Pediatric Cancer, Family Conflict and Child Adjustment

描述(申请人提供)：随着大多数癌症儿童预期寿命的延长，人们已将注意力转向改善癌症幸存者及其家庭成员的生活质量。众所周知，家庭冲突是儿童行为问题最好的家庭预测因素之一。最近也有证据表明，与健康对照组相比，癌症儿童与父母的冲突程度更高，而且年轻的癌症患者及其照顾者的家庭冲突与更高的心理痛苦有关。然而，人们对癌症诊断后和治疗过程中家庭冲突的性质和过程知之甚少。为了制定干预措施，减少癌症诊断和治疗的不利影响，改善癌症患者、其家人及其照料者的结局，必须确定家庭内冲突的性质和过程，并确定家庭冲突是否与癌症儿童及其照顾者的适应不良有关。在家庭研究领域最近的概念和方法进展的基础上，拟议的研究将使用多方法方法来测试癌症诊断和治疗中固有的压力如何影响家庭冲突和儿童和照顾者调整的概念模型。在一项短期的前瞻性纵向研究中，将使用自我报告、观察和生理学的方法来研究被诊断患有最常见的幼儿癌症的家庭：急性淋巴细胞性白血病、中枢神经系统肿瘤、肾母细胞瘤和神经母细胞瘤。拟议研究的主要目的将是：(1)描述癌症治疗过程中家庭冲突的过程；(2)测试癌症治疗期间发生的压力是否与疾病过程中的家庭冲突有关，以及家庭冲突是否随着压力的增加而增加；(3)测试疾病过程早期阶段的家庭冲突是否可预测家庭处理治疗过程本身的方式；以及(4)测试家庭冲突是否在癌症治疗期间的压力与癌症儿童及其照顾者的适应之间起调节作用。与父母抑郁和父母过度保护相关的相互竞争的冥想模型也将被测试。患有癌症的儿童与其主要照顾者之间的积极品质，以及儿童的情绪调节能力，将被探索为缓冲儿童免受负面后果影响的潜在复原力因素。有希望的发现可以为预防和干预工作提供方向，这些工作可能对癌症儿童及其照顾者的长期发展产生重大影响。 公共卫生相关性： 这项拟议的研究将研究儿科癌症诊断和治疗中固有的压力如何影响家庭冲突和儿童适应。我们的目标是描述整个疾病过程中家庭冲突的过程，确定癌症治疗期间发生的哪些压力源与整个治疗过程中的家庭冲突相关，确定疾病过程早期阶段的家庭冲突程度是否可以预测家庭处理治疗过程本身的方式，并测试与癌症相关的压力如何影响家庭冲突以及儿童和照顾者调整的模型。

DESCRIPTION (provided by applicant): With the improved life expectancy of most children with cancer, attention has been turned to improving the quality of life of cancer survivors and their family members. It is well-known that family conflict is one of the best familial predictors of childhood behavior problems. There is also recent evidence that children with cancer have higher levels of conflict with their parents than healthy controls, and that family conflict is associated with higher psychological distress in young cancer patients and their caregivers. Yet, little is known about the nature and course of family conflict post-cancer diagnosis and through the treatment process. To develop interventions to reduce the adverse effects of cancer diagnosis and treatment and improve outcomes for cancer patients, their families and their caregivers, it is important to identify the nature and course of conflict within the family and determine whether family conflict is associated with maladjustment in children with cancer and their caregivers. Building on recent conceptual and methodological advances in the field of family research, the proposed research will use a multi-method approach to test a conceptual model of how the stresses inherent in cancer diagnosis and treatment affect family conflict and child and caregiver adjustment. In a short-term prospective longitudinal study, self-report, observational and physiological methods will be used to study families of young children diagnosed with the most common forms of young childhood cancer: acute lymphoblastic leukemia, central nervous system tumors, Wilms tumor and neuroblastoma. The primary aims of the proposed research will be: (1) to describe the course of family conflict across the disease process; (2) to test whether stress occurring during cancer treatment is associated with family conflict across the disease process and whether family conflict increases with increases in stress; (3) to test whether family conflict at the early stages of the disease process predicts the manner in which families deal with the treatment process itself; and (4) to test whether family conflict mediates relations between stress during cancer treatment and adjustment in children with cancer and their caregivers. Competing meditational models relating to parental depression and parental overprotection will also be tested. Positive qualities of the relationship between the child with cancer and their primary caregiver, as well as children's emotion regulation abilities, will be explored as potential resilience factors that buffer children from the negative outcomes. Promising findings can provide direction for prevention and intervention efforts that can have significant impact on the long-term development of children with cancer and their caregivers. PUBLIC HEALTH RELEVANCE: The proposed research will examine how the stresses inherent in the diagnosis and treatment of pediatric cancer affect family conflict and child adjustment. Our goals are to describe the course of family conflict across the disease process, identify which stressors occurring during cancer treatment are associated with family conflict across the treatment process, determine whether the degree of family conflict at the early stages of the disease process predicts the manner in which families deal with the treatment process itself, and test a model of how stresses associated with cancer affect family conflict and child and caregiver adjustment.