Parental Pain Expectancy as a Mediator Between Child Expected and Experienced Procedure-related Pain Intensity During Painful Medical Procedures Effectiveness of Regular Breathing Technique (Hey-Hu) on Reduction of Intrathecal Injection Pain in Leukemic Children: A Randomized Clinical Trial Differences in mothers’ and fathers’ health-related quality of life after pediatric SCT: a longitudinal study A community-based approach to cancer counselling for patients and carers: a preliminary study. Internet‐based guided self‐help for parents of children on cancer treatment: a randomized controlled trial A pilot trial of a stress management intervention for primary caregivers of children newly diagnosed with cancer: preliminary evidence that perceived social support moderates the psychosocial benefit of intervention. A Systematic Review of Randomized Controlled Interventions for Parents' Distress in Pediatric Leukemia Treatment of posttraumatic stress symptoms in adolescent survivors of childhood cancer and their families: a randomized clinical trial. Effects of distraction using virtual reality glasses during lumbar punctures in adolescents with cancer. Alteration of memory in the reduction of children's distress during repeated aversive medical procedures. Conducting a randomized clinical trial of an psychological intervention for parents/caregivers of children with cancer shortly after diagnosis. Anxiety and depression in adolescent cancer: findings in patients and parents at the time of diagnosis. Brief report: parents of children undergoing bone marrow transplantation: documenting stress and piloting a psychological intervention program. Psychological distress in parents of children with advanced cancer. Feasibility and preliminary outcomes from a pilot study of a brief psychological intervention for families of children newly diagnosed with cancer. Brief report: Evaluation of an interactive intervention designed to reduce pediatric distress during radiation therapy procedures. Impact of a parent-based interdisciplinary intervention for mothers on adjustment in children newly diagnosed with cancer. Music Therapy to Reduce Pain and Anxiety in Children With Cancer Undergoing Lumbar Puncture: A Randomized Clinical Trial Report from a multi-institutional randomized clinical trial examining computer-assisted problem-solving skills training for English- and Spanish-speaking mothers of children with newly diagnosed cancer. Psychological adaptation and social support of parents of pediatric cancer patients: a prospective longitudinal study. Brief report: an intervention program for parents of pediatric cancer patients: a randomized controlled trial. Pain, distress, and adult-child interaction during venipuncture in pediatric oncology: an examination of three types of venous access. Virtual reality as a distraction intervention for older children receiving chemotherapy. Effects of Distraction on Pain, Fear, and Distress During Venous Port Access and Venipuncture in Children and Adolescents With Cancer Clinical hypnosis versus cognitive behavioral training for pain management with pediatric cancer patients undergoing bone marrow aspirations. A prospective study to determine the costs incurred by families of children newly diagnosed with cancer in Ontario. Cognitive behavioral interventions for children during painful procedures: research challenges and program development. Problem-Solving Skills Training for Mothers of Children with Newly Diagnosed Cancer: A Randomized Trial The monetary costs of childhood cancer to the families of patients. 6MP adherence in a multiracial cohort of children with acute lymphoblastic leukemia: a Children's Oncology Group study. Art therapy as support for children with leukemia during painful procedures. Clinical Hypnosis in the Alleviation of Procedure-Related Pain in Pediatric Oncology Patients Predictors of distress in parents of children with cancer: a prospective study. Psychological adjustment of parents of pediatric cancer patients revisited: five years later. Distraction intervention for preschoolers undergoing intramuscular injections and subcutaneous port access. Survival from childhood acute lymphoblastic leukaemia: the impact of social inequality in the United Kingdom. Using problem-solving skills training to reduce negative affectivity in mothers of children with newly diagnosed cancer: report of a multisite randomized trial. Influence of parental and family adjustment on the later psychological adjustment of children treated for cancer. A pilot and feasibility study of virtual reality as a distraction for children with cancer. Parental coping with the diagnosis of childhood cancer: gender effects, dissimilarity within couples, and quality of life. A clinic-based interdisciplinary intervention for mothers of children newly diagnosed with cancer: a pilot study. CHILDHOOD CANCER: Its Impact and Financial Costs for Australian Families Risk factors for psychological maladjustment of parents of children with cancer. Relationships between cognitive behavioral techniques, temperament, observed distress, and pain reports in children and adolescents during lumbar puncture. Specificity of problem-solving skills training in mothers of children newly diagnosed with cancer: results of a multisite randomized clinical trial.
Objectives The aim of this prospect i ve investigation was to evaluate child and parental expectancies as a predictor of pain perception in pediatric oncology patients undergoing painful medical procedures . Methods Forty-five children with leukemia or non-Hodgkin lymphoma and their parents rated expected and experienced pain during lumbar punctures at baseline , during intervention ( ie , cognitive-behavior therapy ) administered by a therapist and when children were using cognitive-behavior therapy skills independently . Results Parental and child expectancies were significantly correlated . Parents consistently expected their children to experience more pain than children were expecting themselves . Parental expectancy was found to mediate the relationship between child expected and experienced pain during every phase of the study . Discussion It is concluded that parental expectancies are reliable predictors of pediatric procedure-related pain and possible useful targets for psychologic interventions to manage such pain Objective Children with chronic diseases such as leukemia are subjected to pain during various procedures . Injection pain in children is so important that it is considered as the most stressful aspect of their disease . Distraction is one of the easiest and least costly methods of non-pharmacological pain relief that has not been paid attention to by nurses . In the present study , the effectiveness of regular breathing method ( Hey-Hu ) in reduction of pain of intrathecal injection in leukemic children was evaluated . Methods This study was conducted as a single blind r and omized clinical trial among 100 patients coming to a referral hospital related to Shahid Sadoughi University of Medical Sciences , Yazd , Iran . The patients were 6 - 15 years old children coming to oncology ward suffering from leukemia . They were selected and r and omly allocated to either regular breathing group or control group in equal numbers . The pain of children was assessed by Wong pain face scale and also general behaviors of the sample s were evaluated by the research er . In Pain Rating Scale , face 0 is considered happy because there is no hurt and face 5 denotes maximum pain . Findings Mean pain score in the regular breathing group was significantly lesser than the control group ( 2.98±1.68 and 3.80±1.30 , respectively ; P=0.01 ) . There was no significant difference between the two sexes but in the regular breathing  group , mean pain score was significantly lower in children aged above 10 years . Conclusion This study showed that regular breathing can significantly reduce the pain of intrathecal injection in leukemic children , especially in those aged above 10 years . Considering the key role of nurses in a health care team , the research ers hope that the results of this study can help them learn this method and implement it in hospitalized children who undergo painful procedures The purpose of this study was to examine longitudinally health-related quality of life ( HRQOL ) and related factors in mothers and fathers of children who undergo SCT , before , and 1 and 2 years after SCT .  