A randomized clinical trial of a parent-focused social-cognitive processing intervention for caregivers of children undergoing hematopoetic stem cell transplantation.

Abstract

Objective Providing care to one’s child during and after a hematopoietic stem cell transplant (HSCT) is a universally stressful experience, but few psychological interventions have been developed to reduce caregiver distress. The goal of this study was to test the efficacy of a brief cognitive–behavioral intervention delivered to primary caregivers. Method Two hundred eighteen caregivers were assigned either best-practice psychosocial care (BPC) or a parent social-cognitive intervention program (P-SCIP). The 5 session P-SCIP was delivered during the HSCT hospitalization. Caregivers completed measures of distress, optimism, coping, and fear appraisals preintervention, 1, 6 months, and 1 year. Results P-SCIP reduced caregiver’s distress significantly more than BPC between the pretransplant assessment (Time 1) and 1-month follow-up assessment (Time 2). P-SCIP had a stronger effect than BPC among caregivers who began the hospitalization reporting higher depression and anxiety, and among caregivers whose children developed graft-versus-host disease (GvHD). Long-term treatment effects of P-SCIP were seen in traumatic distress among caregivers who reported higher anxiety pretransplant as well as among caregivers whose children had GvHD at HSCT discharge. Conclusions Screening caregivers for elevations in pretransplant anxiety and targeting interventions specifically to these caregivers, as well as targeting caregivers to children who develop GvHD, may prove beneficial.

Parent Coping Support Interventions During Acute Pediatric Hospitalizations: A Meta-Analysis

“…61 Others asked parents to spend considerable time completing activities independently. 28,30,32,35 The most intensive interventions required multiple sessions in which parents participated in individualized, in-person counseling sessions or other activities with a clinical staff member. 31 but some began before a planned hospitalization 33,34 or followed the family after discharge.…”

“…28 Most were singlecenter studies, with the exception of 3 studies that included parents from 2 NICUs 28, 32, 39 and 1 study that included parents of children receiving stem cell transplants at 4 centers. 35…”

“…23,25,28,31,39,43,45,52 PTSSs were statistically significantly lower after intervention participation in 3 of the 5 studies in which parent posttraumatic stress was measured. 30,35,37…”

Longitudinal examination of family efficacy following pediatric stem cell transplant

“…Support from the medical team may include ongoing psychological support to address emotional needs particularly around medical uncertainty. Cognitive and behavioral interventions have shown promising effects at reducing psychological distress in caregivers, and extending these interventions via psychosocial care providers to the family unit may potentially enhance family efficacy and overall resilience. In addition to addressing emotional aspects of treatment, regular follow‐up visits with social workers and/or patient and family resource centers may provide assistance with tangible support needed, including assistance with the financial aspects of treatment.…”

Psychological treatment for family members of children with cancer: A systematic review and meta‐analysis

“…The most common interventions for parents have been based on the cognitive behavioral model, such as problem‐solving skills training; coping skills training; cognitive restructuring or positive self‐instruction; positive reinforcement or behavioral trials; relaxation training, and training in communication skills, assertiveness, or guided communication . As for siblings, problem‐solving skills training, cognitive restructuring, and coping skills training have been used .…”