Parents' experience of cancer who have young children: a literature review

Maternal Experiences of Parenting Young Children While Battling Breast Cancer in Taiwan

BACKGROUND

Western mothers with breast cancer find themselves struggling with parenting responsibilities. Because parenting is culturally shaped, literature on ill mothers' experiences of parenting young children from a collectivist culture is limited.

OBJECTIVE

The aim of this study was to examine Taiwanese mothers' experiences of and cultural practices embedded in parenting young children while in treatment for breast cancer.

METHODS

Sixteen mothers with at least 1 child younger than 12 years were recruited from a breast cancer organization in Taiwan. Data were collected from November 2016 to June 2017 via a semistructured individual interview and analyzed using a content analysis technique.

RESULTS

Five themes, namely, "maternal limited disclosure, complementary with children's tacit knowledge," "the scar is no longer a scar but a symbol for intimate bonding," "issues of maternal absence for young children and school-aged children," "the power of 'We are a family'," and "to live a simple life and to live for one's self," elucidate how cultural beliefs and practices shape maternal parenting experiences during treatment of breast cancer.

CONCLUSIONS

The findings illustrate how Taiwanese mothers interpret their illness, contextualize illness-related messages in daily life, and maintain family ties while coping with breast cancer. The will to maintain the family's integrity, including the extended family, can empower mothers throughout the trajectory.

IMPLICATIONS FOR PRACTICE

Ill mothers may benefit from nurses' guidance on daily routines and cultural practices that they can exploit to frame illness messages for their children. Maternal efforts to change their outlook on life, vocalize their needs, and become more assertive should be acknowledged and supported.

Feeling like the sky is falling down: Experiences of parents of adolescents diagnosed with cancer in one-child families in China - A qualitative study

BACKGROUND

As a result of the one-child policy of 1979, today there are numerous one-child families with adolescents in Mainland China. Little is known about the experiences of parents of such adolescents diagnosed with cancer.

OBJECTIVES

This study explored the experiences of parents whose adolescent child was diagnosed with cancer in one-child families in China.

METHODS

A qualitative methodology based on hermeneutic phenomenology was employed. The participants were parents of adolescent cancer patients in one-child families. Data were collected using in-depth semi-structured interviews and analysed using van Manen's hermeneutic phenomenological approach. The COREQ checklist was used for this study.

RESULTS

Fourteen parents (eleven mothers, three fathers) participated in the study. One overarching theme emerged: feeling like the sky is falling down. In addition, there were five related themes: self-condemnation; 'white lies' - that is, difficulty in telling the truth; struggling with a sense of collapse; fear of losing the child and hopelessness. Almost all the participants experienced insomnia after learning about the diagnosis. In a few cases, hopelessness-induced suicidal ideation or even suicidal behaviour.

CONCLUSIONS

Parents of adolescents diagnosed with cancer in one-child families in China experienced extremely painful emotions. The truth about their child's condition not only caused immense psychological trauma but also induced pessimism about their own future.

IMPLICATIONS FOR CLINICAL PRACTICE

The experiences of parents in one-child families where an adolescent child has been diagnosed with cancer should be taken seriously. In addition, support should be provided to help parents maintain a normal life and feel hopeful for their future.

Disrupted mothering in Iranian mothers with breast cancer: a hybrid concept analysis

Background

Defining the disrupted mothering would contribute to developing strategies to support mothers with breast cancer. The aim of this study was to analyze the concept of mothering disruption using a hybrid model.

Methods

The Hybrid method for concept analysis was implemented consisting of three phases: theoretical, fieldwork, and final analysis. In the theoretical phase, the literature was searched using electronic databases including PubMed, ScienceDirect, Scopus, ProQuest, Google Scholar, CINAHL, Wiley, Ovid, Magiran, and SID from 2000 to 2020. Any quantitative or qualitative studies published in English or Persian, which were focused on mothering disruption in mothers with breast cancer were included in the study. In the phase of fieldwork, 20 mothers were interviewed to explore the aspects of mothering disruption. The interviews were transcribed and analyzed with conventional content analysis. In the final phase, an overall analysis of the two previous phases was performed.

Results

In the theoretical phase, the following attributes were determined: “disturbance in maternal identity and roles”, “maternal insensitivity and unresponsiveness: disconnection physically and psychologically”, “the career disruption process” and “biographical disruption”. The fieldwork phase explored three themes including “the unbalance between multiple roles”, “role failure”, and “reduced maternal sensitivity”. The final synthesis yielded that the main integrated elements of mothering disruption are “disease as threating maternal role and identity”, “inability to interpret and respond to child behaviors and needs”, and “support for transitioning from being patient toward maternal competency”.

