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Smout A, Melvin G, Jorm A, Yap MBH. Adapting a coach-assisted web-based intervention for parents of adolescents who refuse school: qualitative study with users of the Partners in Parenting Plus programme. BJPsych Open 2024; 10:e68. [PMID: 38487861 PMCID: PMC10951848 DOI: 10.1192/bjo.2024.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 12/12/2023] [Accepted: 01/24/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND School refusal is a heterogenous problem which typically emerges in adolescence and co-occurs with internalising disorders. A substantial proportion of adolescents do not respond to existing treatment modalities; thus, novel, effective intervention options are needed. Partners in Parenting Plus (PiP+) is a coach-assisted, web-based intervention designed to empower parents to respond to adolescent internalising disorders. AIMS To conduct a process evaluation of PiP+ and identify programme adaptations required to meet the needs of parents of adolescents who refuse school. METHOD Semi-structured interviews were conducted with 14 Australian mothers who had: (a) received the PiP+ programme (not tailored for school refusal) during a prior research trial; and (b) reported that their adolescent was refusing school during their participation in PiP+. Inductive thematic analysis was used to analyse interview transcripts. RESULTS Participants were 41-53 years old (M = 47.8) and parenting adolescent children aged 14-17 years (M = 14.9). Three themes illustrated how PiP+ features met or could better meet the needs of parents of adolescents who were refusing school: (a) feeling heard, supported and respected; (b) relevance to me and my context; and (c) seeing positive changes. Participants had favourable views of PiP+, especially coached components. Participants requested programme enhancements to better meet the needs of parents of neurodiverse adolescents and discussed the impact of cumulative help-seeking 'failures' on self-efficacy and locus of control. CONCLUSIONS PiP+ was highly acceptable to the majority of parents navigating the issue of school refusal. This has implications for the enhancement of coach-assisted parenting interventions and the context-specific adaptation of PiP+ for school refusal.
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Affiliation(s)
- Anna Smout
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Glenn Melvin
- School of Psychology, Deakin University, Melbourne, Victoria, Australia
| | - Anthony Jorm
- Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
| | - Marie B. H. Yap
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia; and Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
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Zhou T, Luo Y, Xiong W, Meng Z, Zhang H, Zhang J. Problem-Solving Skills Training for Parents of Children With Chronic Health Conditions: A Systematic Review and Meta-Analysis. JAMA Pediatr 2024; 178:226-236. [PMID: 38165710 PMCID: PMC10762633 DOI: 10.1001/jamapediatrics.2023.5753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 10/25/2023] [Indexed: 01/04/2024]
Abstract
Importance Problem-solving skills training (PSST) has a demonstrated potential to improve psychosocial well-being for parents of children with chronic health conditions (CHCs), but such evidence has not been fully systematically synthesized. Objective To evaluate the associations of PSST with parental, pediatric, and family psychosocial outcomes. Data Sources Six English-language databases (PubMed, Embase, CINAHL, PsycINFO, Web of Science, and Cochrane Library), 3 Chinese-language databases (China National Knowledge Infrastructure, China Science and Technology Journal Database, and Wanfang), gray literature, and references were searched from inception to April 30, 2023. Study Selection Randomized clinical trials (RCTs) that performed PSST for parents of children with CHCs and reported at least 1 parental, pediatric, or family psychosocial outcome were included. Data Extraction and Synthesis Study selection, data extraction, and quality assessment were conducted independently by 2 reviewers. Data were pooled for meta-analysis using the standardized mean difference (SMD) by the inverse variance method or a random-effects model. Subgroup analyses of children- and intervention-level characteristics were conducted. Main Outcomes and Measures The psychosocial outcomes of the parents, their children, and their families, such as problem-solving skills, negative affectivity, quality of life (QOL), and family adaptation. Results The systematic review included 23 RCTs involving 3141 parents, and 21 of these trials were eligible for meta-analysis. There was a significant association between PSST and improvements in parental outcomes, including problem-solving skills (SMD, 0.43; 95% CI, 0.27-0.58), depression (SMD, -0.45; 95% CI, -0.66 to -0.23), distress (SMD, -0.61; 95% CI, -0.81 to -0.40), posttraumatic stress (SMD -0.39; 95% CI, -0.48 to -0.31), parenting stress (SMD, -0.62; 95% CI, -1.05 to -0.19), and QOL (SMD, 0.45; 95% CI, 0.15-0.74). For children, PSST was associated with better QOL (SMD, 0.76; 95% CI, 0.04-1.47) and fewer mental problems (SMD, -0.51; 95% CI, -0.68 to -0.34), as well as with less parent-child conflict (SMD, -0.38; 95% CI, -0.60 to -0.16). Subgroup analysis showed that PSST was more efficient for parents of children aged 10 years or younger or who were newly diagnosed with a CHC. Significant improvements in most outcomes were associated with PSST delivered online. Conclusions and Relevance These findings suggest that PSST for parents of children with CHCs may improve the psychosocial well-being of the parents, their children, and their families. Further high-quality RCTs with longer follow-up times and that explore physical and clinical outcomes are encouraged to generate adequate evidence.
