Psychometric Evaluation of the Brief RCOPE and Relationships with Psychological Functioning among Caregivers of Children Undergoing Hematopoietic Stem Cell Transplant.

2021

2021 Apr 16

1099-1611

<p><strong>OBJECTIVE: </strong>Spiritual and religious (S/R) coping is a relevant yet understudied domain of coping among caregivers of children undergoing hematopoietic stem cell transplantation (HCT). The aims of this manuscript are to: 1) conduct the first psychometric evaluation of the Brief RCOPE in this population; 2) examine levels of and changes in S/R coping over time; and 3) explore the relationship between S/R coping trajectories and psychological functioning post-HCT.</p>

<p><strong>METHODS: </strong>Caregivers (n=170) of children (ages ≤12 years, n=170) undergoing HCT completed the Brief RCOPE and the Brief Symptom Inventory (BSI) pre- and at multiple time points post-HCT discharge. Factor structure, internal consistency, and validity were examined. Growth mixture models were used to identify subgroups with similar S/R coping trajectories, with group memberships added to mixture models to explore relationships between group membership and caregiver psychological functioning trajectories.</p>

<p><strong>RESULTS: </strong>The Brief RCOPE exhibited the previously-supported two factor structure and each subscale demonstrated strong internal consistency (α=.85 and .92). Validity was supported by significant correlations with BSI scores. There were distinct subgroups of caregivers with different patterns of positive (n=4 subgroups) and negative (n=3 subgroups) S/R coping, with negative coping subgroup membership predicting changes in psychological functioning.</p>

<p><strong>CONCLUSIONS: </strong>The Brief RCOPE is a promising measure for assessing S/R coping among caregivers of children undergoing HCT and has the potential to identify caregivers at risk for poorer long-term psychological functioning. This article is protected by copyright. All rights reserved.</p>

10.1002/pon.5705

Psychooncology

33864325

Adherence to Multiple Treatment Recommendations in Adolescents and Young Adults with Cancer: A Mixed Methods, Multi-Informant Investigation.

2020

2020 May 11

2156-535X

<p>This mixed methods study sought to assess adolescent and young adult (AYA) adherence to three cancer treatment recommendations (medications, diet, physical activity), and determine the individual, family, and health system factors associated with suboptimal adherence. In Stage 1, 72 AYA-caregiver dyads completed a validated adherence interview and surveys about individual and family functioning. Matched providers ( = 34 who reported on 61 AYAs) completed global adherence ratings through survey. In Stage 2, a subset ( = 31) completed qualitative interviews. Medication adherence was higher ( = 94.8%) than diet ( = 73.9%) and physical activity ( = 55.4%), although ≥50% demonstrated "Imperfect Adherence" for each subtask. Univariately, AYAs who missed a medication had more depressive symptoms, worse health-related quality of life (HRQOL), and more medication barriers; their families had more financial stress, worse family functioning, and lower self-efficacy. The odds of adhering to medications were lower with worse HRQOL (odds ratio [OR] = 1.08; 95% confidence interval [CI], 1.02-1.15) and family functioning (OR = 0.18; 95% CI, 0.04-0.91). The odds of adhering to physical activity and diet were lower with worse family functioning (OR = 0.09; 95% CI, 0.01-0.91) and more barriers (OR = 0.24, CI: 0.10-0.61), respectively. Qualitative themes further supported multilevel influences on AYA adherence. Adherence challenges were identified across medications, diet, and physical activity. Multilevel contextual factors were associated with suboptimal adherence, including poorer HRQOL and family functioning. Findings support the need to improve clinical adherence assessment and develop contextually tailored interventions.</p>

10.1089/jayao.2020.0013

J Adolesc Young Adult Oncol

32392434

Parental Efficacy and Control Questionnaire in Hematopoietic Stem Cell Transplant: Preliminary Validation.

2020

2020 Mar 27

1460-2105

<p><strong>OBJECTIVE&nbsp;: </strong>Develop and evaluate the preliminary validity of a self-report measure of parents' treatment-related efficacy and control, Parental Efficacy and Control Questionnaire-Hematopoietic Stem Cell Transplant (PECQ-HCT), in a pediatric HCT sample.</p>

<p><strong>METHODS&nbsp;: </strong>Participants included 185 parents of children (≤12 years old) receiving HCT participating in a larger, longitudinal study. Parents completed the PECQ-HCT as well as measures of social problem-solving skills, collective family efficacy, family beliefs, and parental distress.</p>

<p><strong>RESULTS&nbsp;: </strong>Exploratory factor analysis results indicated that a 37-item four-factor model was the best fitting and most theoretically sound, χ2(df = 1,596) = 14,089.95, p &lt; .01, comparative fit index = 0.92, Tucker-Lewis Index = 0.90, and root mean square error of approximation = 0.07. Preliminary subscale scores demonstrated adequate internal consistency as well as good content and criterion-related validity.</p>

<p><strong>CONCLUSIONS&nbsp;: </strong>If replicated using a confirmatory factor analysis in a separate sample, these findings suggest that the four-factor PECQ-HCT measure may be useful for measuring HCT-related parental efficacy and perceived control.</p>

10.1093/jpepsy/jsaa010

J. Natl. Cancer Inst.

32219411

Association between day of the week and medication adherence among adolescent and young adult kidney transplant recipients.

