A Clinic-Based Interdisciplinary Intervention for Parents of Children with Cancer

针对癌症儿童家长的基于临床的跨学科干预

• 批准号: 8627420
• 负责人: Larry L. Mullins
• 金额: $ 69.96万
• 依托单位: CINCINNATI CHILDRENS HOSP MED CTR
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-26 至 2019-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8627420
• 关键词: 18 year old; 8 year old; Address; Aftercare; Age; Anxiety; Attention; Behavior; Behavioral; Bioinformatics; Child; Child Behavior; Childhood; Clinic; Communication; Complex; Diagnosis; Discipline of Nursing; Distress; Dose; Education; Educational process of instructing; Emotional; Event; Gender; Goals; Information Management; Intervention; Knowledge; Lead; Malignant Childhood Neoplasm; Malignant Neoplasms; Measures; Mediating; Mediator of activation protein; Medical; Mental Depression; Modeling; Moods; Nature; Newly Diagnosed; Nurses; Outcome; Parents; Perception; Pilot Projects; Prevention; Problem Solving; Psychological Impact; Psychologist; Psychology; Psychosocial Assessment and Care; Randomized; Reporting; Risk; Social support; Socioeconomic Status; Support Groups; Symptoms; Testing; Thinking; Time; Treatment Protocols; Uncertainty; base; cancer care; cancer diagnosis; cancer therapy; clinical care; comparative efficacy; depressive symptoms; design; efficacy testing; evidence base; experience; group intervention; improved; innovation; interdisciplinary approach; intervention effect; post intervention; post-traumatic stress; prevent; psychologic; psychological distress; psychosocial; public health relevance; skills; treatment as usual; treatment effect

PROJECT SUMMARY Illness uncertainty refers to thoughts and perceptions about illness-related events that are unpredictable, ambiguous, and/or complex in nature. Higher levels of illness uncertainty consistently and robustly predict increased psychological distress in both parents and children (e.g., posttraumatic stress symptoms, anxiety, and depression). Therefore, strategies to decrease uncertainty are central to optimizing the adjustment of children with cancer and their parents. A recent pilot study conducted by our team evaluated acceptability and feasibility of the Parental Uncertainty Management Intervention (PUMI), a clinic-based interdisciplinary intervention for parents of children newly diagnosed with cancer. The goal of the PUMI is to help parents manage uncertainty in order to promote both parent adjustment and, subsequently, child adjustment in the context of a child's new cancer diagnosis. Parents in the PUMI group demonstrated significant improvements in maternal distress and child behavior problems compared to the treatment as usual group at 1- and 3-months post-treatment follow-ups. The proposed multisite trial will test the PUMI's efficacy and durability with regard to improving parent and child adjustment shortly following a child's cancer diagnosis. Parents of children between two and 18 years of age will be randomly assigned at baseline to either the PUMI or the Education/Support Only (ESO; attention control) condition. Both conditions consist of six-sessions that will be delivered jointly by a nurse and psychologist. The PUMI teaches parents to identify triggers that lead to uncertainty, utilize strategies to prevent those triggers, as well as manage uncertainty that is unavoidable. In addition, parents will have access to an on-line portal designed to increase knowledge and decrease perceived ambiguities about the child's illness and treatments. Parents in the ESO will also complete six in-clinic sessions with a nurse and psychologist. These sessions will provide education about pediatric cancer and social support. [Parents in both groups will complete measures of psychological distress, illness uncertainty, posttraumatic stress, problem- solving, and parent-reported child emotional and behavioral functioning at five time points: baseline, 1-week post-intervention, as well as 3-, 6-, and 12-months post-treatment. The primary aims for the proposed study are to compare the PUMI to the ESO group on parent and child psychological distress 1-week post- intervention. The secondary aims are to compare the durability of the PUMI to the ESO group on parent and child overall distress and posttraumatic stress symptoms. Potential mediators of the treatment effects, including levels of uncertainty and portal use, will also be examined.] This study will provide an empirically- supported intervention that will significantly mitigate the adverse impact pediatric cancer has on child and parent adjustment and, ultimately, advance the practice of comprehensive cancer care.

项目概要 疾病不确定性是指对不可预测的疾病相关事件的想法和看法， 性质不明确和/或复杂。一致且稳健地预测疾病不确定性水平较高 父母和孩子的心理困扰增加（例如创伤后应激症状、焦虑、 和抑郁症）。因此，减少不确定性的策略对于优化调整至关重要。 患有癌症的儿童及其父母。我们团队最近进行的一项试点研究评估了可接受性和 家长不确定性管理干预（PUMI）的可行性，这是一种基于临床的跨学科方法 对新诊断出患有癌症的儿童的父母进行干预。 PUMI 的目标是帮助家长 管理不确定性，以促进父母的调整，以及随后的孩子的调整 儿童新的癌症诊断的背景。 PUMI 组的家长表现出显着的进步 1 个月和 3 个月时与常规治疗组相比，产妇痛苦和儿童行为问题的情况 治疗后随访。拟议的多站点试验将测试 PUMI 在以下方面的功效和耐久性： 在儿童癌症诊断后不久改善父母和儿童的适应能力。孩子的父母之间 2 岁和 18 岁的儿童将在基线时被随机分配到 PUMI 或教育/支持 仅（ESO；注意力控制）条件。这两个条件都包括六个会议，将由一个 护士和心理学家。 PUMI 教导家长识别导致不确定性的触发因素，利用策略 防止这些触发因素，并管理不可避免的不确定性。此外，家长还会有 访问旨在增加知识并减少对相关内容的模糊认识的在线门户 孩子的疾病和治疗。 ESO 中的家长还将与护士和护士一起完成六次诊所内课程 心理学家。这些课程将提供有关儿科癌症和社会支持的教育。 [双方父母 小组将完成心理困扰、疾病不确定性、创伤后压力、问题的测量 解决问题，并由家长报告五个时间点的儿童情绪和行为功能：基线、1 周 干预后以及治疗后 3、6 和 12 个月。拟议研究的主要目标 将 PUMI 组与 ESO 组在治疗后 1 周的父母和儿童心理困扰方面进行比较 干涉。第二个目标是比较 PUMI 与 ESO 组在母体和母体上的持久性 儿童整体痛苦和创伤后应激症状。治疗效果的潜在中介因素， 包括不确定性和门户使用的水平，也将受到审查。] 这项研究将提供经验性的- 支持的干预措施将显着减轻儿科癌症对儿童和儿童的不利影响 家长的调整，并最终推进综合癌症护理的实践。