Token economy for managing behaviors of pediatric cancer inpatients

Background: Hospitalization for treatment of diseases including cancer amongst children may lead to developmental and behavioral disorders (Petersen, Kube, Whitaker, Graff & Palmer, 2009). This may result in decreased socialization and impairment in performance of activities of daily living (ADL), including grooming, personal hygiene, eating and drinking. Not adhering to these ADLs may make things complicated for cancer patients as their immunity is already compromised, thus making them vulnerable to developing bloodstream infections and oral complications, resulting in prolonged hospital stay. They may further exhibit behavioral problems which may not be present at the time of admission but appear gradually due to hospitalization and the treatment. Thus the aim of this study to explore efficacy of token economy (TE) in managing behaviors in paediatric inpatients diagnosed with leukaemia. Methodology: The study adopted a quasi-experimental post assessment study design with control to assess the impact of TE on activities of daily living, social interactions, adaptation to treatment and participation in engaging activities amongst paediatric cancer inpatients with leukaemia over a period of 29 days. Patients meeting the inclusion criteria were alternatively assigned to control and experimental groups. Author based semi-structure interview was used to collect data post intervention. Results: Thirty patients participated in the study. The experimental group performed better on all dimensions of ADL assessed in this study (bathing, eating, oral hygiene and grooming) and social interaction. However, the changes in treatment adaptation and participation in engaging activities did not improve significantly. Conclusion: Behavioral difficulties were present in majority of the children diagnosed with leukaemia at the time of admission. Token economy as an intervention was effective in management of ADLs and social interaction in paediatric cancer inpatients diagnosed with leukaemia.背景：包括癌症在内的儿童疾病住院治疗，可能引发发育与行为障碍（Petersen、Kube、Whitaker、Graff与Palmer，2009）。此类障碍可导致社交能力下降，以及日常生活活动(Activities of Daily Living, ADL)功能受损，涵盖梳洗、个人卫生、进食与饮水等环节。若无法遵循这些日常活动要求，本就因免疫受损而处于脆弱状态的癌症患者病情会进一步复杂化，更易罹患血流感染与口腔并发症，进而延长住院时长。患儿还可能出现行为问题——此类问题在入院时或许尚未显现，却会因住院与治疗过程逐渐浮现。因此本研究旨在探讨代币制(Token economy, TE)在管理白血病儿科住院患者行为问题中的应用效果。 研究方法：本研究采用类实验后测对照设计，以评估代币制在29天周期内，对白血病儿科癌症住院患者的日常生活活动、社交互动、治疗适应度与参与趣味活动程度的影响。符合纳入标准的患者被交替分配至对照组与实验组。本研究采用研究者自编半结构化访谈工具，于干预后开展数据收集。 研究结果：本研究共纳入30例患者。实验组在本研究评估的所有日常生活活动维度（沐浴、进食、口腔卫生与梳洗）以及社交互动方面表现更优。不过，治疗适应度与参与趣味活动程度的改善未达到统计学显著性水平。 研究结论：多数白血病患儿在入院时已存在行为困难。作为干预手段的代币制，可有效改善白血病儿科癌症住院患者的日常生活活动能力与社交互动表现。