Narrative E-Writing Intervention (NeW-I) for Parents of Children With Chronic Life-Threatening Illness

NCT ID: NCT03684382

Last Updated: 2019-02-18

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

66 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-02-01

Study Completion Date

2020-10-31

Brief Summary

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Narrative e-Writing Intervention (NeW-I) is an evidence-based, strength-focused and meaning-oriented approach that aims at enhancing well-being, alleviating burden, and reducing adverse grief outcomes among Singaporean parents caring for a child with chronic life-threatening illness. In collaboration with KK Women's and Children's Hospital and Club Rainbow Singapore, a pilot randomized controlled trial with a built-in qualitative evaluation and feasibility study will be carried out to assess the efficacy of the therapist-facilitated NeW-I protocol and platform among a purposive sample of 66 participants. The findings generated will form the foundation for a full-scale RCT for advancing paediatric palliative care and parental bereavement support.

Detailed Description

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Background: Conventional grief support interventions for parents whose children are suffering from a chronic life-threatening illness often begin only after the child's death. Despite robust evidence which shows that pre-loss interventions that enhance death preparedness can alleviate psychological distress and prevent adverse grief outcomes among family caregivers of dying patients, there is no known program designed specifically to address the psycho-emotional-spiritual needs of parents facing child loss. And while the National Strategy for Palliative Care in Singapore aims to promote holistic end-of- life care services to patients and their caregivers, vast inadequacy continues to exist in the support provided to parents caring for a dying child in the local context.

Objective and Methods: A novel therapist-facilitated, online intervention is conceived to fill this critical service gap. Adopting an evidence-based approach, the research team has developed a strength-focused and meaning-oriented Narrative e-Writing Intervention (NeW-I) for parents anticipating the death of their child due to a chronic life-threatening condition. The design of NeW-I is informed by an existing body of research (i.e. international systematic review and local qualitative inquiry) that critically examines the lived experience of bereaved parents of children with life- limiting illnesses. NeW-I will be implemented in Singapore in collaboration with KK Women and Child's Hospital and Club Rainbow Singapore. A pilot Randomized Control Trial (RCT) with a built-in accessibility and feasibility study will examine the efficacy of the NeW-I therapeutic protocol for enhancing quality of life, spiritual wellbeing, hope and perceived social support, as well as reducing depressive symptoms, caregiver burden and anticipatory grief among a purposive sample of 66 participants.

Significance: NeW-I aspires to enhance quality of life, spiritual well-being, hope and sense of social support, as well as alleviating depressive symptoms, caregiving burden, and adverse grief outcomes among Singaporean parents facing the terminal illness and eventual death of their sick child. The findings generated will form the foundation of a full-scale RCT for advancing holistic paediatric palliative care and parental bereavement support locally and around the world.

Conditions

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Parent of Child With Chronic Life-threatening Illness

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Participants who have completed the online consent form, affirmed their study participation and completed the baseline assessments are then randomly allocated to either the NeW-I group or the control group via the online NeW-I platform that is developed for the purpose of this study. Such random assignment reduces the potential of bias.
Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

NONE

Consenting participants are randomly allocated to either the intervention or the control group.

Study Groups

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NeW-I group

Participants engage in a weekly structured writing task of 15-30 minutes which provides them an opportunity to reflect on the emotional, practical and financial demands of caregiving, and the means to cope with these challenges (week 1), explore avenues where they can seek information and resources for caregiving (week 2), explore the sources of support which they have within their network of family and friends (week 3) and examine how they (and their children) can rise above illness-related challenges and live their lives as fully as possible (week 4). After participants complete their weekly writing task, the written narrative will be reviewed and edited by the therapist within the next 3-4 days. The revised draft will be shared with the participant along with constructive feedback, empathic support and psychoeducation. In week 5, participants will receive a 'legacy' document and engage in a voice call with the therapist to receive psychosocial support and for closure of therapy.

