Stress, Adjustment And Growth In Children With Cancer And Their Parents
| Status: | Active, not recruiting |
|---|---|
| Conditions: | Psychiatric |
| Therapuetic Areas: | Psychiatry / Psychology |
| Healthy: | No |
| Age Range: | 3 - 25 |
| Updated: | 7/13/2018 |
| Start Date: | July 7, 2009 |
| End Date: | December 31, 2020 |
This proposal examines trauma and growth responses in the childhood cancer experience. It
addresses a number of gaps and unanswered questions in the literature, while integrating
several distinct but related lines of research. The rationale for this proposal is outlined
briefly as follows:
1. Traumatic stress models focused on pathology dominate pediatric psychosocial oncology
research despite empiric evidence of low levels of post-traumatic stress in this
population.
2. The assumption of 'cancer as a traumatic event' has biased research designs (including
lack of control comparisons) to focus on deficits and pathological outcomes.
3. This deficit-oriented approach has stimulated the development of interventions to treat
or prevent PTSD, which may be unnecessary or even harmful.
4. Theoretical and empiric evidence suggests that a more common response to traumatic
stress is growth and positive change, but posttraumatic growth phenomenon have been
understudied in pediatric populations.
5. Cognitive and personality factors are important determinants of PTSD and positive growth
outcomes, and some constructs from positive psychology theory may be particularly
relevant in children with cancer.
6. Empirically, parents of children with cancer appear to be at higher risk of PTSD/PTSS,
although results are not unequivocal, and the same research biases have applied to
parental outcomes. This proposal includes assessment of parental PTSS and PTG, both as
an outcome and a predictor of child outcomes.
addresses a number of gaps and unanswered questions in the literature, while integrating
several distinct but related lines of research. The rationale for this proposal is outlined
briefly as follows:
1. Traumatic stress models focused on pathology dominate pediatric psychosocial oncology
research despite empiric evidence of low levels of post-traumatic stress in this
population.
2. The assumption of 'cancer as a traumatic event' has biased research designs (including
lack of control comparisons) to focus on deficits and pathological outcomes.
3. This deficit-oriented approach has stimulated the development of interventions to treat
or prevent PTSD, which may be unnecessary or even harmful.
4. Theoretical and empiric evidence suggests that a more common response to traumatic
stress is growth and positive change, but posttraumatic growth phenomenon have been
understudied in pediatric populations.
5. Cognitive and personality factors are important determinants of PTSD and positive growth
outcomes, and some constructs from positive psychology theory may be particularly
relevant in children with cancer.
6. Empirically, parents of children with cancer appear to be at higher risk of PTSD/PTSS,
although results are not unequivocal, and the same research biases have applied to
parental outcomes. This proposal includes assessment of parental PTSS and PTG, both as
an outcome and a predictor of child outcomes.
This study examines the following outcomes:
1. To examine outcomes of posttraumatic growth and benefit finding (PTG) in children with
cancer/cancer survivors in comparison to a population of children without history of
serious illness.
2. To examine outcomes of posttraumatic stress (PTSS/PTSD) in children with cancer/cancer
survivors in comparison to children without a history of serious illness.
3. To examine predictors of child posttraumatic stress and posttraumatic growth from
medical variables, life events history, family environment, and child personality
variables.
4. To apply an accelerated longitudinal design to examine trajectories of both pathological
outcomes such as posttraumatic stress (PTSS) and positive outcomes such as
challenge-related growth (CRG) in children with cancer/cancer survivors in comparison to
a population of children without a history of serious illness. Additional observations
will be obtained at 1-, 3-, and 5-years post study entry.
5. To examine outcomes of PTG and PTSS/PTSD in parents of children with cancer/cancer
survivors in comparison to parents of healthy children. Parental PTSS/PTSD and PTG will
be examined both as outcomes and as predictors of child outcomes.
6. To examine predictors of parent PTSS/PTSD and PTG from demographic and medical
variables, life events history, and parent personality variables.
7. To determine the sensitivity/specificity of measures of PTSS in screening for PTSD based
on diagnostic interview.
8. To examine the validity and reliability of a new measure of child personality, the Child
and Adolescent Five Factor Inventory (CAFFI).
9. To examine emerging social developmental outcomes in this longitudinal cohort.
10. To develop an electronic version of the study measures and to compare data obtained
electronically (on desktop or laptop computer), with data obtained on paper for
comparability in reliability and outcomes obtained.
1. To examine outcomes of posttraumatic growth and benefit finding (PTG) in children with
cancer/cancer survivors in comparison to a population of children without history of
serious illness.
2. To examine outcomes of posttraumatic stress (PTSS/PTSD) in children with cancer/cancer
survivors in comparison to children without a history of serious illness.
3. To examine predictors of child posttraumatic stress and posttraumatic growth from
medical variables, life events history, family environment, and child personality
variables.
4. To apply an accelerated longitudinal design to examine trajectories of both pathological
outcomes such as posttraumatic stress (PTSS) and positive outcomes such as
challenge-related growth (CRG) in children with cancer/cancer survivors in comparison to
a population of children without a history of serious illness. Additional observations
will be obtained at 1-, 3-, and 5-years post study entry.
5. To examine outcomes of PTG and PTSS/PTSD in parents of children with cancer/cancer
survivors in comparison to parents of healthy children. Parental PTSS/PTSD and PTG will
be examined both as outcomes and as predictors of child outcomes.
6. To examine predictors of parent PTSS/PTSD and PTG from demographic and medical
variables, life events history, and parent personality variables.
7. To determine the sensitivity/specificity of measures of PTSS in screening for PTSD based
on diagnostic interview.
8. To examine the validity and reliability of a new measure of child personality, the Child
and Adolescent Five Factor Inventory (CAFFI).
9. To examine emerging social developmental outcomes in this longitudinal cohort.
10. To develop an electronic version of the study measures and to compare data obtained
electronically (on desktop or laptop computer), with data obtained on paper for
comparability in reliability and outcomes obtained.
Inclusion Criteria:
Primary Group
1. Research participant is 8-17 years inclusive
2. Research participant has a primary diagnosis of malignancy
3. Research participant is at least one month from diagnosis with no upper limit in terms
of time elapsed since diagnosis;
4. Research participant is able to speak and read English;
5. Research participant does not have any significant cognitive or sensory deficits that
would preclude participation;
6. Parent/LAR and research participant is willing to participate and provide
consent/assent
Young Child Group
1. Research participant is 3 - 6 years of age, inclusive
2. Primary diagnosis of malignancy
3. At least one month from diagnosis
4. One parent/LAR willing to participate and provide consent
5. No history of sensory or developmental disorder that would invalidate study assessment
procedures.
Young Adult Group
1. Research participant is 18-25 years of age inclusive
2. Primary diagnosis of malignancy
3. At least one month from diagnosis with no upper limit in terms of time elapsed from
diagnosis
4. Able to read and speak English
5. No cognitive or sensory deficits that would preclude participation
6. Willing to participate and provide consent
Control Groups
1. Research participant in 3 age groups (3 - 6 years; 8-17 years; 18-25 years) to match
patient groups
2. No history of chronic or life-threatening illness
3. No cognitive or sensory impairment that would preclude completion of study measures
4. Able to speak and read English
5. Parent/LAR and research participant are willing to participate and provide informed
consent/assent
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