Conclusion

With a deeper understanding of the term ‘disrupted mothering’ or ‘mothering disruption’, healthcare providers will have a foundation to improve cancer care, deliver effective communication and help such mothers cross this disruption and achieve restoration of their mothering role. Future research is needed to validate this concept and explore connections with health outcomes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-021-01346-w.

The Fuelbox "Young Next of Kin"-A Mixed-Methods Study on the Development and Piloting of a Communication Tool for Adolescents Coping With Parental Cancer or Death

BACKGROUND

Adolescents' ability to cope with parental cancer and death is largely dependent on information and open communication, but parents and professionals often feel uncertain in such circumstances.

OBJECTIVES

To develop and pilot a communication tool to enhance communication with adolescents living with or having lost a parent with cancer.

METHODS

A Fuelbox was developed in a 4-phased process including adolescents and professionals and piloted by 51 participants (adolescents, parents, and professionals) over 4 months. Using a mixed-methods study with a convergent design, data were collected via a questionnaire and interviews and were then merged.

RESULTS

The final "Young Next of Kin" Fuelbox consisted of 8 topics and 176 questions. Participants used the Fuelbox in different contexts, utilizing a variety of approaches. The participants found that it covered significant topics and questions important to adolescents' situation. The Fuelbox was considered a very useful and beneficial tool to promote communication with adolescents, given that users maintain awareness of voluntary participation, confidentiality, preparedness, time, and safe frames.

CONCLUSION

The Fuelbox "Young Next of Kin" seems to be a flexible and accessible communication tool in private and professional settings to enhance communication with adolescents living with or having lost a parent with cancer. As the Fuelbox is diagnosis-neutral in nature, it may be transferable to other populations and settings.

IMPLICATIONS FOR CLINICAL PRACTICE

The Fuelbox is a flexible, accessible, and useful tool for communication between adolescents and parents, and adolescents and healthcare professionals in specialist and primary healthcare settings.

Talking With Children About Prognosis: The Decisions and Experiences of Mothers With Metastatic Cancer

PURPOSE

Parents with metastatic cancer report unique concerns and challenges when discussing their illness with their minor children. Greater understanding of parents' communication experiences can facilitate these discussions. This study aimed to describe the challenges, approaches, and decisions related to discussing prognosis among a sample of mothers with metastatic cancer.

METHODS

We conducted a web-based cross-sectional survey assessing the psychosocial concerns of 224 women with metastatic cancer who had minor children. This analysis focused on participant responses to structured and open-ended questions addressing communication with their children. We used descriptive statistics to summarize responses to the structured questions and qualitative content analysis for responses to open-ended questions.

RESULTS

Nearly 80% (n = 176) reported they had discussed their prognosis with at least one of their children; 79% identified at least one barrier to these discussions. The most common obstacles were participants' uncertainty about their illness trajectory (43%) and emotional distress associated with these conversations (41%). Qualitative analyses revealed three principles that guided mothers' communication decisions: commitment to honesty and protection; child developmental readiness; and beliefs about the right time. Approaches to discussing prognosis included total honesty, using the language of chronic illness, gradual disclosure, waiting for questions, and emphasizing hope, love, and reassurance.

CONCLUSION

This study provides further evidence of the complexity and challenges of parental communication with their children about metastatic cancer. There is a need for both clinicians and researchers to identify, test, and implement evidence-based strategies to assist ill parents with their communication concerns.

Association Between Loneliness and the Frequency of Using Online Peer Support Groups Among Cancer Patients With Minor Children: A Cross-Sectional Web-Based Study

CONTEXT

Cancer patients with minor children are increasing; however, they do not receive sufficient support.

OBJECTIVE

This study aimed to investigate the association between loneliness and the frequency of using online peer support groups among cancer patients with minor children.

METHODS

A cross-sectional web-based survey was conducted from April to May 2019. Cancer patients with minor children were recruited from an online peer support group called "Cancer Parents." Individuals diagnosed with cancer and whose youngest children were younger than 18 years were enrolled. Materials included: the UCLA Loneliness Scale version 3 (UCLA-LS), K6 scale, abbreviated Lubben Social Network Scale, and the sociodemographic/clinical characteristics questionnaire. Multivariate logistics regression analysis was performed to determine the factors associated with the high loneliness group (defined as those above the median score on the UCLA-LS).

