama, Birmingham, Alabama
| | - Sunita K Patel
- City of Hope Medical Center and Beckman Research Institute, Duarte, California
| | - Sima Zadeh
- National Cancer Institute Pediatric Oncology Branch, Bethesda, Maryland
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