Michelle Fortier · University of California, Irvine · PhdFit
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Michelle Fortier
· Professor of NursingVerified
University of California, Irvine · Population Health & Disease Prevention
Michelle Fortier, PhD, is an Associate Professor at the Sue & Bill Gross School of Nursing at the University of California, Irvine. She earned her PhD from the University of Nebraska-Lincoln in 2006, specializing in Clinical Child Psychology. Her research interests include pediatric pain, pediatric oncology, healthcare disparities, and mobile health (mHealth). Dr. Fortier is involved with the Center on Stress & Health at UC Irvine, where her work focuses on understanding and addressing health challenges faced by children, particularly in the context of pain management and healthcare equity. She contributes to advancing knowledge in pediatric health and developing interventions to improve health outcomes for children and their families.
Background: Parents of children with cancer experience significant psychological distress that is associated with poorer health outcomes. A recent review of caregiver interventions illustrated none targeting Latino parents of children with cancer and a significant need for culturally congruent intervention approaches. Aims: Following our first paper in this issue describing the development of a community co-developed intervention to address psychosocial outcomes in Spanish-speaking Latino families impacted by childhood cancer, this second paper describes the formative evaluation and exploratory analysis of preliminary efficacy in a single-arm pre–post trial. Methods: A total of 32 Spanish-speaking Latino parents/caregivers of children with cancer received the 12-session intervention targeting health literacy, culturally congruent care, and caregiver well-being. Quantitative measures of health literacy and emotional well-being were collected at baseline, post-intervention, and 3 months post-intervention and mixed methods formative evaluation data were collected immediately post-intervention. Results: Mixed methods formative evaluation showed that the intervention was useful, helpful, and relevant. Exploratory preliminary efficacy data using a non-parametric Friedman test showed that health literacy doubled from pre- (33%) to post-intervention (67%) and was sustained at 3 months (X2(2) = 12.52, p = 0.002; Cohen’s d = 0.65). Repeated measures ANOVA showed that emotional distress decreased significantly from baseline to immediately post-intervention with sustained treatment effects at 3 months post-intervention (F(2,62) = 4.37, p = 0.046; Cohen’s d = 0.42). Satisfaction scores were well above treatment acceptability (M = 39.13, SD = 2.80). Conclusions: Implementation of a community co-developed intervention with the goal of achieving cultural congruency was feasible, likeable, and relevant for Spanish-speaking Latino parents and caregivers of children undergoing treatment for cancer. Moreover, the exploratory analysis showed the intervention was associated with improvements in health literacy and emotional well-being and high levels of treatment satisfaction.
Despite abundant evidence that the admission of an infant to a neonatal intensive care unit (NICU) is a highly stressful and potentially traumatic experience for both infants and parents, few psychosocial interventions target the needs of parents of NICU infants. In particular, interventions supporting parents beyond the initial medical crisis are notably lacking. Relational savoring (RS) is a brief, positive psychology intervention that attunes one's focus to moments of positive connectedness within their relationships, including parent-child relationships. While the benefits of RS for parent-child dyads are well documented, its efficacy has not been evaluated in parent-child dyads facing significant relational stressors, such as those experienced in post-NICU contexts. Using a randomized controlled design, this study tests the effects of RS compared to a neutral control in 240 post-NICU parents in the United States. Parents reported on their closeness to their child, parental emotional well-being, and parental satisfaction before and after the intervention, as well as their history of perinatal loss and stress. Results of multilevel models suggest that, relative to a neutral control task, parents assigned to the RS intervention group exhibited significantly greater increases in feelings of closeness to their child, parenting satisfaction, and parental emotional well-being. Interestingly, the reduction in negative affect pre- to post-intervention was more pronounced for parents with a history of miscarriage, stillbirth, child loss, and/or fertility difficulties. These findings suggest that RS may represent a scalable intervention to support parent-child relationships and parental well-being in the post-NICU period, particularly for parents with prior perinatal loss and stress.
