Oral Presentation COSA-IPOS Joint Scientific Meeting 2012

Neuropsychological assessment recommendations after childhood brain tumor treatment: Barriers to implementation at home and school. (#70)

Claire E Wakefield 1 2 , Lorraine L.T Cheung 2 , Sarah J Ellis 1 2 , Anna Mandalis 3 , Eleanor Frow 3 , Richard J Cohn 1 2
  1. School of Women’s and Children’s Health, University of NSW, Sydney, NSW, Australia
  2. Centre for Children's Cancer and Blood Disorders, Sydney Children's Hospital, Sydney, NSW, Australia
  3. Clinical Psychology, Sydney Children's Hospital, Sydney, NSW, Australia

Aims: Pediatric brain tumor survivors are at increased risk of neurocognitive decline and emotional/social distress. A neuropsychological assessment is therefore often conducted to evaluate the child’s functioning and highlight potential challenges. This study examined parent and teacher understanding, implementation, perceived effectiveness and barriers to implementation of recommendations made in survivors’ post-treatment neuropsychological reports. Methods: Twenty-five semi-structured interviews were conducted with 17 parents and 8 teachers of brain tumor survivors (mean age: 10.6 years [SD:4.6]; 66.7% male) from 15 Australian families who had received a neuropsychology report in the preceding 2 years. A total of 24 neuropsychology reports encompassing 131 recommendations were reviewed and analyzed with SPSS (v19) and QSR NVivo 9.0. Results: The majority of parents (72.2%; n=13) and teachers (75.0%; n=6) had a sound understanding of the report. Implementation of recommendations at home and school was 47% and 41%, respectively. Participants perceived the recommendations as mostly effective, providing mean effectiveness ratings of 7.3/10 (for home-based recommendations) and 7.8/10 (for school). The recommendations were described as relatively easy to implement, with mean ‘difficulty to implement’ scores being 3.7/10 (home) and 2.5/10 (school). Recommendations that did not require extra effort/organization were more likely to be implemented. However, those perceived as more effective/helpful did not appear to have higher implementation rates. The most commonly reported implementation barrier was perceived patient reluctance (exacerbated by lack of maturity, reluctance to be singled out, or by being overwhelmed by multiple interventions), reported by 10/15 parents and 4/8 teachers. Parents’ lack of willingness to incorporate some recommendations was a barrier in 7/15 families. Conclusions: Despite reasonable levels of understanding, high perceived effectiveness and low perceived difficulty to implement recommendations, less than half of all recommendations were implemented post-assessment. Collaboration between the patient, teacher, parent and neuropsychologist is vital to ensure optimal outcomes for survivors.