A digital health parent coaching intervention to improve neurodevelopmental outcomes for young childhood cancer survivors in underserved communities - PROJECT SUMMARY: There are almost half a million childhood cancer survivors in the United States. Over two-thirds of survivors will develop at least one late effect. Young childhood cancer survivors (YCCS; age at diagnosis <7 years) are at the highest risk for developing neurocognitive late effects, given their developmental vulnerability and absence from early education. YCCS miss critical opportunities to develop foundational school readiness skills, including preacademic, social-emotional, and self-regulatory skills. Neurocognitive risk is exacerbated for YCCS living in rural and Appalachian areas, who are at elevated risk due to poverty and distance from specialty care. Digital health interventions (DHIs) targeting positive parenting skills show promise in promoting neurodevelopmental outcomes in other neurologically vulnerable groups. The proposed research is the first to co-design a positive parenting DHI for YCCS (3-6 years), called Preparing for Life and Academics for Young survivors (PLAY) program, to improve their neurodevelopmental trajectory. Following the ORBIT model phases, PLAY has been adapted in partnership with caregivers and oncology healthcare providers from parent-coaching DHIs developed by the mentoring team. PLAY involves 6 self-directed web-modules and 8 virtual coaching sessions for caregivers of YCCS (Phase Ia). The rationale and central hypothesis for this project is that PLAY will improve parent-child interactions and reduce parenting stress, which will lead to improvements in child school readiness, or prevent future declines.68,71 In Aim 1, the research team will iteratively refine the PLAY program through rapid cycle testing (Phase 1b) until three families sequentially endorse above-average usability, feasibility, and acceptability, or until 15 families have completed the intervention. In Aim 2, a single arm trial (Phase IIa) will be conducted with 15 families to evaluate the feasibility, acceptability, and proof-of-concept of the refined PLAY program in improving (or maintaining at normative levels) observed positive parenting skills, parenting stress, and school readiness at 3-and-6 month follow ups. In Aim 3, a feasibility trial (Phase IIb) will be conducted by randomizing families to either PLAY or an internet resource comparison group (n = 15 per group) to determine acceptability of randomization and retention. With the guidance of an exceptional mentorship team, the K08 candidate, Dr. Moscato, will acquire training in: 1) mixed-methods assessment approaches and intervention strategies for young children, 2) community-engaged research with rural and Appalachian populations, 3) iterative digital health co-design and refinement, and 4) the design, conduct, and analysis of behavioral trials based on the ORBIT model. This training will facilitate Dr. Moscato’s long-term goal to become an independent clinician-scientist focused on developing equitable DHI for childhood cancer survivors. This K08 proposal will provide preliminary data and the expertise needed to conduct a large scale RCT. The ultimate goal is to inform culturally responsive, accessible psychosocial care that enhances quality of life across the lifespan for childhood cancer survivors.
