SibACCESS: Developing a Telehealth Intervention to Address Unmet Psychosocial Needs of Siblings of Children With Cancer

Background:

Prolonged, complicated, and intensive pediatric cancer treatment regimens challenge and disrupt the entire family. Siblings of youth with cancer are a psychosocially at-risk and underserved group. Siblings frequently report strong negative emotions, disruptions to family life, poorer academic functioning, more school absenteeism (school-aged siblings), and riskier health behaviors and poorer health outcomes than comparisons (adult siblings). Approximately one-quarter of siblings meet diagnostic criteria for cancer-related posttraumatic stress disorders. Outcomes are worse for siblings from under-represented minority groups and those with fewer socioeconomic resources. Additionally, siblings report low social support and indicate a strong desire to connect with other siblings. The need for sibling support is well established, as outlined in the recently developed evidence- and consensus-based Standards for Psychosocial Care for Children with Cancer and Their Families. Unfortunately, the Sibling Standard is among those least likely to be met within pediatric oncology programs nationwide.

SibACCESS Program Description:

SibACCESS (Acceptance, Coping, Communication, Engagement, and Social Support) targets the proposed mechanisms of sibling difficulties. The primary goal is to increase siblings' exposure and opportunities to process cancer-related cues to decrease the onset or intensification of posttraumatic stress (PTS). Treatment targets include emotional acceptance, treatment involvement, family communication (via between-session assignments), and social support (fostered by the group format).

SibACCESS is based on acceptance-based cognitive-behavioral frameworks, drawing primarily on trauma-focused CBT (TF-CBT). TF-CBT is a structured, short-term treatment that incorporates cognitive-behavioral approaches to promote recovery from trauma. It is a logical starting point for the present study for multiple reasons: (a) TF-CBT was developed specifically for children and adolescents; parent participation is recommended but not required; (b) it has been tested in a group format and using telehealth; (c) it has demonstrated effectiveness across cultural groups; and (d) it is appropriate for youth who meet diagnostic criteria for PTSD and those with sub-clinical PTS. TF-CBT has not yet been evaluated in the context of childhood cancer and may require some adaptations. Thus, SibACCESS also includes skills from Dialectical and Behavioral Therapy (i.e., self-validation of emotions, mindfulness, radical acceptance) to better address distress tolerance and acceptance of the aspects of cancer that are beyond siblings' control.

SibACCESS sessions will be facilitated remotely using Zoom. The intervention includes one pre-recorded parent webinar, one brief orientation meeting (sibling and parent), seven weekly sibling group sessions, one individual sibling session, and one individual parent session. The 30-minute parent webinar will provide a program overview, psychoeducation, and brief skills training. Parents will be given "discussion starter" questions to facilitate communication throughout the program. Sibling group sessions are 75 minutes and will include an ice breaker, review of last week's homework (except first session), introduction of new topics, interactive practice of new skills, and assignment of home practice (except final session). Exposure to cancer-related emotions and cues will be emphasized throughout the program, including talking about cancer, confronting cancer-related thoughts and emotions, selecting several individualized cancer-related exposures, and crafting a sibling narrative.

Inclusion criteria

• 2 or more children in the family (i.e., child with cancer and >1 sibling)

• Sibling(s) and child with cancer each under the age of 18 at the time of cancer diagnosis
• Sibling(s) can be biologically-related, step-siblings, foster-siblings, or adopted-siblings
• Parent and sibling(s) fluent in English
• Sibling(s) 12-17 years of age
• Sibling report of at least mild posttraumatic stress (score >11 on the Child Posttraumatic Stress Scale for DSM-5)
• Child with cancer must have received cancer diagnosis at least 3 months prior to the family's enrollment in the study

Exclusion criteria

• A cognitive impairment that would interfere with pilot program and interview completion (as reported by parent)
• Bereavement
• Significant externalizing behaviors that would interfere with group participation (as reported by parent)