Group Type EXPERIMENTAL

NeW-I group

Intervention Type OTHER

A 5-week intervention offered to parents of children with chronic life-threatening illness using an internet-based narrative approach with life review elements. After completion of the first four weeks of the intervention, participants will receive a 'legacy' document which is a compiled and edited document of their narrative expression during the first four weeks. This legacy document is structured in a manner that enables participants to find a sense of spiritual well-being and hope in their experience of caring for their child through examination of past experiences and achievements as well as future aspirations.

Control group

Participants engage in a weekly unstructured writing task of 15-30 minutes with a single open-ended question for each week which allows them to respond in any manner they find acceptable. Simple empathic weekly feedbacks are provided by the therapist to encourage continuous participation. In week 5, a consolidated document that includes all unedited journal writings together with a brief summary statement of appreciation by the therapist will be given to participants to indicate conclusion of participation.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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NeW-I group

A 5-week intervention offered to parents of children with chronic life-threatening illness using an internet-based narrative approach with life review elements. After completion of the first four weeks of the intervention, participants will receive a 'legacy' document which is a compiled and edited document of their narrative expression during the first four weeks. This legacy document is structured in a manner that enables participants to find a sense of spiritual well-being and hope in their experience of caring for their child through examination of past experiences and achievements as well as future aspirations.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Mother or father whose child has been diagnosed with a chronic life-threatening illness between the ages of 0-19 years, with a prognosis of more than 3 months since time of study participation so as to ensure successfully completion of all intervention components before child's death.
* Able to speak, read and write in English, as well as to provide informed consent.

Exclusion Criteria

* Cannot provide informed consent
* Suffering from severely high levels of depressive symptoms, anxiety and psychological distress (i. e. score of 19 or higher on Patient Health Questionnaire-9 (PHQ-9) or score of 29 or higher on Kessler Psychological Distress Scale (K-10))
Minimum Eligible Age

21 Years

Maximum Eligible Age

99 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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KK Women's and Children's Hospital

OTHER_GOV

Sponsor Role collaborator

Club Rainbow Singapore

UNKNOWN

Sponsor Role collaborator

Muscular Dystrophy Association Singapore

UNKNOWN

Sponsor Role collaborator

Rare Disorders Society Singapore

UNKNOWN

Sponsor Role collaborator

Nanyang Technological University

OTHER

Sponsor Role lead

Responsible Party

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Andy Hau Yan Ho, PhD, EdD

Assistant Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Club Rainbow Singapore

Singapore, , Singapore

Site Status RECRUITING

KK Women's and Children's Hospital

Singapore, , Singapore

Site Status NOT_YET_RECRUITING

Muscular Dystrophy Association Singapore

Singapore, , Singapore

Site Status RECRUITING

Rare Disorders Society Singapore

Singapore, , Singapore

Site Status RECRUITING

Countries

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Singapore

Central Contacts

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Andy Ho, PhD, EdD

Role: CONTACT

+65 63168943

Oindrila Dutta, MA

Role: CONTACT

+65 94464402

Facility Contacts

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Sashikumar Ganapathy

Role: primary

+65 91997314

Lee Beng Ang

Role: primary

+65 63941634

Sherena Loh

Role: primary

+65 62596933

Kenneth Mah

Role: primary

+65 64022898

References

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Bredle, J. M., Salsman, J. M., Debb, S. M., Arnold, B. J., & Cella, D. (2011). Spiritual Well-Being as a Component of Health-Related Quality of Life: The Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp). Religions, 2(1), 77-94. https://doi.org/10.3390/rel2010077

Reference Type BACKGROUND

Dutta O, Tan-Ho G, Choo PY, Ho AHY. Lived experience of a child's chronic illness and death: A qualitative systematic review of the parental bereavement trajectory. Death Stud. 2019;43(9):547-561. doi: 10.1080/07481187.2018.1503621. Epub 2018 Oct 4.

Reference Type BACKGROUND
PMID: 30285557 (View on PubMed)

Graessel E, Berth H, Lichte T, Grau H. Subjective caregiver burden: validity of the 10-item short version of the Burden Scale for Family Caregivers BSFC-s. BMC Geriatr. 2014 Feb 20;14:23. doi: 10.1186/1471-2318-14-23.

