Twelve-Month Follow-Up of a Randomized Controlled Trial of Internet-Based Guided Self-Help for Parents of Children on Cancer Treatment

Abstract

BackgroundA substantial proportion of parents of children on cancer treatment report psychological distress such as symptoms of post-traumatic stress (PTSS), depression, and anxiety. During their child’s treatment many parents also experience an economic burden.ObjectiveThe aim of this study was to evaluate the long-term efficacy of Internet-based guided self-help for parents of children on cancer treatment.MethodsThis study was a parallel randomized controlled trial comparing a 10-week Internet-based guided self-help program, including weekly support from a therapist via encrypted email, with a wait-list control condition. The intervention was based on cognitive behavior therapy (CBT) and focused on psychoeducation and skills to cope with difficult thoughts and feelings. Primary outcome was self-reported PTSS. Secondary outcomes were self-reported symptoms of depression, anxiety, health care consumption, and sick leave during the past month. Outcomes were assessed pre- and postintervention and at 12-month follow-up. Parents of children on cancer treatment were invited by health care personnel at pediatric oncology centers, and parents meeting the modified symptom criteria on the PCL-C were included in the study. Self-report assessments were provided on the Web.ResultsA total of 58 parents of children on cancer treatment (median months since diagnosis=3) were included in the study (intervention n=31 and control n=27). A total of 18 participants completed the intervention, and 16 participants in each group participated in the 12-month follow-up. Intention-to-treat analyses revealed significant effects in favor of the intervention on the primary outcome PTSS, with large between-group effect sizes at postassessment (d=0.89; 95% CI 0.35-1.43) and at 12-month follow-up (d=0.78; 95% CI 0.25-1.32). Significant effects in favor of the intervention on the secondary outcomes depression and anxiety were also observed. However, there was no evidence for intervention efficacy on health care consumption or sick leave.ConclusionsUsing the Internet to provide psychological interventions shows promise as an effective mode of delivery for parents reporting an increased level of PTSS and who consider Internet-based interventions as a viable option. Future research should corroborate these findings and also develop and evaluate interventions and policies that may help ameliorate the economic burden that parents may face during their child’s treatment for cancer.

Parents’ needs of support following the loss of a child to cancer: a Swedish, prospective, longitudinal, multi-centre study

“…Furthermore, as evaluated parental grief interventions have shown no or only modest effect [10,18], models of assessment and delivery of psychosocial support are important targets for future studies. Previous findings from our group suggest that online psychological support can be effective in reducing depression, anxiety, and PTSS among parents of children on cancer treatment who report an increased level of PTSS [24]. Moreover, an Australian study has shown promising results in terms of feasibility and acceptability for an online group-based psychological intervention for parents of survivors of childhood cancer [25].…”

Web-Based Measure of Life Events Using Computerized Life Events and Assessment Record (CLEAR): Preliminary Cross-Sectional Study of Reliability, Validity, and Association With Depression (Preprint)

“…The need for a new reliable and valid life stress measure of LEs that is less time-and cost-intensive than an interview but improves on checklists, is approached here through technological online advances, which are increasingly popular in researching psychological concepts and disorders [21][22][23]. The Computerised Life Events Assessment Record (CLEAR) is an online measure of LEs, including SLEs and Long-Term Problems (LTPs).…”

Development of an Internet-Administered Cognitive Behavior Therapy Program (ENGAGE) for Parents of Children Previously Treated for Cancer: Participatory Action Research Approach (Preprint)

“…Second, PRPs were introduced to the conceptualisation of distress experienced by parents of children previously treated for cancer, as informed by previous research conducted by our group [4,11,12, "Personal communication" by L Ljungman, 20171023].…”

“…As such, the development was informed by previous research [4,5,11,12, "Personal communication by L Ljungman, 20171023], PRPs' lived experience, and…”

“…One previous study has shown high acceptability and feasibility of an online, group-based, CBT intervention, delivered "live" by a psychologist, for parents following cancer treatment completion [10]. We have previously shown an online psychological self-help intervention to be effective in reducing PTSS, depression, and anxiety among parents of children recently diagnosed with cancer [11], with improvements maintained at one year follow-up [12].…”