Trauma and Growth in Pediatric Cancer

小儿癌症的创伤和生长

• 批准号: 7888616
• 负责人: Sean Phipps
• 金额: $ 34.86万
• 依托单位: ST. JUDE CHILDREN'S RESEARCH HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-03-03 至 2013-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7888616
• 关键词: Accounting; Address; Adult; Affect; Algorithms; Cancer Control; Cancer Survivor; Child; Childhood; Data Sources; Development; Diagnosis; Diagnostic; Ensure; Environment; Evaluation; Event; Family history of; Frequencies; Government; Growth; Health Status; Incidence; Intervention; Interview; Life; Literature; Malignant Childhood Neoplasm; Malignant Neoplasms; Measures; Medical; Medical History; Modeling; Outcome; Parenting behavior; Parents; Participant; Pathway interactions; Patient Self-Report; Patients; Personality; Persons; Population; Post-Traumatic Stress Disorders; Psychology; Psychopathology; Recording of previous events; Relative (related person); Reporting; Research; Research Design; Risk; Risk Factors; Screening procedure; Sensitivity and Specificity; Stress; Structure; Symptoms; Trauma; base; cancer diagnosis; catalyst; clinically significant; comparison group; design; experience; improved; novel; optimism; peer; predictive modeling; primary outcome; public health relevance; resilience; secondary outcome; theories

DESCRIPTION (provided by applicant): Childhood cancer is widely viewed as a traumatic event, and application of traumatic stress models has become the dominant approach in pediatric psychooncology research. This approach to understanding the experiences of children with cancer presupposes 'cancer as trauma', and focuses on psychopathology rather than adjustment. These biases have influenced research design, and contribute to proliferation of deficit- oriented models, despite the fact that the majority of studies have not shown an increased incidence of post- traumatic stress disorder (PTSD) or of subclinical levels of post-traumatic stress symptoms (PTSS) in children with cancer. This proposal is based on the assumption that the diagnosis of cancer represents a significant life event that is not only a potential trauma, but also a potential catalyst for growth and positive change, calling for examination of positive outcomes such as post-traumatic growth (which we now refer to as challenge-related growth) and benefit-finding (CRG), constructs that have been studied primarily in adults with cancer but not in children. The proposed study will address several gaps in our understanding of PTSD outcomes in pediatric cancer, while broadening the focus to include simultaneous assessment of positive outcomes. Guided by positive psychology theory, we will examine determinants of PTSD and CRG outcomes, focusing on several resilience-related personality variables, including adaptive style, optimism, and dispositional positive affect. The aims of this proposal will be addressed with a two-group (cancer and healthy control), cross-sectional design, using patient self-report, parent-report, and structured diagnostic interviews as the primary sources of data. A frequency matching approach will be used to ensure demographic comparability of the cancer and healthy comparison groups. Measures of child PTSS and CRG along with dichotomous PTSD diagnosis will be obtained as primary outcomes. Measures of parental PTSS/PTSD and CRG will be obtained as secondary outcomes. Determinants of child PTS and CRG outcomes will be identified from child personality factors, life events history, medical factors (within the cancer group), parental PTSS/CRG, and parenting behavior. Separate predictive models will be developed for PTSS/PTSD and CRG outcomes. These analyses will advance our understanding of risk factors for the development of PTSD, which will improve targeting of intervention efforts to those most in need, while identification of factors associated with resilient, or growth outcomes will inform the development of intervention strategies and approaches. PUBLIC HEALTH RELEVANCE: This study will address gaps in our understanding of the traumatic effects of childhood cancer, while simultaneously examining positive outcomes such as growth and benefit-finding. Determinants of posttraumatic stress and posttraumatic, or 'challenge-related' growth outcomes will be examined, focusing on resilience-promoting factors. Separate predictive models will be developed for posttraumatic stress and growth outcomes. These analyses will advance our understanding of risk factors for the development of posttraumatic stress disorder, which will improve targeting of intervention efforts to those most in need, while identification of factors associated with resilient, or growth outcomes will inform the development of novel intervention strategies and approaches.

描述（由申请人提供）： 儿童癌症被广泛视为创伤事件，创伤压力模型的应用已成为小儿心理学研究中的主要方法。这种理解癌症儿童经历的方法以“癌症为创伤”为前提，并专注于心理病理学而不是调整。这些偏见影响了研究设计，尽管大多数研究并未显示出增加后创伤后应激障碍（PTSD）或亚临床后水平的发生率增加，但有助于面向赤字模型的扩散。 （PTSS）在癌症儿童中。该提议基于以下假设：癌症的诊断代表了一个重大的生活事件，不仅是潜在的创伤，而且是增长和积极变化的潜在催化剂，呼吁检查积极成果，例如创伤后生长（这是该结果）现在，我们称之为挑战相关的增长）和福利找到（CRG），这些结构主要是在患有癌症的成年人但不在儿童中进行的。拟议的研究将解决我们对小儿癌症中PTSD结局的理解时的几个差距，同时扩大了重点，以包括对积极结果的同时评估。在积极心理学理论的指导下，我们将研究PTSD和CRG结果的决定因素，重点关注与弹性相关的几个人格变量，包括适应性风格，乐观和性格积极的影响。该提案的目的将通过两组（癌症和健康对照），横断面设计，使用患者自我报告，父母报告和结构化诊断访谈作为主要数据来源。频率匹配方法将用于确保癌症和健康比较组的人口统计学可比性。儿童PTSS和CRG的度量以及二分PTSD诊断将作为主要结果获得。父母PTSS/PTSD和CRG的度量将作为次要结果获得。儿童PT和CRG结局的决定因素将从儿童人格因素，生活事件历史，医学因素（癌症组内），父母PTSS/CRG和育儿行为中确定。将为PTSS/PTSD和CRG结果开发单独的预测模型。这些分析将提高我们对PTSD发展风险因素的理解，这将改善对最有需要的人的干预工作的目标，同时确定与弹性或增长结果相关的因素或增长结果将为干预策略和方法的发展提供信息。 公共卫生相关性： 这项研究将解决我们对儿童癌症的创伤作用的理解的差距，同时研究了积极的结果，例如增长和福利发现。将检查创伤后压力和创伤后或“与挑战相关”的增长结果的决定因素，重点是促进弹性因素。为创伤后压力和生长结果开发单独的预测模型。这些分析将提高我们对创伤后应激障碍发展风险因素的理解，这将改善对最有需要的人的干预措施的靶向，同时确定与弹性或增长结果相关的因素，将为新的干预策略和新的干预策略提供信息。方法。