Online Problem Solving Skills Training

Research and experience document that caregivers of children with cancer encounter
extraordinary stresses during the child's illness. These stresses are particularly severe
during diagnosis and early therapy and can interfere significantly with a caregiver's ability
to make reasoned and timely decisions on their child's behalf. With increasing survivor
rates, it has become evident that decisions made in the early stages of cancer management can
have profound long-term effects, adding to the distress caregivers feel trying to make the
"right" decisions. Too help mothers of newly diagnosed children cope more effectively with
these challenges, the investigators conducted randomized controlled trials (R25CA65520,
R01CA098954) to develop, field test, and evaluate the efficacy of the Bright IDEAS paradigm
of problem-solving skills training (PSST), a cognitive-behavioral therapy shown to decrease
anxiety and depression - two symptoms of post-traumatic stress commonly experienced among
this group of mothers. Our findings clearly show that PSST significantly increases
problem-solving skills (primary effect) and decreases negative affectivity (secondary effect)
in mothers from a variety of racial, ethnic, and socioeconomic backgrounds. Particularly
powerful and long-lasting effects were noted in Spanish-speaking mothers, an especially
underserved population. In March 2010, the NCI designated Bright IDEAS as a Research-based
Therapy/Intervention Program (RTIP) and entered it into the National Registry of
Evidence-based Programs and Practices (NREPP). As an 8-session, in-person intervention,
Bright IDEAS is labor intensive and, to date, has only been available at a few institutions
with trained personnel. However, as a part of the RTIPs evaluation process, the Dissemination
Capability of Bright IDEAS was rated 5/5. This proposal is designed to meet the challenge
inherent in this perfect score. The investigators will also immediately broaden the scope of
users by including fathers as eligible participants in this study of a new delivery paradigm
the investigators believe they will find appealing. Aim 1 is implementation of an engaging,
easy-to-use on-line version of Bright IDEAS that would be available 24/7 to any person
anywhere who has access to the Internet. Aim 2 is the use of "Diffusion of Innovations"
theory to craft a framework for disseminating not only Bright IDEAS but other similar
interventions with the greatest effectiveness and efficiency. In past studies, the
investigators have shown that the human element (time and attention) inherent in in-person
interventions is effective in bringing immediate relief of distress but not sufficient to
maintain its benefits over time. In contrast, mothers receiving PSST increase their skills
and continue to improve their sense of well-being 3 months after the intervention. What the
investigators have not investigated is whether a computer-based intervention is as effective
as (not inferior to) an in-person intervention. The results will have significant
implications for future dissemination strategies, especially the use of Internet II and other
emerging technologies.

Inclusion Criteria: Subjects will be drawn from the pool of all parents who are primary
caregivers of children diagnosed with any form of cancer 4-16 weeks prior to contact about
the Problem Solving Skills Training intervention and cared for at one of the 4 data
collection sites. No attempt will be made to stratify the sample by any particular
demographic variables (e.g., age, ethnic background, or type of cancer diagnosed in their
child), except that monolingual Spanish-speaking parents will be specifically recruited to
provide adequate representation for statistical analysis at Childrens Hospital Los Angeles
and UT/MD Anderson Cancer Center. Goal: 20% total enrollment.

Exclusion Criteria: Parents of children with cancer will be excluded if (1) they do not
read or speak English or Spanish; (2) their child is in severe a medical crisis, as
determined by the oncologist, or (3) they live a prohibitive distance to complete the
intervention (typically, >50 miles from the Center) and do not have access to a telephone
for phone intervention sessions. Internet access will be facilitated as part of the e-PSST
intervention arm. These exclusionary criteria are identical to our previous work; <10% of
eligible mothers have been excluded.