Triple P for Parents of Children With a Diagnosis of Cancer
Condition: Cancer
Study type: Interventional
Phase: Phase 1/Phase 2

Summary: 
      The purpose of the study is to assess the characteristics of parents who enroll in parenting
      interventions and to assess the utility and efficacy of a self-directed Triple-P intervention
      for parents of children with a diagnosis of cancer. The study aims to recruit parent(s) or
      primary caregiver of children with a diagnosis of cancer.Participants will be parents of
      children aged between 3-10 years who have had a diagnosis of cancer for 6 months or more.
      Recruitment will take place nationally via cancer voluntary groups/charities and other
      relevant organisations. The project will be advertised through these organisations and their
      various media outlets such as newsletters and social media pages (e.g. Facebook). All data
      collection will take place online. Following completion of the initial survey, parents will
      have the option to opt in to a case series whereby 10 parents will have the opportunity to
      receive the Triple P Every parents self- directed workbook to complete over 10 weeks.
    

Detailed description: 
      The risk of developing cancer in childhood is around 1 in 500, with leukemia being the most
      common diagnosis. Eight out of ten children now survive for five years or more. Consequently,
      there is a growing need to support the survivors of cancer and their families post treatment,
      particularly in relation to psychosocial well-being. Despite some children achieving good
      psychological adjustment, there is an increasing recognition of emotional and behavioural
      problems in child cancer survivors. Children with cancer have shown significantly higher
      scores for hyperactivity/impulsivity, rule-breaking behaviours and aggressive behaviours when
      compared to healthy controls.

      The Triple P - Positive Parenting Program is a successful treatment for emotional and
      behavioural difficulties designed to improve the quality of parenting advice available to
      parents through a multilevel system intervention. All forms of Triple P have shown to have
      moderate to large effects on parent reported child behaviours. More recently, self-directed
      Teen Triple P has been shown to be effective in reducing illness related conflict and
      behavioural problems in adolescents with type-1 diabetes.

      There is emerging research addressing the predictors and barriers of parental enrolment and
      engagement to parenting programmes. Historically, factors studied in relation to
      participation and engagement have been limited in scope and often include socioeconomic
      disadvantage perceived need for help and rates of problem behaviours. Little is known about
      the parent factors associated with participation, particularly in a cancer population. Caring
      for a child with a chronic illness, such as cancer, typically causes significant and
      prolonged distress for parents. Whilst parental motivation has been shown to indicate
      engagement, stress and helplessness and increased negative life events have been linked to
      reduced efficacy and non- completion. However, there is a paucity of research indicating
      whether such factors affect enrolment for parents of children with a diagnosis of cancer.

      A need for parenting information has been demonstrated by Williams et al who report that
      parents require information about parenting strategies particularly to manage challenging
      behaviours being exhibited by their child. In addition, at a local level, a survey undertaken
      with parents of children with a diagnosis of cancer attending the oncology service at the
      Royal Manchester Children's hospital has indicated a need for intervention, which is
      accessible and provides written support to parents for managing children's behavioural
      difficulties. The survey identified that 97% of parents believe parenting information should
      be given as a matter of routine following a child's diagnosis of cancer. Furthermore, parents
      reported a need for support with a range of behavioural difficulties, including tantrums and
      angry outbursts (43%). The purpose of the current study is to examine the predictors of
      parental enrollment to and pilot the efficacy of a self -directed version of the Triple P -
      Positive Parenting Program for parents of children with a diagnosis of cancer. Specifically
      the investigators aim to address whether a parent's experiences of their child's illness
      affects their ability to enroll to the study and whether Triple P is a suitably accessible
      intervention for parents of children with a diagnosis of cancer. Research suggests that
      interventions with minimal or no therapist or methods which promote self-regulation, such as
      written work books with self-directed exercises can be effectively employed to address child
      behaviour problems.To date, there have been no studies investigating self-directed measures
      to help parenting in the context of children with cancer. It is hoped the proposed project
      will determine the efficacy of this.

      Aims:

      To investigate the predictors of enrolment to a self-directed Triple P- Positive Parenting
      Program for parents of children with a diagnosis of cancer aged 3 to 10 years. Specifically,
      testing whether parents' perceived distress and emotional resource (as measured by the
      Parents Experience of Child Illness Questionnaire, PECI), psychosocial risk factors (as
      measured by the Family Background questionnaire; FBQ), parenting style (as measured by the
      parenting style questionnaire; PS), parental confidence (as measured by the parenting sense
      of competency questionnaire; PSOC), number of behavioural difficulties (measured by the Royal
      Marsden Hospital Pediatric Oncology quality of life measure; RMH-PQLQ), quality of life
      (measured by RMH-PQLQ) and cancer diagnosis predict enrolment to the intervention.

      To assess the effectiveness of a self-directed Triple-P Positive Parenting Program in:

        1. Improving quality of life as measured by the Royal Marsden Hospital Paediatric Oncology
           Quality of Life Questionnaire (RMH-PQLQ) (Primary outcome).

        2. Reducing behavioural difficulties as measured by the Royal Marsden Hospital Paediatric
           Oncology Quality of Life Inventory (RMH-PQLQ) Life Questionnaire (Q's 47-67) (Secondary
           Outcome).

        3. Promoting change in parenting style and feelings about being a parent as measured by the
           Parenting Scale (PS) and Parent self -confidence as measured by the Parenting Sense of
           Competence Questionnaire (PSOC) (Secondary Outcome).
    

Intervention name(s): Self-Directed Triple P
Intervention type(s): Behavioral
Intervention description(s): 10 Week Triple P Self directed workbook
Other intervention name(s): Triple P
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: Cancer; Parenting; Self-directed Triple P