A multi-site clinical trial including the University of Colorado Cancer Center shows that the benefit of Bright IDEAS problem-solving skills training goes beyond teaching parents to navigate the complex medical, educational, and other systems that accompany a child's diagnosis of cancer – the training also leads to durable reduction in mothers' levels of anxiety and symptoms of posttraumatic stress, and improves overall coping with a child's illness. Results of the study were published online last week in the Journal of Clinical Oncology.
"Earlier research shows that a mom is the keystone of a family. After a child's cancer diagnosis, if mom is stressed and not coping, you see the effects on the marriage and on siblings as well," says Diane Fairclough, DrPH, MSPH, CU Cancer Center investigator and director of the Analytics Core at the Colorado Health Outcomes Center.
Support the mother and you support the family, including the ill child.
A previous clinical trial had shown the effectiveness of the Bright IDEAS problem-solving skills training, and the current study hoped to disentangle the benefits of the training from the simple, potentially powerful effect of a mother's interaction with a compassionate listener. Was it Bright IDEAS specifically or the byproducts of compassion and understanding once a week for eight weeks that led to mothers' gains?
The results of this multi-site, 309-mother study are interesting: immediately after Bright IDEAS training, mothers showed the same gains as with another intervention called nondirective support, which is effectively compassionate listening. But three months later, the gains from Bright IDEAS remained, while the gains from an understanding ear evaporated. In fact, at the three-month mark, the benefits from problem-solving skills training were growing – not only were mothers more adept problem-solvers, but this increased ability transferred to ever-more gains in mood, decreased anxiety and fewer symptoms of posttraumatic stress.
You know the phrase, If you give a man a fish you feed him for a day, but if you teach a man to fish, you feed him for a lifetime. In this study, it was as if Bright IDEAS taught mothers to fish – not only helping mothers, but helping mothers learn to help themselves.
"I've been a cancer patient myself," Fairclough says, "and I think the most stressing thing is that there's a sense that the disease has taken over your life. It defines your schedule, your family vacations, you can't change employers because of insurance concerns. I think problem-solving skills training helps mothers pull back some control after their child's diagnosis. It makes things seem manageable and gives parents a sense they're not just helpless observers."
The group also includes members from the University of Rochester, M.D. Anderson Cancer Center, University of Texas El Paso, Miller Children's Hospital Long Beach, Children's Hospital Los Angeles, Children's Hospital of Pittsburgh, and St. Jude Children's Research Hospital. To date, the training has required eight weekly individual meetings between a mother and her trainer. This approach, while successful, is resource intensive. This past summer, the research group received funding from the National Cancer Institute to develop a web-based version to make Bright IDEAS available anytime, wherever a parent or other caregiver has access to the Internet.
For more information and free downloads of the 8-session training, including instruction manuals, workbooks and worksheets in English and Spanish, visit the Research-Tested Intervention Programs page hosted by the National Cancer Institute or contact O.J. Sahler, MD, the Principal Investigator of the project, at OJ_Sahler@urmc.rochester.edu.
Journal of Clinical Oncology