| Author: | Liu, Qi |
| Title: | Preliminary effectiveness of an integrated hope techniques and narrative-based card game intervention for pediatric patients with cancer in China : a pilot randomized controlled trial |
| Advisors: | Ho, Eva (SN) Lam, Winsome (SN) Wong, Frances (SN) |
| Degree: | Ph.D. |
| Year: | 2024 |
| Subject: | Cancer in children -- China -- Psychological aspects Child psychotherapy Hong Kong Polytechnic University -- Dissertations |
| Department: | School of Nursing |
| Pages: | xvii, 174 pages : color illustrations |
| Language: | English |
| Abstract: | Introduction Cancer is a life-threatening disease and various spiritual needs can arise in children with cancer. Unmet spiritual needs can cause low levels of spiritual well-being, which is a central component in overall quality of life (QoL) among children with cancer. A high level of spiritual well-being can protect children with cancer from anxiety and depressive symptoms. Despite the importance of spiritual well-being, interventions are lacking that focus on improving spiritual well-being among pediatric patients with cancer. Using a narrative approach can potentially improve spiritual well-being in children with cancer by assisting patients with expressing emotions and shifting their focus from negative experiences to their strengths and resources. Because hope is a reinforcing element of spiritual well-being, the integration of hope techniques with a narrative approach is expected to enhance the effectiveness of intervention regarding spiritual well-being. In this study, we developed an integrated hope techniques and narrative-based card game (HT-NCG) intervention. Objective The first objective of this pilot study was to assess the feasibility of the HT-NCG intervention among Chinese pediatric patients with cancer. The second objective was to examine the preliminary effectiveness of the HT-NCG intervention on spiritual well-being, hope, anxiety, depressive symptoms, and QoL among pediatric patients with cancer. Methods Before the interventional study, we conducted a qualitative study to explore the spiritual needs of Chinese children with cancer. The psychometric properties of the Chinese version of scales used to assess spiritual well-being and hope were examined. A path analysis model of spiritual well-being, hope, anxiety, and depressive symptoms was used to explore the associations among variables. These studies informed development of the intervention and selection of the outcome variables. A total of 60 Chinese pediatric patients with cancer aged 12–17 years were recruited from Hunan Children's Hospital. Among them, 30 children were randomized to the experimental group and received four sessions of the HT-NCG intervention. Another 30 children were allocated to the control group and were provided with a placebo intervention. Spiritual well-being, hope, anxiety, and depressive symptoms were assessed at baseline (T0), post-intervention (T1), and at 1-month (T2) and 3-month (T3) follow-up. Assessors were blinded to the group allocation. The feasibility outcomes covered recruitment rate, attendance rate, retention rate and attrition rate. Descriptive statistics, the chi-square test, independent t-test, generalized estimating equations, and content analysis were used for data analysis. Results The feasibility of the HT-NCG intervention was confirmed with a high recruitment rate (80%), high attendance rates in both groups (86.7% for the experimental group and 93.3% for the control group) and low attrition rate (20.0%) at 3 months. No adverse events were reported. Compared with the control group, patients in the intervention group showed significantly greater improvement in spiritual well-being at all three evaluation time points (T1: Β=8.48, 95% CI: 2.33, 14.63, p=0.007; T2: Β=6.15, 95% CI: 0.43, 11.88, p=0.035; and T3: Β=5.99, 95% CI: 0.27, 11.75, p=0.042); improvement in hope post-intervention and at 1-month follow-up (T1: Β=7.57, 95% CI:3.14, 11.99, p=0.001;T2:Β=5.93, 95%CI: 1.32, 10.53, p=0.012); greater reduction in anxiety post-intervention (T1: Β=−2.23, 95% CI: −4.44, -0.01, p=0.049); and greater reduction in depressive symptoms at all three evaluation timepoints (T1:−7.25, 95% CI:−13.05, −1.45, p=0.014; T2:Β=−7.08, 95% CI: −13.10, −1.07, p=0.021; T3: Β=−6.41, 95% CI: −12.75, −0.07, p=0.047). There was no significant improvement of Qol in the intervention group compared with the control group at all three evaluation time points. Conclusions This study supports that the HT-NCG is a feasible intervention among pediatric patients with cancer. The overall results provided evidence that this intervention can effectively improve spiritual well-being and decrease depressive symptoms in this patient population. Implications for Practice This study bridged the gap in the existing literature by focusing on the spiritual well-being of children with cancer. The HT-NCG intervention can serve to address the spiritual needs and improve spiritual well-being in children with cancer. This short, engaging, and relaxing card game intervention is concise and structured as well as easy to integrate into the daily activities of children with cancer, for whom play is a natural part of life. Additionally, its low cost and ease of dissemination make it highly applicable for clinical settings. |
| Rights: | All rights reserved |
| Access: | open access |
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