Objective: Illness remains among the leading causes of death for children in the United States. Bereaved parents are at risk for poor psychosocial outcomes, including suicidal ideation and death by suicide. Although professional ethics and national standards recommend psychosocial care for parents of children with chronic or life-limiting illnesses, there are ethical challenges associated with managing parent suicidality within a pediatric institution. Method: We present two cases illustrating the ethical challenges of responding to suicide risk in parents experiencing bereavement within pediatric institutions. Lack of systematic psychosocial support or standard operating procedures (SOP) in both cases resulted in several ethical concerns and suboptimal clinical care. Results: We reference the American Psychological Association’s Ethical Principles of Psychologists and Code of Conduct ( American Psychological Association [APA], 2017 ) and apply an ethical framework ( Andrews, 2021 ) for delivering psychological services to parents in pediatric institutions in these two cases. We describe the ethical challenges of: Conflicting interests of parent and child, multiple relationships, documentation and billing, informed consent, provider competence, and systemic racism within health care and law enforcement when managing suicide risk of grieving parents. Conclusions: We discuss practices for the ethical management of suicide risk in parents experiencing bereavement within a pediatric institution. We provide recommendations for clinical practice and organizational policy, as well as strategies to improve assessment and management of parental suicidality and suggestions for future research. Implications for Impact Statement: Clinical management of suicide risk in bereaved parents within pediatric institutions is complicated by a range of ethical concerns, which often underlie organizational barriers and practical challenges of caring for these parents. This article includes illustrative case examples, provides clinical and practical recommendations, and prepares pediatric psychologists and health care settings to develop standardized operating procedures to care for this vulnerable population.

Background: Mobile health (mHealth) apps can address health inequities and enhance access to care for individuals with immunocompromising conditions. Although hundreds of oncology apps exist, research on provider perspectives regarding their use in clinical care remains limited. Objective: This study aimed to describe oncology providers’ recommended apps, mHealth attitudes and beliefs, and perceived barriers to and facilitators of mHealth adoption. Exploratory aims examined differences based on provider type (medical vs psychosocial), provider age (<45 vs ≥45 years old), and patient population (pediatric vs adult). Methods: We conducted a cross-sectional survey administered via REDCap (Research Electronic Data Capture) to oncology providers across the United States between June and November 2024. Data were summarized using descriptive statistics. Pearson’s chi-square analyses examined exploratory group differences based on provider type, provider age, and patient age. Results: Of 188 respondents, the majority self-identified as female (150/188, 79.8%), White (161/188, 85.6%), and non-Hispanic/Latino (174/188, 92.6%). Nearly all providers (178/188, 94.7%) reported either recommending or using mHealth apps with their patients, with primary use for patient-provider communication (139/188, 73.9%). Providers perceived potential benefit across a broad spectrum of holistic care functions. Providers, on average, reported a growth mindset and confidence in their ability to learn mHealth tools and in its potential to improve care access. Key facilitators included alignment with patient needs, increased accessibility, and cost-effectiveness, while barriers included disparities in technology access, digital health literacy, and data security and privacy. Exploratory analyses showed some significant group differences by provider role, provider age, and patient age. Psychosocial providers were significantly more likely to recommend or use apps for pain management (χ21=14.34, P<.001, φ=0.28), mental health (χ21=50.54, P<.001, φ=0.53), and sleep health (χ21=25.47, P<.001, φ= 0.38). Psychosocial providers also perceived higher benefit for sleep health apps (χ21=6.40, P=.01, φ=0.19). Medical providers were significantly more likely to perceive medication management apps as potentially beneficial (χ21=10.93, P<.001, φ=0.25). Older providers (16/88, 18.2%) and adult care providers (8/32, 25%) were significantly more likely to recommend or use disease management apps compared to younger providers (5/100, 5%; χ21=8.20, P=.004, φ=0.21) and pediatric care providers (6/101, 5.9%; χ22=9.22, P=.01, Cramer V=0.22), respectively. Pediatric care providers (83/101, 82.2%) were more likely to recommend or use medical team communication apps compared to adult care providers (15/32, 46.9%; χ22=15.66, P<.001, Cramer V=0.29). Conclusions: Our study underscores the opportunity to develop inclusive mHealth solutions tailored to the diverse needs of individuals across the cancer care continuum, including those in active treatment and survivorship care. Engaging diverse medical and psychosocial providers is essential to inform clinical integration of mHealth technologies in oncology care.