A total of 84 parents ( 49 mothers/35 fathers ) of patients diagnosed mainly with leukemia completed a HRQOL measure before SCT , 46 at 1 year ( 26 mothers/20 fathers ) and 50 parents ( 31 mothers/19 fathers ) at 2 years post SCT  . Physical and psychosocial HRQOL summary scores are reported . Parents ’ age and gender , child 's diagnosis , radiation history , age , behavior and physical health were examined . Linear mixed models for repeated measures with a covariate structure were used for analysis . Physical HRQOL did not differ between mothers and fathers or over time . Maternal and paternal psychosocial HRQOL scores improved by 2 years post SCT . Child 's behavior problems and poor health , and maternal age ( younger ) predicted poor maternal psychosocial HRQOL 2 years post SCT . Child 's behavior problems , diagnosis and treatment severity predicted poor paternal psychosocial HRQOL . These findings identify similar ( child 's poor behavior ) and differential risk factors ( parental young age , disease and treatment severity , and child 's poor health status ) for poor HRQOL for mothers and fathers . These findings can guide comprehensive family-care interventions before , during and after pediatric SCT OBJECTIVE The delivery of psychological care services to people with cancer and their carers is a key clinical priority that has yet to be broadly implemented . The present study aim ed to provide guidance for service provision by describing a community-based intervention approach ; outlining the characteristics , psychological concerns , and distress outcomes for people who utilise the service . METHODS Over a 3-year period 681 patients and 520 significant others referred from a community-based Cancer Helpline received  tele-based psychosocial interventions . RESULTS In this case series presenting problems varied between patients and significant others , with significant others reporting higher levels of distress ( p<0.001 ) . Both patients and significant others experienced decreases in distress over the period of the intervention ( p<0.001 ) . CONCLUSIONS This study provides level IV evidence that the tele-based intervention for cancer-related distress is an effective approach to service delivery . A r and omised control trial is currently underway to assess the effectiveness of this approach Abstract Objective The aim of the study was to investigate the feasibility and preliminary efficacy of an Internet‐based guided self‐help intervention for posttraumatic stress symptoms ( PTSS ) and related symptoms in parents of children on cancer treatment . Methods Parents of children on cancer treatment , who fulfilled the modified symptom criteria on the PTSD Checklist , were r and omly allocated to the intervention  or to a  wait‐list control condition . The intervention group accessed a 10‐week guided self‐help program via the Internet based on principles from cognitve behavior therapy . The primary outcome PTSS and the secondary outcomes depression and anxiety were assessed by self‐report preintervention and postintervention . Results Seven hundred forty‐seven parents were approached and informed about the study , 92 were assessed for eligibility , and 58 were included and r and omized to the intervention ( n = 31 ) or wait list ( n = 27 ) . Eightteen participants completed the intervention . Intention‐to‐treat analyses indicated a significant effect of the intervention on PTSS with a large between‐group effect size at post assessment ( Cohen 's d = 0.88 ) . The intervention group reported reductions in PTSS with a large within‐group effect size ( d = 1.62 ) compared with a minimal reduction in the wait‐list group ( d = 0.09 ) . There was a significant intervention effect on depression and anxiety and reductions in the intervention group with large within‐group effect sizes ( d = 0.85–1.09 ) . Conclusions Findings indicate a low enrollment rate and considerable attrition but also that Internet‐based guided self‐help shows promise for parents of children on cancer treatment who report a high level of PTSS and would like to take part in an Internet‐based intervention . © 2015 The Authors . Psycho‐Oncology published by John Wiley & Sons , OBJECTIVES ( 1 ) To examine the acceptability and feasibility of a stress management intervention for caregivers of children recently diagnosed with cancer . ( 2 ) To explore whether caregivers with lower baseline perceived social support derive greater benefit from the intervention than those with higher perceived support . METHODS 45 primary caregivers were r and omly assigned to intervention or st and ard care . Of these , 37 completed measures of social support , depression , anxiety , and perceived stress at both pre-intervention ( T1 ; mean = 24 days post-diagnosis ) and post-intervention time points ( T2 ; mean = 165 days post-diagnosis ) . RESULTS Enrollment , retention , and satisfaction data support feasibility and acceptability of the intervention . There was no overall significant impact of participation in the intervention on levels of distress at T2 . However , T1 social support moderated intervention response , with caregivers who perceived lower T1 support showing greater psychological benefit from the intervention . CONCLUSIONS Primary caregivers with lower levels of perceived social support may benefit from preemptive stress management intervention Objective . This review aims to summarize the existing evidence concerning interventions towards reducing stress in parents with a child with leukemia and their effect in child and family wellbeing . Methods . A systematic review strategy was conducted using MEDLINE covering the period January 1980 to June 2010 . Results . Seven r and omized controlled trials met the inclusion criteria including in total 1045 parents participants . A variety of cognitive-behavioral interventions problem-solving skills training programs have been used for managing distress in parents and children . Outcome measures are assessed by self-report , observer report , behavioral/psychological , and physiological measures . The most prominent method ological problems were the marked heterogeneity in stress measurement and the relative absence of proper measurement and adjustment of moderating and mediating factors . The largest effect has been obtained by combined cognitive-behavioral interventions with promising but limited evidence for several other psychological interventions . Conclusions . Recommendations for future RCTs are provided , and particular attention to the quality of trial design and reporting is highlighted Posttraumatic stress symptoms ( PTSS ) , particularly intrusive thoughts , avoidance , and arousal , are among the most common psychological aftereffects of childhood cancer for survivors and their mothers and fathers . We conducted a r and omized wait-list control trial of a newly developed 4-session , 1-day intervention aim ed at reducing PTSS that integrates cognitive-behavioral and family therapy approaches -- the Surviving Cancer Competently Intervention Program ( SCCIP ) . Participants were 150 adolescent survivors and their mothers , fathers , and adolescent siblings . Significant reductions in intrusive thoughts among fathers and in arousal among survivors were found in the treatment group . A multiple imputations approach was used to address nonr and om missing data and indicated that treatment effects would likely have been stronger had more distressed families been retained . The data are supportive of brief interventions to reduce PTSS in this population and provide additional support for the importance of intervention for multiple members of the family PURPOSE / OBJECTIVES To determine the effects of virtual reality ( VR ) glasses on adolescents with cancer undergoing lumbar punctures ( LPs ) . DESIGN Pilot study using an experimental , control group design . SETTING In-hospital oncology clinic . SAMPLE 30 adolescents with cancer ( 17 in the VR and 13 in the control group ) undergoing frequent LPs . METHODS Subjects were r and omly assigned to groups . Both groups received st and ard intervention during the LP , but the experimental group also wore VR glasses and watched a video . Following the LP , both groups rated their pain using a visual analog scale ( VAS ) and were interviewed to evaluate their experience . MAIN RESEARCH VARIABLES Pain , subjective evaluation of experience . FINDINGS Although VAS pain scores were not statistically different between the two groups ( p = 0.77 ) , VAS scores tended to be lower in the VR group ( median VAS of 7.0 , range 0 - 48 ) than in the control group ( median VAS of 9.0 , range 0 - 59 ) . 