RESULTS

A total of 334 patients participated (79.9% female; mean age 43.1 years, standard deviation 5.8). The most common primary cancer type was breast (34.1%). The median score of the UCLA-LS was 45 (interquartile range 37-53). The multivariate logistics regression analysis revealed that the high loneliness group was significantly associated with the frequent use of online peer support group less than once a week (odds ratio [OR] = 0.47; 95% CI = 0.26-0.85; P = 0.012), with a smaller social network (OR = 0.78; 95% CI = 0.73-0.83; P < 0.001), and higher psychological distress (OR = 1.16; 95% CI = 1.09-1.23; P < 0.001).

CONCLUSIONS

Frequent use of online peer support groups was associated with less loneliness among cancer patients with minor children.

Young Child-Rearing Latina Cancer Survivors Living in the US-Mexico Border Region: A Qualitative Study

Background:

Despite increasing cancer incidence among young Latinas (<50 yrs.) in the US, little is known about how young, child-rearing Latinas cope with cancer in the US-Mexico border region.

Objective:

The purpose of this study was to explore how young, child-rearing Latinas described their challenges, strengths, and social support sources for coping with cancer in the US-Mexico border region.

Methods:

Nine Latinas that had been diagnosed with cancer, had at least one child 5 to 13 years old, and lived in one of two targeted border counties participated in audio-recorded, semi-structured focus groups (n = 6) or interviews (n = 3) in their preferred language (i.e., English or Spanish). Interview recordings were transcribed and inductively coded using methods based on grounded theory.

Results:

Three major themes emerged. First, in reporting their physical and emotional struggles with cancer as the most difficult time of their lives, participants described feeling alone as they navigated treatment side effects and continued fear of cancer. Second, they explained figuring out how to live day-by-day, reporting the negative impact of cancer on their families and on their ability to maintain their roles as mothers. Third, they highlighted factors that gave them the strength to fight and carry on, emphasizing their children and their inner strength.

Conclusions:

Even with a supportive family, young Latina mothers felt alone as they navigated cancer (i.e., treatment, fear, and impact on their families) and as they worked to garner the strength to overcome the stress of cancer. Interventions for young Latina survivors should be designed to address their needs, build on their fighting spirit, incorporate the family, and connect them with other survivors for personalized support. Further research is warranted to better understand cancer survivorship among child-rearing Latina mothers experiencing a cancer diagnosis in under-resourced communities like the US-Mexico border region.

Cross-sectional study of sex differences in psychosocial quality of life of long-term melanoma survivors

PURPOSE

A cancer diagnosis and subsequent treatment can have a significant impact on an individual's quality of life. Differences in quality of life by sex among long-term melanoma survivors remain unclear. The objective of this study was to describe sex differences in cancer-specific psychosocial quality of life of long-term melanoma survivors.

METHODS

Melanoma survivors 7-10 years post-diagnosis from a previously conducted population-based case-control study were recruited for a cross-sectional survey. Validated measures of psychosocial quality of life related to melanoma diagnosis were assessed. Outcomes were compared by sex using linear regression models adjusting for age, education, income, and marital status.

RESULTS

The survey response rate was 62% (433 females, 291 males; 86% stage I disease). Females were more likely to report changes in their appearance (p = 0.006) and being more fearful of recurrence (p = 0.001) or a second melanoma (p = 0.001) than males but were also more likely to report that melanoma had a positive impact on their lives (p < 0.0001). Males were more likely to agree with statements that emphasized that life's duration is limited (p < 0.0001).

CONCLUSION

Long-term melanoma survivors reported generally favorable measures of psychosocial quality of life related to their diagnosis. Females and males reported unique quality of life concerns and may require varied methods of support following a melanoma diagnosis.

The perspectives of children and young people affected by parental life-limiting illness: An integrative review and thematic synthesis

BACKGROUND

Although the death of a parent during childhood is relatively commonplace, the voices of children affected by parental life-limiting illness are under-represented in research evidence. Guidance for healthcare professionals is largely based upon professional opinion rather than the experience of children themselves.

AIM

To synthesise and appraise the literature from primary research with children about their experience of having a parent with a life-limiting illness.

DESIGN

Integrative review and thematic synthesis. Registered on PROSPERO (CRD42019094581).

DATA SOURCES

PsychINFO, Medline, Embase, Scopus and Web of Science were searched, supplemented by searches of grey literature and systematic reviews. There were no restrictions on publication date, and study quality was appraised using the Hawker checklist. Studies reporting the findings of primary research with participants under 18, whose parent has a life-limiting illness, were eligible for inclusion.