Reference Type BACKGROUND
PMID: 24555474 (View on PubMed)

Herth K. Abbreviated instrument to measure hope: development and psychometric evaluation. J Adv Nurs. 1992 Oct;17(10):1251-9. doi: 10.1111/j.1365-2648.1992.tb01843.x.

Reference Type BACKGROUND
PMID: 1430629 (View on PubMed)

Ho, A. H. Y. (2017). A Qualitative Study on the Lived Experience of Bereaved Parents of Young Children with Life Threatening Illness: Advancing Parental Bereavement Support in Singapore and Greater Asia (No. 2017-T1-001-034). Singapore Ministry of Education (MOE) Academic Research Fund (AcRF) Tier 1 Fund.

Reference Type BACKGROUND

Ho AHY, Car J, Ho MR, Tan-Ho G, Choo PY, Patinadan PV, Chong PH, Ong WY, Fan G, Tan YP, Neimeyer RA, Chochinov HM. A novel Family Dignity Intervention (FDI) for enhancing and informing holistic palliative care in Asia: study protocol for a randomized controlled trial. Trials. 2017 Dec 4;18(1):587. doi: 10.1186/s13063-017-2325-5.

Reference Type BACKGROUND
PMID: 29202863 (View on PubMed)

Hogan NS, Schmidt LA. Testing the grief to personal growth model using structural equation modeling. Death Stud. 2002 Oct;26(8):615-34. doi: 10.1080/07481180290088338.

Reference Type BACKGROUND
PMID: 12243195 (View on PubMed)

Ito M, Nakajima S, Fujisawa D, Miyashita M, Kim Y, Shear MK, Ghesquiere A, Wall MM. Brief measure for screening complicated grief: reliability and discriminant validity. PLoS One. 2012;7(2):e31209. doi: 10.1371/journal.pone.0031209. Epub 2012 Feb 14.

Reference Type BACKGROUND
PMID: 22348057 (View on PubMed)

Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001 Sep;16(9):606-13. doi: 10.1046/j.1525-1497.2001.016009606.x.

Reference Type BACKGROUND
PMID: 11556941 (View on PubMed)

Shear KM, Jackson CT, Essock SM, Donahue SA, Felton CJ. Screening for complicated grief among Project Liberty service recipients 18 months after September 11, 2001. Psychiatr Serv. 2006 Sep;57(9):1291-7. doi: 10.1176/ps.2006.57.9.1291.

Reference Type BACKGROUND
PMID: 16968758 (View on PubMed)

Siebens HC, Tsukerman D, Adkins RH, Kahan J, Kemp B. Correlates of a Single-Item Quality-of-Life Measure in People Aging with Disabilities. Am J Phys Med Rehabil. 2015 Dec;94(12):1065-74. doi: 10.1097/PHM.0000000000000298.

Reference Type BACKGROUND
PMID: 25888654 (View on PubMed)

Dutta O, Tan-Ho G, Low XC, Tan THB, Ganapathy S, Car J, Ho RM, Miao CY, Ho AHY. Acceptability and feasibility of a pilot randomized controlled trial of Narrative e-Writing Intervention (NeW-I) for parent-caregivers of children with chronic life-threatening illnesses in Singapore. BMC Palliat Care. 2022 Apr 29;21(1):59. doi: 10.1186/s12904-022-00945-0.

Reference Type DERIVED
PMID: 35488270 (View on PubMed)

Ho AHY, Dutta O, Tan-Ho G, Tan THB, Low XC, Ganapathy S, Car J, Ho RM, Miao CY. A Novel Narrative E-Writing Intervention for Parents of Children With Chronic Life-Threatening Illnesses: Protocol for a Pilot, Open-Label Randomized Controlled Trial. JMIR Res Protoc. 2020 Jul 5;9(7):e17561. doi: 10.2196/17561.

Reference Type DERIVED
PMID: 32623367 (View on PubMed)

Other Identifiers

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IRB-2018-07-009

Identifier Type: -

Identifier Source: org_study_id

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