77 % of subjects in the experimental group said the VR glasses helped to distract them from the LP . CONCLUSIONS VR glasses are a feasible , age-appropriate , nonpharmacologic adjunct to conventional care in managing the pain associated with LPs in adolescents . IMPLICATION S FOR PRACTICE The clinical application of various age-appropriate distracters to reduce pain in adolescents undergoing painful procedures should be explored The present study sought to reduce  children 's distress during aversive medical procedures using a brief , cost-effective intervention aim ed at reframing memory . Fifty children diagnosed with leukemia ( 25 treatment , 25 attention control , aged 3 - 18 ) were observed as they underwent  3 consecutive lumbar punctures ( LPs ; baseline , postintervention , and follow-up ) . Self-report , physiological , and observable distress measures were collected before and after each LP . At posttreatment , children in the intervention group showed reductions in anticipatory physiological and self-report ratings relative to the control group . At follow-up , these effects generalized to reductions in procedural distress . These results suggest that ( a ) a simple memory-based intervention is efficacious at reducing  children 's distress and ( b ) benefits from this intervention are maintained over 1 week even without continued intervention OBJECTIVE To report acceptability , feasibility , and outcome data from a r and omized clinical trial ( RCT ) of a brief intervention for caregivers of children newly diagnosed with cancer . METHOD Eighty-one families were r and omly assigned following collection of baseline data to Intervention or Treatment as Usual ( TAU ) . Recruitment and retention rates and progression through the protocol were tracked . Measures of state anxiety and posttraumatic stress symptoms served as outcomes . RESULTS Difficulties enrolling participants included a high percentage of newly diagnosed families failing to meet inclusion criteria ( 40 % ) and an unexpectedly low participation rate ( 23 % ) . However , movement through the protocol was generally completed in a timely manner and those completing the intervention provided positive feedback . Outcome data showed no significant differences between the arms of the RCT . CONCLUSIONS There are many challenges inherent in conducting a RCT shortly after cancer diagnosis . Consideration of alternative research design s and optimal timing for interventions are essential next steps Adolescent cancer is uncommon and presents an exceptional stress for the young patient and their parents . The emotional needs of adolescents with cancer are a major factor in the recommendation for the establishment of adolescent cancer units in major cancer centres in the U.K. However , there have been no prospect i ve , longitudinal studies assessing the psychological impact of a diagnosis of cancer on the adolescent patient and their family . In 1994 we began a longitudinal study of the emotional impact of the diagnosis of cancer in patients and their families presenting to an adolescent cancer unit and of the coping strategies they employ . This first report presents the results of the study at the time of diagnosis in 42 adolescents , 34 mothers and 27 fathers . The  Beck Depression Inventory ( BDI )  was used to assess depression and anxiety levels were measured using Spielberger 's State Trait Anxiety Inventory  ( STAI ) . Adolescents and their parents completed the question naires on first admission to the adolescent cancer unit . The median time since cancer diagnosis was approximately 3 weeks . To provide normative data for the U.K. adolescent population , control values were obtained from 173 pupils of the same age and background . The results showed that , contrary to expectation , adolescents with cancer were no more anxious or depressed than the control adolescent population . Nevertheless , a substantial minority of patients and controls had elevated anxiety or depression scores . Girls were significantly more anxious ( P = 0.011 ) and depressed ( P < 0.0001 ) than boys . Mothers were the most anxious family members and were significantly more anxious than fathers ( P = 0.038 ) . Parental anxiety scores , especially mothers , were much higher than reported norms . There was no significant difference between mothers ' and fathers ' depression scores . Although at the time of diagnosis adolescent cancer patients are not more anxious or depressed than their healthy peers , many adolescents without cancer are anxious or depressed . Staff on adolescent cancer units should therefore be aware of the frequency of emotional disturbance in this population . Mothers are the most anxious family members . Although the findings are relatively reassuring at the time of diagnosis , follow-up data from this cohort will show whether anxiety and depression change with treatment involving intensive chemotherapy , surgery and radiotherapy and will indicate the coping strategies which patients and their families adopt in dealing with both the disease and its treatment OBJECTIVE To document levels of stress in parents of children undergoing bone marrow transplantation ( BMT ) over the course of hospitalization and to pilot a psychological intervention program design ed to teach parents techniques for managing stress associated with their child 's illness and hospitalization . METHODS Twenty-two mothers of children ( ages 2 - 16 ) undergoing BMT  were followed prospect ively from preadmission to three weeks posttransplant . Eleven mothers , r and omly assigned to participate in a pilot intervention program , were compared with 11 control mothers receiving st and ard care preparation of their child 's BMT .  RESULTS Repeated measures ANOVAs detected significant changes in stress over time , with most stress reported preadmission . Mothers in the intervention condition reported using more stress management techniques than mothers in the st and ard care condition , though the majority of analyses revealed no significant differences in stress between groups . CONCLUSIONS Increased levels of parenting distress may occur pretransplant , suggesting the need for additional psychological intervention at that time IMPORTANCE Parent psychological distress can impact the well-being of childhood cancer patients and other children in the home . Recognizing and alleviating factors of parent distress may improve overall family survivorship experiences following childhood cancer . OBJECTIVES To describe the prevalence and factors of  psychological distress ( PD ) among parents of children with advanced cancer . DESIGN Cohort study embedded within a r and omized clinical trial ( Pediatric Quality of Life and Evaluation of Symptoms Technology [ PediQUEST ] study ) . SETTING Multicenter study conducted at 3 children 's hospitals ( Boston Children 's Hospital , Children 's Hospital of Philadelphia , and Seattle Children 's Hospital ) . PARTICIPANTS Parents of children with advanced ( progressive , recurrent , or refractory ) cancer . MAIN OUTCOME MEASURE Parental PD , as measured by the Kessler-6 Psychological Distress Scale . RESULTS Eighty-six of 104 parents completed the Survey About Caring for Children With Cancer ( 83 % participation ) ; 81 parents had complete Kessler-6 Psychological Distress Scale data . More than 50 % of parents reported high PD and 16 % met criteria for serious PD ( compared with US prevalence of 2%-3 % ) . Parent perceptions of prognosis , goals of therapy , child symptoms/suffering , and financial hardship were associated with PD . In multivariate analyses , average parent Kessler-6 Psychological Distress Scale scores were higher among parents who believed their child was suffering highly and who reported great economic hardship . Conversely , PD was significantly lower among parents whose prognostic underst