Enhancing Connections-Palliative Care: A Cancer Parenting Program for Patients With Advanced Cancer and Their Children

Treatment efficacy assessed by parents' mood (CES-D)

时间窗: At 3 months post-baseline

Depressed mood will be measured by the 20-item Center for Epidemiological Studies- Depression Scale (CES-D) (Benazon \& Coyne, 2000; Lewis, Fletcher, Cochrane, \& Fann, 2008; Radloff, 1977). The CES-D Scale measures the recent occurrence of symptoms of depression. For each symptom, the respondent indicates the frequency with which that symptom has occurred during the past week, from "rarely or none of the time (less than 1 day)" to "most or all of the time (5-7 days)." This measure has been well- accepted in both ill and non-ill samples. Internal consistency in three samples from the general population has been reported by Radloff (Radloff, 1977) and ranged between .84 to .85. Validity has been well- established, including its link to the broader concept of "distress" in cancer-related research (Benazon \& Coyne, 2000; Coyne et al., 1987; Given et al., 2004) The internal consistency reliability is 0.85 or higher (Benazon \& Coyne, 2000; Coyne et al., 1987; Given et al., 2004).

Treatment efficacy assessed by parents' anxiety [Spielberger State-Trait Anxiety (STAI, state scale)]

时间窗: At 3 months post-baseline

State anxiety will be measured by the state component of the State-Trait Anxiety Inventory. This 20-item self-report questionnaire evaluates current feelings of apprehension, tension, nervousness, and worry. The respondent circles a response that best depicts their current feelings best. Response options range from \[1 - Not at all\] to \[5 - Very much so\]. Sample items include "I feel calm", I am tense." Higher scores denote greater anxiety. Internal consistency reliability is 0.90 or above in community and population samples \[Edwards and Clarke, 2004\]

Parent's confidence in being able to talk with her child about the child's cancer-related concerns (CASE Help Child Subscale)

时间窗: At 3 months post-baseline

Parenting Self-efficacy: Measured by the Help Child subscale of the parent-reported cancer Self-efficacy Scale (CASE). The Help Child subscale (9 items) measures the parent's confidence in being able to talk with her child about the child's cancer-related concerns; e.g., "I can assist my child to talk out his/her worries about my cancer." Structured response options range from "Not at all confident" (1) to "Very confident." The internal consistency reliability The internal consistency reliabilities in the EC seminal trial with parents with early stage cancer was 0.97.

Parents' skills in helping their child cope and manage the toll of the parents' cancer (Connecting and Coping Subscale)

时间窗: At 3 months post-baseline

Parenting skills will be measured by the parent reported Parenting Skills Checklist: Connecting and Coping subscale developed by the study team and tested for reliability and validity in a 6-state randomized control trial (Lewis et al., 2015). The measure describes the observable interactional behaviors parents can use to assist their child disclose, discuss, and cope with the parent's cancer. The developmental-contextual model of parenting was the conceptual basis for the measure. An example item on the Connecting and Coping subscale includes, "I work with my child to help my child manage the child's stress related to my cancer."

Child-Behavioral Emotional Functioning: Anxious/Depressed score on CBCL

时间窗: At 3 months post-baseline

The child's behavioral-emotional adjustment will be measured by the Anxious/Depressed score of the CBCL which is part of the Child Behavior Checklist. This measure will be obtained from both the ill parent and the non-ill parent/parent surrogate. Response options range from 0 to 2 from "Not True (as far as you know)" to "Somewhat or Sometimes True" to "Very True or Often True." This score is part of the Internalizing score of the CBCL that measures the child's fearful, inhibited, and over-controlled behavior. The internal consistency reliabilities for the EC clinical trial were 0.90 for the Internalizing score and 0.94 for the Externalizing score. For the current study, we will use the CBCL form for 6-18 year-olds and its computer software.

Quality of Parent-ChildRelationship: Conflict, Closeness, Dependence Subscales

时间窗: At 3 months post-baseline

The Child-Parent Relationship Scale (CPRS) is a 15-item parent-reported measure assessing parent-child closeness and relational conflict. The stability and consistency of parents' perceptions of their relationships with their children (N = 563) has been evaluated across 3 years. The stability and consistency of parents' perceptions of their relationships with their children were evaluated in a large study sample of children (N = 563) across 3 years. Validity testing with the CBCL between the 2 subscales and total scale score were 0.83 for every age of child in the study. Alpha internal consistency reliability was 0.83 for relational conflict and 0.72 for closeness.