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Cognitive Processing Among Mothers of Children Undergoing Bone Marrow/Stem Cell Transplantation

From the Program for Cancer Prevention and Control, Derald H. Ruttenberg Cancer Center, Mount Sinai School of Medicine, New York, New York (K.N.D., N.N., L.W., G.W., W.H.R.); Fox Chase Cancer Center, Philadelphia, Pennsylvania (S.M.); Memorial Sloan-Kettering Cancer Center, New York, New York (J.O., F.B.); Children’s Memorial Hospital, Northwestern University Medical Center, Chicago, Illinois (R.M.); Dana Farber Cancer Institute, Boston, Massachusetts (S.P.); Packard Children’s Hospital, Palo Alto, California (S.W.); and Emory University Medical Center, Atlanta, Georgia (L.M., S.S.).

Katherine N. DuHamel, PhD, Ruttenberg Cancer Center, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1130 New York, NY 10029-6574. Email: katherine.duhamel{at}mssm.edu

OBJECTIVE: This study investigated the role of cognitive processing in maternal adjustment to a life-threatening pediatric medical procedure (bone marrow/stem cell transplantation: BMT/SCT).

METHODS: Ninety-one mothers participated in structured interviews about their fears, intrusions, avoidance, and distress regarding their child’s BMT/SCT at two time points: during their child’s hospitalization and during his/her recovery. Structural equation modeling was used to determine the role of fears, intrusions, and avoidance in mothers’ distress.

RESULTS: Mothers’ fears played a primary role in their adjustment to their child’s transplantation. Intrusions mediated the relations of fears with distress at both time points. Mothers’ avoidance of thoughts, feelings, and reminders of their child’s illness during the child’s transplantation was associated with their distress three months later. The child’s risk for an unsuccessful transplantation outcome was not associated with mothers’ fears or distress during the child’s hospitalization, but was associated with mothers’ distress during the child’s posthospital course of recovery.

CONCLUSIONS: The results of this study indicate the critical role of mothers’ fears, intrusions, avoidance, and the child’s transplant risk in maternal distress and have treatment implications for reducing maternal distress during pediatric transplantation.

Key Words: cognitive processing, • pediatric, • bone marrow and stem cell transplantation, • cancer, • mothers.

Abbreviations: ALL = acute lymphoblastic leukemia;; AML = acute myeloid leukemia;; BAI = Beck anxiety inventory;; BDI = Beck depression inventory;; BMT/SCT = bone marrow/stem cell transplantation;; GvHD = graft vs. host disease;; IES = impact of events scale;; IESA = IES avoidance subscale;; IESI = IES intrusion subscale.