Sibling and Parent Bereavement from Childhood Cancer

描述(申请人提供)：癌症导致的儿童死亡比任何其他疾病都多，但儿童死亡对家庭的影响还没有得到充分的研究。失去亲人的家庭可能面临许多心理社会困难的风险，这些困难可能会持续多年。其他人可能在最初的悲痛期之后经历新的能力和个人成长(例如，成熟、同情心)；各种风险和阻力因素(例如，年龄、应对技能和社会支持)可能会影响结果，但人们对什么可以缓解困难，什么可以促进复原力知之甚少。一个主要问题是缺乏关于这一主题的精心设计的研究。我们的长期目标是通过对这些家庭的心理社会后果进行可控的、纵向的研究，减少受癌症影响的家庭的痛苦和发病率以及失去孩子的情况。这项申请的目的是为了区分需要帮助的兄弟姐妹和父母的亚群，并确定与调整相关的可修改因素。在我们的四个站点研究中，我们将招募180个在过去3-12个月内死于癌症的儿童家庭，以及180个非丧亲家庭。每个失去亲人的家庭中的一个兄弟姐妹(8-17岁)将被随机选择参加，并与相同性别、种族和年龄的同学进行匹配作为比较。在儿童失踪后第一年(T1)和一年后的后续家访期间(T2)，将从每个儿童的教室(即，同伴、教师、儿童)和家庭(即，母亲、父亲、儿童)的多个来源收集数据。这些信息将确定在临床试验中作为目标的特定因素和丧失亲人的亚群，以加速从悲痛中恢复并防止长期发病率。目的1：比较丧亲家庭和对照家庭的心理社会适应(即社会、情绪、行为、家庭功能)随时间的变化，并检验中介和调节关系。目的2：考察悲伤症状的病程和心理社会适应与疾病/死亡特征、儿童发育水平和悲伤工作的关系。

DESCRIPTION (provided by applicant): Cancer kills more children than any other disease, but the impact of a child's death on families is understudied. Bereaved families may be at risk for numerous psychosocial difficulties, which can persist for years. Others may experience new competencies and personal growth (e.g., maturity, compassion) after the initial grieving period; a variety of risk and resistance factors (e.g., age, coping skills, and social support) may affect outcomes, but little is known about what ameliorates difficulties and what promotes resilience. A primary problem has been a lack of well-designed research on the topic. Our long-term goal is to reduce the suffering and morbidity of families affected by cancer and the loss of a child through controlled, longitudinal research on the psychosocial outcomes of these families. The objective of this application is to differentiate subgroups of siblings and parents in need of assistance and to identify modifiable factors associated with adjustment, in our four-site study, we will recruit 180 families of children who died from cancer in the past 3- 12 months, and 180 non-bereaved comparison families. One sibling (aged 8-17 years) from each bereaved family will be randomly selected to participate and matched to a classmate of the same gender, race, and age as a comparison. Data will be collected from multiple sources in each child's classroom (i.e., peer, teacher, child) and home (i.e., mother, father, child) during the first year post-loss (T1) and during a follow-up home visit one year later (T2). This information will identify specific factors and subgroups of bereaved individuals to target in clinical trials to hasten recovery from grief and prevent long-term morbidity. Aim 1: compare the psychosocial adjustment (i.e., social, emotional, behavioral, family functioning) of bereaved and comparison families over time and examine mediating and moderating associations. Aim 2: Examine the course of grief symptoms and psychosocial adjustment as a function of characteristics of the illness/death, the child's developmental level, and grief work.