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Affiliation(s)
- Tianji Zhou
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Yuanhui Luo
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Wenjin Xiong
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Zhenyu Meng
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Hanyi Zhang
- Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jingping Zhang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
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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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Park M, Kim S, Lee H, Shin YJ, Lyu CJ, Choi EK. Development and effects of an internet-based family resilience-promoting program for parents of children with cancer: A randomized controlled trial. Eur J Oncol Nurs 2023; 64:102332. [PMID: 37146351 DOI: 10.1016/j.ejon.2023.102332] [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: 11/16/2022] [Revised: 04/20/2023] [Accepted: 04/27/2023] [Indexed: 05/07/2023]
Abstract
PURPOSE The diagnosis of cancer in children can negatively impact their parents, owing to the complex treatment processes. Families with high levels of resilience can overcome these difficulties and thus perform higher family functions. We aimed to develop an internet-based family resilience-promoting program for parents of children with cancer and evaluate its effect on the levels of family resilience, depression, and family function. METHODS This prospective, parallel-group, randomized-controlled study that was conducted at Yonsei Cancer Center from June to October 2021 included 41 parents of children with cancer. In total, four sessions of the internet-based family resilience-promoting program, led by a nurse, were conducted individually for parents. Levels of family resilience, depression, and family function were measured before, immediately after, and 4 weeks after the program. The data were analyzed using the linear mixed-effect model, and program satisfaction was evaluated through an internet-based questionnaire and interview. RESULTS The experimental group (the family resilience-promoting program participants) differed more significantly from the control group in the level of change in family resilience (β = 13.214, p = 0.003, effect size = 0.374) and family function (β = 1.256, p = 0.018, effect size = 0.394). However, there was no significant difference between the groups in the level of depression (β = 2.133, p = 0.187, effect size = 0.416). All the program participants showed a high program satisfaction score of 4.75 out of 5.00 points overall. CONCLUSIONS The applicability of the internet-based family resilience-promoting program as an appropriate nursing intervention was verified. Its application can help the families of children with cancer adapt to the stressful situation of their children's cancer diagnosis and treatment.
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Affiliation(s)
- Mina Park
- Yonsei Cancer Center, Yonsei University Health System, Seoul, South Korea; Department of Nursing, Yonsei University Graduate School, Seoul, South Korea
| | - Sunah Kim
- College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, South Korea
| | - Hyejung Lee
- College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, South Korea
| | - Yoon Jung Shin
- Yonsei Cancer Center, Yonsei University Health System, Seoul, South Korea
| | - Chuhl Joo Lyu
- Yonsei Cancer Center, Yonsei University Health System, Seoul, South Korea; Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea
| | - Eun Kyoung Choi
- College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, South Korea.
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Canter KS, Vega G, Perez Ramirez A, Munoz Osorio A, Thomas C, Lewis AM, Arasteh K, Kazak A. Acceptability and Feasibility of eSCCIP: Results From a Pilot Study of the Electronic Surviving Cancer Competently Intervention Program. J Pediatr Psychol 2023; 48:216-227. [PMID: 36303445 PMCID: PMC10027060 DOI: 10.1093/jpepsy/jsac082] [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: 05/03/2022] [Revised: 10/04/2022] [Accepted: 10/05/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Providing high-quality psychosocial care to parents and other primary caregivers of children with cancer (henceforth referred to as caregivers) is important, given the numerous challenges associated with a pediatric cancer diagnosis and the increased risk for negative psychosocial sequelae among caregivers. The Electronic Surviving Cancer Competently Intervention Program (eSCCIP) is a psychosocial eHealth intervention for caregivers, developed using an iterative, user-centered process. METHOD eSCCIP was tested in a single-arm pilot trial at Nemours Children's Hospital, Delaware (NCT05333601). The primary outcomes were intervention acceptability and feasibility, assessed via enrollment and retention targets, and item-level acceptability ratings. Enrollment and retention targets of 45% were set based on previous work, and an item-level acceptability threshold of 80% was set. A secondary exploratory analysis was conducted examining acute distress, anxiety, symptoms of post-traumatic stress, and family functioning. RESULTS 44 caregivers enrolled in the study and 31 completed. The intervention was rated favorably by completers, with over 80% of the sample selecting "mostly true" or "very true" for all items of the eSCCIP Evaluation Questionnaire, which was used to assess acceptability and feasibility. Enrollment and retention rates were 54% and 70%, respectively. Exploratory psychosocial outcomes showed statistically significant decreases from pre-intervention to post-intervention for overall symptoms of post-traumatic stress disorder (PTSD), cluster D symptoms of PTSD (negative mood and cognitions), and anxiety. Small-moderate effect sizes were observed for all psychosocial outcomes of interest. CONCLUSIONS eSCCIP is an acceptable and feasible intervention for caregivers. Results are promising regarding reductions in symptoms of post-traumatic stress and anxiety.
