Objective The diagnosis and treatment of cancer present children and adolescents with significant stress. However, research on the ways that children and adolescents cope with cancer-related stress has not yielded clear findings on the efficacy of different coping strategies, and has been limited by reliance primarily on self-reports of both coping and distress. To address this gap, the current study used a control-based model of coping to examine self- and parent reports of child/adolescent coping and symptoms of anxiety and depression in a sample of children with cancer. Method Children and adolescents (5 to 17 years old) and their parents were recruited near the time of a child’s diagnosis or relapse of cancer (M = 1.30 months postdiagnosis). Child self-reports (n = 153), mother reports (n = 297), and father reports (n = 161) of children’s coping and symptoms of anxiety/depression were obtained. Results Bivariate correlations revealed significant associations for secondary control coping (efforts to adapt to source of stress; e.g., acceptance, cognitive reappraisal) and disengagement coping (e.g., avoidance, denial) with anxiety/depression within and across informants. Linear multiple regression analyses indicated that secondary control coping accounted for unique variance in symptoms of anxiety/ depression both within and across informants. Conclusions Secondary control coping appears important for children and adolescents during early phases of treatment for cancer, and it may serve as an important target for future interventions to enhance adjustment in these children.

Objective Childhood cancer metrics are currently primarily focused on survival rates and late effects of therapy. Our objectives were to design and test a metric that reflected overall quality and safety performance, across all cancer types, of an oncology–bone marrow transplant service line and to use the metric to drive improvement. Method The Cancer Care Index (CCI) aggregates adverse safety events and missed opportunities for best practices into a composite score that reflects overall program performance without regard to cancer type or patient outcome. Fifteen domains were selected in 3 areas as follows: (1) treatment-related quality and safety, (2) provision of a harm-free environment, and (3) psychosocial support. The CCI is the aggregate number of adverse events or missed opportunities to provide quality care in a given time frame. A lower CCI reflects better care and improved overall system performance. Multidisciplinary microsystem-based teams addressed specific aims for each domain. The CCI was widely followed by all team members, particularly frontline providers. Results The CCI was easy to calculate and deploy and well accepted by the staff. The annual CCI progressively decreased from 278 in 2012 to 160 in 2014, a 42% reduction. Improvements in care were realized across most index domains. Multiple new initiatives were successfully implemented. Conclusions The CCI is a useful metric to document performance improvement across a broad range of domains, regardless of cancer type. By the use of quality improvement science, progressive reduction in CCI has occurred over a 3-year period.

The aim of this review was to critically evaluate the literature on anticipatory guidance and psychoeducation for youth with cancer and their caregivers. Twenty‐one publications were identified. Overall, psychoeducation efforts and interventions were well‐liked and accepted by patients and caregivers, improved patient and family knowledge about childhood cancer, and increased patient's health locus of control. A number of modalities are effective in giving families anticipatory guidance, provided the content and delivery are matched to the needs and preferences of individual patients and caregivers. Evidence supports a strong recommendation for psychoeducation for youth with cancer and their families. Pediatr Blood Cancer 2015; 9999:1–11 © 2015 Wiley Periodicals, Inc.

Fellows reported open beliefs about palliative care, but acknowledged weaknesses in their training and level of competence. The workshop showed efficacy in improving knowledge, but additional research is needed to evaluate larger educational initiatives and their long-term impact on clinical services and family satisfaction.

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Maternal primary control coping and depressive symptoms predict mothers' subsequent harsh and withdrawn communication about cancer.

Objective Meaning‐making may assist individuals in adaptation to stressful life events, particularly bereavement. However, few studies have examined meaning‐making among pediatric populations with advanced illness to understand how this process unfolds before the child's death. This study explores meaning‐making pre‐bereavement among children with advanced cancer and their parents. Methods As part of a larger study examining shared decision‐making near the end of life, 24 children with advanced cancer and/or high‐risk cancer, 26 mothers, and 11 fathers participated in individual, semi‐structured interviews. Analyses focused on questions regarding meaning‐making. Four coders analyzed the data via directed content analysis. Results Three major meaning‐making themes emerged: (1) sense‐making (i.e., unknown, no sense/meaning, religious/spiritual explanations, scientific explanations), (2) benefit‐finding, and (3) purpose/legacy. Some stated they were unable to make sense of the diagnosis, because there was no reason, they were not there yet, or they were dealing with the situation and moving forward. Others reported finding meaning through spiritual and scientific explanations. Many identified benefits related to the child's illness, such as personal growth and stronger relationships. Some parents expressed their purpose in life was to live for their children, while others shared their child's legacy as a way to find meaning. Conclusions Our findings highlight the struggle children and parents often face when attempting to make sense of the child's advanced or high‐risk illness. Clinicians might consider if meaning‐centered interventions designed for use in adults at the end of life and bereaved parents may be helpful for children with advanced or high‐risk cancer and their parents.