Research and experience document that caregivers, especially, mothers of children with cancer encounter extraordinary stresses during the child's illness. These stresses are particularly severe during diagnosis and induction therapy and can interfere significantly with caregivers' ability to make reasoned and timely decisions on their children's behalf. With increasing survivor rates, it has become evident that decisions made in the early stages of cancer management can have profound, long-term effects, adding to the distress caregivers feel trying to make the """"""""right"""""""" decisions. To help mothers of newly diagnosed children cope more effectively with these challenges, we conducted two randomized trials as part of our previous work (R25-CA65520) to develop, field test, and evaluate the efficacy of problem-solving skills training (PSST), a cognitive behavioral therapy shown to decrease anxiety and depression --- two symptoms of post-traumatic stress commonly experienced among this group of mothers. We also pilot tested a multimedia, technology-based PSST enhancement, Carmen's Bright IDEAS. Our findings clearly show that PSST significantly increases problem-solving skills (primary effect) and decreases negative affectivity (secondary effect) in mothers from a variety of racial, ethnic, and socioeconomic backgrounds. Particularly powerful and long-lasting effects were noted in Spanish-speaking mothers, an especially underserved population. At this stage, it is essential that we investigate PSST as rigorously as possible by testing its clinical effectiveness against an active control and that we intensify the intervention to extend its duration of action among all users. These goals are the basis for the 4-5 aims of the proposed project.
Aim 1 """""""" To develop a time-and-attention control condition to better assess the direct and mediational effects of PSST independent of social support (placebo).
Aim 2 : To develop a personal digital assistant hand-held supplement to standard PSST to provide real-time training, reinforcement, and on-the-spot documentation of PSST usage.
Aim 3 A, B: To develop independent measures of the application of problem-solving strategies in everyday life.
Aim 4 : To measure utilization of and satisfaction with other resources accessed by mothers as independent indicators of the usefulness and cost-effectiveness of PSST.
(Aim 5) To incorporate a maintenance phase into the PSST protocol to promote longer term change.
