Psychosocial Interventions to Relieve Traumatic Stress Symptoms in Family Caregivers of Children With Cancer: A Scoping Review.
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BACKGROUND: Traumatic stress symptoms are common, severe, and persistent in family caregivers of children with cancer, but the benefits of therapeutic interventions to relieve them are not well established. AIM: To review, describe, and appraise the available research on psychosocial interventions aimed at alleviating traumatic stress symptoms in family caregivers of children with cancer. METHODS: Systematic searches of APA PsycInfo, CINAHL, MEDLINE, and Embase were conducted to identify randomized controlled trials (RCTs) and nonrandomized studies of psychosocial interventions (NRSIs) for families affected by pediatric cancer in which traumatic stress symptoms were reported as a primary or secondary outcome. Results were screened by independent reviewers in duplicate. 18 articles were included. All were evaluated for risk of bias and data on study design, intervention format, delivery, and impact, and were abstracted for narrative synthesis. RESULTS: Study samples (8-430 participants) were primarily comprised of mothers of children with acute leukemia. Most interventions (1 day-15 weeks) involved an interventionist (n = 17; 94%) and used cognitive-behavioral techniques (n = 14; 78%). Eight RCTs (n = 10; 80%) and seven NRSIs (n = 8; 87.5%) found a significant reduction in traumatic stress symptoms following intervention delivery, with small to large effect sizes (Cohen's d = 0.28-1.30). However, only three RCTs confirmed having adequate power to comment on effectiveness. Risk of bias ranged from low to moderate. CONCLUSIONS: The prevalence and problematic nature of traumatic stress symptoms in this population is well documented in the observational literature. However, the evidence remains unclear as to the effectiveness of psychosocial interventions to alleviate them due to methodological limitations in current interventional research. High quality RCTs that include a diverse group of family caregivers are needed to demonstrate their effectiveness and to inform clinical care practices aimed at improving family wellbeing.