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Pediatr Blood Cancer DOI 10.1002/pbc
Resilience and Psychosocial Outcomes 5
directional associations. For example, we cannot determine which
comes rst: resilience resources, psychological distress, or health-
related behaviors. This lack of directionality, in turn, limits the
ability to design appropriate interventions. In addition, we had no
control group of parents of similar demographics. While we tried to
narrow our comparisons where applicable (e.g., we compared
parent reported behaviors to those of well adults in Washington
State rather than nationwide), our comparisons to generic
population norms should be interpreted cautiously. Nevertheless,
we endeavored to describe novel relationships and generate
hypotheses for future studies. Our current on-going investigations
include a longitudinal assessment of the RPCA among adolescents
with cancer and their parents; this project will allow for greater
exploration and understanding of the here-described constructs.
Second, eligibility for this study included having a valid led
mailing address and willingness to be contacted for future research.
Our sample is therefore biased to include those parents willing to be
reached and perhaps invested in on-going research, a sample that
may be more resilient at baseline than is typical. Likewise, even
within our sample, not all parents responded to questions about
health behaviors such as drinking and driving; our ndings may be
biased by those who were willing to respond to these questions.
Additionally, we only requested one respondent per family and
most were mothers. Our ndings are therefore more generalizable
to mothers, even though we adjusted for parent sex in multivariate
analyses. Furthermore, our sample lacked ethnic and demographic
diversity. We were unable to assess multi-cultural aspects of distress
and resilience. Indeed, another element of psychosocial outcomes
must include cultural perspectives.
Finally, we conducted multiple exploratory and hypothesis-
generating comparisons and this approach may increase the risk of
type 1 errors. Even with our large number of sub-scales, this analysis
provided a limited view into the multitude of measurable
psychosocial covariates and outcomes. There are many more
(e.g., trait-optimism, sense of coherence, spirituality, coping, degree
of involvement of psychosocial clinicians, benet-nding, and post-
traumatic growth) that likely relate to this complex picture. While
we queried self-reported religiousness, for example, we did not
assess spirituality, which has been related to meaning making and
coping [38]. Still, we met our objective to identify associations that
could inform the design of larger studies and/or interventions.
CONCLUSIONS
Supporting the psychosocial wellbeing of parents of pediatric
cancer patients is a critical component of whole patient care [28].
This cross-sectional study provides preliminary evidence that
resilience resources are related to parent psychosocial health and
functional outcomes. Future studies should evaluate the trajectory of
resilience resources over time and should assess the corresponding
relationships between changing resilience resources and outcomes.
Interventions that target and improve resilience resources have the
potential to improve parent, and by extension patient, wellbeing.
ACKNOWLEDGMENTS
None of the authors has a nancial or other conict of interest to
disclose. ARRis a St. Baldricks Foundation Fellowand is supported
by a Conquer Cancer Foundation of ASCO Jane C. Wright, MD
Young Investigator Award, supported by the ASCO and Conquer
Cancer Foundation Board of Directors. Any opinions, ndings and
conclusions expressed in this material are those of the author(s) and
do not necessarily reect those of the American Society of Clinical
Oncology, the Conquer Cancer Foundation, or the ASCO and the
Conquer Cancer Foundation Board of Directors. We would like to
thank Barbara Stansfeld for her assistance in the coordination of this
study. We are grateful to the parents and caregivers who participated
and offered their thoughtful consideration to this work.
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Pediatr Blood Cancer DOI 10.1002/pbc
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