Background: Cancer health disparities among Latinos in the United States are pervasive and manifest in higher morbidity and mortality among pediatric cancer patients and their parents/caregivers. There is a need to engage in culturally congruent approaches to develop interventions that effectively mitigate cancer health disparities among Latino caregivers. Aims: The purpose of this manuscript is to present the methodological process of adopting a community-based participatory research (CBPR) approach to develop a culturally congruent intervention to address psychosocial cancer health disparities in Spanish-speaking Latino families impacted by childhood cancer. Materials and Methods: We established two partnerships with Spanish-speaking parents of children previously treated for cancer and whose children were currently undergoing cancer treatment to collaboratively identify psychosocial intervention targets. A total of 22 meetings were held with community collaborators (n = 13) that followed CBPR principles. All meetings were audio recorded, transcribed, and coded using an inductive approach. Results: The intervention framework identified three psychosocial outcomes: caregiver health literacy, culturally congruent care, and emotional well-being. A 12-session intervention addressing the three outcomes was developed integrating cultural values and bilingual and bicultural community and healthcare providers. Conclusions: A CBPR approach was adopted to address disparities in quality of life in Spanish-speaking caregivers of children with cancer, which resulted in a multicomponent intervention that addresses the informational, practical, and psychosocial needs of Latino caregivers. The intervention can help mitigate disparities in well-being for Latino families impacted by childhood cancer by incorporating culturally relevant strategies to optimize health.
BACKGROUND: A total of 80% of children experience postoperative pain following discharge. Effective postoperative pain management involves reliable caregiver pain assessment and/or child self-report of pain. Unfortunately, caregiver and child ratings of postoperative pain are not always consistent (i.e., concordant). This study aimed to identify postoperative pain concordance among caregiver-child dyads and predictors for postoperative pain discordance. METHODS: Children and their caregivers completed preoperative baseline demographic, anxiety, and distress measures. Postoperatively, children and caregivers completed pain severity ratings using the Child Health Rating Inventories (CHRIS 2.0). On the basis of postoperative pain scores, caregiver-child dyads were classified as overestimators (i.e., caregivers rated pain as higher than children), in agreement, or underestimators (i.e., caregivers rated pain as lower than children). RESULTS: A large proportion of dyads disagreed on pain ratings (n = 104; 44%), with 64 (27%) caregivers classified as overestimators and 40 (17%) caregivers classified as underestimators. Caregivers were more likely to underestimate male children's pain, β = 1.238, OR = 3.35 (95% CI: 1.26, 9.43), p = 0.16, and Spanish-speaking Latinx caregivers were more likely to underestimate children's pain, β = 2.27, OR = 9.63 (95% CI: 2.35, 39.37), p = 0.002. CONCLUSION: Although most caregiver-child dyads agreed with pain ratings, 44% of the dyads disagreed. Among those who disagreed, males from Spanish-speaking Latinx households were at greatest risk of having their pain underestimated by their caregiver, which could be explained by the influence of intersecting social identities on pain beliefs, expression, and behaviors. Future studies should explore how pain discrepancies influence postoperative recovery outcomes for Latinx children.
