Pediatric Cancer, Family Conflict and Child Adjustment

描述（由申请人提供）：随着大多数癌症儿童预期寿命的提高，人们的注意力已经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的最佳家庭预测因子之一。最近也有证据表明，患有癌症的儿童与父母的冲突程度高于健康对照组，并且家庭冲突与年轻癌症患者及其照顾者的心理困扰程度较高有关。然而，很少有人知道的性质和过程中的家庭冲突后，癌症的诊断和治疗过程。为了制定干预措施，以减少癌症诊断和治疗的不良影响，并改善癌症患者，他们的家人和他们的照顾者的结果，重要的是要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。基于最近在家庭研究领域的概念和方法学进展，拟议的研究将使用多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以及儿童和照顾者调整的概念模型。在一项短期前瞻性纵向研究中，将采用自我报告、观察和生理学方法研究被诊断患有最常见形式的幼儿癌症的幼儿家庭：急性淋巴细胞白血病、中枢神经系统肿瘤、Wilms肿瘤和神经母细胞瘤。这项研究的主要目的是：（1）描述整个疾病过程中的家庭冲突过程;（2）测试癌症治疗期间发生的压力是否与整个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）检验疾病过程早期的家庭冲突是否预示着家庭处理治疗过程本身的方式;以及（4）检验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中介作用。与父母抑郁和父母过度保护有关的竞争冥想模型也将被测试。癌症儿童和他们的主要照顾者之间的关系的积极品质，以及儿童的情绪调节能力，将被探讨为潜在的弹性因素，缓冲儿童的负面结果。有希望的发现可以为预防和干预工作提供方向，这些工作可以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： 拟议的研究将探讨儿童癌症的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的家庭冲突过程，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预测了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.