and ing was aligned with concrete goals of care . CONCLUSIONS AND RELEVANCE Parenting a child with advanced cancer is strongly associated with high to severe levels of PD . Interventions aim ed at aligning prognostic underst and ing with concrete care goals and easing child suffering and financial hardship may mitigate parental PD OBJECTIVE To report initial feasibility and outcome from a pilot study of a new three-session intervention for caregivers of children newly diagnosed with cancer , Surviving Cancer Competently Intervention Program-Newly Diagnosed ( SCCIP-ND ) . METHOD Nineteen families ( 38 caregivers ) were r and omly assigned to  SCCIP-ND  or treatment as usual subsequent to learning of their child 's illness . The study design included pre- and 2-month postintervention assessment s , with state anxiety and posttraumatic stress symptoms as outcomes . Feasibility was based on therapist feedback and supervision , program evaluations , and data from study -tracking procedures . RESULTS SCCIP-ND appears to be an acceptable intervention that can be used successfully with caregivers over the first few months after diagnosis . Recruitment and retention data document feasibility but also highlight challenges . Preliminary outcome data show changes in the desired direction [ e.g. , reduced anxiety and parental posttraumatic stress symptoms ( PTSS ) ] . CONCLUSIONS The pilot data are supportive of the value and challenges of developing evidence -based family interventions in pediatric psychology OBJECTIVE To evaluate the efficacy of an interactive intervention in reducing distress related to radiation therapy ( RT ) among pediatric cancer participants as measured by occurrence of sedation , observed behavioral distress ( OBD ) , and heart rate ( HR ) . METHODS Seventy-nine children receiving RT simulation  were assigned r and omly to a STARBRIGHT Hospital Pals group ( i.e. , interactive intervention group ; IG ) or modified control group ( MCG ) . The interactive intervention included filmed modeling , exposure to an interactive Barney character , and passive auditory distraction . RESULTS Children in the IG experienced significantly lower HR when compared with MCG participants . No differences were found in terms of sedation or OBD . CONCLUSIONS The interactive intervention was effective at reducing RT-related distress ( as measured by HR ) and would be a useful tool in pediatric radiation oncology setting OBJECTIVE To determine if maternal distress predicts child adjustment outcomes or if child adjustment outcomes predict maternal distress among children newly diagnosed with cancer , and if a parent-focused intervention has downstream effects on child adjustment . METHODS Mothers ( n = 52 ) were r and omly assigned to a clinic-based , interdisciplinary intervention for parents of children newly diagnosed with cancer .  Measures of maternal distress and child adjustment were collected at baseline , posttreatment , and follow-up . RESULTS A lagged relationship was identified between maternal distress and child internalizing symptoms , but not externalizing symptoms . The parent intervention  reduced child internalizing and externalizing symptoms at follow-up . Only the child internalizing symptoms effect was mediated by reduced maternal distress . The child externalizing symptoms effect was mediated by unobserved parent factors . CONCLUSIONS This study provides support for illness adjustment and coping models that emphasize the role of parent factors in driving child adjustment outcomes and is encouraging for future parent-focused intervention research A nonpharmacological method can be an alternative or complement to analgesics . The aim of this study was to evaluate if music medicine influences pain and anxiety in children undergoing lumbar punctures .  A r and omized clinical trial was used in 40 children ( aged 7 - 12 years ) with leukemia , followed by interviews in 20 of these participants . The participants were r and omly assigned to a music group ( n = 20 ) or control group ( n = 20 ) . The primary outcome was pain scores and the secondary was heart rate , blood pressure , respiratory rate , and oxygen saturation measured before , during , and after the procedure . Anxiety scores were measured before and after the procedure . Interviews with open-ended questions were conducted in conjunction with the completed procedures . The results showed lower pain scores and heart and respiratory rates in the music group during and after the lumbar puncture . The anxiety scores were lower in the music group both before and after the procedure . The findings from the interviews confirmed the quantity results through descriptions of a positive experience by the children , including less pain and fear OBJECTIVES To evaluate the feasibility and efficacy of a h and held personal digital assistant (PDA)-based supplement for maternal Problem-Solving Skills Training ( PSST ) and to explore Spanish-speaking mothers ' experiences with it . METHODS Mothers ( n = 197 ) of children with newly diagnosed cancer were r and omized to traditional PSST or PSST + PDA 8-week programs . Participants completed the Social Problem-Solving Inventory-Revised , Beck Depression Inventory-II , Profile of Mood States , and Impact of Event Scale-Revised pre- , post-treatment , and 3 months after completion of the intervention . Mothers also rated optimism , logic , and confidence in the intervention and technology . RESULTS Both groups demonstrated significant positive change over time on all psychosocial measures . No between-group differences emerged . Despite technological " glitches , " mothers expressed moderately high optimism , appreciation for logic , and confidence in both interventions and rated the PDA-based program favorably . Technology appealed to all Spanish-speaking mothers , with younger mothers showing greater proficiency . CONCLUSIONS Well- design ed , supported technology holds promise for enhancing psychological interventions OBJECTIVE To investigate levels of support and the concurrent and prospect i ve effects of support on the psychological functioning of parents of children with cancer in a prospect i ve longitudinal study . METHODS Parents ' ( n = 128 ) self-perceived level of psychological distress , quantity of support , and dissatisfaction with support  were assessed , at diagnosis , at 6 , and at 12 months . RESULTS Parents received most support at diagnosis . Self-perceived quantity decreased with time , but parents indicated they remained equally satisfied . Support significantly predicted concurrent and prospect i ve distress of fathers , but not of mothers . Dissatisfaction with support and negative interactions were consistent risk factors for fathers . Mothers who adjusted well psychologically received more support and were less dissatisfied than mothers who remained clinical ly distressed . Nevertheless , no persisting effect of support was found . CONCLUSIONS Findings illustrate that social support varies with the stress situation and with gender . Identification of vulnerable parents at diagnosis on the basis of their perception of received quantity of and dissatisfaction with support seems difficult . Intervention efforts aim ed at mobilization of needed support may be efficacious OBJECTIVE To evaluate a psychoeducational intervention program for parents of pediatric cancer patients , using cognitive and behavioral techniques . METHODS Parents were r and omly assigned to an intervention ( n = 39 ) and a control condition ( n = 42 ) . Baseline assessment took place at diagnosis . Short-term effects were measured immediately after the intervention , long-term effects six months later . Control parents received st and ard care . Intervention parents received , in addition , a manual-guided program during the first six months following the diagnosis . RESULTS With time all parents became significantly less psychologically distressed . However , no between-group differences were noted in psychological functioning , satisfaction with support , and intensity of emotions immediately postintervention and six months later . CONCLUSIONS Although the clinical evaluation of the intervention was positive , it appeared that a structured intervention program as described in this study was not any more effective than st and ard care This study examined pain and distress from needles in children undergoing blood sampling as a function of  adult-child interaction  and type of  venous  access ( i.e. , central external venous lines , internalized ports , or peripheral access via venipuncture ) . Participants were 55 pediatric oncology patients , aged 3 - 18 years , who were undergoing routine blood work .  