A skills-based training program for parents of children with diagnoses of lymphoma, leukemia, or CNS tumors was more beneficial when delivered in a 1-on-1 setting. The findings from this study were published in JAMA Open Network.
Although the negative impact of parental stress related to the diagnosis of cancer in a child or adolescent is well recognized, few interventions have been specifically designed to help parents of children with cancer cope with this stress.
The Promoting Resilience In Stress Management-Parents (PRISM-P) trial (ClinicalTrials.gov Identifier: NCT02998086) is a phase 2 clinical trial in which parents of children with a new diagnosis of cancer were randomly assigned in a 1:1:1 ratio to receive training in resilience skills delivered in a 1-to-1 setting or in a group setting, both in conjunction with usual psychosocial care, or usual psychosocial care alone.
Resilience resources provided by a single doctoral-level psychologist as part of the PRISM-P study focused on the development of skills related to stress management, goal-setting, cognitive retraining, and benefit finding. Study participants in the 1-on-1 arm attended 4 separate sessions, occurring approximately every other week and corresponding to each of the 4 resources. In contrast, all 4 resources were covered in a single session with those parents assigned to the group session arm.
The primary end point of the study was parent-reported resilience, with parent-reported stress, psychological distress, social support, quality of life, and benefit finding as secondary study end points. These domains were assessed at baseline and 3 months through completion of specific validated survey measures by study participants.
Study inclusion criteria included adult, English-speaking parent or legal guardian of a child or adolescent aged 2 to 24 years with a diagnosis of a new cancer 1 to 10 weeks prior to study enrollment and receiving treatment at Seattle Children’s Hospital in Seattle, Washington.
The 1-to-1, group, and usual care alone arms included 36, 35, and 36 parent, respectively. Lymphoma/leukemia was the most common diagnosis for the children of study participants, followed by CNS tumors, and other solid-tumor cancers. The majority of study participants were married white women with at least some college education.
Study survey measures were completed at 3 months by 26, 22, and 29 of the parents in the 1-to-1 setting, group setting, and usual psychosocial care alone arms, respectively.
An intention-to-treat analysis of self-reported assessments showed significant improvement in resilience (P =.04) and benefit finding (P =.001) for parents receiving 1-on-1 resilience training compared with those receiving usual psychosocial care alone. However, no significant differences were observed in other study outcomes in comparisons between these 2 groups. Furthermore, no significant improvement for any study outcome was observed in the group setting arm compared with the usual psychosocial care alone arm.
Regarding the latter finding, the researchers speculated that pressure to share personal experiences in a group setting, the variability in scheduling needed to accommodate study participants, and the small median number of participants per group (n=2) may have been contributing factors.
One overall study limitation was the absence of a corresponding assessment of the children of the study participants, noted the researchers.
The study authors concluded that “these findings underscore a critical goal in caregiver support: PRISM-P may help parents feel more resilient, which in turn may facilitate their continued ability to care for their child.”
Rosenberg AR, Bradford MC, Junkins CC, et al. Effect of the Promoting Resilience In Stress Management intervention for parents of children with cancer (PRISM-P): a randomized clinical trial. JAMA Netw Open. 2019;2(9):e1911578.