Ethical challenges faced by healthcare workers in pediatric oncology care during the COVID-19 pandemic in Australia.

OBJECTIVE: This qualitative study examined ethical challenges reported by healthcare professionals (HCPs) working in a large Australian pediatric oncology center during a period of strict COVID-19 restrictions. METHODS: We conducted semi-structured interviews with 21 HCPs who provided pediatric cancer care during the pandemic in 2020, during strict lockdown periods. Interviews examined the difficulties they faced, as well as their own ethical evaluation of the impact of COVID-19 policies on oncology care. Data were analyzed using inductive content analysis and thematic analysis. RESULTS: HCPs faced several challenges, primarily originating from hospital restrictions, which led to changes in usual clinical practices. These challenges included delivering care with personal protective equipment (PPE), the impact of a one-parent visitation policy, changes in psychosocial and allied health services, and COVID-19 swabbing policies. Overall, there was consensus from participants that hospital restrictions were justified and, while difficult, HCPs simply had to provide the best care possible given the circumstances. However, participants described decreased capacity to deliver holistic patient care and, in some instances, a tendency to avoid ethical reflection. Lastly, there was a consistent theme of shame and sense of responsibility underlying some participants' anxiety around inadvertently transmitting COVID-19 to immunocompromised patients. CONCLUSION: Our findings show that many staff felt unease at the disruptions in patient care due to COVID-19 restrictions. Some HCPs indicated a degree of moral distress, with a possibility of moral injury among some HCPs. A focus on ethical recovery could assist in preventing any ongoing difficulties among HCPs because of their experiences.

Online parent-targeted cognitive-behavioural therapy intervention to improve quality of life in families of young cancer survivors: study protocol for a randomised controlled trial.

BACKGROUND: Due to advances in multimodal therapies, most children survive cancer. In addition to the stresses of diagnosis and treatment, many families are now navigating the challenges of survivorship. Without sufficient support, the ongoing distress that parents experience after their child's cancer treatment can negatively impact the quality of life and psychological wellbeing of all family members. METHODS/DESIGN: The 'Cascade' (Cope, Adapt, Survive: Life after C AncEr) study is a three-arm randomised controlled trial to evaluate the feasibility and efficacy of a new intervention to improve the quality of life of parents of young cancer survivors. Cascade will be compared to a peer-support group control and a 6-month waitlist control. Parents (n = 120) whose child (under 16 years of age) has completed cancer treatment in the past 1 to 12 months will be recruited from hospitals across Australia. Those randomised to receive Cascade will participate in four, weekly, 90-minute online group sessions led live by a psychologist. Cascade involves peer discussion on cognitive-behavioural coping skills, including behavioural activation, thought challenging, mindfulness and acceptance, communication and assertiveness skills training, problem-solving and goal-setting. Participants randomised to peer support will receive four, weekly, 90-minute, live, sessions of non-directive peer support. Participants will complete measures at baseline, directly post-intervention, one month post-intervention, and 6 months post-intervention. The primary outcome will be parents' quality of life. Secondary outcomes include parent depression, anxiety, parenting self-agency, and the quality of life of children in the family. The child cancer survivor and all siblings aged 7 to 15 years will be invited to complete self-report quality of life measures covering physical, emotional, social and school-related domains. DISCUSSION: This article reviews the empirical rationale for group-based, online cognitive-behavioural therapy in parents of children who have recently finished cancer treatment. The potential challenges of delivering skills-based programs online are highlighted. Cascade's videoconferencing technology has the potential to address the geographic and psychological isolation of families after cancer treatment. Teaching parents coping skills as they resume their normal lives after their child's cancer may see long-term benefits for the quality of life of the family as a whole. TRIAL REGISTRATION: ACTRN12613000270718 (registered 6 March 2013).

Adapting acceptance and commitment therapy for parents of children with life-threatening illness: pilot study.

We piloted a novel parent-targeted intervention, Take A Breath (TAB), for parents of children diagnosed with a life-threatening illness (LTI) with the aim of reducing parental distress. Parents were assisted to adapt to their child's diagnosis, treatment, and recovery via TAB's combined acceptance and commitment therapy (ACT) and problem-solving skills training (PSST) approach. Participants were 11 parents of children with a diagnosis of cancer, or who had life-saving cardiac surgery at least 4 months prior. Parents completed questionnaires at pre, post, and 6-month follow-up assessing parent posttraumatic stress symptoms (PTSS), the emotional impact of the child's LTI (e.g., feelings of uncertainty, guilt and sorrow, emotional resources), and psychological elements targeted by the intervention (parental psychological flexibility and mindfulness). Parents reported significant reductions in PTSS and emotional impact from their child's LTI, along with significant improvements in parental psychological flexibility and mindfulness. Effect sizes were medium to large, and improvements were maintained at 6-month follow-up. Our pilot indicates the TAB intervention has promise for preventing or reducing parental distress associated with child LTI and warrants more rigorous evaluation. Although preliminary, these findings suggest that targeting parents' subjective perceptions of their child's LTI may be an effective approach to reducing parental distress. Our results also indicate the potential for such an approach to be adopted across diverse child diagnoses in the acute pediatric setting. Further, our findings provide early indications that ACT combined with PSST is an appropriate therapeutic approach within this context.