Parent-Child Communication Outcomes of a RCT Testing a Legacy Intervention for Children with Advanced Cancer (GP703)

Objectives: Explain gaps in legacy research for pediatric palliative care and oncology. Explain key components of our legacy intervention for children with advanced cancer. Explain methods of our study that was part of a larger RCT. Importance: Although legacy-building is a priority for quality palliative care, research has rarely examined effects of legacy interventions in children, particularly their impact on parent-child communication. Objective(s): We examined the impact of a legacy intervention on parent-child communication. We hypothesized that compared to usual care, legacy-making would improve quality of parent-child communication. Method(s): Between 2015 and 2018, Facebook advertisements were used to recruit families of children (ages 7-17) with relapsed/refractory cancer. Parent-child dyads were randomly assigned to the intervention or usual care group. The intervention website guided children to create digital storyboards over 2 weeks by directing them to answer legacy questions about themselves and upload photographs, videos, and music. Families received a copy of the child's final digital story. Children and parents completed the Parent-Adolescent Communication Scale pre- (T1) and post-intervention (T2). Linear regressions tested for differences in change from T1 to T2 between the groups controlling for T1 values using an alpha of p < .05. Intervention effects were measured using Cohen's d. Frequency distributions summarized parent feedback on the intervention. Results: Ninety-eight parent-child dyads were included for analysis. Changes in parent-child communication were not statistically significantly different between the groups, yet meaningful intervention effects were observed. The strongest effects were observed for improving father-child communication (Cohen's d ¼ 0.21-0.31). Parents reported that the intervention improved parent-child communication (72%) and child expression of feelings (86%). Conclusion(s): Although quantitative results suggest small effects of legacy-making most notably on father-child communication, qualitative findings indicate more positive experiences to the intervention for both the child and parents. Impact: Legacy-making shows promise to facilitate improved parent-child communication. Future studies should include fathers and measure expression of feelings and parent-child interaction. Providers should continue to facilitate family communication for children with advanced disease and realize that legacy interventions may impact mother-child versus father-child communication differently.