[WITHDRAWN] What Works?; A Qualitative Exploration of Play Therapy for Children in Pediatric Oncology

Background/Purpose:

Pediatric cancer treatment and the corresponding hospitalization is a physically and emotionally taxing experience that affects patients and their families far beyond treatment itself. One significant impact is the development of socio-emotional challenges that linger into adulthood. Although a wealth of literature explores play interventions used to treat medically complex children, few explore such interventions in pediatric oncology settings through the perspectives of the clinicians that employ it. Therefore, the aim of this study is to understand the use and perceived effectiveness of play interventions for pediatric patients with socio-emotional issues brought about by cancer treatment.

Method:

Informed by Bronfenbrenner’s ecological model, this phenomenological study examines the lived experience and the perceptions of ten clinicians who provide play interventions to pediatric cancer patients in a hospital setting. Consenting participants were interviewed over the Zoom platform for 60 minutes using a 5 question semi-structured interview guide. Interviews were audio recorded with participant name omitted, and transcribed. Following transcription, interviews were put through a coding process of horizontalization wherein themes began to emerge. Both textural and structural descriptions were completed for each identified theme, which then helped form the essence of the experience. To enhance credibility of the findings, peer debriefing, auditing, and member checking were completed.

Results:

The five primary themes (e.g., Toys and Play, Families, Affective and Behavioral Impact, Trust building, Understanding, Integrating, and Coping) represent the multi-layered impact of cancer treatment and the influence of play interventions on the child. Considered together, these themes provide the basis through which the essence of play in pediatric oncology settings emerged. This essence is best described as “trust is the foundation for coping”. This trust is influenced by the factors existing at each level of the child’s system including their family, peers, schools, culture, race, language, and the macro level structural issues of employment, finances, and the healthcare industry. Specifically, race, culture, and ethnicity play a prominent role in influencing preferred toys and treatments, guide familial roles, values, and practices, and change how the family and child interact with the medical team and hospital system. Constructing the relationship, by analyzing the repercussions of outside influences, creates the setting wherein play interventions can effectively address needs and enhance the development of coping skills.

Conclusions/Implications:

This study expands on previous literature on play therapy interventions for patients in pediatric oncology settings. It posits the importance of taking into consideration multiple systemic influences over the child’s needs. Beyond diagnosis, factors such as family stressors, hospital leadership and finances, broader economic and regulatory functioning on the macrosystem, and advancements in pediatric cancer treatment all interact with the child’s experiences in distinct ways. Results suggest that incorporating developmentally appropriate play interventions and supporting the family through the process of treatment provides the environment for effective coping.