OBJECTIVE: Pediatric cancer treatment is stressful for caregivers. Research has indicated that problem-solving coping reduces stress related to caregiving. The current study examines the effects of a problem-solving intervention (Parent Empowerment Program), based on Problem-Solving Therapy, for caregivers of children on active cancer treatment. It was hypothesized that participants who received the intervention would show decreases in caregiving stress and posttraumatic stress symptoms, and increases in problem-solving ability between baseline and post-test assessments compared to those who received an attention control. METHOD: Thirty-nine caregivers (all parents; 48% participation rate) participated. The majority were mothers (90%), married or partnered (59%) and Caucasian (56%). Participants were randomly assigned to condition (intervention vs. attention control) after completing baseline questionnaires. Participants who received the intervention received one session of problem solving intervention and a follow-up session. Those in the attention control condition received two general support sessions. Participants were assessed at baseline, one month after the second session, and three months after the second session. RESULTS: There were no effects of the intervention on any of the outcome variables when data for all participants was examined. However, there was a significant effect of the intervention on problem-solving ability among participants of children between 4-16 weeks post-diagnosis. CONCLUSIONS: There were many factors that contributed to the lack of effect, including small sample size, variations in time since diagnosis, low participation rates, and limited number of sessions. Future studies should target parents who are under the highest levels of stress and increase the intensity of sessions. However, the finding that the intervention has an effect on problem-solving ability early in the treatment trajectory replicates previous research and has potential clinical utility.

abstract: Over 25% of children in the United States suffer from a chronic illness, and close to 70% of all childhood deaths are due to chronic illness. Prevalence of childhood chronic illness continues to increase, and as a result, the pervasiveness of parents faced with stress associated with caregiving for their child with a chronic illness is also rising. The Stress Process Model (SPM) conceptualizes the caregiving experience as a multidimensional process influenced by the caregiving context, primary and secondary stressors, resources, and caregiver outcomes. Utilizing the SPM, the goals of this study were to examine the relations between caregiving stress (role overload and role strain) and resources (instrumental support, social support, and positive attitudes) and psychological outcomes (depression and anxiety) to determine whether resources moderated the associations between caregiving stress and psychological outcomes. Participants included 200 parent caregivers of a child with a chronic illness. Participants responded to an online survey that measured demographics, role overload (Role Overload scale), role strain (The Revised Caregiver Burden Measure), instrumental support and social support (Medical Outcomes Survey), positive attitudes about caregiving (Brief Assessment Scale for Caregivers), depression (Patient Health Questionnaire-9), and anxiety (Generalized Anxiety Disorder scale-7). Pearson correlations and six hierarchical regression models were tested to examine caregiving stress, resources, and psychological outcomes. Consistent with the study hypotheses, positive correlations between caregiving stress (role overload and role strain) and depression and anxiety were found. Negative correlations were found between resources (instrumental support, social support, positive attitudes) and depression and anxiety. Both instrumental support and social support had negative moderating effects on the relations between role overload and psychological outcomes (depression and anxiety). Positive attitudes also negatively moderated the relations between role strain and psychological outcomes. Thus, when participants reported high instrumental and social support, they also reported low depression and anxiety, even when role overload was high. Participants also reported low anxiety and depression when they reported high positive attitudes, even when role strain was high. Implications of these findings are discussed. / Dissertation/Thesis / Doctoral Dissertation Counseling Psychology 2020