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Affiliation(s)
- Kimberly S Canter
- Nemours Center for Healthcare Delivery Science, Nemours Children’s Health, Wilmington, DE, USA
- Department of Pediatrics, Thomas Jefferson University, Philadelphia, PA, USA
| | - Gabriela Vega
- Nemours Center for Healthcare Delivery Science, Nemours Children’s Health, Wilmington, DE, USA
| | - Alejandra Perez Ramirez
- Nemours Center for Healthcare Delivery Science, Nemours Children’s Health, Wilmington, DE, USA
| | - Angel Munoz Osorio
- Nemours Center for Healthcare Delivery Science, Nemours Children’s Health, Wilmington, DE, USA
| | - Courtney Thomas
- Nemours Center for Healthcare Delivery Science, Nemours Children’s Health, Wilmington, DE, USA
| | - Amanda M Lewis
- Nemours Center for Healthcare Delivery Science, Nemours Children’s Health, Wilmington, DE, USA
| | - Kamyar Arasteh
- Nemours Center for Healthcare Delivery Science, Nemours Children’s Health, Wilmington, DE, USA
| | - Anne Kazak
- Nemours Center for Healthcare Delivery Science, Nemours Children’s Health, Wilmington, DE, USA
- Department of Pediatrics, Thomas Jefferson University, Philadelphia, PA, USA
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Zhai S, Chu F, Tan M, Chi NC, Ward T, Yuwen W. Digital health interventions to support family caregivers: An updated systematic review. Digit Health 2023; 9:20552076231171967. [PMID: 37223775 PMCID: PMC10201006 DOI: 10.1177/20552076231171967] [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] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 04/10/2023] [Indexed: 05/25/2023] Open
Abstract
Objective Chronic diseases are the leading causes of death and disability in the U.S., and disease management largely falls onto patients' family caregivers. The long-term burden and stress of caregiving negatively impact caregivers' well-being and ability to provide care. Digital health interventions have the potential to support caregivers. This article aims to provide an updated review of interventions using digital health tools to support family caregivers and the scope of the Human-Centered Design (HCD) approaches. Methods We conducted a systematic search on July 2019 and January 2021 in PubMed, CINAHL, Embase, Cochrane Library, PsycINFO, ERIC, and ACM Digital Library, limiting to 2014-2021 to identify family caregiver interventions assisted by modern technologies. The Mixed Methods Appraisal Tool and the Grading of Recommendations Assessment, Development and Evaluation were used to evaluate the articles. Data were abstracted and evaluated using Rayyan and Research Electronic Data Capture. Results We identified and reviewed 40 studies from 34 journals, 10 fields, and 19 countries. Findings included patients' conditions and relationships with family caregivers, how the technology is used to deliver the intervention, HCD methods, theoretical frameworks, components of the interventions, and family caregiver health outcomes. Conclusion This updated and expanded review revealed that digitally enhanced health interventions were robust at providing high-quality assistance and support to caregivers by improving caregiver psychological health, self-efficacy, caregiving skills, quality of life, social support, and problem-coping abilities. Health professionals need to include informal caregivers as an essential component when providing care to patients. Future research should include more marginalized caregivers from diverse backgrounds, improve the accessibility and usability of the technology tools, and tailor the intervention to be more culturally and linguistically sensitive.