RESULTS

Twenty-one papers met the inclusion criteria (n = 13 qualitative; n = 8 quantitative), reporting on n = 18 studies from high-income countries. Findings reveal that throughout parental life-limiting illness, children strive for agency, but are often shielded and excluded by adults. The experience of living with a dying parent is emotionally demanding for children and involves significant caregiving responsibilities. However these children are not passive, developing strategies to cope with the situation and wanting to be involved.

CONCLUSIONS

The review has enabled the voices of children affected by parental life-limiting illness to be heard and will inform the development of guidance for parents and professionals.

Experiences of adults as parents with cancer: a systematic review and thematic synthesis of qualitative studies

PROBLEM IDENTIFICATION

This thematic synthesis is aimed at providing an overview of qualitative studies on parenting experiences during cancer and focuses on the investigation of the challenges parents face and the strategies they use to adapt to a new situation.

LITERATURE SEARCH

A search of five electronic databases was conducted, specifying publication dates between 1993 and 2020. Qualitative studies, which focused on parenting experiences of cancer patients with minor children from an ill parent perspective, were included in the review. Thematic synthesis was undertaken to examine the included studies by referring to a theoretical model of family resilience by Froma Walsh.

DATA EVALUATION

12,345 articles were discovered and, after assessment for eligibility, 27 studies were included in the review. The thematic synthesis involved line by line coding of the findings of the primary studies and the development of descriptive and analytical themes.

CONCLUSIONS

This review showed that parenting is a process that requires restructuring in the face of cancer. After cancer diagnosis, requirements connected to the illness and its treatments are imposed on previous family life duties.

"I'll Try My Best to be a Dad": The Experiences of Japanese Fathers with Cancer

This study explored the experiences of Japanese fathers with cancer. Twenty-four adult men undergoing cancer treatment and raising minor children (aged ≤ 19 years) participated. Data gathered using semi-structured interviews were analyzed using the grounded theory approach. One main theme- "transformed identity: cancer made me into a father"-and eight additional sub-themes were identified from the analysis. Fathers with cancer experienced changes in work and income; weakening of their bodies and minds; and a transformation from the protector of their children to the protected, which severely challenging their identities. Through interaction with their children and self-reflection, fathers started to examine fatherhood for the first time, heightening their self-awareness as fathers. Nurses can support fathers by facilitating interactions with their children while receiving treatment and by understanding and respecting the range of emotions identified in this study.

Going against patients' will? A qualitative study of how palliative health-care professionals handle competing considerations when children are excluded from parental illness and death

PURPOSE

The Norwegian Health Personnel Act (HPA §10a) obliges health professionals to contribute to meeting minor children's need for information about their parents' illness and prognosis. Previous research has shown that many parents withhold information about illness and anticipated death from their children. This study explored main considerations for palliative health-care professionals in these situations, and how they negotiate conflicting considerations of confidentiality and child involvement.

METHOD

This qualitative exploratory study involved semi-structured interviews with 11 palliative health-care professionals. Hermeneutics informed the data analysis.

RESULTS

The health professionals' main considerations were sustaining patients' hope and building trust in the professional-patient relationship. Both concerns were grounded in respect for patient autonomy. The health professionals negotiated patient autonomy and child involvement in different ways, defined in the present analysis on a continuum ranging from granting full patient autonomy to going directly against patients' will.

CONCLUSIONS

The professional-patient relationship is the primary consideration in the health care context, and decision making on the degree of children's involvement happens in a dialogical process between health professionals and patients. Close professional-patient relationships might increase the emotional impacts on health professionals, who consequently might give greater relative weight to patients' will. We propose that procedures for initiating collaboration with professionals in the child's everyday life context help health professionals involving the child without threatening trust.

Striving towards Normality in Daily Life: A Qualitative Study of Patients Living with Metastatic Gastrointestinal Stromal Tumour in Long-Term Clinical Remission

Background

This study explored how patients with metastatic gastrointestinal stromal tumour (GIST) experience the psychosocial challenges associated with their disease and its treatment, as well as how that experience influenced their practical, relational, vocational, and existential life.

Methods

This qualitative study has an explorative design and applied a phenomenological and hermeneutical approach. We conducted in-depth, semistructured interviews with 20 patients with metastatic GIST in long-term clinical remission. The gathered data were interpreted using a thematic analysis.

