The Effect of Parental Monitoring on Diabetes Management in Adolescents: A Systematic Review of the Literature

poster abstractObjective: Adolescents with Type 1 Diabetes require parental guidance when it comes to the management of their glycemic control. Little is known regarding how parental monitoring affects adolescents’ diabetes control. A systematic review of the literature was performed to gain more insight into how parental monitoring influences glycemic control in adolescents with Type 1 Diabetes. Methods: Databases used to identify articles included: CINAHL, PsycINFO, and Web of Science. Search terms used were teenagers, adolescents, young adults, Type 1 Diabetes, parental monitoring, diabetes management and glycemic control. Inclusion criteria included: peer-reviewed research articles published between 2000 and 2013; involved a sample of adolescents (ages 8-18); conducted in the United States; written in English; and identified parental monitoring as the main independent variable. Results: Nine studies met the inclusion criteria. Six studies were longitudinal and three were cross-sectional. Seven studies collected data from the adolescent and parent while the other two studies collected data only from the adolescent. Sample sizes ranged from n=81-376. The most common glycemic control outcome factors measured were: hemoglobin A1C scores, adherence and glucose monitoring. Findings showed that parental monitoring is positively associated with adolescents’ adherence to diabetes management. There was mixed evidence regarding the father’s role. One study showed the father’s parental monitoring had significant impact on the adolescent adherence and A1C scores; however, another study reported the opposite. Overall, adolescents’ perception of positive parental monitoring provided better adherence. Conclusion: From the nine studies reviewed, it seems that there is some evidence that parental monitoring is positively associated with beneficial outcomes in glycemic control. However, future research is needed and should examine long-term effects of parental monitoring. Additionally, greater attention is needed on diverse populations such as single parent homes, families from different ethnic backgrounds, families of differing socioeconomic statuses and adolescents without parental figures

The Impact of Family-Based Interventions on Adolescent Glycemic Control: A Systematic Review of the Literature

poster abstractObjective: Glycemic control is a major source of family conflict among adolescents with type 1 diabetes and their parents. Family conflict is a determinant of how well adolescents will maintain glycemic control throughout adolescence; thus, family conflict resolution is a crucial step to managing their diagnosis. The purpose of this systematic review is to evaluate the effectiveness of family-based interventions on glycemic control of adolescents with type 1 diabetes. Methods: Databases utilized were Medline Ovid, PsycINFO, and Web of Science. Inclusion criteria for the studies selected included: peer-reviewed studies conducted in the United States; published between January 1994 to December 2014; and evaluated a family-based intervention’s effectiveness on adolescent diabetic glycemic control. Results: 11 studies met the criteria. Methods used to resolve family conflict included teamwork interventions, tailored interventions, behavioral family systems therapy, and family problem-solving management. Six studies did not show any significant influence on glycemic control. The only significant results on lowering glycemic control were found when a12-month follow-up was completed. Behavioral family systems therapy and family problem-solving management were found to be significant in improving adolescent glycemic control. Conclusion: It is crucial for healthcare providers to be aware of effective family-based interventions to help resolve family conflict and promote healthy glycemic control among adolescents with type 1 diabetes. Interventions specifically designed to address family conflict will not only foster healthy family relationships, but will target adolescents struggling to maintain adequate glycemic control. Results from this review shows that interventions based on family systems therapy and problem-solving management seem to be most effective. Future research is needed to replicate these findings in larger, more diverse samples

Principles and Strategies for Monitoring Data Collection Integrity in a Multi-site Randomized Clinical Trial of a Behavioral Intervention

Although treatment fidelity strategies for enhancing the integrity of behavioral interventions have been well described, little has been written about monitoring data collection integrity. This article describes the principles and strategies developed to monitor data collection integrity of the "Stories and Music for Adolescent/Young Adult Resilience During Transplant" study (R01NR008583; U10CA098543; U10CA095861) -- a multi-site Children's Oncology Group randomized clinical trial of a music therapy intervention for adolescents and young adults undergoing stem cell transplant. The principles and strategies outlined in this article provide one model for development and evaluation of a data collection integrity monitoring plan for behavioral interventions that may be adapted by investigators and may be useful to funding agencies and grant application reviewers in evaluating proposals

Perceptions of communication, family adaptability and cohesion: a comparison of adolescents newly diagnosed with cancer and their parents