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Affiliation(s)
- Shumenghui Zhai
- School of Nursing, University of Washington, Seattle, WA, USA
| | - Frances Chu
- School of Nursing, University of Washington, Seattle, WA, USA
- Providence Health System, Swedish First Hill, Seattle, WA, USA
| | - Minghui Tan
- School of Nursing, Peking Union Medical University, Beijing, China
| | - Nai-Ching Chi
- College of Nursing, University of Iowa, Iowa City, IA, USA
| | - Teresa Ward
- School of Nursing, University of Washington, Seattle, WA, USA
| | - Weichao Yuwen
- School of Nursing & Healthcare Leadership, University of Washington Tacoma, Tacoma, WA, USA
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Viola AS, Kwok G, Levonyan-Radloff K, Manne SL, Noll RB, Phipps S, Sahler OJZ, Devine KA. Feasibility and Acceptability of Bright IDEAS-Young Adults: A Problem-Solving Skills Training Intervention. Cancers (Basel) 2022; 14. [PMID: 35804896 DOI: 10.3390/cancers14133124] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/09/2022] [Accepted: 06/17/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Young adults with cancer are a vulnerable group with unique emotional, social, and practical needs. There is a lack of evidence-based interventions to address their needs and to foster skills that could increase their capacity to cope. Bright IDEAS is a problem-solving skills training intervention that has demonstrated efficacy in improving people's problem-solving ability and reducing distress among caregivers of children with cancer. This study evaluated the feasibility and acceptability of Bright IDEAS adapted for young adults (Bright IDEAS-YA). METHODS Forty young adults recently diagnosed with cancer were enrolled in a single arm feasibility study. RESULTS Feasibility was demonstrated by the adequate enrollment (67.8%), retention (80.0%), and participants' adherence to the intervention (average of 5.2 out of 6 sessions completed). Participants reported satisfaction with the intervention. Qualitative feedback identified the systematic approach to problem-solving and interaction with the trainer as strengths of the intervention. Participants demonstrated improvements in problem-solving skills and symptoms of depression and anxiety. CONCLUSIONS In conclusion, the results support the feasibility of the intervention and an adequately powered randomized controlled trial is needed to determine the efficacy of the intervention on psychosocial outcomes.
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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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Sharp K, Tillery R, Long A, Wang F, Pan H, Phipps S. Trajectories of resilience and posttraumatic stress in childhood cancer: Consistency of child and parent outcomes. Psychol Health 2022; 41:256-267. [PMID: 34855418 PMCID: PMC9809178 DOI: 10.1037/hea0001132] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Childhood cancer represents a potentially traumatic experience for both patients and caregivers. We examined trajectories of posttraumatic stress symptoms (PTSS) across a 5-year period in children with a history of cancer and their parents/caregivers. Medical, demographic, and dispositional variables were examined as predictors of PTSS trajectories. METHOD Using a longitudinal design, children with cancer history (n = 254, age 8-17 years at baseline) and one parent or caregiver (n = 255) completed measures of PTSS at baseline, and 1-, 3-, and 5-years poststudy entry. Children and caregivers completed dispositional measures including optimism, positive or negative affect, and Five-Factor Inventories. Latent class growth analysis (LCGA) was used to identify latent trajectories of PTSS, and univariate logistic regression models were conducted to predict LCGA class membership from medical, demographic, and disposition factors Results: Very similar trajectories were observed in children and caregivers, with two-class solutions providing the best fit: a "resilient" class, with low PTSS at baseline, which declined significantly over time (83.5% in children; 71.5% in parents), and an "elevated PTSS" class, which was moderately high at baseline and increased significantly over time. There was a small, but significant relationship between child and caregiver trajectories. Latent trajectories observed in children and parents were more strongly associated with dispositional variables than medical factors. CONCLUSIONS Resilience, depicted by low PTSS, is by far the most common outcome observed in both children and caregivers. However, the smaller subset with elevated PTSS do not show recovery over time, and are identified as a group in need of targeted interventions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Katianne Sharp
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Rachel Tillery
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Alanna Long
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Fang Wang
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN
| | - Haitao Pan
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN
| | - Sean Phipps
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
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Dolgin PhD MJ, Asper Ba A, Greizer Ba Y, Kariel Ba Y, Malka Ba M, Peretz Ba O, Rosenzweig Ba N, Shalev Ba S, Sandberg PhD DE. Meaningful Change and Treatment Responsivity in Intervention Research: A Targeted Review of Studies Published in the Journal of Pediatric Psychology. J Pediatr Psychol 2022; 47:723-741. [PMID: 35199833 DOI: 10.1093/jpepsy/jsac005] [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: 11/04/2021] [Revised: 01/19/2022] [Accepted: 01/26/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Randomized-controlled trials (RCTs) in pediatric psychology form the foundation for evidence-based treatment and best practices in the field. Relying heavily on continuous outcome measures and group comparisons, questions concerning meaningful clinical change and treatment response rates remain open. This targeted review aimed to provide an initial description of the current state of intervention research in pediatric psychology in terms of attention to meaningful clinical change and efforts to assess and characterize participants in terms of treatment responsivity. METHODS Online databases were used to identify a sample of RCT published in the Journal of Pediatric Psychology from 2010 to 2021 using the term "randomized" in the title. Using predefined eligibility and exclusion criteria, 43 studies were identified and analyzed with regard to characteristics of intervention, population, measurement, data reporting, and reference to indicators of clinical significance, meaningful change, treatment responsivity rates, and predictors. RESULTS 26 studies (60%) made no reference at all to meaningful clinical change, treatment response criteria and rates, or characteristics of treatment responders. 15 studies (35%) reported measures of meaningful change in their interpretation of group differences, to calculate sample size, in relation to baseline data only, or in describing a measure. 2 studies (5%) reported criteria for assessing meaningful change to determine individual response rates and characteristics of responders. CONCLUSIONS These findings highlight the need for greater emphasis on defining standards and analyzing treatment outcome research in terms of metrics of meaningful change and treatment response in order to better target intervention and optimize limited resources.
