Colloque RI 2014 : Intervention de O.J. SAHLER, MD (Golisano Children’s Hospital, University of Rochester Medical Center)
Download as PPTX, PDF1 like1,264 views
The document discusses a problem-solving skills training program called Bright Ideas aimed at reducing emotional distress in mothers of children recently diagnosed with cancer. Research has shown the program's effectiveness in improving the psychological well-being of mothers by enhancing their problem-solving abilities and reducing anxiety and depression. A significant dissemination strategy includes providing online access to the training and conducting workshops to increase its adoption in child cancer centers across the U.S.
Colloque RI 2014 : Intervention de O.J. SAHLER, MD (Golisano Children’s Hospital, University of Rochester Medical Center)
- 1. REDUCING EMOTIONAL DISTRESS IN MOTHERS OF CHILDREN RECENTLY DIAGNOSED WITH CANCER O.J. Sahler, MD Professor of Pediatrics, Psychiatry, Medical Humanities, & Oncology Golisano Children’s Hospital University of Rochester Medical Center Rochester, NY USA 1
- 2. From Science to Clinical Practice: DEVELOPMENT, IMPLEMENTATION, AND DISSEMINATION OF THE BRIGHT IDEAS 2 PROBLEM-SOLVING SKILLS TRAINING PROGRAM
- 3. THE PRESENTER HAS NO 3 CONFLICT OF INTEREST TO DISCLOSE
- 4. 4 Key Points 1. Mothers of children newly diagnosed with cancer often have increased anxiety and depression 2. We have completed 3 RCTs proving the efficacy of the Bright IDEAS paradigm of problem-solving skills training in > 820 mothers 3. Adding skills building to a social support intervention continues to have positive effects 3 months after the intervention ends 4. Dissemination strategy: (a) train-the-trainer workshops to build capacity for using Bright IDEAS at child cancer centers throughout the US (b) an on-line version of Bright IDEAS for 24/7 availability
- 5. 1986 - 2014 Supported by the WT Grant Foundation and NCI/NIH Grants R25 CA65520, RO1 CA098954, and RO1 CA159013
- 6. Background 6 In the mid-1980’s, it was controversial if child cancer in the family was a traumatic or a growth experience for siblings We developed a 7-site survey study
- 7. 7 Conceptual Model: Childhood Cancer: Sibling Adaptation
- 8. Sibling Study Interviewed parents of 279 siblings 8 • 270 respondents = mothers • 9 respondents = fathers* • We have focused on mothers in studies published to date * Typical distribution of parental participation in open studies
- 9. RESULTS OF THE SIBLING STUDY
- 11. Mother’s Well-Being Using NHANES Comparison Data 11
- 12. Resource Utilization: 12 Mothers seeking help for themselves past year
- 13. Hypothesis 13 • Mothers of siblings who were less well adapted would be isolated and have access to few resources
- 14. Resource Utilization: 14 Mothers seeking help for themselves past year
- 15. Why? Hypotheses: 1. Mothers could not define the problem well enough to access appropriate resources 2. Mothers could not implement advice they received 15
- 16. 16 OUR SOLUTION Problem-Solving Skills Training • Based on Problem-Solving Therapy, which is effective in treating clinical depression, anxiety • Skills training is a psychological intervention that teaches management of life stresses to a non-clinical population
- 17. Problem-Solving Program Goals • Learn new ways to: - solve problems - resolve conflicts - make effective decisions • Control the controllable • Feel better during an extremely difficult time • Understand the thinking-feeling connection 17
- 18. The Bright IDEAS Model 18
- 19. The Model “Bright” = OPTIMISM Adopting a positive attitude toward solving problems 19
- 20. Step 1: Identify the Problem 20 • What is the problem? • Where is this a problem? • When does the problem occur? • Who does the problem involve? • Why does the problem occur? • How do you feel when the problem occurs?
- 21. Step 2: Define Options 21 • Define possible solutions • Brainstorm without judgment • Be creative • S- t- r- e- t- c- h yourself
- 22. Step 3: Evaluate Your Options 22 For each proposed solution, rate: • Likelihood of achieving • Time-effort commitment • Short- and long-term cost/benefits • Potential barriers Rank your solutions
- 23. Step 4: Act 23 • Decide on first choice • Create a specific detailed action plan • Envision the plan mentally & write it out • Then, do it!