Results

Living with metastatic GIST, as well as the side effects of the required medication, led to changes that limited the participants' daily life. They expressed how tiredness, impaired memory, and physical challenges were among the detrimental impacts of the disease on their family life, vocational life, social life, and leisure time. Adjustments were necessary to ensure they had sufficient energy to cope with the practical and relational aspects of everyday life. Feelings of uncertainty stemming from drug resistance, disease progression, and the possibility of early death were also experienced as challenging. Half the participants stated that it was difficult to keep negative mental health issues at bay, and all of them considered the time spent waiting for their scheduled follow-up scan to be burdensome.

Conclusions

It is important to focus increased attention on how the daily practical and psychosocial life of patients with chronic cancer, including metastatic GIST, is affected by their disease. Doing so might provide health-care workers with clues regarding how best to guide and support such patients throughout their emotional journey and, therefore, to improve their quality of life. As new medical treatments can also prolong survival and induce long-term clinical remission in relation to several other forms of metastatic cancer, the findings concerning GIST reported in this study might have widespread implications.

The perceived effect of parental cancer on children still living at home: According to oncology health professionals

OBJECTIVE

How children are affected by their parent's diagnosis is limited in the literature, and children are typically not considered in current clinical practice. Despite suggestion that the patient's oncology team are well placed to support their children, this is yet to be sufficiently explored. This study aimed to explore how oncology healthcare professionals (HPs) perceive children are affected by a parent's diagnosis of cancer.

METHODS

This qualitative study was informed by principles of grounded theory and embedded within a social constructivist framework. 15 health professionals working in oncology were interviewed using a semi-structured format. Data were analysed using methods of constant comparison.

RESULTS

From the perspective of HPs, when a parent is diagnosed with cancer, their dependent children are rendered invisible. Factors within the (a) clinical healthcare system and (b) the families' psychosocial context were identified, which contribute to the invisibility of children.

CONCLUSION

HPs are well-placed to facilitate an entry point into the healthcare system for patients' children; however, this is not occurring due to children's lack of visibility. Clinical and psychosocial barriers need to be addressed to ensure HPs are visibly aware of all children and thus able to appropriately support, intervene or refer on.

The Parenting Concerns Questionnaire: A validation study with Portuguese parents with cancer

OBJECTIVES

To examine the psychometric properties of the Parenting Concerns Questionnaire (PCQ) in a sample of Portuguese parents with cancer.

METHODS

The PCQ was completed by 209 adults with cancer, who are parents of at least one minor child. Participants reported on parenting concerns, depressive and anxiety symptoms, parental stress as well as quality of life. Confirmatory factor analysis and Item Response Theory (IRT) were used to assess the psychometric properties of the PCQ. Cronbach's alpha was used to examine its reliability. Pearson correlation coefficients provided information regarding convergent validity. Criterion validity was analysed.

RESULTS

Confirmatory factor analysis confirmed the original three-factor structure. IRT indicated that most of the items were highly discriminant and better identified as moderate versus low or high levels of parenting concerns in the three dimensions of PCQ. The pattern of associations with depressive and anxiety symptoms, parental stress, and quality of life provided evidence for the convergent validity. The PCQ differentiated between parents with and without depressive symptoms.

CONCLUSION

Exploring parenting concerns provides additional relevant information about the experiences and the potential psychological distress experienced by these parents with cancer. The PCQ can be an important tool to identify parents with cancer who might benefit from psychological support regarding parenting.

Assessing competencies of healthcare professionals caring for parents with cancer: The development of an innovative assessment tool

OBJECTIVE

This paper describes the development of an assessment tool capturing competencies of healthcare professionals (HCPs) in caring for cancer patients with minor children.

METHODS

We combined the methods of clinical case vignettes and situational judgement tests (SJTs). Scenarios were created based on literature and interviews with patients, HCPs, and experts. We pretested the instrument by conducting cognitive interviews with n = 6 HCPs, who gave feedback on realism, clarity, and difficulty of the scenarios.

RESULTS

The developed assessment tool measures the following competencies: HCPs' (1) application of knowledge, (2) behavioural responses to clinical scenarios, (3) attitudes regarding the relevance of integrating the parental role in cancer care, and (4) empathic behaviour towards affected parents. Results of the cognitive interviews indicate that the scenarios are perceived as realistic and clear.

CONCLUSIONS

We provide an innovative approach by methodologically combining clinical case vignettes and SJTs. Next, the assessment tool will be applied in the context of a pilot evaluation of a newly developed training for HCPs that aims at enhancing their competencies in caring for cancer patients with minor children.