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Affiliation(s)
| | - Ariel Asper Ba
- Department of Psychology, Ariel University, Ariel, Israel
| | | | | | - Meshi Malka Ba
- Department of Psychology, Ariel University, Ariel, Israel
| | - Or Peretz Ba
- Department of Psychology, Ariel University, Ariel, Israel
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MacKinnon AL, Silang K, Penner K, Zalewski M, Tomfohr-Madsen L, Roos LE. Promoting Mental Health in Parents of Young Children Using eHealth Interventions: A Systematic Review and Meta-analysis. Clin Child Fam Psychol Rev 2022; 25:413-434. [PMID: 35184262 PMCID: PMC8858396 DOI: 10.1007/s10567-022-00385-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2022] [Indexed: 12/11/2022]
Abstract
Parent stress and mental health problems negatively impact early child development. This study aimed to systematically review and meta-analyze the effect of eHealth interventions on parent stress and mental health outcomes, and identify family- and program-level factors that may moderate treatment effects. A search of PsycINFO, Medline, CINAHL, Cochrane and Embase databases was conducted from their inception dates to July 2020. English-language controlled and open trials were included if they reported: (a) administration of an eHealth intervention, and (b) stress or mental health outcomes such as self-report or clinical diagnosis of anxiety and depression, among (c) parents of children who were aged 1–5 years old. Non-human studies, case reports, reviews, editorials, letters, dissertations, and books were excluded. Risk of bias was assessed using the National Institutes of Health (NIH) Study Quality Assessment Tools. Random-effects meta-analyses of standardized mean differences (SMD) were conducted and meta-regressions tested potential moderators. 38 studies were included (N = 4360 parents), from 13 countries (47.4% USA). Meta-analyses indicated eHealth interventions were associated with better self-reported mental health among parents (overall SMD = .368, 95% CI 0.228, 0.509), regardless of study design (k = 30 controlled, k = 8 pre-post) and across most outcomes (k = 17 anxiety, k = 19 depression, k = 12 parenting stress), with small to medium effect sizes. No significant family- or program-level moderators emerged. Despite different types and targets, eHealth interventions offer a promising and accessible option to promote mental health among parents of young children. Further research is needed on moderators and the long-term outcomes of eHealth interventions. Prospero Registration: CRD42020190719.
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Affiliation(s)
- Anna L MacKinnon
- Department of Psychology, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute (ACHRI), Calgary, AB, Canada
| | - Katherine Silang
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Kailey Penner
- Department of Psychology, University of Manitoba, 66 Chancellors Cir., Winnipeg, MB, R3T 2N2, Canada
| | | | - Lianne Tomfohr-Madsen
- Department of Psychology, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute (ACHRI), Calgary, AB, Canada
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Leslie E Roos
- Department of Psychology, University of Manitoba, 66 Chancellors Cir., Winnipeg, MB, R3T 2N2, Canada.