Pain ratings were obtained using the  Faces Pain Scale-Revised  ( FPS-R ) and conversation during the procedure was audio taped for coding using the Child-Adult Medical Procedure Interaction Scale-Revised ( CAMPIS-R ) . Children 's ratings of pain using the FPS-R were similar in the port ( M=2.57/10 , st and ard deviation [SD]=3.46 ) and peripheral ( M=2.56/10 , SD=3.24 ) groups , despite the fact that most children with internal ports were given a topical anesthetic . Similarly , there were no differences between port and peripheral groups in rates of child coping or distress , or parent and nurse observations of child pain . As would be expected , external line access was not associated with pain or distress , even among very young children , suggesting that they appropriately understood the pain rating scale . Results of the transcribed CAMPIS-R data indicate that the influences in adult-child interaction are bidirectional . Support was found for the well-established positive relationship between child distress and adult reassurance and empathy . Implication s for intervention and selection of central venous access devices are discussed The purpose of this pilot study was to describe the perceived effectiveness and feasibility of using virtual reality ( VR ) as a distraction intervention for children , aged 10 - 17 , receiving outpatient chemotherapy .  Treatments for cancer are intensive and difficult to endure . Distraction interventions are effective because the individual concentrates on pleasant or interesting stimuli instead of focusing on unpleasant symptoms . VR is a computer-simulated technique allowing an individual to hear and feel stimuli that correspond with a visual image . Evaluation of the VR intervention demonstrated positive outcomes . Eighty-two percent of the children ( n = 11 ) indicated the chemotherapy treatment with the VR was better than previous chemotherapy treatments . All subjects responded positively when asked if they would like to use the VR again . The intervention was easy to implement , did not require practice to be effective , and required minimal nursing time . Results from this pilot study suggest that VR as a distraction intervention has the potential to enhance positive clinical outcomes . This intervention warrants further investigation with both pediatric and adult population This study evaluates the effect of self-selected distracters ( ie , bubbles , I Spy : Super Challenger book , music table , virtual reality glasses , or h and held video games ) on pain , fear , and distress in 50 children and adolescents with cancer , ages 5 to 18 , with port access or venipuncture . Using an intervention-comparison group design , participants were r and omized to the  comparison group ( n = 28 ) to receive st and ard care or intervention group ( n = 22 ) to receive distraction plus st and ard care . All participants rated their pain and fear , parents rated participant fear , and the nurse rated participant fear and distress at 3 points in time : before , during , and after port access or venipuncture . Results show that self-reported pain and fear were significantly correlated ( P = .01 ) within treatment groups but not significantly different between groups . Intervention participants demonstrated significantly less fear ( P < .001 ) and distress ( P = .03 ) as rated by the nurse and approached significantly less fear ( P = .07 ) as rated by the parent . All intervention parents said the needlestick was better because of the distracter . The authors conclude that distraction has the potential to reduce fear and distress during port access and venipuncture A r and omized controlled trial was conducted to compare the efficacy of clinical hypnosis versus cognitive behavioral ( CB ) coping skills training in alleviating the pain and distress of 30 pediatric cancer patients ( age 5 to 15 years ) undergoing bone marrow aspirations . Patients were r and omized to one of three groups : hypnosis , a package of CB coping skills , and no intervention . Patients who received either hypnosis or CB reported less pain and pain-related anxiety than did control patients and less pain and anxiety than at their own baseline . Hypnosis and CB were similarly effective in the relief of pain . Results also indicated that children reported more anxiety and exhibited more behavioral distress in the CB group than in the hypnosis group . It is concluded that hypnosis and CB coping skills are effective in preparing pediatric oncology patients for bone marrow aspiration OBJECTIVES A diagnosis of cancer in childhood places a considerable economic burden on families , although costs are not well described . The objectives of this study were to identify and determine independent predictors of the direct and time costs incurred by such families . METHODS A prospect i ve , cost-of-illness study was conducted in families of children newly diagnosed with cancer . Parents recorded the re sources consumed and costs incurred during 1 week per month for three consecutive months beginning the fourth week following diagnosis and listed any additional costs incurred since then . Descriptive and multiple regression analyses were performed to describe families ' costs ( expressed in 2007 Canadian dollars ) and to determine direct and time cost predictors . RESULTS In total , 28 fathers and 71 mothers participated . The median total direct and time costs in 3 months were $ CAD3503 and $ CAD23 130 , respectively , per family . The largest component of direct costs was travel and of time costs was time allocated previously for unpaid activities . There were no statistically significant predictors of direct costs . Six per cent of the variance for time costs was explained by language spoken at home . CONCLUSIONS Families of children with cancer are confronted with a wide range of direct and time costs , the largest being travel and time allocated previously for unpaid activities The purpose of this report is to describe a pilot program design ed to introduce the use of cognitive behavioral interventions for painful pediatric procedures at a university hospital , and to discuss the challenges that occurred during this process . Participants in the program included ten parents and their children who were newly diagnosed with leukemia , and staff who provided treatment for these children . Measures included direct videotaped observations of the children , perceptions of pain and anxiety completed by children , parents , and staff , and parent and staff ratings of satisfaction with the program . Results indicated strong acceptance of the interventions . This report discusses the challenges encountered , implication s of the findings , and plans for future program development ABSTRACT . Mothers of children with serious illnesses have lower levels of well-being than mothers in the general population . Problem-solving therapy ( PST ) , a cognitive-behavioral intervention , has been shown to be effective in treating negative affectivity ( depression , anxiety ) and other manifestations of reduced well-being . This report describes a problem-solving skills training ( PSST ) intervention , based on problem-solving therapy , for mothers of newly diagnosed pediatric cancer patients . Ninety-two mothers were r and omly assigned to receive PSST or to receive st and ard psychosocial care ( Control Group ) . After the 8-week intervention , mothers in the PSST Group had significantly enhanced problem-solving skills and significantly decreased negative affectivity compared with controls . Analysis revealed that changes in self-reports of problem-solving behaviors accounted for 40 % of the difference in mood scores between the two groups . Interestingly , PSST had the greatest impact on improving constructive problem solving , whereas improvement in mood was most influenced by decreases in dysfunctional problem solving . The implication s of these findings