I'm Still Mom: Young Mothers Living With Advanced Breast Cancer

PURPOSE

To conduct a detailed content analysis of the theme "I'm still Mom" as described by young women living with advanced breast cancer.

PARTICIPANTS & SETTING

12 young adult women living with advanced breast cancer were recruited from across the United States.

METHODOLOGIC APPROACH

van Manen's hermeneutic phenomenologic method was used to analyze qualitative data from interviews and establish subthemes.

FINDINGS

Women were a mean age of 36 years and had at least one child. The following three subthemes emerged from the overarching theme of I'm still Mom.

IMPLICATIONS FOR NURSING

This study provides a foundation for additional research that can inform family-centered education and interventions to help align the parenting priorities of this cohort of women, as well as optimize their quality of life.

Unmet information needs predict anxiety in early survivorship in young women with breast cancer

PURPOSE

To examine variations in anxiety and longitudinal associations between unmet supportive care needs and elevated anxiety in young women (< 50 years) within 13 months of their breast cancer diagnosis.

METHODS

Two hundred and nine women recruited through Victorian Cancer Registry completed questionnaires at study entry (T1) (average 7 months post-diagnosis) then 3 (T2) and 6 months later (T3). Women completed the Hospital Anxiety and Depression Scale (HADS) and Supportive Care Needs Survey-Breast Cancer (SCNS-Breast) at each time point. Primary outcome was anxiety with six domains of SCNS-Breast (physical daily living, information, psychological, health system information, peer support, patient care and miscellaneous needs) the key predictors. Generalised estimating equations examined longitudinal associations.

RESULTS

Over the 6 months, the proportion of young women with elevated anxiety decreased (T1, 41% to T3, 35%; p = .06) as did the proportion with any moderate or high unmet needs (T1, 88%; T3, 74%; p < .01). While psychological needs and peer needs were positively associated with anxiety levels in multivariable cross-sectional analyses, in multivariable longitudinal analysis, only informational needs were associated with higher levels of anxiety (p < .001) with this association holding after adjusting for baseline anxiety levels.

CONCLUSIONS

While reducing over time, a third of young women treated for breast cancer enter early survivorship with elevated anxiety and unmet supportive care needs.

IMPLICATIONS FOR CANCER SURVIVORS

As informational needs were positively associated with future levels of anxiety, addressing needs in this domain may decrease the risk of anxiety in younger women with breast cancer.

How psychosocial interventions meet the needs of children of parents with cancer: A review and critical evaluation

INTRODUCTION

The aim of this study was to evaluate how psychosocial interventions for children aged 0-18 years of a parent with cancer meet their needs, using key needs as consumer-based "standards."

METHODS

A systematic literature review was conducted. Fifteen interventions met inclusion criteria and were assessed against six key needs identified by Ellis et al. (Eur. J. Cancer Care, 26, 2017, e12432): (1) provide children with age-appropriate information about their parent's cancer; (2) support family communication; (3) normalise and reduce feelings of isolation through peer support; (4) provide a space to share feelings; (5) individually tailor support; and (6), where appropriate, provide specialised bereavement support.

RESULTS

No intervention clearly met all six needs, but each partially addressed at least two needs, and three clearly met at least four needs. The most commonly addressed need was supporting family communication, and the least addressed need was bereavement support.

CONCLUSION

Interventions identified in this review addressed some needs of children impacted by a parent's cancer. This research provides a framework to inform the creation, modification and implementation of psychosocial support interventions that best meet the needs of these children, thereby mobilising consumer-focused service provision.

Children's Self-Reports About Illness-Related Information and Family Communication When a Parent Has a Life-Threatening Illness

Children's experiences of information and family communication when a parent has a life-threatening illness have been sparsely studied, though such information is important for the child's wellbeing. The aim of this study was to explore children's reports of illness-related information and family communication when living with a parent with a life-threatening illness. Forty-eight children, aged 7 to 19 years, were recruited from four specialized palliative home care units in Stockholm, Sweden. All but one child reported that someone had told them about the parent's life-threatening illness; however, two thirds wanted more information. A quarter of the teenagers reported that they had questions about the illness that they did not dare to ask. Half of the children, aged 8 to 12, reported that they felt partially or completely unable to talk about how they felt or show their feelings to someone in the family. Interventions are needed that promote greater family communication and family-professional communication.