BACKGROUND: Young adult childhood cancer survivors (YACCS) experience persistent challenges that could delay their transition to independent adulthood. This study examined disparities in life milestone achievement between YACCS and a matched population-based control group and assessed the impact of clinical and demographic factors, including time since diagnosis, treatment intensity, and race/ethnicity. METHODS: This matched case-control study utilized data from Project Forward and the California Health Interview Survey. YACCS were matched to general population controls at a 1:3 ratio based on age, sex, year of survey, and race/ethnicity. Multivariable logistic regression models were used to compare life milestone achievement between the groups and to examine associations between survivor characteristics and life milestone achievement, adjusting for neighborhood socioeconomic status. RESULTS: The study included 1106 YACCS and 3292 matched controls. YACCS were less likely to attain a college degree (OR = 0.79, 95% CI: 0.66-0.95), be employed full-time (OR = 0.39, 95% CI: 0.33-0.45), or be married/partnered (OR = 0.69, 95% CI: 0.58-0.82). Conversely, they were more likely to be unemployed (OR = 1.89, 95% CI: 1.61-2.23), work part-time (OR = 1.67, 95% CI: 1.38-2.02), and live with a parent (OR = 3.34, 95% CI: 2.78-4.00). Long-term survivors (15+ years) and those who received more intensive treatments continue to encounter difficulties, particularly with achieving independent living and securing stable employment. CONCLUSIONS: YACCS experience significant delays in achieving key life milestones compared to their peers, highlighting the lasting socioeconomic impact of childhood cancer. Intensive treatments further exacerbate these disparities. Targeted interventions and survivorship support programs are needed to address these challenges and improve long-term outcomes.
Frontiers in Psychology · 2025-04-29 · 1 citations
articleOpen accessSenior authorCorresponding
Introduction: Cancer pain remains a significant burden among children with cancer, and many patients experience pain starting around the time of diagnosis and throughout the course of treatment. A biopsychosocial treatment approach has been recommended to improve pain management in this population; however, specific psychosocial factors that contribute to pain in the early phases of pediatric cancer treatment have yet to be identified. The purpose of this study was to explore the biopsychosocial factors associated with pain experiences during the early phases of pediatric cancer treatment, with the goal of identifying children who may be at the highest risk for pain to inform future intervention and prevention efforts. Methods: = 10 weeks). Children completed self-report questionnaires and caregivers completed self- and parent-proxy questionnaires at baseline. Cancer-related data, including diagnosis and date of diagnosis, were abstracted from the child's electronic medical record. Multiple regression analysis was used to examine associations between biopsychosocial risk factors, pain intensity, and pain interference. Results: Older age, female gender, and elevated depressive symptoms, fatigue, and child self-reported pain catastrophizing were significantly associated with increased pain intensity. Additionally, lower annual income, decreased physical functioning, and greater fatigue, child pain catastrophizing, and parent stress were significantly associated with increased pain interference. Discussion: Findings underscore the importance of utilizing a comprehensive biopsychosocial approach to pain assessment and management in pediatric oncology. This approach highlights the need for targeted interventions that address not only the physical aspects of pain but also the psychological and social contexts of patients, ensuring a more holistic and effective treatment strategy.
Abstract Objectives There has been a growing emphasis on holistic approaches to assessing postoperative recovery by using self-reported health-related quality of life (HRQoL). Identifying groups of children at higher risk of poor recovery has become important. The aim of the study is to identify predictors of paediatric postoperative recovery assessed by self-reported HRQoL. Methods One hundred forty-eight children ages 4 to 12 years completed the Child Health Rating Inventories (CHRIS2.0) to measure overall, physical and mental health, preoperative anxiety, and postoperative pain. Four linear regressions were used to identify predictors of overall, physical and mental health and postoperative pain. Predictors included child gender, race/ethnicity and language, surgical severity, child and caregiver preoperative anxiety, and caregiver distress. Results Child male gender (p = 0.03, 95% confidence interval [CI] [−10.15, −0.65]) and identifying as English-speaking Latinx (p = 0.03, 95% CI [0.58, 13.25]) predicted poorer postoperative overall health. Higher child preoperative anxiety (p < 0.001, 95% CI [0.39, 1.50]) and higher caregiver preoperative distress (p = 0.003, 95% CI [−1.09, 0.28]) predicted poorer postoperative overall health. Conclusions The results of this self-reported study validated previously established predictors of recovery (preoperative anxiety and caregiver distress). Novel predictors, including child male gender and race/ethnicity and language, were identified, providing new insights into factors influencing recovery outcomes.
