Trial Information

Online Implementation of Problem Solving Skills Training for Mothers of Newly Diagnosed Childhood Cancer Patients

Research and experience document that caregivers of children with cancer encounter
extraordinary stresses during the child's illness. These stresses are particularly severe
during diagnosis and early therapy and can interfere significantly with a caregiver's
ability to make reasoned and timely decisions on their child'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. Too help mothers of newly diagnosed children cope more
effectively with these challenges, the investigators conducted randomized controlled trials
(R25CA65520, R01CA098954) to develop, field test, and evaluate the efficacy of the Bright
IDEAS paradigm 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. 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. In March 2010, the NCI designated Bright
IDEAS as a Research-based Therapy/Intervention Program (RTIP) and entered it into the
National Registry of Evidence-based Programs and Practices (NREPP). As an 8-session,
in-person intervention, Bright IDEAS is labor intensive and, to date, has only been
available at a few institutions with trained personnel. However, as a part of the RTIPs
evaluation process, the Dissemination Capability of Bright IDEAS was rated 5/5. This
proposal is designed to meet the challenge inherent in this perfect score. The investigators
will also immediately broaden the scope of users by including fathers as eligible
participants in this study of a new delivery paradigm the investigators believe they will
find appealing. Aim 1 is implementation of an engaging, easy-to-use on-line version of
Bright IDEAS that would be available 24/7 to any person anywhere who has access to the
Internet. Aim 2 is the use of "Diffusion of Innovations" theory to craft a framework for
disseminating not only Bright IDEAS but other similar interventions with the greatest
effectiveness and efficiency. In past studies, the investigators have shown that the human
element (time and attention) inherent in in-person interventions is effective in bringing
immediate relief of distress but not sufficient to maintain its benefits over time. In
contrast, mothers receiving PSST increase their skills and continue to improve their sense
of well-being 3 months after the intervention. What the investigators have not investigated
is whether a computer-based intervention is as effective as (not inferior to) an in-person
intervention. The results will have significant implications for future dissemination
strategies, especially the use of Internet II and other emerging technologies.