Australian Hospital-Based Parenting Support for Adults with Incurable End-Stage Cancer: Parent Perspectives

Parenting support needs of patients diagnosed with incurable end-stage cancer (IESC) with young families are not addressed as part of routine hospital health care. Their support needs and experiences of hospital-based parenting support are largely unknown. The study aims to explore hospital-based parenting support delivery from patient and co-parent perspectives in context to their parenting experience and support needs. Exploratory, prospective, cross-sectional qualitative design. Semi-structured in-depth interviews with eight adult patients with IESC and four co-parents purposively recruited from a tertiary hospital in Melbourne, Australia. Findings were thematically analyzed. Parents desire support with challenging multidimensional parenting issues. Organization, health professionals (HP), and parental-based factors hinder and facilitate optimal service provision. Responsibility rests with HP to initiate parenting support. Interdisciplinary family-focused support offered throughout IESC health-care journey is key. Patient-centered family-focused support is warranted. Surmountable challenges lie with management and HPs to address barriers affecting optimal service delivery.

A summary of high quality online information resources for parents with cancer who have adolescent and young adult children: A scoping review

OBJECTIVE

Parents with cancer want information about maintaining family functioning despite cancer. This scoping review assesses what online information resources are available to help parents with cancer maintain family functioning, the quality of the available information, and whether resources provide specific advice for parents of adolescent and young adult (AYA) children.

METHODS

To identify available relevant English-language online information resources, we imitated a parental online information search using three search engines (Google, Yahoo, and Bing). Online resources from the last 10 years for parents with cancer addressing family functioning were included. These resources were rated using the DISCERN instrument-a tool for rating the reliability and quality of health information resources.

RESULTS

684 results were screened and 33 online information resources from the USA, UK, Australia, Canada, and Ireland met the inclusion criteria. Average DISCERN quality was 54/80 (95% CI:50-58), which is typical for online health information. The highest rated resources provided information for parents on supporting their AYA children's needs for information and support with feelings, but few comprehensively covered other specific AYA needs. Details on resource weaknesses as identified by the DISCERN are presented.

CONCLUSIONS

Several high-quality resources for parents with cancer were identified from multiple countries, allowing health professionals internationally to direct patients with cancer to relevant high quality online information. Highlighted limitations in resource quality and scope will guide future resource development and revision, ensuring more comprehensive high quality information is available to support families affected by parental cancer internationally.

Process-evaluation and outcome-evaluation of a training programme for healthcare professionals in oncology to enhance their competencies in caring for patients with minor children: a study protocol for a randomised controlled pilot study

INTRODUCTION

Patients with cancer having minor children experience particular burden and strains. Being patient and parent at the same time is associated with specific needs of support. Therefore, the communication of child-related and family-related issues plays an important role in patient care. This study aims at testing the feasibility of a training to improve the situation of patients with cancer having minor children and their families by enhancing the competencies of healthcare professionals (HCPs, eg, physicians, nurses, psychologists) in caring for patients with cancer having minor children. Moreover, the study aims at testing the study design and outcomes of the evaluation concept and preliminary effects of the training.

METHODS AND ANALYSIS

We will conduct a randomised controlled pilot trial with three arms (face-to-face training versus web-based training versus waitlist control group) to investigate the study aims. Primary outcome will be the competency to approach child-related and family-related topics in patients with cancer measured using comprehensive case vignettes. Secondary outcomes will be communication and attitudes regarding child-related and family-related topics and self-efficacy in clinical communication skills. Outcomes will be assessed prior to the training and after the training as well as 3 months after the training. Data will be analysed using descriptive analyses, group comparisons and linear mixed models.

ETHICS AND DISSEMINATION

The study was approved by the Local Psychological Ethics Committee of the Center for Psychosocial Medicine of the University Medical Center Hamburg-Eppendorf (LPEK-001). At the end of the study, a web-based training and a face-to-face training intervention to enhance the competencies of HCPs in caring for patients with cancer having minor children will have been systematically developed and the study design and evaluation concept will have been evaluated. The results of the study will be disseminated through peer-reviewed journals and conference presentations.

TRIAL REGISTRATION NUMBER

DRKS00015794.

Challenges and support needs of parents and children when a parent is at end of life: A systematic review

BACKGROUND

Preparing children for the death of a parent is challenging. Parents are often uncertain if and how to communicate and support their children. Many parents feel it is protecting their children by not telling them about the prognosis. Children less prepared for parental death from a terminal illness are more susceptive to later adversities. To facilitate coping and moderate for such adversities, there is a need to gain insight and understand the experience and challenges confronted by families.

AIM

This review synthesised evidence on the experiences of parents and children when a parent is at end of life to discern their challenges, support needs and factors that facilitated good practice.