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12
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Brosnan P, Davis KA, Mazzenga M, Oberoi AR, Sharkey CM, Buchbinder D, Alderfer MA, Long KA. Psychosocial care providers' perspectives: Barriers to implementing services for siblings of children with cancer. Pediatr Blood Cancer 2022; 69:e29418. [PMID: 34786821 DOI: 10.1002/pbc.29418] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/01/2021] [Accepted: 10/05/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Siblings of children with cancer are at increased risk for poor long-term psychosocial outcomes. The standard of psychosocial care in pediatric oncology calling for sibling support is not routinely implemented, often leaving siblings with unmet psychosocial needs. Barriers to implementing the sibling standard may exist at multiple levels. This study addresses research gaps regarding multilevel barriers to supporting siblings at the health care system, oncology center, and family levels. PROCEDURE Qualitative interviews were conducted with psychosocial care providers (N = 27; 18 psychologists, five social workers, three psychiatrists, and one child life specialist) employed at oncology centers within hospitals across the United States, varying in extent of sibling programming and center size. Interviews included questions about providers' roles, oncology center characteristics, existing psychosocial sibling services, barriers to providing systematic sibling assessment, and ideas about how to overcome barriers. Data were analyzed using applied thematic analysis. RESULTS Qualitative analysis revealed (a) barriers to providing sibling services occur at multiple levels (health care system, oncology center, family); (b) barriers at multiple levels frequently interact with one another; and (c) interacting barriers maintain a cycle: barriers to providing services contribute to limited provision of services, low service provision leads to limited utilization of existing services and underprioritization of siblings, and together this leads to siblings being off the radar, which further limits sibling service provision. CONCLUSION Addressing health care system and oncology center barriers to implementing sibling assessment and support may be important potential targets for interventions to help ensure that siblings receive needed psychosocial assessment and support.
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Affiliation(s)
- Phoebe Brosnan
- Department of Psychological & Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Kathryn A Davis
- Department of Psychological & Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Marcella Mazzenga
- Department of Psychological & Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Anjali R Oberoi
- Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Christina M Sharkey
- Department of Neurology, Children's National Hospital, Washington, District of Columbia, USA
| | - David Buchbinder
- Division of Hematology, CHOC Children's Hospital, Orange, California, USA
| | - Melissa A Alderfer
- Center for Healthcare Delivery Science, Nemours Children's Health, Wilmington, DE & Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Kristin A Long
- Department of Psychological & Brain Sciences, Boston University, Boston, Massachusetts, USA
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13
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Noyes K, Zapf AL, Depner RM, Flores T, Huston A, Rashid HH, McNeal D, Constine LS, Fleming FJ, Wilding GE, Sahler OJZ. Problem-solving skills training in adult cancer survivors: Bright IDEAS-AC pilot study. Cancer Treat Res Commun 2022; 31:100552. [PMID: 35358820 PMCID: PMC9106910 DOI: 10.1016/j.ctarc.2022.100552] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/19/2022] [Accepted: 03/22/2022] [Indexed: 05/13/2023]
Abstract
PURPOSE Cancer patients experience significant distress and burden of decision-making throughout treatment and beyond. These stressors can interfere with their ability to make reasoned and timely decisions about their care and lead to low physical and social functioning and poor survival. This pilot study examined the impact of offering Problem-Solving Skills Training (PSST) to adult cancer survivors to help them and their caregivers cope more successfully with post-treatment decision-making burden and distress. PATIENTS AND METHODS Fifty patients who completed their definitive treatment for colorectal, breast or prostate cancer within the last 6 months and reported distress (level > 2 on the National Comprehensive Cancer Network distress thermometer) were randomly assigned to either care as usual (CAU) or 8 weekly PSST sessions. Patients were invited to include a supportive other (n = 17). Patient and caregiver assessments at baseline (T1), end of intervention or 3 months (T2), and at 6 months (T3) focused on problem-solving skills, anxiety/depression, quality of life and healthcare utilization. We compared outcomes by study arm and interviewed participants about PSST burden and skill maintenance. RESULTS Trial participation rate was 60%; 76% of the participants successfully completed PSST training. PSST patients reported reduction in anxiety/depression, improvement in QoL (p < 0.05) and lower use of hospital and emergency department services compared to CAU patients (p = 0.04). CONCLUSIONS The evidence from this pilot study indicates that a remotely delivered PSST is a feasible and potentially effective strategy to improve mood and self-management in cancer survivors in community oncology settings.
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Affiliation(s)
- Katia Noyes
- University at Buffalo, Buffalo, NY, United States of America.