2019

2019 Sep 10

1600-6143

<p>Disruption of usual routines may hinder adherence, increasing the risk of rejection. We aimed to compare weekend versus weekday medication adherence among adolescent and young adult kidney transplant recipients, hypothesizing poorer adherence on weekends. We examined data from the Teen Adherence in Kidney transplant Effectiveness of Intervention Trial (TAKE-IT). We assessed the 3-month run-in period (no intervention) and the 12-month intervention interval, considering a potential interaction between weekend/weekday and treatment group. Adherence was monitored using electronic pillboxes in participants 11-24 years followed in 8 transplant centers in Canada and the United States. We used logistic regression with generalized estimating equations to estimate the association between weekends/weekdays and each of perfect taking (100% of prescribed doses taken) and timing (100% of prescribed doses taken on time) adherence. Taking (OR=0.72 (95%CI 0.65-0.79)) and timing (OR=0.66 (95%CI 0.59-0.74)) adherence were poorer on weekends than weekdays in the run-in (136 participants), and the intervention interval (taking OR=0.74 (0.67-0.81) and timing OR=0.71 (95%CI 0.65-0.77)). There was no interaction by treatment group (64 intervention and 74 control participants). Weekends represent a disruption of regular routines, posing a threat to adherence. Patients and families should be encouraged to develop strategies to maintain adherence when routines are disrupted.</p>

10.1111/ajt.15590

Am. J. Transplant.

31507087

A Randomized Trial of a Multicomponent Intervention to Promote Medication Adherence: The Teen Adherence in Kidney Transplant Effectiveness of Intervention Trial (TAKE-IT).

2018

2018 Mar 15

1523-6838

<p><strong>BACKGROUND: </strong>Poor adherence to immunosuppressive medications is a major cause of premature graft loss among children and young adults. Multicomponent interventions have shown promise but have not been fully evaluated.</p>

<p><strong>STUDY DESIGN: </strong>Unblinded parallel-arm randomized trial to assess the efficacy of a clinic-based adherence-promoting intervention.</p>

<p><strong>SETTING &amp; PARTICIPANTS: </strong>Prevalent kidney transplant recipients 11 to 24 years of age and 3 or more months posttransplantation at 8 kidney transplantation centers in Canada and the United States (February 2012 to May 2016) were included.</p>

<p><strong>INTERVENTION: </strong>Adherence was electronically monitored in all participants during a 3-month run-in, followed by a 12-month intervention. Participants assigned to the TAKE-IT intervention could choose to receive text message, e-mail, and/or visual cue dose reminders and met with a coach at 3-month intervals when adherence data from the prior 3 months were reviewed with the participant. "Action-Focused Problem Solving" was used to address adherence barriers selected as important by the participant. Participants assigned to the control group met with coaches at 3-month intervals but received no feedback about adherence data.</p>

<p><strong>OUTCOMES: </strong>The primary outcomes were electronically measured "taking" adherence (the proportion of prescribed doses of immunosuppressive medications taken) and "timing" adherence (the proportion of doses of immunosuppressive medications taken between 1 hour before and 2 hours after the prescribed time of administration) on each day of observation. Secondary outcomes included the standard deviation of tacrolimus trough concentrations, self-reported adherence, acute rejection, and graft failure.</p>

<p><strong>RESULTS: </strong>81 patients were assigned to intervention (median age, 15.5 years; 57% male) and 88 to the control group (median age, 15.8 years; 61% male). Electronic adherence data were available for 64 intervention and 74 control participants. Participants in the intervention group had significantly greater odds of taking prescribed medications (OR, 1.66; 95% CI, 1.15-2.39) and taking medications at or near the prescribed time (OR, 1.74; 95% CI, 1.21-2.50) than controls.</p>

<p><strong>LIMITATIONS: </strong>Lack of electronic adherence data for some participants may have introduced bias. There was low statistical power for clinical outcomes.</p>

<p><strong>CONCLUSIONS: </strong>The multicomponent TAKE-IT intervention resulted in significantly better medication adherence than the control condition. Better medication adherence may result in improved graft outcomes, but this will need to be demonstrated in larger studies.</p>

<p><strong>TRIAL REGISTRATION: </strong>Registered at ClinicalTrials.gov with study number NCT01356277.</p>

10.1053/j.ajkd.2017.12.012

29602631