Background/Objectives: Psychosocial care for siblings and caregivers of youth with cancer (SCYC) is a critical yet under-implemented component of comprehensive pediatric oncology care, as outlined by the Standards for Psychosocial Care for Children with Cancer and Their Families. Despite evidence supporting psychosocial interventions, such as integrative care interventions, as effective for stress mitigation and coping, barriers to implementation include revenue-generating funding models and siloed psychosocial disciplines, which hinder accessibility for adult caregivers within pediatric institutions and geographically dispersed families. This manuscript describes the relevant extant literature as well as a model for leveraging short-term funding opportunities and interdisciplinary collaboration to develop integrative care programs for these underserved groups. Methods: Philanthropic funding supported part-time child life specialist and creative arts therapist deployment to develop and implement integrative virtual group programs, as well as interdisciplinary integrative programs, to serve SCYC. Attendance, engagement, and qualitative feedback were used for program iteration and supported the transition to institutional funding. Results: Integrative programs provided 331 caregiver and sibling encounters during the two-year pilot. Qualitative feedback from caregivers highlighted the value of virtual services in reaching geographically dispersed families and addressing feelings of isolation among SCYC at the universal and targeted levels of care. Communication about these key outcomes led to operational funding and sustained integrated care programs. Conclusions: This manuscript illustrates a successful model of leveraging philanthropic funding to support the development of integrative care programs to serve SCYC. Future research should focus on refining the clinical and financial feasibility of such models and assessing their impact on family well-being.

BACKGROUND Mobile health (mHealth) apps can address health inequities and enhance access to care for individuals with immunocompromising conditions. Although hundreds of oncology apps exist, research on provider perspectives regarding their use in clinical care remains limited. OBJECTIVE This study aimed to describe oncology providers’ recommended apps, mHealth attitudes and beliefs, and perceived barriers to and facilitators of mHealth adoption. Exploratory aims examined differences based on provider type (medical vs psychosocial), provider age (<45 vs ≥45 years old), and patient population (pediatric vs adult). METHODS We conducted a cross-sectional survey administered via REDCap (Research Electronic Data Capture) to oncology providers across the United States between June and November 2024. Data were summarized using descriptive statistics. Pearson’s chi-square analyses examined exploratory group differences based on provider type, provider age, and patient age. RESULTS Of 188 respondents, the majority self-identified as female (150/188, 79.8%), White (161/188, 85.6%), and non-Hispanic/Latino (174/188, 92.6%). Nearly all providers (178/188, 94.7%) reported either recommending or using mHealth apps with their patients, with primary use for patient-provider communication (139/188, 73.9%). Providers perceived potential benefit across a broad spectrum of holistic care functions. Providers, on average, reported a growth mindset and confidence in their ability to learn mHealth tools and in its potential to improve care access. Key facilitators included alignment with patient needs, increased accessibility, and cost-effectiveness, while barriers included disparities in technology access, digital health literacy, and data security and privacy. Exploratory analyses showed some significant group differences by provider role, provider age, and patient age. Psychosocial providers were significantly more likely to recommend or use apps for pain management (χ21=14.34, P<.001, φ=0.28), mental health (χ21=50.54, P<.001, φ=0.53), and sleep health (χ21=25.47, P<.001, φ= 0.38). Psychosocial providers also perceived higher benefit for sleep health apps (χ21=6.40, P=.01, φ=0.19). Medical providers were significantly more likely to perceive medication management apps as potentially beneficial (χ21=10.93, P<.001, φ=0.25). Older providers (16/88, 18.2%) and adult care providers (8/32, 25%) were significantly more likely to recommend or use disease management apps compared to younger providers (5/100, 5%; χ21=8.20, P=.004, φ=0.21) and pediatric care providers (6/101, 5.9%; χ22=9.22, P=.01, Cramer V=0.22), respectively. Pediatric care providers (83/101, 82.2%) were more likely to recommend or use medical team communication apps compared to adult care providers (15/32, 46.9%; χ22=15.66, P<.001, Cramer V=0.29). CONCLUSIONS Our study underscores the opportunity to develop inclusive mHealth solutions tailored to the diverse needs of individuals across the cancer care continuum, including those in active treatment and survivorship care. Engaging diverse medical and psychosocial providers is essential to inform clinical integration of mHealth technologies in oncology care.