- 24. Step 5: See If It Worked 24 • Assess if result was satisfactory • If not satisfied, analyze why • Modify the plan or try Plan B
- 25. 25
- 26. 26
- 27. 27
- 28. 28
- 29. 29
- 30. 30
- 31. 31
- 32. 32
- 33. Currently, Bright IDEAS Is Provided Face-to-Face Manualized training program 8 1-hour individual training sessions Participant identifies problems to solve Practice Homework 33
- 34. Conceptual Model 34 Crisis Intervention Primary Outcome Secondary Outcome Diagnosis of Cancer PSST Negative Affectivity (POMS/BDI/IES) Problem- Solving Skills (SPSI) Non-Specific Effect Specific Effect
- 35. PSST Study Methods 35 Eligibility Criteria - Mothers of children with newly diagnosed cancer 2-16 weeks after diagnosis - English, Spanish, Hebrew Language (2005 only) Procedures - Recruitment Time 1 Assessment Randomization PSST Training Intervention (8 1-hr sessions) - Time 2 Assessment (immediately post PSST or 3 mos. post T1) - Time 3 Assessment (3 mos. post T2) Assessments - SPSI-R; POMS, BDI-II, IES-R Sahler OJZ, et al. Problem-solving skills training for mothers of children with newly diagnosed cancer: A randomized trial. J Dev Behav Pediatr 2002; 23:77-86. PMID: 11943969 Sahler OJ, et al. Using problem-solving skills training to reduce negative affectivity in mothers of children with newly diagnosed cancer: Report of a multi-site randomized trial . JCCP, 2005;73:272283. Askins MA, et al. Report from a multi-institutional randomized clinical trial examining computer-assisted problem-solving skills training for English- and Spanish-speaking mothers of children with newly diagnosed cancer. JPP, 2009; 34(5):551-563. Sahler OJ, et al. Specificity of problem-solving skills training in mothers of children newly diagnosed with cancer: Results of a multi-site randomized clinical trial. J Clin Oncol; 2013; 31(10):1329- 35. Epub 2013 Jan 28.
- 36. Sequence of PSST Studies • Randomization Groups by Study 36 - 1995: Efficacy --- PSST vs. Usual Psychosocial Care (n = 92) - 2005: PSST vs. Usual Psychosocial Care (n = 430) - 2010: PSST vs. Reflective Listening (n = 301) - 2013: f 2 f vs. Online (n = 620; to date >125 enrolled)
- 37. 2005 Study (n = 430) Mothers gaining more benefit • Single • Young • Introverted • Spanish immigrant 37
- 38. 38 Differential Impact of PSST: English- vs. Spanish-Speaking Mothers
- 39. Relationships among Cultural Factors & Baseline Measures Lower acculturation correlated with: • Poorer problem solving Higher immigrant stress correlated with: • Depressive symptoms • Traumatic stress symptoms Sherman-Bien, et al. “A cross-cultural perspective of mothers of children with newly diagnosed cancer: Results of multi-institutional randomized trials of maternal problem-solving skills training”. International Society of Pediatric Oncology (SIOP), Boston, Massachusetts, October 21, 2010. 39
- 40. Conclusions about PSST and Spanish-speaking Mothers • Cultural factors predict both psychosocial 40 functioning and problem-solving skills at baseline • Interventions for specific cultural groups need to incorporate culturally sensitive approaches relevant to mothers’ unique experiences PSST can be effective for any cultural group
- 41. Take Away Point: Problem-Solving Skills Training is generic and culturally neutral but… the specific problems and solutions individuals focus on are culturally determined 41
- 42. Overall Study Conclusions 42 • PSST effectively teaches problem-solving skills to mothers of children with cancer • PSST reduces maternal depression and increases sense of competence • Differences between PSST and control groups diminish over time as control mothers improve confidence/competence
- 43. 43 Trajectory of Negative Affectivity
- 44. Next Step 44 • Replicate with time and attention control to measure the role of non-specific (social) support
- 45. Conceptual Model 45 Crisis Intervention Primary Outcome Secondary Outcome Diagnosis of Cancer PSST Negative Affectivity (POMS/BDI/IES) Problem- Solving Skills (SPSI) Non-Specific Effect Specific Effect
- 46. Time and Attention Control Condition (TACC) Non-Directive Support (Reflective Listening) 8 1-hour sessions Manualized Process and Content 1. Reflection 2. Focus on Feelings 3. Empathetic 4. Accept affective experiences 5. Supportive statements 46
- 47. Hypothesis Mothers receiving PSST would have: Problem-solving skills Negative affectivity 47
