Changing factors associated with parent activation after pediatric hematopoietic stem cell transplant

PURPOSE: To identify factors associated with parent activation in parents of children undergoing pediatric hematopoietic stem cell transplant (HSCT) in the 6 months following HSCT, and to address if their association with parent activation changes over time. METHODS: Measures for this analysis, including the Parent Patient Activation Measure (Parent-PAM), were completed by parents (N=198) prior to their child’s HSCT preparative regimen and again at 6 months post-HSCT. Clinical data were also collected. A repeated measures model was built to estimate the association between clinical and demographic factors and parent well-being on Parent-PAM scores. Interactions with time were considered to test for changing effects over time. RESULTS: Throughout the HSCT course, older parent age was associated with lower Parent-PAM scores (β=−0.29, p=0.02) and never being married was associated with higher scores (versus married, β=12.27, p=0.03). While higher parent emotional functioning scores were not associated with activation at baseline, they were important at 6 months (baseline: β=−0.002, p=0.96; interaction: β=0.14, p=0.03). At baseline longer duration of illness was associated with increased activation, but this effect diminished with time (baseline: β=3.29, p=0.0002; interaction: β=−2.40, p=0.02). Activation levels dropped for parents of children who went from private to public insurance (baseline: β=2.95, p=0.53; interaction: β=−13.82, p=0.004). Clinical events did not affect Parent-PAM scores. CONCLUSIONS: Our findings reveal important changes in the factors associated with parent activation in the first 6 months after pediatric HSCT. These findings may reflect the emotional and financial toll of pediatric HSCT on parent activation