for refinement of the PSST intervention and for extension to other groups of children with serious illnesses are discussed The medical costs of cancer treatment are well described , but there are few reports of expenses incurred by families of children with malignant disease . The objective of this study was to describe the monetary costs borne by families of patients with childhood cancer and to determine whether these costs represent an important component of the burden of illness . Families completed a prospect i ve diary survey about daily expenses incurred during each sample week of therapy . We also undertook a retrospective , cross-sectional question naire survey about expenses , incurred during the entire duration of treatment , associated with major or one-time cost items . Seventy families of children treated for high risk acute lymphoblastic leukemia , 19 families of children treated for Wilms ' tumor stages 2 - 5 , and 16 families of children treated for neuroblastoma stages 3 and 4 completed diaries or question naires detailing the costs result ing from the diseases and their treatment . The mean total expenses ( in 1986 Canadian dollars ) incurred by families of childhood cancer patients over the entire course of therapy are $ 26,070 for acute lymphoblastic leukemia ? $ 20,074 for Wilms ' tumour , and $ 10,376 for neuroblastoma . On-going weekly costs rather than major one-time purchases account for the largest share of expenses . Overall , in spite of universal first dollar coverage for medical care in Canada , family-borne costs during the course of these illnesses are at least one-third of the average family 's after-tax income Durable remissions in children with acute lymphoblastic leukemia ( ALL ) require a 2-year maintenance phase that includes daily oral 6-mercaptopurine ( 6MP ) . Adherence to oral 6MP among Asian-American and African-American children with ALL is unknown . We enrolled 298 children with ALL ( 71 Asian Americans , 68 African Americans , and 159 non-Hispanic whites ) receiving oral 6MP for the maintenance phase . Adherence was measured electronically for 39 803 person-days . Adherence declined from 95.0 % ( month 1 ) to 91.8 % ( month 5 , P < .0001 ) . Adherence rates were significantly ( P < .0001 ) lower in Asian Americans ( 90.0 % ± 4.9 % ) and African Americans ( 87.1 % ± 4.4 % ) , as compared with non-Hispanic whites ( 95.2 % ± 1.3 % ) . Race-specific sociodemographic characteristics helped explain poor adherence ( African Americans : low maternal education [ less than a college degree : 78.9 % , vs at least college degree : 94.6 % ; P < .0001 ] ; Asian Americans : low-income households [ < $ 50 000 : 84.5 % , vs ≥$50 000 : 96.7 % ; P = .04 ] ; households without mothers as full-time caregivers [ 85.6 % ] vs households with mothers as full-time caregivers [ 97.2 % ; P = .05 ] ) . Adherence rate below 90 % was associated with increased relapse risk ( hazard ratio , 3.9 ; P = .01 ) . Using an adherence rate < 90 % to define nonadherence , 20.5 % of the participants were nonadherers . We identify race-specific determinants of adherence , and define a clinical ly relevant level of adherence needed to minimize relapse risk in a multiracial cohort of children with ALL . This trial was registered at www . clinical trials.gov as # NCT00268528 BACKGROUND Children with leukemia undergo painful procedures such as  lumbar puncture and bone marrow aspiration .  To overcome pain , certain units offer total anesthesia ; others offer generic support ; others offer no preparation at all . Since September , 1997 , we have provided leukemic children  with art therapy ( AT ) , a nonverbal and creative modality that develops coping skills . Our goal is to prevent anxiety and fear during painful interventions as well as prolonged emotional distress . PROCEDURE We treated 32 children aged 2 - 14 years . The modes of AT before , during , and after the punctures were as follows : clinical dialogue to calm children and help them cope with painful procedures ; visual imagination to activate alternative thought processes and decrease the attention towards overwhelming reality and raise the peripheral sensitivity gate ; medical play to clarify illness , eliminate doubts , and offer control over threatening reality ; structured drawing to contain anxiety by offering a structured , predictable reality ( the drawing ) that was controllable by children ; free drawing to allow children to externalize confusion and fears ; and dramatization to help children accept and reconcile themselves to body changes . RESULTS Children hospitalized before September , 1997 , exhibited resistance and anxiety during and after painful procedures . By contrast , children provided with AT from the first hospitalization exhibited collaborative behavior . They or their parents asked for AT when the intervention had to be repeated . Parents declared themselves better able to manage the painful procedures when AT was offered . CONCLUSION AT was shown to be a useful intervention that can prevent permanent trauma and support children and parents during intrusive interventions This prospect i ve controlled trial investigated the efficacy of a manual-based clinical hypnosis intervention in alleviating pain in 80 pediatric cancer patients ( 6–16 years of age ) undergoing regular lumbar punctures . Patients were r and omly assigned to 1 of 4 groups : direct hypnosis with st and ard medical treatment , indirect hypnosis with st and ard medical treatment , attention control with st and ard medical treatment , and st and ard medical treatment alone . Patients in the hypnosis groups reported less pain and anxiety and were rated as demonstrating less behavioral distress than those in the control groups . Direct and indirect suggestions were equally effective , and the level of hypnotizability was significantly associated with treatment benefit in the hypnosis groups . Therapeutic benefit de grade d when patients were switched to self-hypnosis . The study indicates that hypnosis is effective in preparing pediatric oncology patients for lumbar puncture , but the presence of the therapist may be critical OBJECTIVE To investigate levels of psychological distress in parents of children with cancer and relationships between distress and measures of illness variables , appraisal , psychosocial re sources and coping strategies . METHODS Question naires were completed by 68 mothers and 58 fathers at 6 ( Time 1 ) and 18 ( Time 2 ) months post-diagnosis . RESULTS High levels of distress for 51 % of mothers and around 40 % of fathers were apparent at both time points , with little change over time . For mothers , their appraisal of the strain of the illness , and their own ability to deal with it , and family cohesion were predictive of distress , both concurrently and prospect ively , and , at Time 1 , greater use of self-directed coping strategies was related to higher levels of distress . For fathers , risk factors of employment problems ( Time 1 ) and the number of the child 's hospital admissions ( Time 2 ) were significant , along with appraisal and family cohesion . CONCLUSIONS Continuation of high levels of distress over time points to the importance of identification of those at risk at an early stage and provision of ongoing support . Implication s for such support are discussed We investigated the psychological functioning of parents of children suffering from pediatric cancer using a prospect i ve design over a five-year time period . Parents of children diagnosed with cancer participated at diagnosis ( T1 ) , six months ( T2 ) , twelve months ( T3 ) , and five years later ( T4 , n = 115 ) . Repeated measures ANOVAs were calculated for the three measures of psychological distress ( GHQ , SCL-90 and STAI-S ) to examine changes over time and gender differences . Independent T-tests were computed to examine differences between the mean scores of the parents at T4 and the norm groups . The effects of health status and earlier levels of distress on T4 functioning were examined using ANOVA and partial correlational analysis . Results showed that levels of reported distress , psychoneurotic symptoms and state anxiety significantly decreased across time to normal levels at T4 except on the GHQ . A significantly higher percentage of parents ( 27 % ) than in the norm group ( 15 % ) showed clinical ly elevated scores on the GHQ . Mothers had higher scores than fathers only on state anxiety .  