Enhancing Connections-Palliative Care: A Quasi-Experimental Pilot Feasibility Study of a Cancer Parenting Program

Abstract

Background: In 2018, >75,000 children were newly affected by the diagnosis of advanced cancer in a parent. Unfortunately, few programs exist to help parents and their children manage the impact of advanced disease together as a family. The Enhancing Connections-Palliative Care (EC-PC) parenting program was developed in response to this gap. Objective: (1) Assess the feasibility of the EC-PC parenting program (recruitment, enrollment, and retention);(2) test the short-term impact of the program on changes in parent and child outcomes; and (3) explore the relationship between parents' physical and psychological symptoms with program outcomes. Design: Quasi-experimental two-group design employing both within-and between-subjects analyses to examine change over time and change relative to historical controls. Parents participated in five telephonedelivered and fully manualized behavioral intervention sessions at two-week intervals, delivered by trained nurses. Behavioral assessments were obtained at baseline and at three months on parents' depressed mood, anxiety, parenting skills, parenting self-efficacy, and symptom distress as well as children's behavioralemotional adjustment (internalizing, externalizing, and anxiety/depression). Subjects: Parents diagnosed with advanced or metastatic cancer and receiving noncurative treatment were eligible for the trial provided they had one or more children aged 5-17 living at home, were able to read, write, and speak English, and were not enrolled in a hospice program. Results: Of those enrolled, 62% completed all intervention sessions and post-intervention assessments. Withingroup analyses showed significant improvements in parents' self-efficacy in helping their children manage pressures from the parent's cancer; parents' skills to elicit children's cancer-related concerns; and parents' skills to help their children cope with the cancer. Between-group analyses revealed comparable improvements with historical controls on parents' anxiety, depressed mood, self-efficacy, parenting skills, and children's behavioral-emotional adjustment. Conclusion:The EC-PC parenting program shows promise in significantly improving parents' skills and confidence in supporting their child about the cancer. Further testing of the program is warranted.

Parents With Advanced Cancer: Worries About Their Children’s Unspoken Concerns

“…Such interactions should be guided by the child’s view and experience, not by emphasizing the biology of the disease. 49,50 Child-focused programs have the potential to replace the parent’s fears and hesitancies with parental competencies and are represented by such programs as Enhancing Connections-Palliative Care 31 and programs offered by Wonders & Worries. 51 Future programs for parents need to be scalable and sustainable within palliative care and cancer survivorship programs, not tacked on as extra.…”

“…Each of the 5 sessions included brief didactic material that framed the session’s focus and then in-session skill-building exercises. 31…”

Upping my game as a parent: Attributed gains in participating in a cancer parenting program for child-rearing parents with advanced cancer

“…Data analyzed for the current study were limited to parents’ responses about their attributed gains in participating in a five-session, fully manualized telephone-delivered counseling program for parents with incurable cancer. The data collected are a subset of a larger study (Lewis et al, 2020).…”

“…The purpose of the current study is to describe parents’ attributed gains in participating in a fully manualized psycho-educational program whose goals were to add to the parent's interactional skills, competencies, and confidence in ongoing communication with their child about the parent's incurable cancer (Lewis et al, 2020).…”

The impact of cancer on the mental health of patients parenting minor children: A systematic review of quantitative evidence

“…While 33 articles focused directly on the parent's mental health situation, seven primarily focused on the children's situation while parental burden was a secondary outcome (e.g., for analyzing associations between parental burden and children's reaction). rehabilitation and after cancer treatment, 33,34 interventions for parents only [35][36][37] and a group intervention for both, affected parents and their children. 38 One study obtained data from a prospective cohort study conducted in the context of a cancer rehabilitation program.…”