An integrated approach to the assessment of family adjustment to acute lymphocytic leukemia in children

A comprehensive model of the development of mental handicap in children treated for acute lymphoblastic leukaemia: A synthesis of the literature

Most clinical studies addressing sequelae in children with leukaemia are not theory-driven. Nonetheless, the role of different mediating biological (e.g. cranial irradiation, chemotherapy) and psychosocial variables (e.g. family functioning) has been empirically acknowledged. In these studies, a cause-effect relationship between biological variables and cognitive deficits, sometimes complex due to multiple agents, has been hypothesised. As for the psychosocial consequences, adaptation to the cancer-related stress has been the main focus, at both the individual and family levels. In this paper, we advocate the use of a global model for the development of handicap, derived from the International Classification of Impairments, Disabilities and Handicaps (ICIDH) by the World Health Organisation. This revised model proposes that handicap is the result of complex interactions between the characteristics of a person’s impairment, disabilities, and the characteristics of the environment. At each of these levels, risk/resilience factors are defined. This means that depending on the environmental obstacles they face, persons with an impairment or a disability may or may not experience a situation creating a handicap which is no longer seen as a stable status resulting from a disease to which the individual must adapt. By reviewing animal and clinical studies, current knowledge pertaining to leukaemia sequelae are integrated into the different levels defined by the model: organic impairment, disabilities, environmental obstacles, and handicap situation. Practical implications for research, policies, and individual treatments, and comparisons with existing models, are also outlined.

Promoting optimal functioning in spinal cord injury: the role of rehabilitation psychology

Comprehensive treatment and rehabilitation includes attention to the psychological needs of individuals with SCI and their families. This chapter is designed to familiarize neurologists and other practitioners with psychological issues and care in SCI. While psychologists play a key role, attention to psychosocial health is a responsibility shared by all members of the rehabilitation team, beginning with the patient and family, and including clinicians who are not formally identified as mental health providers. Treatment planning for a person with SCI begins with a thorough assessment of the cognitive, emotional, personality, and social factors that influence functioning and rehabilitation. Rehabilitation psychologists use a mixture of assessment tools, including clinical interviews, behavioral observations, and a wide range of standardized test instruments. Psychological interventions can involve direct intervention with the patient, in individual, family or group-based therapies. Other psychological strategies involve assistance through less direct methods - consultation and training to other rehabilitation team members or facilitating peer role-modeling and support groups. The chapter provides an overview of core clinical issues (emotional responses, substance use, pain, cognitive deficits, sexuality and vocational rehabilitation), delineates the process of psychological assessment and intervention, and provides guidance on incorporation of rehabilitation psychology into SCI rehabilitation.

Gender differences of parental distress in children with cancer

BACKGROUND

Reports published over the last few decades present contradictory findings about the psychological distress and coping patterns of parents whose children have cancer. Although an increasing number of studies have focused on psychological distress and the adjustment process that parents experience when their children are diagnosed with cancer, few of these studies have been conducted in Taiwan.

AIMS

Gender differences of parental distress experienced by Taiwanese mothers and fathers (164 couples) whose children were undergoing treatment for cancer were investigated.

METHODS

Parenting stress, psychological distress, somatization, as well as marital satisfaction were compared between mothers and fathers whose children had cancer.

RESULTS

Mothers averaged significantly higher levels than fathers for all forms of distress. Mothers and fathers whose children had been diagnosed within the previous 2 months reported higher levels of depression, anxiety, and global stress than those in the other groups. Both mothers and fathers whose children had been diagnosed within the past 2 months reported greater marital dissatisfaction than parents whose children were in the other treatment groups.

CONCLUSIONS

This finding indicates the need for a thorough psychiatric consultation at the time of diagnosis for children who have cancer and their families. Ongoing psychosocial support and education should have been integral components of the treatment program when relapse occurred.

Predictors of affective responses of mothers and fathers of children with cancer

We investigated predictors of affective responses for 125 parents (77 mothers, 48 fathers) of children with various types of cancer who varied in time of diagnosis from newly diagnosed to 13 years following cancer treatment. The primary rationale of the investigation was to determine whether cognitive appraisals, perceived social supports, and caregivers' perceptions of children's behavior would predict affective responses differentially for mothers and fathers. We defined affectivity as self-reported depressive symptoms, and state and trait anxiety symptoms. Parents did not differ on any of the variables, including affective responses, although differential predictors of affective responses were revealed for mothers and fathers. Affiliation-related attributions were associated with affective responses for mothers, and achievement-related attributions and perceived social support were associated with affective responses for fathers.

The need for psychosocial support in parents with cochlear implanted children

OBJECTIVE

The aim of the study was to assess the need of parents with Cochlear implanted children for psychosocial support, based on psychic symptoms reported by these parents and their motivation to make use of psychosocial interventions.

METHODS

Fifty seven mothers and 46 fathers of 57 Cochlear implanted children were evaluated separately, employing validated questionnaires (Symptom Checklist-90-R and Questionnaire on Psychosocial Support).

RESULTS

26% of the mothers and 25% of the fathers showed severe psychic symptoms as reflected in the Symptom Checklist-90-R. Fifty nine percent of the mothers and 60% of the fathers were highly motivated to participate in psychosocial interventions--especially in the form of further information on their children's ailment and in parents' groups.

CONCLUSIONS

The data presented suggest that there is a need for psychosocial support in 18% of the parents; 8% of the parents show high psychic stress, but low motivation. The rest of the parents are not in need of support; nevertheless, 42% of the parents are highly motivated in favor of psychosocial interventions.

Social support in children with cancer: a review of the literature

Families experiencing childhood cancer are confronted with many stressors throughout the course of illness. For children with cancer, such stressors may be especially challenging. The extent to which they are able to deal with such challenges appears to be partly contingent on the support available from others. Positive social relations are considered to improve the quality of life of individuals in general and to help protect or buffer them from stressful life events such as cancer. This article presents a critical review and synthesis of research examining social support in children with cancer. Recommendations for research that will provide a foundation for understanding social support in children with cancer are outlined. These recommendations include the need to investigate (a) social support as a guiding, central construct, (b) social support from a family socio-cultural perspective, (c) social support from a developmental perspective, and (d) social support as a process. Implications for pediatric oncology nursing practice are discussed.

Parents' perceptions of their quality of life

The purpose of this study was to assess parents' perceptions of their quality of life after the diagnosis and treatment of cancer in their child. The following questions were addressed: (1) How do parents of children with cancer perceive their quality of life; (2) How do parents of children with cancer perceive their quality of life compared with before their child was diagnosed; and (3) Is there a statistically significant difference in parents' quality of life perceptions now as compared with before their child had cancer? Using Roy's Adaptation Model as a theoretical framework, a descriptive study research design was used with a convenience sample of 30 parents. Data collection involved parental completion of the Varricchio-Wright Impact of Cancer Questionnaire-Parents, a 17-item instrument measuring parental quality of life in each of Roy's domains, and a Demographic Information Form. Measures of central tendency were used to describe the sample and to answer the first two research questions; student's t-test was used to answer the third. Results indicated that this sample of parents perceived their quality of life now as good, but not as good as before their child was diagnosed with cancer. There was a statistically significant difference in parents' perceptions of their quality of life now and before their child was diagnosed with cancer. The significance of this study related to nursing practice and research is discussed and recommendations for future research are given.