- 48. 2010 Study (n = 301) Results: PSST vs. TACC 1. No differences in subjects’ ratings --- both interventions seen as potentially useful 48 2. Problem-solving skills were significantly improved in PSST mothers 3. Both groups showed significant improvement in affectivity at T2 (immediately post intervention)
- 49. 49 But… 3 months after the intervention Mothers in the PSST Group continued to improve at a significantly greater rate than mothers in the TACC Group
- 50. 50 PSST LESS DISTRESS OVER TIME
- 51. If you give a man a fish, you feed him for a day If you teach a man to fish, you feed him for a lifetime 51
- 52. 52 In 2010, data from Bright IDEAS RCTs were independently analyzed: Research Integrity 4.4/5.0 Dissemination Capability 5.0/5.0 Intervention Impact 2.0/5.0
- 53. 53 was designated a Research-Tested Intervention Program (RTIP) by NCI
- 54. 54 Our impact score of 2.0 reflects the very low incidence (~12,000) of new child cancer diagnoses/yr Our dissemination capability score of 5.0 reflects comprehensive product development
- 55. In reality: Bright IDEAS is a generic approach to problem solving that can be used • by anyone • at any time • under any circumstance • for any problem 55
- 56. The Challenge: …Disseminate! …Disseminate! 56 …Disseminate!
- 57. The Problem: 57 The intervention is labor intensive and requires trained personnel
- 58. The Solutions: 58 #1: Build capacity: Train 200 psychologists, nurses, and social workers to increase the number of skilled providers #2: Increase accessibility: Put Bright IDEAS online (PC and App)
- 59. The Question: Will ePSST be as effective as f2f PSST? 59
- 60. 60 OR… If you give a man a rod and reel and an instruction book, will he learn to fish as well by himself as he would if you were standing next to him coaching him?
- 61. Thank you to my many colleagues • Martha A. Askins, PhD UT/MD Anderson Cancer Center • Oscar A. Barbarin, PhD University of Michigan • Robert W. Butler, PhD Oregon Health Sciences Center • Donna R. Copeland, PhD UT/MD Anderson Cancer Center • Katie A. Devine, PhD Rutgers University • Michael J. Dolgin, PhD Ariel University (Israel) • Diane L. Fairclough, DrPH University of Colorado Denver • Ernest R. Katz, PhD Children’s Hospital, Los Angeles • Raymond K. Mulhern, PhD St. Jude Children’s Research Hospital • Robert B. Noll, PhD Children’s Hospital of Pittsburgh • Sean Phipps, PhD St. Jude Children’s Research Hospital • Klaus J. Roghmann, PhD University of Rochester • Janice R. Sargent, PhD University of Utah • Sandra Sherman-Bien, PhD Miller Children’s Hospital • James W. Varni, PhD University of California San Diego • Lonnie K. Zeltzer, MD University of California Los Angeles • 61
- 62. 62
Editor's Notes
- #13: We expected that mothers of children with cancer would access more resources than mothers in the general population
- #15: We expected that mothers of children with cancer would access more resources than mothers in the general population
- #16: From this we concluded that they probably accessed the wrong resources because they either could not define the problem for which they were seeking help accurately enough to tap the best resource or they could not implement the advice they did receive that would have been helpful to them.
- #35: The general model which we used to guide our study is shown in this schematic. The stressor or crisis in the study which we are now just completing was the diagnosis of cancer in a child. The intervention which we provided was problem-solving training. Our primary outcome was to be an increase in problem-solving skills. Our secondary outcome was a decrease in negative affectivity defined as anxiety, depression, and anger.
- #46: The general model which we used to guide our study is shown in this schematic. The stressor or crisis in the study which we are now just completing was the diagnosis of cancer in a child. The intervention which we provided was problem-solving training. Our primary outcome was to be an increase in problem-solving skills. Our secondary outcome was a decrease in negative affectivity defined as anxiety, depression, and anger.
- #51: T3 (3 months after the end of treatment) you begin to get significant splits between PSST and non-directive supportive therapy on distress measures T2 (end of treatment) PSST and supportive non-directive care are equal (distress measures) but not on the problem solving skills measures