Parents of relapsed children reported higher anxiety levels than parents of surviving and deceased children .  Psychological functioning at T1 was significantly related to functioning at T4 . These results support the conclusion that although parental distress decreases with time , a significant number of parents still suffer from clinical distress after five years . Parents of relapsed children are at risk for long-term psychological problems as are those with higher levels of psychosomatic complaints at diagnosis This study evaluated a distraction intervention design ed to reduce the distress of preschool children undergoing repeated chemotherapy injections . Twenty-nine children aged 2 - 5 years were r and omly assigned either to distraction by a developmentally appropriate electronic toy or to a wait-list control . Children who received the distraction intervention demonstrated lower overt behavioral distress and were rated by parents and nurses as less anxious than children in the control condition . The improvements were maintained over the 8-week intervention . The results suggest that a developmentally appropriate , multisensory , variable-distracting activity that requires active cognitive processing and active motor responses may be a viable cost-effective alternative to more time-intensive parent-training programs for preschool-age children BACKGROUND Survival from childhood acute lymphoblastic leukaemia ( ALL ) has continued to improve in economically-developed regions of the world , but 20 % of patients still die within 5-years of diagnosis . Treatment is prolonged and complex ; and as survival rates plateau , factors relating to socio-economic status and /or treatment adherence are increasingly scrutinised as potentially important determinants of outcome . METHODS Predicated on the frame-work of the United Kingdom ( UK ) NHS , the relationship between socio-demographic factors and ALL survival is examined here using data from a large follow-up study conducted in the 1990s . One thous and five hundred and fifty nine children ( 0 - 14 years ) diagnosed in Engl and , Scotl and & Wales during the era of the national UKALL XI r and omized-controlled trial ( RCT ) were followed-up for an average of 15.9 years ( 20,826.3 person-years ) . Area-based deprivation scores and father 's occupational social class at the time of the child 's birth were used as markers of socio-economic status . Information on deaths was obtained from the NHS Information Centre for Health and Social Care . All children were included in the analyses , irrespective of RCT enrolment or participation in the founding epidemiological study (www . UKCCS.org).Survival effects were assessed using proportional hazards regressions models . RESULTS Survival varied with both area-based deprivation at diagnosis ( hazard ratio ( HR ) 1.29 ; 95 % confidence interval ( CI ) 1.05 - 1.57 ) and fathers occupational social class at birth ( HR 1.12 ; 95 % CI 0.97 - 1.29 ) ; the divergence beginning 6 - 9 months after diagnosis , and widening thereafter during home-administered therapy . The findings became more marked when analyses were restricted to those enrolled in UKALL XI ( n = 1341 ) . As expected , survival differences were also observed with sex , and age at diagnosis . CONCLUSION The existence of significant social disparities in ALL survival , which are not due to treatment accessibility , is of major clinical importance . Trends should be monitored and further research into potentially modifiable risk factors conducted Mothers of children with cancer experience significant distress associated with their children 's diagnosis and treatment . The efficacy of problem-solving skills training ( PSST ) , a cognitive-behavioral intervention based on problem-solving therapy , was assessed among 430 English- and Spanish-speaking mothers of recently diagnosed patients . Participants were r and omized to usual psychosocial care ( UPC ; n=213 ) or UPC plus 8 sessions of PSST ( PSST ; n=217 ) . Compared with UPC mothers , PSST mothers reported significantly enhanced problem-solving skills and significantly decreased negative affectivity . Although effects were largest immediately after PSST , several differences in problem-solving skills and distress levels persisted to the 3-month follow-up . In general , efficacy for Spanish-speaking mothers exceeded that for English-speaking mothers . Findings also suggest young , single mothers profit most from PSST OBJECTIVE To examine the relationship between  parental adjustment and family adjustment  during the period after the children 's diagnosis of cancer and the psychological adjustment of children 2 years after their diagnosis . METHOD The study used a prospect i ve design . Children aged 2 to 5 years with cancer and their parents and families ( n = 38 ) were assessed immediately after the children 's diagnosis and again 2 years after the diagnosis . Path analysis was used to investigate the relationship between  parental and family adjustment  during the period after diagnosis and the psychological adjustment of the children 2 years after their diagnosis . RESULTS Maternal adjustment during the period after the children 's cancer was diagnosed had a significant relationship with the children 's psychological adjustment 2 years after diagnosis . In contrast , the adjustment of fathers and family adjustment appeared to have a more limited impact on the later psychological adjustment of the children . CONCLUSION The level of distress experienced by mothers after the children 's diagnosis may have an important influence on the later psychological adjustment of the children . It is possible that this is due to the impact of maternal distress on the capacity of mothers to care for their children during the children 's treatment for cancer OBJECTIVE To pilot and test the feasibility of a novel technology to reduce anxiety and pain associated with an invasive medical procedure in children with cancer . METHOD Children with cancer ( ages 7 - 19 ) whose treatment protocol s required access of their subcutaneous venous port device ( port access ) were r and omly assigned to a virtual reality distraction intervention , a non-virtual reality distraction , or treatment as usual without a distraction . The research ers obtained assessment s of the child 's pain and anxiety from the parent , child , and unblinded nurses . Pulse rate was monitored throughout the procedure , and behavioral indices of distress were recorded , as observed by the research ers . RESULTS Reductions in pain and anxiety were found for children who used the virtual reality distraction in comparison with the no distraction condition as evidence d by lower pulse rate and reports of pain by nurses . No significant differences were found for the non-virtual reality condition versus the no distraction condition on pulse rate . CONCLUSIONS These findings suggest that virtual reality may be a useful tool for distraction during painful medical procedures , but further studies are needed to test potential efficacy and feasibility during other , more distressing medical procedures with larger sample sizes OBJECTIVE Considering coping as dynamic process within the family , effects of gender and diagnosis are investigated . Dissimilarity within couples in coping with childhood cancer is studied longitudinally in its effects on quality of life  of mothers , fathers , and the sick children . METHODS A total of 108 parents out of 54 complete families participated in a prospect i ve study . Twenty-five families had a child newly diagnosed with cancer , 29 families had a child newly diagnosed with juvenile diabetes or epilepsy .  