| | - Alaina L Zapf
- University of Rochester Medical Center, Rochester, NY, United States of America
| | - Rachel M Depner
- Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Tessa Flores
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States of America
| | - Alissa Huston
- University of Rochester Medical Center, Rochester, NY, United States of America
| | - Hani H Rashid
- University of Rochester Medical Center, Rochester, NY, United States of America
| | - Demetria McNeal
- University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America
| | - Louis S Constine
- University of Rochester Medical Center, Rochester, NY, United States of America
| | - Fergal J Fleming
- University of Rochester Medical Center, Rochester, NY, United States of America
| | | | - Olle Jane Z Sahler
- University of Rochester Medical Center, Rochester, NY, United States of America
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Canter KS, McIntyre R, Babb R, Ramirez AP, Vega G, Lewis A, Bottrell C, Lawlor C, Kazak AE. A community-based trial of a psychosocial eHealth intervention for parents of children with cancer. Pediatr Blood Cancer 2022; 69:e29352. [PMID: 34532970 DOI: 10.1002/pbc.29352] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 08/12/2021] [Accepted: 08/31/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND The Electronic Surviving Cancer Competently Intervention Program (eSCCIP), a psychosocial eHealth intervention for parents and caregivers of children with cancer (parents), was delivered in a community-based psychosocial oncology center. Primary endpoints were intervention acceptability, feasibility, and accessibility, with a secondary exploratory focus on psychosocial outcomes. PROCEDURE Oncology therapists in a psychosocial oncology center were trained in eSCCIP delivery. Participants were eligible for participation if they were the primary caregiver of a child with cancer between the ages 0 and 17, could read and write in English, and had reliable internet access to complete eSCCIP. Surveys were administered electronically at baseline and post intervention to evaluate study endpoints. Effect sizes (Cohen's d) were computed for exploratory psychosocial outcomes. Nineteen parents completed the intervention. RESULTS Parents rated eSCCIP as highly acceptable, feasible, and accessible. A large clinical effect was detected for acute distress (d = 0.79). Moderate clinical effects were reported for overall posttraumatic stress disorder (PTSD) symptoms (d = 0.37), negative mood/cognitions (d = 0.59), and symptoms of anxiety (d = 0.48). CONCLUSIONS Results indicate that eSCCIP is an acceptable, feasible, and accessible psychosocial intervention for parents. Exploratory analyses suggest that participation in eSCCIP may contribute to decreases in acute distress, symptoms of anxiety, and symptoms of PTSD.
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Affiliation(s)
- Kimberly S Canter
- Nemours Center for Healthcare Delivery Science, Wilmington, Delaware, USA.,Department of Pediatrics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Rebecca McIntyre
- Inova Schar Cancer Institute, Life with Cancer, Fairfax, Virginia, USA
| | - Rebecca Babb
- Inova Schar Cancer Institute, Life with Cancer, Fairfax, Virginia, USA.,Department of Pediatric Hematology/Oncology, Inova Children's Hospital, Fairfax, Virginia, USA
| | | | - Gabriela Vega
- Nemours Center for Healthcare Delivery Science, Wilmington, Delaware, USA
| | - Amanda Lewis
- Nemours Center for Healthcare Delivery Science, Wilmington, Delaware, USA
| | - Cathy Bottrell
- Inova Schar Cancer Institute, Life with Cancer, Fairfax, Virginia, USA.,Center for Cancer and Blood Disorders, Pediatric Specialists of Virginia, Fairfax, Virginia, USA
| | - Christopher Lawlor
- Center for Cancer and Blood Disorders, Pediatric Specialists of Virginia, Fairfax, Virginia, USA.,Department of Pediatrics, George Washington University, Washington, District of Columbia, USA.,Department of Oncology, Children's National Medical Center, Washington, District of Columbia, USA
| | - Anne E Kazak
- Nemours Center for Healthcare Delivery Science, Wilmington, Delaware, USA.,Department of Pediatrics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Eche IJ, Yusufov M, Isibor DA, Wolfe J. A systematic review and meta-analytic evaluation of psychosocial interventions in parents of children with cancer with an exploratory focus on minority outcomes. Pediatr Blood Cancer 2021; 68:e29328. [PMID: 34523798 DOI: 10.1002/pbc.29328] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 05/10/2021] [Revised: 07/28/2021] [Accepted: 08/13/2021] [Indexed: 11/11/2022]
Abstract
Parents of children with cancer are prone to psychosocial distress, yet little is known about intervention response among diverse parents. Our systematic review and meta-analysis evaluated the efficacy of psychosocial interventions on anxiety and depression among parents of children with cancer and explored race and/or ethnicity differences in the efficacy of these interventions. Twenty articles met inclusion. The aggregate effect size on anxiety (-0.01, 95% CI: -0.95, 0.93, p = .97) and depression (-0.56, 95% CI: -1.65, 0.54, p = .32) showed micro to medium effects, with larger negative effect sizes indicating that anxiety and depression scores after treatment were lower for parents in intervention group as compared to control group. Neither aggregate effect size was statistically significantly different from zero. Due to underrepresentation of minorities, we could not perform subgroup or moderator analyses. Several efficacious psychosocial interventions were found to reduce parental anxiety. Future studies to examine psychosocial interventions in minority parents are warranted.
