Cancer Control Research5R21CA107973-02
PROBLEMSOLVING WITH PARENTS OF PEDIATRIC CANCER SURVIVOR
DESCRIPTION (provided by applicant): Transitioning from active treatment to the off-treatment survivorship phase is challenging for families. This is a period of relief as well as heightened anxiety and concern that without active treatment the disease will return. Yet, parental concerns have not been empirically documented. Additionally, there is no empirical literature addressing the unmet needs of families completing active treatment. Caregiver (i.e., family member responsible for day to day childcare; typically mothers, sometimes fathers, or other family members) adaptation and adjustment is strongly associated with children's adjustment. Thus, meeting the needs of caregivers will mediate the effect of children's health and psychological well-being. Specifically adoption of a problem-solving strategy has been identified as a resilience factor for maternal adaptation to a child's chronic illness. Based on research documenting the efficacy of problem solving training and employing a risk-resilience-adaptation model, an intervention strategy will be employed with caregivers of youth completing cancer treatment. The objective is to enhance problem-solving skills to improve the quality of life for the child patient, caregiver, and their families. This proposed study will provide preliminary data documenting the nature of problems experienced by families parenting a child who has just completed cancer treatment, as well as examine the preliminary effectiveness of problem-solving training with caregivers: The proposed pilot study will implement a randomized clinical trial (RCT) comparing two intervention conditions: Problem-solving (PST) and Attention-Placebo Control (APC) - with 60 families of youth (2-18 years) who have just completed active treatment for all types of cancer, including stem cell transplant, and brain tumors. Each condition involves an initial face-to-face session; weekly 30-40 minute telephone sessions for the next month; biweekly 30-40 minute telephone sessions over the following 2 months; and a final face-face-face session within 2-weeks of last telephone training session. Treatment effectiveness will be assessed using psychometrically sound instruments at the time of enrollment, immediately upon completion of PST or APC intervention; and at 8 months from enrollment. Outcomes include: parental problem-solving skills, psychological adjustment including posttraumatic symptoms, and quality of life_; health care utilization (i.e., total number of telephone calls by the parents to the Pediatric Ontology clinic both during and after hours, unscheduled clinic visits;) as well as parental use of healthcare services (i.e., emergency room visits, hospitalizations, primary care visits), and feasibility and accessibility of the program. A series of repeated mixed mode MANOVA and ANOVA as well as regression analyses will be used to test directional hypotheses corresponding to the specific aims.