Leukemia maintenance therapy primarily involves oral chemotherapy at home, with less frequent hospital visits, and lower intensity symptoms that are expected to have less impact on daily activities. ALL (acute lymphoblastic leukemia) experts believe it is medically safe to resume developmentally appropriate activities during maintenance, and that promoting physical activity and social engagement may mitigate the severity of symptoms, late effects, and improve quality of life.
A significant gap and variability in the education provided at the start of maintenance therapy was identified by members of the leukemia team at SickKids. Building on the success of the new diagnosis education program, a structured education intervention called REDiAL (REsuming normalcy During Acute Leukemia treatment) was created by an expert interdisciplinary team, delivered by the leukemia clinic nurses, and evaluated.
The overall goal of the education sessions is to support families’ capacity to resume a sense of normalcy, and identify those who will need additional support to adjust to maintenance therapy.
Over the past year, the education sessions were delivered to over forty families of a child diagnosed with ALL, within one month of starting maintenance therapy. Sessions were delivered both in-person and virtually to meet the needs of the caregivers. The average length of the sessions was 35 minutes. 50% of sessions were attended by one caregiver, and the other 50% was a combination of 2 caregivers, 2 caregivers and their child, or 1 caregiver and 1 child. Most (60%) sessions were delivered virtually based on caregiver preference. Notable topics included transitioning back to school in person, extracurricular activities, sleeping independently, travel, review of medications, and healthy nutrition.
The team reviewed caregiver feedback collected with a survey for ongoing tailoring of the content, length of session, and delivery. 100% of caregivers responded ‘Yes’ to ‘Did you learn something new during this education session?’, and ‘Would you recommend this session to another family?’ Caregivers also provided valuable qualitative feedback, including:
“Learning about the social aspects (school, work), dietary, and positive transitions we are being suggested to make was reassuring and comforting.”
Another caregiver noted the session helped with feeling prepared for meeting with the team on day one of Maintenance. Another caregiver asked for:
“More focus on mental health and dealing with the longevity of treatment.”
The contact nurses provided valuable field notes with each session, with unanimous reports of feeling the sessions strengthened their therapeutic relationships with their patients and respective families.
As of October 2025, REDiAL education sessions have been adopted into the standard of care for leukemia patients receiving treatment at SickKids. Evaluations of the content, delivery, and follow up remain ongoing. The team is excited to share their insight to inspire other institutions to adopt similar initiatives, and expand caregiver education to other time points in leukemia therapy.
This story was written for the spring 2026 issue of The RePORTer, POGO’s Nursing Newsletter by Tanya Pryshlak, Clinical Program Coordinator, RN, BScN, The Hospital for Sick Children. Tanya has over eight years of inpatient and outpatient experience in pediatric oncology nursing. She brings a passion for empowering patients and their families through education, and has played a crucial role in the development and roll out of the education sessions.
