(PS6-C60) A Pilot Randomized Controlled Trial of Cognitive Behavioral Problem-solving Skills Training for Parents of Children Undergoing Hematopoietic Stem Cell Transplantation

Introduction: Parents of children undergoing hematopoietic stem cell transplantation (HSCT) for serious medical illness experience increased psychological distress. They must manage prolonged hospitalizations, complex medical care, and disruptions to family routines, while facing extreme stressors such as possible death of their child. Evidence-based psychological interventions to support parent wellbeing in the pediatric HSCT setting are needed, yet few such resources exist. Bright IDEAS (BI) is a cognitive behavioral intervention focused on problem solving skills shown to effectively reduce distress in caregivers of children newly diagnosed with cancer, but has not yet been studied in the unique setting of HSCT. The objective of this pilot randomized controlled trial was to assess the feasibility and preliminary efficacy of BI to reduce caregiver distress among diverse parents of children undergoing HSCT.

Method: English and Spanish speaking parents of children (ages 0-21) admitted for HSCT at a large urban children’s hospital were eligible. Participants completed measures of depression (Beck Depression Inventory; BDI-II), anxiety (Beck Anxiety Inventory; BAI), and traumatic stress (Inventory of Events Scale-Revised; IES-R) at the time of their child’s HSCT (pre-intervention) and 60 days later (post-intervention). We randomly assigned participants to either BI or standard care control. BI entailed 6-8 individualized sessions of problem solving skills training that targeted participant-identified challenges and goals for wellbeing, including self-care needs, supporting and enjoying their child, and improving family communication. BI completion was defined as >6 sessions.

Results: Of 37 enrolled parents (BI N = 19; Control N = 18), 76% were English-speaking and 24% were Spanish-speaking. Parent-reported genders, ethnicities, and race were female (94%) and male (6%); non-Hispanic/Latino (35%) and Hispanic/Latino (52%); and white (40%), Asian (13%), and other (27%), respectively. Reason for HSCT included cancer (71%), red cell disorder (10%), immune deficiency (10%), metabolic disorder (3%), and other (6%). One BI participant withdrew before completing any sessions. Of the remining 18, 13 (72%) completed, 2 (11%) are still completing, and 3 (17%) did not complete. BI participants’ mean BDI-II score at baseline (M = 42.5, SD = 26.4) indicated extreme depression, and at Day 60 (M = 25.3, SD = 20.6) decreased to moderate depression (M change = -15.9, SD = 18.6). BI group BAI (M change = -3.5, SD = 6.6) and IES-R (M change = -6.9, SD = 16.7) change scores showed decreased anxiety and traumatic stress post-intervention. Control participants’ mean BDI-II score at baseline (M = 27.4, SD = 16.6) indicated moderate depression, and at Day 60 (M = 26.5, SD = 22.0) remained similar (M change = -0.5, SD = 21.9). Control BAI (M change = +0.7, SD = 6.9) and IES-R (M change = +0.3, SD = 14.1) change scores showed similar anxiety and traumatic stress levels over time.

Conclusion: Results suggest preliminary feasibility and efficacy of the BI intervention to reduce distress among parents of children undergoing HSCT. Future directions include expanded recruitment (including fathers) and rigorous comparison testing of longitudinal family outcomes.