PubMed · 9582150
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C M Parkes. 1998-05-16. Facing loss.. https://doi.org/10.1136/bmj.316.7143.1521
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BACKGROUND: Siblings of children with cancer have higher levels of psychological stress and adaptational difficulties compared to siblings of healthy children and children with other chronic illness. This is the first study to report on the mental health of Australian siblings of children with cancer and examines the effects of a therapeutic peer support camp-Camp Onwards, as an intervention. PROCEDURE: A protocol, designed to reduce levels of distress, improve social competence, and improve knowledge about the impact of cancer and its treatment was developed. Siblings (n=26) 8-13 years were assessed using standardised self-report measures pre and post intervention and at -8 weeks follow-up with: the Behaviour Assessment for Children (BASC) (Reynolds & Kamphaus, 1992), Self Perception Profile for Children (SPP-C) (Harter, 1985), Sibling Perception Questionnaire (SPQ) (Carpenter & Sahler, 1991). RESULTS: Change was measured using paired t tests. At pre-test, 40% of the sample demonstrated increased levels of emotional distress when compared to the normal population. Post intervention, siblings reported lower levels of distress demonstrated by decreased anxiety (P=0.01) and positive changes in the Self Report of Personality [BASC] (P=0.00). Improved social competence was noted in the interpersonal domain of the SPQ (P=0.01) and also greater social acceptance scores on the SPP-C (P=0.01). Improved knowledge about the impact of cancer and its treatment was evidenced by significant reductions in the fear of disease domain on the SPQ (P=0.01). CONCLUSIONS: Siblings who attended Camp Onwards demonstrated improved mental health outcomes that were sustained at follow-up, demonstrating its effectiveness as an intervention strategy in supporting sibling adjustment.
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BACKGROUND: Family caregivers for cancer patients experience high levels of stress and burden and diminished quality of life (QOL). Interventions to improve coping skills of caregivers have been shown to be effective with other populations, but their impact has not been assessed in the difficult context of hospice care. The purpose of this study was to determine whether hospice plus a coping skill training intervention improved family caregivers' QOL, burden, coping, and mastery, compared with hospice plus emotional support, and usual hospice care. METHODS: A three group randomized controlled trial was conducted including baseline, 16 day, and 30 day assessments conducted from March 1999 to May 2003. The sample consisted of 354 family caregivers of community dwelling hospice patients with advanced cancer. Patient/caregiver dyads were randomly divided into three groups, including a control group (n = 109) who received standard hospice care, a group (n = 109) who received standard hospice care plus three supportive visits, and a group (n = 111) who received standard care plus three visits to teach a coping skills intervention. Primary outcomes included caregiver QOL, caregiver burden due to patient symptoms, caregiver burden due to tasks, and caregiver mastery. RESULTS: At the 30-day follow-up, the coping skills intervention led to significantly greater improvement in caregiver QOL (estimate = -0.16, standard error [SE] = 0.07, P = 0.03), burden of patient symptoms (estimate = 0.28, SE = 0.07, P < 0.001), and caregiving task burden (estimate = -0.01, SE = 0.01, P = 0.038) than did the other two conditions. None of the groups showed significant change in overall caregiving mastery, caregiver mastery specific to caregiving tasks, problem-focused or emotion-focused coping. CONCLUSIONS: The coping skills intervention was effective in improving caregiver QOL, reducing burden related to patients' symptoms, and caregiving tasks compared with hospice care alone or hospice plus emotional support. Structured caregiver skill-training interventions for caregivers are promising even in the difficult environment of end-of-life care and for families already receiving benefits of hospice care.