Resources, Parent-Child Communication and Adjustment to Pediatric Cancer

小儿癌症的资源、亲子沟通和调整

• 批准号: 8080379
• 负责人: Louis A. Penner
• 金额: $ 61.01万
• 依托单位: WAYNE STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-08-01 至 2014-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8080379
• 关键词: Affect; Anxiety; Cancer Patient; Child; Clinic Visits; Clinical; Communication; Control Groups; Diagnosis; Distress; Enrollment; Family; Goals; Health; Institution; Intervention; Malignant Childhood Neoplasm; Malignant Neoplasms; Medical; Methods; Modeling; Modern Medicine; Nature; Outcome; Pain; Parent-Child Relations; Parents; Pattern; Personal Satisfaction; Phase; Plant Roots; Procedures; Process; Quality of life; Randomized; Reaction; Relative (related person); Research; Research Personnel; Resources; Risk; Social Environment; Spinal Puncture; Staging; Stress; Sum; Testing; Time; Translating; Treatment/Psychosocial Effects; Video Recording; Visit; Work; active method; base; communication behavior; design; experience; improved; low socioeconomic status; parent-child communication; psychosocial; psychosocial adjustment; research study; response; social; standard of care; stressor; success; therapy design; treatment duration

DESCRIPTION (provided by applicant): Many pediatric cancer patients and their parents experience serious psychosocial problems during and long after completing treatment. Designing interventions to significantly reduce these problems requires understanding their origins. Thus, our primary objective is to identify specific factors that directly and indirectly affect psychosocial adjustment. Previous research shows: (a) both parents' and children's long-term psychosocial outcomes are rooted in the treatment experience; (b) invasive treatment procedures during clinic visits (e.g., lumbar punctures) are one of the most stressful aspects of pediatric cancer; and thus (c) negative responses to these procedures (e.g., distress) place parents and children at greater risk for subsequent psychosocial problems. We have found that variability in children's immediate responses to treatment procedures is associated with variability in situational resources (i.e., resources on days of clinic visits) and in parent-child communication patterns during clinic visits. Our model of causes of psychosocial problems associated with pediatric cancer is based on these and other empirical findings. It posits that: (a) stable family resources (i.e., social, personal, and fiscal/material resources) directly affect parents' and children's psychosocial well-being; (b) stable and situational family resources affect parent-child communication during clinic visits; and (c) parent-child communication affects their responses to procedures and subsequent psychosocial adjustment. Our first aim (Phase 1) is to replicate and extend prior research on relationships among the variables in the model and to determine the viability of the overall model. Our second aim (Phase 2) is to experimentally test causal relationships between specific variables in the model and parents' and children's responses to procedures. We will conduct two separate experiments that manipulate specific situational resources and parent communication behavior and examine the direct and/or indirect effects on immediate responses to treatment procedures and on subsequent psychosocial adjustment. Phase 1 will enroll 130-150 total families of recently diagnosed pediatric cancer patients at two institutions. Families' stable resources and situational resources on days of clinic visits will be assessed. Parent-child interactions during three clinic visits will be video recorded and responses to treatment procedures will be assessed. Children's and parents' psychosocial adjustment will be assessed three, six, and nine months after completion of video-recorded clinic visits. In Phase 2, 130-150 families from the two institutions will be randomly assigned to control and experimental treatment conditions. Experimental groups will receive the manipulations. Control groups will receive standard of care. Families will be assessed in the same manner as in Phase 1. PUBLIC HEALTH RELEVANCE: Previous research indicates that: (a) invasive treatment procedures are one of the most stressful aspects of pediatric cancer and (b) parents' and children's negative long-term psychosocial outcomes are rooted in distress reactions associated with those procedures. Families' personal and social resources at the time of treatment and parent-child communication patterns during treatment-related clinic visits are associated with children's responses (i.e., pain and distress) to treatment procedures. The proposed study will identify and experimentally test relationships between specific social and personal resources and parent-child communication and parent/child immediate responses to treatment procedures and psychosocial adjustment. The study will provide the basis for interventions ameliorating some of the major negative psychosocial effects of pediatric cancer.

描述（由申请人提供）：许多儿科癌症患者及其父母在完成治疗后和很长时间后会遇到严重的社会心理问题。设计干预措施以大大减少这些问题需要了解它们的起源。因此，我们的主要目标是确定直接和间接影响社会心理调整的特定因素。先前的研究表明：（a）父母和孩子的长期社会心理结局都植根于治疗经验； （b）诊所就诊期间的侵入性治疗程序（例如，腰椎穿刺）是小儿癌最受压力的方面之一；因此（c）对这些程序（例如，遇险）的负面反应使父母和孩子面临更大的随后的社会心理问题的风险。我们发现，儿童对治疗程序的立即反应的可变性与情境资源的可变性（即诊所就诊的日期）以及诊所就诊期间的亲子沟通方式有关。我们与儿科癌症相关的社会心理问题原因的模型是基于这些和其他经验发现。它认为：（a）稳定的家庭资源（即社会，个人和财产/物质资源）直接影响父母和孩子的社会心理健康； （b）稳定和情境家庭资源会影响诊所访问期间的亲子交流； （c）亲子沟通会影响他们对程序的反应以及随后的社会心理调整。我们的第一个目标（第1阶段）是复制和扩展对模型中变量之间关系的先前研究，并确定整体模型的可行性。我们的第二个目标（第2阶段）是在模型中的特定变量与父母和孩子对程序的反应之间进行实验测试因果关系。我们将进行两个独立的实验，以操纵特定的情况资源和父沟通行为，并检查对治疗程序的直接响应以及随后的心理社会调整的直接和/或间接影响。第1阶段将在两个机构的最近被诊断的小儿癌患者的总部招募130-150个家庭。将评估家庭稳定的资源和诊所就诊时代的情况。将记录三次诊所访问期间的亲子互动，并评估对治疗程序的反应。完成视频诊所就诊后的三个，六和九个月，儿童和父母的社会心理调整将进行评估。在第2阶段，来自两个机构的130-150个家庭将被随机分配给对照和实验治疗条件。实验组将接受操作。对照组将获得护理标准。家庭将以与第1阶段相同的方式进行评估。公共卫生相关性：先前的研究表明：（a）侵入性治疗程序是儿科癌症的最紧张的方面之一，（b）父母和孩子的负面长期心理社会心理结局植根于与这些程序相关的遇险反应中。在治疗时，家庭和社会资源在与治疗相关的诊所访问期间的个人和社会资源与儿童对治疗程序的反应（即疼痛和困扰）有关。拟议的研究将确定并通过实验测试特定的社会和个人资源与亲子沟通之间的关系，以及父母/孩子对治疗程序和社会心理调整的立即反应。这项研究将为改善小儿癌的一些主要负面心理影响提供干预措施提供基础。