"AFRONTA Emotional Care" Intervention for Family Caregivers of Children With Cancer.

The intervention "AFRONTA Emotional Care to Reduce Caregiver Overload" proposed to reduce the caregiver overload of a child with cancer through the strengthening of emotional coping strategies based on the management of anxiety, stress and depression, for which components that influence these same variables were considered from intervention studies and showing a relationship with the NIC taxonomy of nursing science. In this sense, the intervention was aimed at identifying emotional coping strategies, encouraging their use and providing new ways of coping which contribute to their well-being and stress management, which represents the main stimulus, according to the Middle Range Coping Theory. The scope of the intervention was based on providing tools for relaxation techniques, emotional support and, therefore, that caregivers have the fundamental bases for the management of anxiety, depression and stress.

On the other hand, each session was made up of a maximum of 10 people who received an intervention of 3 sessions of dialogue circles for the management of emotions supported by the technique of dialogue circles that aims to improve emotional coping and reduce caregiver overload from the creation of safe spaces (circles) that allow people to be protagonists of the situation, express with complete confidence problems, difficulties and feelings that are inherent to their role as caregivers, in addition to the expression of emotions and experiences that in a guided way they can share from an environment of confidentiality and mutual respect.

The caregivers' time is essential, therefore, the recommendation of the author like Tinoco who has had experiences in the application of dialogue circles mentions first hand that it is important not to exceed more than 3 circles because it is an unexplored population, so it can be counterproductive in the acceptability and viability of the study, since if more than 3 circles are proposed at the beginning, people may possibly reject the invitation for being too long. In addition to this, the intervention studies mentioned above also recommend a reduced number of sessions in this specific population.

Furthermore, agreements will be incorporated into the activities that allow for the appropriate use of voice, participation, and topics to be discussed. In the first circle, the facilitator will explain the methodology and dynamics of the circles, and then each participant will introduce themselves to the rest, one by one. The use of the article will be explained. This is a material object that indicates whose turn it is to speak at that moment and that the others should pay attention and remain silent. The object will be passed around the circle in the hands of the participants, giving each the opportunity to share their thoughts and feelings if they wish.

• AFRONTA Emotional Care (Other), also known as AFRONTA, Emotional Care: Group intervention in which caregivers express their feelings through the dialogue circle tool.

Primary outcomes

• Acceptability [3 months]: It is assessed using the "Intervention Acceptability" questionnaire, which consists of 37 items organized into 6 sections: Section 1. Open-ended questions: positive aspects of the intervention and areas for improvement; Section 2. Intervention content; Section 3. Delivery method; Section 4. Benefits of the intervention; Section 5. Drawbacks of participating in the study; Part 6. Overall acceptability. The questions in Parts 2 through 6 use a Likert scale ranging from 1 to 5; higher scores indicate a higher level of acceptance of the intervention and its components. In addition, the study will be evaluated based on the enrollment rate (the number of people who agree to participate divided by the total number of people who met the inclusion criteria, multiplied by 100) and the dropout rate (the total number of people who drop out of the study divided by the total number who agreed to participate, multiplied by 100).
• Feasibility [3 months]: Feasibility is assessed descriptively based on five indicators: material resources, contextual characteristics, human resources, the interventionist's training, and implementation of the intervention (aspects of clarity, comprehensiveness, and logical sequence of the information provided to participants; the ease with which the intervention activities were carried out as directed; the time it took to deliver the various components of the intervention; relevance of the components; difficulties in implementing the recommendations)

Secondary outcomes

• Caregiver burden [3 months]: Zarit Caregiver Burden Scale for Children with Chronic Illnesses: validated in Mexico by Montero, Jurado, Valencia, Méndez, and Mora in 2014, with a Cronbach's alpha of 0.84, criterion validity r = 0.46, and construct validity r = 0.36. It consists of 12 Likert-scale items (1=never, 2=almost never, 3=sometimes, 4=often, and 5=always). The cut-off scores are: 12 to 22 indicates no burden, 23 to 29 indicates mild burden, and 30 to 60 indicates excessive burden. It also consists of three dimensions or factors: the impact of care, interpersonal relationships, and self-efficacy expectations. The higher the score, the greater the burnout.

Sex: All, ages: 18 Years to any, accepts healthy volunteers

Inclusion Criteria:

* parent of a child with cancer
* primary caregiver
* experiencing a mild or excessive burden

Exclusion Criteria:

* psychological therapy, medical or psychiatric treatment for emotional problems

• Aldo Pelcastre Neri, Doctor in Nursing Science, Principal investigator, Universidad Autónoma del Estado de Hidalgo