Family psychosocial risk, distress, and service utilization in pediatric cancer

Abstract

BACKGROUND:The way families negotiate diagnosis and early treatment for pediatric cancer sets the stage for their adaptation throughout treatment and survivorship. The Psychosocial Assessment Tool (PAT) is a brief parent‐report screener capable of systematically identifying families at risk for problems of adaptation. The current study evaluated stability and predictive validity of PAT psychosocial risk classification with regard to distress, family functioning, and the use of psychosocial services over the first 4 months of treatment.METHODS:Caregivers of children with cancer completed the PAT and measures of distress and family functioning at diagnosis and again 4 months into treatment. At the second time point, social workers completed checklists of services provided and rated the intensity of their work with each family. Referrals to psychologists also were tracked.RESULTS:Psychosocial risk classification, based on the PAT, was stable across the first 4 months of cancer treatment; 57% to 69% of families remained at the same level of risk. PAT total scores did not differ across time, but subscale scores indicated increases in family and child (patient) problems and decreases in unhelpful beliefs. Families classified at higher levels of psychosocial risk at diagnosis had more distress, more family problems, and greater psychosocial service use 4 months into treatment.CONCLUSIONS:Understanding and identifying risks for psychosocial adjustment difficulties within families of children with cancer, considering changes across treatment and beyond, is very complex. Despite evidence of the predictive validity of PAT, additional research is necessary to find ways to effectively use this screener in practice to guide intervention. Cancer 2009;115(18 suppl):4339–49. © 2009 American Cancer Society.

Screening for Psychosocial Risk at Pediatric Cancer Diagnosis

“…However, future research is necessary to investigate the validity of screening at diagnosis, as opposed to at a later point and in outpatient settings, or repeated psychosocial screening over time. Given that psychosocial risks may change over the course of treatment, 16,17 the risks reported within the first days after diagnosis may not fully reflect psychosocial problems and/or service needs across time.…”

“…15,16 Cronbach's a for the total score is 0.83. Two week test-retest reliability is strong for mothers (r=0.78, P<0.001) and fathers (r=0.87, P<0.001).…”

“…In earlier research, the majority of families (65% to 75%) fall, as predicted, within the Universal level of risk, with 20% to 25% within the Targeted range and r10% in the Clinically distressed range. [13][14][15][16][17] Thus, PAT shows promise as a feasible, useful screener of psychosocial risk in pediatric cancer.…”

Quality of Life in Pediatric Cancer Survivors: Contributions of Parental Distress and Psychosocial Family Risk

“…Psychosocial family risk was assessed using the Psychosocial Assessment Tool (pat 2.0) 26,27 , which is a parentreport tool used to identify areas of psychosocial family risk following cancer diagnosis. The questionnaire consists of Likert ratings on 15 response sets that address the following subscales: family structure and resources, family social support, family problems, parent stress reactions, family beliefs, child problems, and sibling problems.…”

“…Higher scores on the pat 2.0 represent higher psychosocial risk (e.g., less support and more family problems). The pat 2.0 has high test re-test reliability and validity with an alpha level of 0.81 and test re-test reliability of 0.78 to 0.87 over a two-week period 26,27 . …”