Abstract

Objective 

Bright IDEAS (BI) is a problem-solving skills training (PSST) program that has been demonstrated in earlier randomized controlled trials (RCTs) to be an effective and specific intervention for improving problem-solving skills and reducing negative affect in caregivers of children with cancer. The objectives of this study were to (a) offer an approach to defining meaningful treatment response and to determine the rates of responsivity to PSST; and (b) identify characteristics of PSST responders and nonresponders.

Methods 

Data from 154 mothers receiving the BI intervention were analyzed. Drawing on the literature on minimal clinically important differences, two criteria for determining responsivity were calculated for the primary outcome of problem-solving skills: (a) The reliable change index (RCI) based on group data, and; (b) The effect size (ES) of each participant’s pre/postintervention change score as a function of the group’s baseline SD.

Results 

Thirty-three percent of the sample met both responsivity criteria immediately posttreatment (39% at follow-up) and 38% (39% at follow-up) met neither. An additional 29% demonstrated a small or greater ES (≥ 0.2) but did not meet the RCI criteria, suggesting possible benefit. The single consistent predictor of responsivity was participants’ pretreatment problem-solving skills, with lower skills at baseline predicting greater improvement (p < .001).

Conclusions 

These findings highlight the need to go beyond group data in interpreting RCTs and to incorporate measures of meaningful treatment response. Our ability to predict and screen for meaningful treatment response is critical to more precise targeting, enhanced outcomes, and better resource allocation.

中文翻译：

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癌症儿童母亲对解决问题技能培训的反应

摘要

客观的 

Bright IDEAS（BI）是一个解决问题的技能培训（PSST）计划，已在较早的随机对照试验（RCT）中证明是一种有效且具体的干预措施，旨在提高解决问题的技能并减少对患有以下疾病的儿童的看护人的负面影响癌症。这项研究的目的是（a）提供一种方法来定义有意义的治疗反应并确定对PSST的反应率；（b）确定PSST响应者和非响应者的特征。

方法 

分析了接受BI干预的154位母亲的数据。利用有关最小的临床重要差异的文献，为解决问题的技能的主要结果计算了确定反应性的两个标准：（a）基于组数据的可靠变化指数（RCI）；以及 （b）每个参与者干预前/干预后变化得分的效应大小（ES）作为小组基线SD的函数。

结果 

33％的样本在治疗后立即符合两项反应标准（随访时为39％），而38％（随访时为39％）均未达到。另有29％的患者表现出较小或较大的ES（≥0.2），但不符合RCI标准，表明可能获益。响应能力的唯一一致预测因子是参与者的解决问题的技能，而基线时较低的技能则预示了更大的改善（p  <.001）。

结论 

这些发现强调了在解释RCT时需要超越群体数据，并纳入有意义的治疗反应的措施。我们预测和筛选有意义的治疗反应的能力对于更精确的靶向，增强的结局和更好的资源分配至关重要。