PURPOSE: To describe and compare adolescent and parent perspectives on communication, family adaptability and cohesion, as well as relationships among these variables, during the first month of an adolescent's cancer diagnosis. METHODS: Seventy adolescent-parent dyads were enrolled as part of a larger multi-site study. The adolescents ranged in age from 11 to 19, and 61% were males. Parents were predominately mothers (83%). Dyads were predominately non-Hispanic Caucasian (63%). Measures included the Parent-Adolescent Communication Scale and the Family Adaptability and Cohesion Evaluation Scale (FACES II). Paired t-tests, Pearson correlations, intra-class correlation coefficients and multiple linear regression analyses were completed. RESULTS: Adolescent scores on communication, family adaptability and cohesion were significantly lower than parent scores. The inter-dyadic agreement between adolescents and parents was low. Communication, family adaptability and cohesion were examined separately for adolescents and for parents, and significant relationships were found. Both adolescent- and parent-perceived communication was significantly associated with family adaptability and cohesion outcomes. CONCLUSIONS: Differences were found in adolescent and parent perceptions of communication, family adaptability and cohesion. When both adolescents and parents had better perceived communication, this was associated with better perceived family adaptability and cohesion. Results suggest that the development of interventions to enhance adolescent-parent communication could help foster better family adaptability and cohesion, which may ultimately impact their psychological adjustment. In addition, understanding the degree to which adolescents and parents disagree on their perceptions, including the results that parents generally have more favorable perceptions, may be a useful starting point when developing interventions

Novice Nurses’ Experiences With Palliative and End-of-Life Communication

Health care providers recognize that delivery of effective communication with family members of children with life-threatening illnesses is essential to palliative and end-of-life care (PC/EOL). Parents value the presence of nurses during PC/EOL of their dying child. It is vital that nurses, regardless of their years of work experience, are competent and feel comfortable engaging family members of dying children in PC/EOL discussions. This qualitative-descriptive study used focus groups to explore the PC/EOL communication perspectives of 14 novice pediatric oncology nurses (eg, with less than 1 year of experience). Audio-taped focus group discussions were reviewed to develop the following 6 theme categories: (a) Sacred Trust to Care for the Child and Family, (b) An Elephant in the Room, (c) Struggling with Emotional Unknowns, (d) Kaleidoscope of Death: Patterns and Complexity, (e) Training Wheels for Connectedness: Critical Mentors during PC/EOL of Children, and (f) Being Present with an Open Heart: Ways to Maintain Hope and Minimize Emotional Distress. To date, this is the first study to focus on PC/EOL communication perspectives of novice pediatric oncology nurses

Recruitment strategies and rates of a multi-site behavioral intervention for adolescents and young adults with cancer

INTRODUCTION: To provide an overview of factors related to recruitment of adolescents and young adults (AYA) into research and recruitment rates and reasons for refusal from a multicenter study entitled "Stories and Music for Adolescent/Young Adult Resilience during Transplant" (SMART). METHODS: A randomized clinical trial study design was used. The settings included 9 hospitals. The sample included AYAs (aged 11-24 years) who were undergoing a stem cell transplant. Several instruments were used to measure symptom distress, coping, resilience, and quality of life in AYA with cancer. RESULTS: A total of 113 AYA were recruited (50%) for this study. Strategies were refined as the study continued to address challenges related to recruitment. We provide a description of recruitment strategies and an evaluation of our planning, implementing, and monitoring of recruitment rates for the SMART study. DISCUSSION: When designing a study, careful consideration must be given to factors influencing recruitment as well as special considerations for unique populations. Dissemination of strategies specific to unique populations will be helpful to the design of future research studies

The Effect of Parenting Styles on Smoking in Adolescents: A Systematic Review of the Literature

poster abstractObjective: The Centers for Disease Control recently reported that nearly 45% of adolescents participate In smoking cigarettes. Adolescence is a transitional period in which parental involvement is crucial in the development of healthy behaviors and practices of adolescents. However, little research has been done to show how parenting styles influence adolescent smoking. A systematic review of literature was conducted to describe how parenting styles (i.e., authoritative, authoritarian, and permissive) influence the likelihood of adolescents’ participation in smoking. Methods: Databases used for this literature search were PubMed and PsycINFO. The inclusion criteria included: peer-reviewed journal articles; written in English; published between 2003 through 2014; and identified parenting styles as the main independent variable in the study. Keywords were parenting style, adolescents, and smoking. Results: A total of seven articles met the criteria. Six studies used a cross-sectional design. Only one study was longitudinal. Studies included large sample sizes ranging from n=382-33,408. Four studies collected data only from adolescents, while the remaining three collected data from both the adolescent and their parent. Comparisons among the results were difficult to compare because many of the studies defined and measured parenting styles differently. Also, a few of the studies had extra parenting styles, such as, rejecting and neglecting in addition to the other three generally used. In the five studies that showed significant results, authoritative parenting was associated with a decrease likelihood of adolescent smoking. Conclusions: This review confirms that there is a limiting in understanding of how parenting styles influence the likelihood of adolescents’ participation in smoking. Authoritative parenting seems to the most favorable parenting style to decrease the likelihood of adolescent smoking. Future research should develop a standard tool to measure parenting styles and also create standard definitions for each parenting style that can be used throughout future research