No abstract

Adolescents with chronic kidney disease often engage in nonadherent behaviors and have poorer outcomes. Dialectical behavior therapy (DBT) promotes quality-of-life improvement, with specific focus on "treatment-interfering behaviors" such as nonadherence. DBT has demonstrated effectiveness with patients who are otherwise difficult to reach, treat, and manage in outpatient settings. This study describes a DBT adaptation for improving adherence in adolescent patients with end-stage renal disease (ESRD). Seven adolescents with ESRD were enrolled in a 9-session DBT program. Process (illness acceptance) and outcome (quality of life, depression) measures were conducted pre-and posttreatment. Transplant team reports of adherence and health improvements were conducted at pre-, mid-, and posttreatment. Significant improvements were evident at posttreatment for depression and adherence. Findings suggest that DBT may promote adherence in difficult-to-treat youth with chronic illness.

BackgroundIndividuals living with cancer must learn to face not only the physical symptoms of their condition, but also the anxiety and uncertainty related to the progression of the disease, the anticipation of physical and emotional pain related to illness and treatment, the significant changes implied in living with cancer, as well as the fear of recurrence after remission. Mindfulness-based meditation constitutes a promising option to alleviate these manifestations.Methods/DesignThis article presents the rationale and protocol development for a research project aimed at evaluating the effects of a mindfulness-based meditation intervention on quality of life, sleep, and mood in adolescents with cancer compared to a control group. A prospective, longitudinal, experimental design involving three time points (baseline, post-intervention, and follow-up) and two groups (experimental and control) was developed for this project. Participants will be assigned randomly to either group. Eligible participants are adolescents aged 11 to 18 years with a diagnosis of cancer, with no specific selection/exclusion based on type, stage, or trajectory of cancer. A final sample size of 28 participants is targeted. Adolescents in the experimental group will be completing the mindfulness meditation intervention, taught by two trained therapists. The intervention will comprise of eight weekly sessions, lasting 90 min each. Once the follow-up assessment is completed by the experimental group, wait-list controls will be offered to complete the mindfulness-based program. Intra-group analyses will serve to evaluate the impact of the mindfulness-based meditation intervention on quality of life, sleep, and mood pre-post intervention, as well as follow-up. Analyses will also be used to carry out inter-group comparisons between the experimental group and the wait-list controls. Voluntary participation, risk of attrition, and the small sample size are potential limitations of this project. In spite of possible limitations, this project will be one among very few aimed at improving quality of life, sleep, and mood in adolescents living with cancer, will evaluate the potential benefits of such a practice on both psychological and physical health of youth with cancer, and help in creating mindfulness-based intervention programs, in order to provide the necessary psychological help to adolescents living with cancer.Trial registrationTrial registration number: NCT01783418