Parenting Intervention for Caregivers who Parent a Young Child while Caring for a Spouse with an Incurable Cancer.

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PROJECT SUMMARY/ABSTRACT An estimated 1 in 5 of newly diagnosed cancer patients parent at least one minor child. Although parents with advanced cancer and their spousal caregivers are particularly vulnerable to reporting low parenting efficacy, their parenting concerns remain largely unaddressed by their oncology teams. Compared to those without dependents, both patients and spousal caregivers with minor children are more anxious and report worse quality of life. In fact, spousal caregivers with minor children are a greater risk of being diagnosed with a psychiatric condition compared to their counterparts without dependents. Many struggle how to manage the competing tasks of caring for their ill partner while maintaining their parenting responsibilities. Moreover, many patients and spousal caregivers struggle with how to inform their children about the cancer; yet, effective communication is crucial as children who are ill-informed of their parent's illness are at an increased risk of anxiety and depression. While the stressors associated with this dual caregiving role are clearly documented, to date, empirical evidence regarding the delivery of feasible and efficacious parenting-related psychosocial care is lacking. To fill these knowledge gaps, we propose to pilot-test a multi-modal parenting support intervention for patients diagnosed with an advanced solid malignancy and their spousal caregivers using a rigorous randomized controlled trial (RCT) design. The content of the intervention will be delivered via three modes including printed psychoeducational materials, a brief education video, and four therapist-led intervention sessions. Patients and caregivers will view the education materials together and jointly attend two manualized videoconference sessions. Caregivers will attend two additional intervention sessions targeting their specific parenting needs. The proposed RCT will randomize dyads to the parenting support intervention arm or a waitlist control arm receiving usual care. The purpose of this RCT is to collect data on acceptability, feasibility and preliminary efficacy of the intervention regarding patient and caregiver psychological health and parenting concerns and patient healthcare utilization at the end of life. Dyads will be assessed via validated self-report instruments at baseline and again 6 weeks and 12 weeks later. Dyads will also complete qualitative interviews to learn about their parenting-, cancer- and caregiving- related concerns and, for those in the intervention arm, if the intervention and its delivery was perceived to be helpful. The next larger trial will also evaluate the intervention effects on children's anxiety and depression levels. The proposed work will provide rich pilot data that will inform a subsequent larger trial for more formal intervention efficacy testing seeking to improve the symptom burden and increase overall health and wellbeing in patients with advanced cancer and their families.