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Affiliation(s)
- Ijeoma Julie Eche
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Miryam Yusufov
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | | | - Joanne Wolfe
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
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16
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Basile NL, Chardon ML, Peugh J, Edwards CS, Szulczewski L, Morrison CF, Nagarajan R, El-Sheikh A, Chaney JM, Pai ALH, Mullins LL. Relationship Between Caregiver Uncertainty, Problem-Solving, and Psychological Adjustment in Pediatric Cancer. J Pediatr Psychol 2021; 46:1258-1266. [PMID: 34350968 DOI: 10.1093/jpepsy/jsab065] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/26/2021] [Accepted: 05/19/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The current study examined the roles of constructive and dysfunctional problem-solving strategies in the relationships between illness uncertainty and adjustment outcomes (i.e., anxious, depressive, and posttraumatic stress symptoms) in caregivers of children newly diagnosed with cancer. METHODS Two hundred thirty-eight caregivers of children (0-19 years of age) newly diagnosed with cancer (2-14 weeks since diagnosis) completed measures of illness uncertainty, problem-solving strategies, and symptoms of anxiety, depression, and posttraumatic stress. RESULTS A mediation model path analysis assessed constructive and dysfunctional problem-solving strategies as mediators between illness uncertainty and caregiver anxious, depressive, and posttraumatic stress symptoms. Dysfunctional problem-solving scores partially mediated the relationships between illness uncertainty and anxious, depressive, and posttraumatic stress symptoms. Constructive problem-solving scores did not mediate these relationships. CONCLUSIONS The current findings suggest that illness uncertainty and dysfunctional problem-solving strategies, but not constructive problem-solving strategies, may play a key role in the adjustment of caregivers of children newly diagnosed with cancer. Interventions aimed at managing illness uncertainty and mitigating the impact of dysfunctional problem-solving strategies may promote psychological adjustment.
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Affiliation(s)
- Nathan L Basile
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University
| | - Marie L Chardon
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center
| | - James Peugh
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center.,Department of Pediatrics, University of Cincinnati College of Medicine
| | - Clayton S Edwards
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University
| | - Lauren Szulczewski
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center.,Department of Pediatrics, University of Cincinnati College of Medicine
| | | | - Rajaram Nagarajan
- Division of Hematology/Oncology, Cincinnati Children's Hospital Medical Center
| | - Ayman El-Sheikh
- Department of Hematology/Oncology, Dayton Children's Hospital
| | - John M Chaney
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University
| | - Ahna L H Pai
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center.,Department of Pediatrics, University of Cincinnati College of Medicine
| | - Larry L Mullins
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University
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17
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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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Flujas-Contreras JM, García-Palacios A, Gómez I. Effectiveness of a Web-Based Intervention on Parental Psychological Flexibility and Emotion Regulation: A Pilot Open Trial. Int J Environ Res Public Health 2021; 18:2958. [PMID: 33805835 PMCID: PMC7998718 DOI: 10.3390/ijerph18062958] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/03/2021] [Accepted: 03/11/2021] [Indexed: 01/07/2023]
Abstract
"Parenting Forest" is an informed contextual therapy parenting program for improving parental emotion regulation strategies and psychological flexibility. The aim of this study was to evaluate the preliminary effectiveness of a self-guided web-based intervention of the Parenting Forest program. The intervention program consists of six self-applied sequential modules that use strategies from contextual therapies for providing a parenting style open to experience, mindful and committed to its actions. A pilot controlled open trial was conducted. Eligible parents (n = 12) enrolled in the web-based intervention completed baseline (T1) and post-intervention (T2) assessment instruments. Parental psychological flexibility, avoidance, emotional regulation, parental stress, satisfaction with life, children's psychological adjustment and client satisfaction were measured to assess the effects of the intervention. Mood, coping, and value-related actions were assessed as measures of progress. The results showed positive effects on the parents' psychological flexibility and emotion regulation. Parents' mood and coping skills improved throughout the intervention program. These results provide preliminary evidence of the web-based Parenting Forest's efficacy, although further research is needed to assess its effectiveness for prevention and in clinical populations.
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Affiliation(s)
- Juan M. Flujas-Contreras
- Department of Psychology, University of Almeria, 04120 Almeria, Spain;
- Health Research Centre (CEINSA/UAL), University of Almeria, 04120 Almeria, Spain
| | - Azucena García-Palacios
- Department of Psychology, University Jaume I, 12071 Castellon, Spain;
- CIBER of Physiopathology of Obesity and Nutrition CIBERobn, CB06/03 Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Inmaculada Gómez
- Department of Psychology, University of Almeria, 04120 Almeria, Spain;
- Health Research Centre (CEINSA/UAL), University of Almeria, 04120 Almeria, Spain
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