The Coping Health Inventory for Parents , the Trier Coping Scales , and the Ulm Quality -of-Life Inventory for Parents were employed 1 - 2 weeks after diagnosis and again 10 - 12 weeks after diagnosis . RESULTS In face of childhood cancer , parents develop more rumination , defense , and information seeking , and less social support seeking strategies compared to the control group . Mothers report more frequent and more effective coping compared with fathers , but mothers and fathers do not differ in their self-reported quality of life . No convergence within couples could be demonstrated in most of the corresponding coping styles . The strongest correlation between mothers and fathers appeared in the religious coping style ( r=0.60 , p<0.001 ) . Coping dissimilarity within couples in social support seeking and religion is correlated with an improvement of parental quality of life . Parental dissimilarity in information seeking is correlated with a decrease in the child 's quality of life . CONCLUSION Coping dissimilarities between fathers and mothers have differential effects on the family members . For this reason , psychosocial interventions should support dis-synchrony when it appears adaptive , and they should help parents to overcome those differences that negatively affect their child OBJECTIVE To determine the feasibility and acceptability of an interdisciplinary intervention for mothers of children newly diagnosed with cancer and to estimate effect sizes for the intervention in reducing distress . Management of illness uncertainty was a key framework for the intervention . METHODS Mothers ( N = 52 ) were r and omly assigned to the intervention or a treatment as usual group , completing measures at baseline and follow-up time points . RESULTS Mothers ' satisfaction ratings were consistently high , and intervention implementation appeared feasible . Significant mean effects or trends in favor of the intervention group were found for pre-to-post change on measures of distress . Evidence of a preventative effect was also observed ; mothers in the intervention group tended to improve or remain stable in their adjustment , whereas many parents in the treatment as usual group showed worsening outcomes . CONCLUSIONS An interdisciplinary intervention targeting maternal illness uncertainty has clinical value within this sample This study evaluated the impact and financial costs of childhood cancer for Australian families by means of a nonr and omized retrospective cross-sectional survey at the oncology department of a large metropolitan pediatric hospital . The Family Impact Scale  ( a st and ardized question naire ) and the  self-reported economic burden  ( a question naire on expenses and lifestyle changes ) were utilized . Results of the family impact score were compared to a previously published cohort of children with insulin-dependent diabetes mellitus . The participants were 56 parents of children newly diagnosed with cancer in the year 2002 . In addition to the expected high social and emotional impacts , the majority of families reported suffering from great or moderate economic hardship . Factors predictive for families at risk included single parenthood , lower household income , and greater distance from the hospital . The results show that the distribution of re sources is not equitable and is currently failing to negate significant financial stresses for many Australian families OBJECTIVE To examine risk variables for future , more immediate , and persistent psychological distress of parents of pediatric cancer patients . METHOD Parents ( n = 128 ) completed question naires  at the time of diagnosis ( T1 ) and 12 months later ( T2 ) . Multiple regression analyses were performed using the following as predictors : demographics , illness-related variables , other life events , personality , coping styles , and social support . RESULTS Trait anxiety was the strongest predictor of both fathers ' and mothers '  future distress . Changes in trait anxiety during the year also accompanied changes in both parents ' levels of distress . Additional prospect i ve predictors for fathers were the coping style " social support-seeking " and dissatisfaction with support . Dissatisfaction with support also had short-term effects for fathers . An additional prospect i ve predictor for mothers was the number of pleasant events they had experienced prior to diagnosis , while a short-term effect was found for performance in assertiveness . No predictors for the persistence of distress were found . CONCLUSIONS These results underscore the importance of personality anxiety in predicting parents ' risk for adjustment difficulties associated with the experience of cancer in one 's child . An additional risk factor for fathers was social support . For mothers , previously experienced life events and the frequency of assertive behavior were additional risk factors A limited number of studies have examined relationships between temperament and children's/adolescents ' responses to painful procedures and have identified several different dimensions of temperament that are related to children 's pain response . The focus of these studies was one-time , acute pain experiences , such as immunization and postoperative pain . In this study , children and adolescents ' responses to a moderately painful procedure , lumbar puncture  , were examined as they related to temperament . Nineteen children and adolescents , ages 4 to 18 years , who were receiving treatment for cancer , were participants in this study . Parents completed one of three age-appropriate temperament question naires at the beginning of the study and prior to the parent and child learning cognitive-behavioral techniques . Behavior during the procedure was videotaped at baseline , and for up to four visits after baseline and coded using the  Observation Scale of Behavioral Distress ( OSBD ) . Pain reports were collected after the procedure using the Oucher pain self-report scale . Improvement in the level of behavioral distress was determined by examining the differences between pre- and post-treatment OSBD scores and self-reported pain ratings . There was a significant improvement in pain reports over the 5-month period , but behavioral distress did not change significantly . At the baseline visit , the temperament dimensions of more positive mood , lower activity , less persistence , and lower distractibility were related to higher pain reports , but not behavioral distress . However , after 5 months , only the dimension of positive mood was significantly correlated with improvement in pain reports . The amount of time parents and children practice d the techniques , their comfort with the techniques and their perceived effectiveness also were correlated with positive mood PURPOSE Diagnosis of cancer in a child can be extremely stressful for parents . Bright IDEAS , a problem-solving skills training ( PSST ) intervention , has been shown to decrease negative affectivity ( anxiety , depression , post-traumatic stress symptoms ) in mothers of newly diagnosed patients . This study was design ed to determine the specificity of PSST by examining its direct and indirect ( eg , social support ) effects compared with a nondirective support ( NDS ) intervention . PATIENTS AND METHODS This r and omized clinical trial included 309 English- or Spanish-speaking mothers of children diagnosed 2 to 16 weeks before recruitment . Participants completed assessment s prer and omization ( T1 ) , immediately postintervention ( T2 ) , and at 3-month follow-up ( T3 ) . Both PSST and NDS consisted of eight weekly 1-hour individual sessions . Outcomes included measures of problem-solving skill and negative affectivity . RESULTS There were no significant between-group differences at baseline ( T1 ) . Except for level of problem-solving skill , which was directly taught in the PSST arm , outcome measures improved equally in both groups immediately postintervention ( T2 ) . However , at the 3-month follow-up ( T3 ) , mothers in the PSST group continued to show significant improvements in mood , anxiety , and post-traumatic stress ; mothers in the NDS group showed no further significant gains . CONCLUSION PSST is an effective and specific intervention whose beneficial effects continue to grow after the intervention ends . In contrast , NDS is an effective intervention while it is being administered , but its benefits plateau when active support is removed . Therefore , teaching coping skills at diagnosis has the potential to facilitate family resilience over the entire course of treatment
Pediatric oncology psychosocial professionals collaborated with an interdisciplinary group of experts and stakeholders and developed evidence -based st and ards for pediatric psychosocial care .