Background and Aims

Caring for children with cancer can be a stressful experience for parents and may have negative impacts on their physical and psychological well-being. Although previous studies have shown that resilience was associated with positive psychological well-being, there is a paucity of interventions designed to enhance the resilience of parents of children with cancer. This study aimed to examine the effectiveness of a mobile-based resilience training programme in reducing depressive symptoms and enhancing resilience and quality of life among parents of children with cancer.

Methods

A two-arm parallel-group randomised controlled trial was conducted in three tertiary hospitals in China. Parents of children who received a diagnosis of cancer within the past year were invited to participate in the study. The participants were randomly assigned either to the experimental group (n=52) to undergo an 8-week mobile-based resilience training programme, or to the control group (n=51) to receive an 8-week placebo intervention. Participants' resilience, depressive symptoms and quality of life were assessed at baseline and 2 and 6 months after starting the intervention.

Results

The participants in the experimental group showed statistically significant higher levels of resilience (67.96±15.8 vs 58.27±19.0; P<0.001) and lower levels of depressive symptoms (40.17±9.9 vs 46.04±10.9; P<0.001) than those in the control group at 6 months of follow-up. The intervention showed statistically significant effects in improving resilience (β=6.082; P=0.010) and decreasing depressive symptoms (β=−2.772; P=0.041) relative to the control group. While no statistically significant intervention effect was detected for quality of life (β=0.020; P=0.383).

Conclusions

The mobile-based resilience training programme effectively enhanced resilience and alleviated depressive symptoms in parents of children with cancer. It is highly recommended that healthcare professionals incorporate this resilience training programme when providing psychological care for parents of children with cancer.

Background and Aims

Caring for pediatric hematology, oncology, and HSCT patients is emotionally and physically taxing on the interdisciplinary team. Peer support reduces isolation, increases connection, builds cohesion, and instills hope in staff (Yalom & Leszcz, 2005). The Hematology/Oncology/Stem Cell Transplant Advancing Resiliency Team or (HART) program at Boston Children’s Hospital (BCH) was developed in 2019 to enhance staff resilience, create a healthier work environment, and improve team morale by offering an easily accessible on-site program led by five nurse coaches available twenty-four hours a week through a real time nurse-driven, peer-to-peer education and support system.

Methods

Since inception, electronic surveys were sent via email to staff on the Hematology/Oncology/Stem Cell Transplant units prior to the start of the HART program to explore individuals’ perceptions of resiliency strategies and again at six-months and twelve-months to evaluate the programs’ effectiveness.

Results

As of March, 2021, there have been 162 HART shifts worked and over 2000 encounters recorded. A HART coach encounter is categorized into work-related, patient-care based, integrative therapy, and or personal concern. Registered nurses make up the largest discipline utilizing HART services, followed by clinical assistants and patient experience representatives with the majority of encounters being work-related 42% (n=621).

Conclusions

Staff reported “feeling more connected to co-workers”, “making time for breaks during a shift”, and “feeling more supported by leadership” in the one-year survey. Staff feedback indicates that peer-to-peer support connects our team members through facilitation of resources, conversations and integrative therapy offered by HART.

Background and Aims

This study aims to identify the needs and wishes for emotional support among survivors of childhood cancer.

Methods

Survivors of childhood cancer (seven men; seven women), aged 19–33 years, participated in semi-structured interviews (November–December 2020). The ages when they were diagnosed were 1–12 years. The interviews lasted between 45-85 minutes. A thematic analysis was used to identify themes.

Results

Needs

Processing late effects of cancer treatment

The participants described visible and invisible as well as physical and psychological late effects and reported that they found these to be difficult to process with people who had not had similar experiences.

Processing psychosocial health

The participants cited psychosocial issues, such as anxiety and social phobia, and the lack of appropriate forums for addressing these issues.

Meeting others who share similar experiences

The participants conveyed a need to meet others who had had similar experiences and who would be able to provide genuine understanding and support through the experiences that they had lived through.

Wishes

Digital tools for connecting with people who had had similar experiences

The participants expressed desires to connect with people who had had similar experiences in terms of issues such as diagnosis and late effects, with the help of digital tools.

Different forms of communication

Certain formats of communication facilitate trust in others. Communication via text and video conferencing meet different needs, such as those based on personality and topics for discussion.

A safe place with varying degrees of anonymity

The need for feelings of security was expressed as a prerequisite for communication, including the option to remain anonymous.

Conclusions

This study emphasized the needs and wishes of childhood cancer survivors to meet others who had had similar experiences in digital spaces that offer a secure place, with options for a variety of methods of communication and levels of anonymity.

Background and Aims

Healthcare professionals are daily facing various moral challenges. Moral case deliberation (MCD) is a method of ethics support with the goal to assist healthcare professionals to deal with morally challenging situations. In Sweden, MCDs are performed in the care team at all paediatric oncology centres, and are led by healthcare professionals trained to facilitate MCDs. The aim of this study was to describe different kinds of morally difficult situations and the following questions raised during MCDs in Swedish childhood cancer care.

Methods

Data was collected by using facilitator-questionnaires from MCDs (n=66), performed at all six paediatric oncology centres between 2017 and 2020. The questionnaires were completed after each MCD by the facilitator (n=15) and included a) information about the difficult situation, and b) the moral question raised. Data was analysed in accordance with qualitative systematic text condensation.

Results

The different kinds of difficult situations, preceding the moral questions, were; medical-, social -and cultural situations. Themes of moral questions were: What is the right care action? How much and when is it right to let the child decide? and How much and when is it right to let parents influence care? One example of a moral question in the last theme was: ‘Should we force parents to accept treatment or not?’.

Conclusions

This study contributes to an increased understanding of what kinds of difficult situations and moral questions that were raised during MCDs in Swedish paediatric oncology. All moral questions relate to shared decision-making. The results will be useful in paediatric oncology training and as a foundation for future studies of moral questions and ethics support in general.

Background and Aims

The Standards for Psychosocial Care for Children with Cancer and Their Families emphasize the importance of assessment/consultation throughout the cancer trajectory, yet little is known about the adjustment of families at the transition off therapy and the impact of psychosocial and cognitive assessment/consultation in promoting positive adjustment. Thus, the objectives of this research were to: (1) characterize distress related to transition, (2) examine differences in reports of receiving information and feeling prepared for transition between families who did and did not receive psychological and cognitive assessment/consultation, (3) explore links between feelings of preparedness and distress ratings.

Methods

Caregivers (n=65; 90% white; 94% female) of children who completed active cancer treatment responded to a questionnaire assessing distress, feelings of preparedness, and feeling informed surrounding the transition. Caregivers also reported on social, emotional, and cognitive/academic concerns for their child and emotional concerns for family members. Frequency analyses were used for objective 1. Objective 2 was explored using ANOVAs, with receipt of psychological consultation and cognitive assessment examined separately. An ANOVA and correlation analyses were used for objective 3.

Results

Nearly 23% completed a transition-related psychology consult and 44% completed a cognitive assessment. Overwhelmingly, caregivers “agreed” or “strongly agreed” with feeling an array of difficult emotions (65-85%) and family struggles (52%) related to the transition. Patient emotional concerns (51%) and school problems (41%) were also endorsed. Caregivers of patients who completed a consultation/cognitive assessment were significantly more likely to report being informed, able to navigate support, and prepared to manage difficulties. Feelings of preparedness were associated with decreased caregiver, patient, and family distress.

Conclusions

Though ending active cancer treatment is a point of celebration for families, it is also marked with distress. Providing psychoeducation, emotional support, and cognitive/academic guidance may increase caregiver efficacy to manage the transition and decrease distress.