Tailored approach to participant recruitment and retention to maximize health equity in pediatric cancer research.

BACKGROUND: Lack of diversity in participants throughout the research process limits the generalizability of findings and may contribute to health disparities. There are unique challenges to recruitment of families to pediatric cancer research studies, especially for those from disadvantaged backgrounds. Thus, there is a need to evaluate the most effective recruitment and retention strategies to optimize equitable recruitment of diverse participants. METHODS: The present study adapted and implemented methods outlined previously in the literature. These previous efforts were developed to address barriers to pediatric research, behavioral health intervention research and research with Black adolescents. Recruitment and retention strategies are described across four different time points: pre-approach, initial connection, building connection and follow-up. Eligible families of children with a pediatric cancer diagnosis were approached during a routine oncology visit. Once consented, enrollment and retention rates over three timepoints of data collection were recorded and evaluated. RESULTS: Results indicated high rates of enrollment (86%) and retention (95%) for eligible participants. There were no trends in heightened attrition for any specific subgroup. CONCLUSIONS: The findings of this study are promising and suggest these recruitment and retention strategies may be useful in recruiting individuals from disadvantaged backgrounds.

Caregiver perceptions of child heath behaviors and weight during treatment for acute lymphoblastic leukemia.

BACKGROUND: Changes in health behaviors and weight are common during the early phases of pediatric acute lymphoblastic leukemia treatment, and may negatively impact treatment tolerability. Given that ALL is most prevalent in children, caregivers play an essential role in shaping health behaviors during treatment. This study presents a qualitative analysis of semi-structured interviews with caregivers of youth in the early phases of ALL treatment. PROCEDURE: Caregivers (N = 17, 95% female) of a child (M age = 6.76 years) diagnosed with ALL and on treatment for less than 1 year (M = 8.7 months since diagnosis) completed a semi-structured interview about perceptions of their child's nutrition, physical activity, sedentary time, and weight during ALL treatment. Thematic analysis followed Braun and Clark's six-step framework (2006). Two coders established reliability (alpha = .88) and used a multi-pass coding system to extract themes. RESULTS: Caregivers' concerns around their child's weight during ALL treatment primarily centered around avoiding malnutrition. Weight gain during treatment was less of a concern and often viewed as protective. Caregivers reported encouraging their child to eat palatable, calorie-dense foods to mitigate risk for weight loss. Caregivers also expressed concern that children were less active and more sedentary due to treatment-related pain. Caregivers discussed health behaviors during treatment as being child-directed, rather than parent- or provider-directed. CONCLUSION: Future interventions may consider strategies to engage in joint parent-child decisions and caregiver education around risks of excessive weight gain during treatment. Interventions should include anticipatory guidance and aim to support parents in developing skills to support their child's health behaviors during treatment.

Risk and Resilient Functioning of Families of Children with Cancer during the COVID-19 Pandemic.

Previous literature highlights the impact of COVID-19 on family functioning. Less is known about the impact of the pandemic on families of pediatric cancer patients. In order to determine universal and unique risk and resilience factors of these families during the pandemic, a qualitative analysis was conducted on families currently receiving cancer treatment at a Midwestern hospital. Results of the data analysis depict ways in which these families have been impacted by and have adapted to COVID-19. These findings suggest that families of pediatric cancer patients have unique experiences in the context of COVID-19, in addition to universal experiences outlined in previous literature.

When is Psychotherapy Brief? Considering Sociodemographic Factors, Problem Complexity, and Problem Type in U.S. Adolescents.

Objective: When psychotherapy is brief (1-2 sessions), "early dropout" - defined as premature treatment discontinuation due to financial or structural barriers - is a commonly assumed cause. However, there are several possible reasons why treatment may be brief, including youth-level factors such as psychopathology complexity or problem type. Better characterizing whether factors beyond financial and structural barriers predict adolescents' receipt of briefer (versus longer-term) treatment may guide efforts to retain specific youth in longer-term services - and disseminate intentionally brief interventions to youth potentially positioned to benefit.Method: Using data from the 2017 SAMHSA National Survey on Drug Use and Health, we examined whether sociodemographic disadvantage (minority race, low-income, government assistance), perceived problem type, and psychopathology complexity (1 versus multiple problem types) related to psychotherapy length (1-2 versus 3-24+ sessions) among adolescents receiving outpatient psychotherapy (N = 1,601; ages 12-17; 60.59% white; 64.50% female).Results: Among adolescents beginning outpatient psychotherapy, 23.36% ended treatment after 1-2 sessions. Psychopathology complexity predicted greater likelihood of receiving >2 sessions, after adjusting for specific problem type (χ2 = 75.14, p < .001, OR = 1.80). Further, although certain problem types (e.g., depression, anxiety, and anger control) were associated with increased likelihood of greater treatment length, these findings did not hold after accounting for psychopathology complexity. No sociodemographic factors significantly predicted treatment length.Conclusions: Structural and financial barriers alone may not explain when and why youth psychotherapy is brief. Additional factors, such as psychopathology complexity, may be important and potentially primary contributors to treatment duration among youth who access outpatient services. Future research may examine whether youth with less comorbidity differentially benefit from intentionally brief interventions, along with strategies for retaining youth who might benefit from longer-term care - such as those with multiple co-occurring problems - in treatment.

The Use of Psychological First Aid in Children Exposed to Mass Trauma.

PURPOSE OF REVIEW: Psychological first aid (PFA) has been widely disseminated and promoted as an intervention to support short-term coping and long-term functioning after disasters. Despite its popularity, earlier reviews cite a startling lack of empirical outcome studies. The current review explores recent studies of PFA, especially pertaining to its use with children. RECENT FINDINGS: Initial studies of PFA show that it is well received by youth, families, and providers as well as being linked to decreases in depressive and posttraumatic stress symptoms, improved self-efficacy, increased knowledge about disaster preparedness and recovery, and enhanced feelings of safety and connection. The flexibility of the modular style of PFA and cultural adaptations emerged as significant themes. Although the studies reviewed cast a favorable light on PFA, more research is needed regarding its use and outcomes. This review describes the challenges to conducting these studies as well as suggestions for paths forward.