Mediators and Moderators of Active Music Engagement to Reduce Traumatic Stress Symptoms and Improve Well-being in Parents of Young Children With Cancer

Abstract

Objective: This trial examined the effects of proximal/distal mediators and moderators of an Active Music Engagement (AME) intervention on young child/parent distress, quality of life, and family function outcomes.

Methods: Child/parent dyads (n = 125) were randomized to AME or Audio-storybooks attention control condition. Each group received 3 sessions with a credentialed music therapist for 3 consecutive days with data collection at baseline, post-intervention (T2), and 30-days later (T3). Potential proximal mediators included within session child and parent engagement. Potential distal mediators included changes in perceived family normalcy, parent self-efficacy, and independent use of play materials. Potential moderators included parent/child distress with prior hospitalizations, parent traumatic stress screener (PCL-6), and child age. Outcomes included child emotional distress and quality of life; parent emotion, traumatic stress symptoms (IES-R), well-being; and family function. Mediation effects were estimated using ANCOVA, with indirect effects estimated using the percentile bootstrap approach. Moderation effects were tested by including appropriate interaction terms in models.

Results: No significant mediation effects were observed. Child distress with prior hospitalizations moderated AME effects for IES-R intrusion subscale scores at T2 (P = .01) and avoidance subscale scores at T3 (P = .007). Traumatic stress screener scores (PCL-6) moderated intervention effects for IES-R hyperarousal subscale scores at T2 (P = .01). There were no moderation effects for child age.

Conclusions: AME is a promising intervention for mitigating traumatic stress symptoms and supporting well-being in parents of children with cancer, particularly for parents who screen high for traumatic stress and whose children are more highly distressed with hospitalization.

Trial registration: ClinicalTrials.gov NCT03085927.

Keywords: cancer; child; hospitalization; music therapy; neoplasms; parents; psychological distress; quality of life.

Figure 1.

Hypothesized path model. *Child Outcomes: Emotional Distress (CHQ Mental Health Subscale); Quality of Life (KINDL^R). Parent Outcomes: Emotional Distress (POMS-SF); Traumatic Stress Symptoms (IES-R); Well-being (Index of Well-being). Family Function (FACES II).

Figure 2.

CONSORT diagram.

Figure 3.

Moderation effect of child distress with prior hospitalizations on AME for parent intrusions symptoms at Time 2. Overall interaction P-value = .01; d = mean difference; SE = standard error; p = P-value from t-test of mean difference; standardized d obtained by dividing mean difference by model residual standard deviation; segments represent 95% confidence interval around estimated marginal means; AME slope = .00, SE (AME slope) = 0.01, P-value = .79; ASB slope = 0.04, SE (ASB slope) = 0.01, P-value = .005.