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- Title
Effect of the Promoting Resilience in Stress Management Intervention for Parents of Children With Cancer (PRISM-P): A Randomized Clinical Trial.
- Authors
Rosenberg, Abby R.; Bradford, Miranda C.; Junkins, Courtney C.; Taylor, Mallory; Zhou, Chuan; Sherr, Nicole; Kross, Erin; Curtis, J. Randall; Yi-Frazier, Joyce P.
- Abstract
Key Points: Question: Does one-on-one delivery or group-based delivery of the Promoting Resilience in Stress Management for Parents (PRISM-P) intervention improve psychosocial outcomes, such as resilience and benefit finding, when compared with usual care among parents of children who receive a new diagnosis of cancer? Findings: This randomized clinical trial of 94 parents of children newly receiving a diagnosis of cancer found that compared with usual care, one-on-one delivery of the intervention was significantly associated with improved parent-reported resilience and benefit finding. These improvements were not observed with group delivery of the intervention. Meaning: This intervention may help parents cope and find meaning after their child has received a diagnosis of a serious illness. Importance: Parents of children with serious illness, such as cancer, experience high stress and distress. Few parent-specific psychosocial interventions have been evaluated in randomized trials. Objective: To determine if individual- or group-based delivery of a novel intervention called Promoting Resilience in Stress Management for Parents (PRISM-P) improves parent-reported resilience compared with usual care. Design, Setting, and Participants: This parallel, phase 2 randomized clinical trial with enrollment from December 2016 through December 2018 and 3-month follow-up was conducted at Seattle Children's Hospital. English-speaking parents or guardians of children who were 2 to 24 years old, who had received a diagnosis of a new malignant neoplasm 1 to 10 weeks prior to enrollment, and who were receiving cancer-directed therapy at Seattle Children's Hospital were included. Parents were randomized 1:1:1 to the one-on-one or group PRISM-P intervention or to usual care. Data were analyzed in 2019 (primary analyses from January to March 2019; final analyses in July 2019). Interventions: The PRISM-P is a manualized, brief intervention targeting 4 skills: stress management, goal setting, cognitive reframing, and meaning making. For one-on-one delivery, skills were taught privately and in person for 30 to 60 minutes approximately every other week. For group delivery, the same skills were taught in a single session with at least 2 parents present. Main Outcomes and Measures: Participants completed patient-reported outcome surveys at enrollment and at 3 months. Linear regression modeling evaluated associations in the intention-to-treat population between each delivery format and the primary outcome (Connor-Davidson Resilience Scale scores, ranging from 0 to 40, with higher scores reflecting greater resilience) and secondary outcomes (benefit finding, social support, health-related quality of life, stress, and distress) at 3 months. Results: In total, 94 parents enrolled, were randomized to 1 of the 3 groups, and completed baseline surveys (32 parents in one-on-one sessions, 32 in group sessions, and 30 in usual care). Their median (interquartile range) ages were 35 to 38 (31-44) years across the 3 groups, and they were predominantly white, college-educated mothers. Their children had median (interquartile range) ages of 5 to 8 (3-14) years; slightly more than half of the children were boys, and the most common cancer type was leukemia or lymphoma. One-on-one PRISM-P delivery was significantly associated with improvement compared with usual care in parent-reported outcomes for resilience (β, 2.3; 95% CI, 0.1-4.6; P =.04) and for benefit finding (β, 0.5; 95% CI, 0.2-0.8; P =.001). No significant associations were detected between either platform and other parent-reported outcomes. Conclusions and Relevance: When delivered individually, PRISM-P was associated with improved parent-reported resilience and benefit finding. This scalable psychosocial intervention may help parents cope and find meaning after their child receives a diagnosis of a serious illness. Trial Registration: ClinicalTrials.gov identifier: NCT02998086 This phase 2 randomized clinical trial compares the effects of individual- or group-based delivery of the novel intervention Promoting Resilience in Stress Management for Parents (PRISM-P) with the effects of usual care on improved self-reported resilience among parents of children receiving a new diagnosis of cancer.
- Subjects
WASHINGTON (State); DIAGNOSIS of tumors in children; PSYCHOLOGICAL adaptation; CANCER patients; CHILDREN'S hospitals; CONFIDENCE intervals; GOAL (Psychology); MOTHERS; PSYCHOLOGY of parents; RESEARCH funding; PSYCHOLOGICAL resilience; STATISTICAL sampling; STRESS management; SURVEYS; SOCIAL support; RANDOMIZED controlled trials; EVALUATION of human services programs; CHILDREN
- Publication
JAMA Network Open, 2019, Vol 2, Issue 9, pe1911578
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2019.11578