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

描述(由申请人提供)：儿科癌症的影响会对整个系统产生影响，这会使儿童及其父母从确诊到存活的整个过程都面临着调整受损的风险。在诊断出儿科癌症后，父母是孩子的主要照顾者，因此，他们不仅在适应孩子的诊断方面面临着巨大的困难，而且在谈判艰难而漫长的疗程方面也面临着巨大的困难。到目前为止，只有少数几项研究试图评估综合心理社会干预对癌症儿童父母的好处。这些新出现的文献表明，心理社会干预确实有可能促进父母的应对努力和改善心理痛苦，而且在孩子确诊后不久进行的干预可能优于治疗后进行的干预。因此，目前的项目是一项试点研究，将评估对新诊断为癌症儿童的父母实施以临床为基础的跨学科(心理学和护理)干预的可行性和可接受性。父母将在基线上随机分配到跨学科干预组(IG)或照常治疗(TAU)组。这项由6个模块、12个课程组成的跨学科干预将侧重于向家长传授技能，帮助他们管理不确定性。干预将每隔几周由一名心理临床医生提供6次门诊会议，并在两次会议之间由一名护士干预者提供6次电话会议。本研究以下列主要目标为指导：1)评估对新诊断为癌症儿童的父母实施为期12个疗程的基于临床的跨学科干预的可行性和可接受性；2)估计干预措施在减少父母心理困扰、创伤后应激症状(PTSS)、照顾者负担和疾病不确定性方面的效果大小。第二，探索性目标包括：1)评估疾病不确定性是否中介了干预对父母心理困扰、PTSS和照顾者负担的影响；2)评估干预是否对儿童的情绪和行为功能产生间接影响。父母将在三个时间点完成心理痛苦、PTSS、照顾者负担、疾病不确定性以及他们孩子的情绪和行为功能的测量：基线、治疗后1个月和3个月。与公共健康相关：目前的研究是一项旨在帮助减少父母因孩子最近被诊断出癌症而产生的痛苦的干预措施。干预将包括心理学家和护士的专业知识，向父母传授技能，帮助他们管理对孩子疾病的不确定性。

DESCRIPTION (provided by applicant): The impact of pediatric cancer exerts system-wide influences, which places both children and their parents at risk for compromised adjustment from the time of diagnosis through survivorship. Parents serve as primary caregivers for their child following the diagnosis of pediatric cancer, and as such, they face substantial difficulties in not only adjusting to their child's diagnosis, but also in negotiating an arduous and lengthy treatment course. To date, only a handful of studies have sought to evaluate the benefits of comprehensive psychosocial interventions for parents of children with cancer. This emerging literature suggests that psychosocial interventions indeed have the potential to promote coping efforts and ameliorate psychological distress in parents, and that interventions taking place soon after the child's diagnosis may be superior to those that occur post-treatment. Thus, the current project is a pilot study that will assess the feasibility and acceptability of implementing a clinic-based interdisciplinary (psychology and nursing) intervention for parents of children newly diagnosed with cancer. Parents will be randomly assigned at baseline to either the interdisciplinary intervention group (IG) or the treatment as usual (TAU) group. The 6-module, 12-session interdisciplinary intervention will focus on teaching parents skills to help them manage their uncertainty. The intervention will alternate weeks with 6 in-clinic sessions delivered by a psychology clinician, coupled with 6 telephone sessions delivered by a nurse interventionist in between the clinic sessions. The current study is guided by the following primary aims: 1) to assess the feasibility and acceptability of implementing a 12-session, clinic-based, interdisciplinary intervention for parents of children newly diagnosed with cancer; 2) to estimate effect sizes for the intervention in reducing parental psychological distress, posttraumatic stress symptoms (PTSS), caregiver burden, and illness uncertainty. Secondary, exploratory aims include: 1) to assess whether illness uncertainty mediates the effect of the intervention on parent psychological distress, PTSS, and caregiver burden; and 2) to assess whether the intervention exerts an indirect effect on the child's emotional and behavioral functioning. Parents will complete measures of psychological distress, PTSS, caregiver burden, illness uncertainty, and their child's emotional and behavioral functioning at three time points: baseline, and 1-month, and 3-months post-treatment. PUBLIC HEALTH RELEVANCE: The current study is an intervention designed to help reduce parents' distress associated with their child's recent diagnosis of cancer. The intervention will include the expertise of both psychologists and nurses in teaching parents skills to help manage their uncertainty about their child's illness.