Problem-Solving Skills Training for Parents of Children Undergoing Hematopoietic Stem Cell Transplantation: A Mixed Methods Feasibility Study

Background: Caregivers of children undergoing hematopoietic stem cell transplantation (HSCT) are at risk for psychological distress. Bright IDEAS (R) (BI) is an effective and acceptable modification of problem-solving therapy for caregivers of children with new cancer diagnoses, but it has not been tested on caregivers of children undergoing HSCT. This randomized controlled pilot examined the feasibility, acceptability, and preliminary efficacy of BI among caregivers of children undergoing HSCT. Methods: English- and Spanish-speaking caregivers of children aged 2-21 years were recruited within 10 days of their child's autologous or allogeneic HSCT. Participants were randomized 1:1 to receive six-to-eight individualized BI sessions or usual care. Participants completed self-report measures of psychological distress at enrollment (pre-intervention) and on days 60, 90, and 180 post HSCT. Qualitative interviews were conducted among a subset (N = 7) of intervention completers to assess caregiver perceptions of BI. Results: A total of 107 caregivers were screened for participation; 64 were eligible. Thirty-eight were enrolled (59.4%) and randomized. In the BI group, 14/20 participants (70%) completed six or more sessions. The completion rate for distress measures was at least 78% for both study groups across timepoints. Despite higher baseline scores, caregivers in the BI group reported lower anxiety and depression scores at follow-up timepoints compared to the control group, based on observed trends. Qualitative interviews reflected acceptability of BI. Conclusions: The results support the feasibility and acceptability of BI for caregivers of children undergoing HSCT. A larger efficacy trial of BI in the pediatric HSCT setting is warranted.