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

产品说明：疾病不确定性是指对疾病相关事件的想法和看法，这些事件在本质上是不可预测的，模糊的和/或复杂的。更高水平的疾病不确定性一致且有力地预测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）。因此，减少不确定性的策略对于优化癌症儿童及其父母的调整至关重要。我们的团队最近进行的一项试点研究评估了父母不确定性管理干预（Parental Uncertainty Management Intervention，简称CIMI）的可接受性和可行性，CIMI是一种针对新诊断癌症儿童父母的基于临床的跨学科干预。该计划的目标是帮助父母管理不确定性，以促进父母的调整，并随后在儿童新的癌症诊断的背景下进行儿童调整。在治疗后1个月和3个月的随访中，与常规治疗组相比，TBI组的父母在母亲痛苦和儿童行为问题方面表现出显着改善。拟议中的多地点试验将测试儿童癌症诊断后不久，在改善父母和子女适应方面，儿童癌症诊断的有效性和持久性。2 - 18岁儿童的父母将在基线时随机分配到ECOMI或仅教育/支持（ESO;注意力控制）条件。这两种情况都包括六次会议，将由护士和心理学家共同提供。该计划教导父母识别导致不确定性的触发因素，利用策略来防止这些触发因素，并管理不可避免的不确定性。此外，父母还可以访问一个在线门户网站，该网站旨在增加对儿童疾病和治疗的了解，减少对儿童疾病和治疗的模糊认识。ESO的家长还将完成六次门诊， 护士和心理学家这些会议将提供有关儿童癌症和社会支持的教育。[两组中的父母将在五个时间点完成心理困扰，疾病不确定性，创伤后应激，解决问题以及父母报告的儿童情绪和行为功能的测量：基线，干预后1周，以及治疗后3个月，6个月和12个月。这项研究的主要目的是比较干预后1周内，父母和孩子心理困扰的ESDI和ESO组。第二个目的是比较的持久性，父母和孩子的整体困扰和创伤后应激症状的ESO组的ESO。还将检查治疗效果的潜在介质，包括不确定性水平和门户网站使用。这项研究将提供一种经验支持的干预措施，将显着减轻儿童癌症对儿童和父母调整的不利影响，并最终推进全面癌症护理的实践。

DESCRIPTION: 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.