The primary objectives of this project are: (1) to develop and empirically refine a Problem-Solving Skills Training (PSST) curriculum to teach mothers of children with cancer problem-solving strategies to reduce their emotional/ behavioral distress; and (2) to conduct a multi-institutional pilot study to investigate the clinical benefits of PSST and provide the basis for designing and conducting a larger, randomized clinical trial. Research on children with cancer and our own collaborative study of 254 siblings of such children have shown that (a) both patients and siblings have increased psychosocial distress compared to the general population, (b) their mothers have a lower sense of well- being (more negative affectivity) compared to matched controls, and (c) mothers of dysfunctional children use more resources, but are less satisfied with them than mothers of resilient children. Because PSST has been shown to decrease negative affectivity, we predict such instruction will decrease maternal depression, anxiety, and anger and increase maternal ability to gather and process information and, thus, access appropriate resources. Also, given that many studies have shown that maternal well-being influences child adjustment, we believe intervening specifically with mothers has high potential as an efficient way to enhance family functioning. The curriculum package will consist of: (1) an implementation manual patterned after widely used instruments of proven efficacy in delivering such training; (2) an item content inventory of relevant issues to guide self-selection of practice exercises (adult learner-centered model of instruction); (3) written supplements to reinforce training exercises; (4) a problem-solving index (skill inventory) to assess durable changes in problem- solving ability; (5) a satisfaction survey to measure perceived usefulness of the curriculum; and (6) an orientation module for health professionals providing training to the mothers. The instruction will be comprised of 6 to 8, 1-1 1/2 hour individual sessions addressing the 5 basic strategies of problem-solving: (1) problem orientation, (2) problem identification, (3) generation of alternative solutions, (4) decision-making, and (5) solution implementation and verification of outcome. Following initial development, the curriculum will be pilot tested on 2 subjects by the principal investigator at each of the 7 participating sites (n= 14). Materials will be revised as necessary and an orientation workshop will be conducted for the research assistant at each site who will field test the PSST protocol. Field testing will be conducted at each site as follows: 10 mothers will be sequentially enrolled and randomly assigned by project headquarters to either the instruction (n=5) or control (n=5) group (total learners =35; total untaught controls =35; total subjects =70). A repeated measures controlled design will be used to assess the efficacy of PSST on problem-solving ability (primary effect) and on negative affectivity and cancer-related knowledge (secondary effects). Structured feedback from the research assistants will guide development of a comprehensive self-instruction handbook for delivery of PSST related to childhood cancer.
