CHANGING PARENTAL BELIEFS IN PEDIATRICS ONCOLOGY

儿童癌症的诊断影响到家庭，并在治疗结束后继续影响父母的功能。我们之前的研究表明，父母创伤后应激障碍的痛苦症状持续存在，并与焦虑有关。在这项建议中，我们专注于确定与儿童癌症治疗期间的焦虑和适应相关的父母信念，并对新诊断为癌症儿童的父母进行认知-行为和家庭治疗干预的随机临床试验(RCT)。三次会议干预，癌症存活能力干预计划修订版(SCCIP-R)是我们针对儿童癌症幸存者及其家人的干预方案的改编。该项目的第一步是系统地确定父母对这种疾病和治疗的信念，样本是120个被诊断为儿童癌症的家庭中的孩子，随机分为SCCIP-R干预或注意力控制条件。基线、2个月和6个月的数据收集将包括父母焦虑、心理适应和家庭的自我报告测量。孩子的生活质量将通过家长和工作人员报告进行评估。我们将确定父母焦虑及其减轻对孩子生活质量的影响。在62例急性淋巴细胞性白血病(ALL)患者中，我们将研究父母焦虑与父母神经内分泌指标(脱氢表雄酮-S/皮质醇比值、促肾上腺皮质激素、P物质)的关系，并探讨父母焦虑水平降低与医疗结局之间的关系。最后，我们将在癌症治疗结束后的两个时间点评估SCCIP-R评估父母和患者创伤后应激的长期影响。据我们所知，这个项目的独特之处在于提供了一种干预措施的RCT，以减少儿童癌症诊断后父母的痛苦，并整合了神经内分泌标志物和医疗结果。如果有效，SCCIP-R将为向癌症患者家属提供系统干预的可行性和重要性提供证据。

The diagnosis of children cancer affects the family and continues to impact parental functioning after treatment ends. Our previous research showed the persistence of parents' distressing symptoms of posttraumatic stress and its association with anxiety. In this proposal, we focus on the identification of parental beliefs associated with anxiety and adaption during treatment for childhood cancer, and conduct a randomized clinical trial (RCT) of a cognitive-behavioral and family therapy intervention for parents of newly diagnosed children with cancer. The three session intervention, Surviving Cancer Competently Intervention Program, Revised (SCCIP-R) is an adaptation of our intervention protocol for survivors of childhood cancer and their families. The first step in the project is the systematic identification of mothers' and fathers' beliefs about the disease and the treatment in a sample of 120 families of children in families at diagnosis of childhood cancer, randomized to SCCIP-R intervention or an attention control condition. Baseline, 2 and 6 month data collections will include self-report measures of parental anxiety, psychological adjustment and family. Child quality of life will be assessed by parent and staff report. We will determine the affects of parental anxiety and its reduction on the child's quality of life. In a subsample of 62 patients with acute lymphoblastic (ALL), we will examine the associations of parental anxiety with parental neuroendocrine makers (DHEA-S/cortosol ratio, ACTH, Substance P) and explore the associations among lowered levels of parental levels of parental anxiety and medical outcomes. Finally, we will assess the long- term impact of SCCIP-R assessing parental and patient posttraumatic stress at two points after cancer treatment ends. To our knowledge, this project is unique in providing a RCT of an intervention to reduce parental distress after diagnosis of childhood cancer and in the integration of neuroendocrine makers and medical outcome. If effective, SCCIP-R would provide evidence for the feasibility and importance of providing systemic intervention with families of patients with cancer.