DESIGN

Mixed-methods systematic review.

DATA SOURCES

Four electronic databases (CINAHL, PubMed, PsycINFO and Ovid MEDLINE) using MeSH terms and word searches in October 2018. Studies were not limited by year of publication, language or country. Grey literature searches were also completed on Google Scholar and OpenGrey.

RESULTS

In all, 7829 records were identified; 27 qualitative and 0 quantitative studies met the inclusion criteria. Eight descriptive themes were identified, further categorised into two broad themes: (1) barriers and facilitators in sharing the news that a parent is dying and (2) strategies to manage the changing situation.

CONCLUSION

Lack of understanding in relation to the parent's prognosis, denial and feeling ill-equipped were suggested as barriers for parents to share the news with their children. Engagement with social networks, including extended family relatives and peers, and maintaining routines such as attending school were suggested supportive by parents and children. Findings are limited primarily to White, middle-class two-parent families. A number of areas for future research are identified.

Maternal breast cancer and communicating with children: A qualitative exploration of what resources mothers want and what health professionals provide

OBJECTIVE

To explore the communication and resource needs of mothers diagnosed with breast cancer treated with curative intent in communicating with their young children and to identify gaps in the resources and support provided to these women.

METHODS

Data were collected via semi-structured telephone interviews from 13 mothers who were diagnosed with breast cancer while parenting a young child (age 3-12 years), and 10 health professionals in Victoria, Australia. Data were analysed qualitatively using the Framework Method.

RESULTS AND CONCLUSION

Mothers and health professionals prioritised communication with children about the cancer diagnosis; however, health professionals and mothers differed in their views of parents' communication needs both in terms of the nature of the support/information needed and the delivery of this support/information. Mothers wanted easily accessible resources that were both instructive and practical. Mothers also emphasised quality over quantity of support. Health professionals were mostly aware of mothers' needs, however, emphasised less instructive support and information. This study highlights the need for improved coordination and tailoring of psychosocial resources and supports for these parents and families communicating about a cancer diagnosis with their young children.

Understanding rural caregivers' experiences of cancer care when accessing metropolitan cancer services: a qualitative study

OBJECTIVE

To explore the experiences of cancer caregivers who live in rural Australia and travel to a metropolitan cancer health service to access cancer treatment.

DESIGN

A qualitative study using semistructured, audio-recorded interviews conducted between December 2017 and July 2018 with caregivers and social workers. Thematic analysis using interpretative descriptive techniques performed on textual interview data within a critical realist paradigm to develop understanding of rural caregivers' lived experiences.

SETTING

Participants were from rural areas attending a metropolitan cancer centre in Australia and social workers.

PARTICIPANTS

21 caregivers (16 female) of people with cancer living in rural Australia within a minimum distance of 100 km from the metropolitan cancer centre where they access treatment, and five social workers employed at a metropolitan cancer service with experience of working with rural patients and caregivers.

RESULTS

Thematic analysis developed two overarching themes: theme 1: caregiving in the rural setting describes the unique circumstance in which caregiving for a person with cancer takes place in the rural setting at considerable distance from the cancer service where the person receives treatment. This is explored in three categories: 'Rural community and culture', 'Life adjustments' and 'Available supports'. Theme 2: accessing metropolitan cancer services captures the multiplicity of tasks and challenges involved in organising and coordinating the journey to access cancer treatment in a metropolitan hospital, which is presented in the following categories: 'Travel', 'Accommodation' and 'Health system navigation'.

CONCLUSIONS

Caregivers who live in rural areas face significant challenges when confronting geographic isolation between their rural home environment and the metropolitan setting, where the patient accessed cancer treatment. There is a need for healthcare services to identify this group to develop feasible and sustainable ways to provide interventions that have the best chance of assisting rural caregivers in supporting the patient while maintaining their own health and well-being.

Web-based counseling for families with parental cancer: Baseline findings and lessons learned

Purpose: This is the first study in Switzerland to report on psychological adjustment in children of a parent with cancer using a web-based intervention during cancer therapy. Design/Sample: Twenty-two families participated in this randomized controlled web-based intervention program. Methods: Quality of life and emotional-behavioral well-being of children were examined using child self-reports, and parent proxy-reports. Furthermore, family communication and satisfaction and feedback on the web-based program were assessed. Findings: Children's first stage adjustment to parental cancer did not show detrimental patterns. The "lesson learned" in this setting emphasizes the challenge to reach families in need. The web-based program was appreciated as an additional source of information and support in this mostly highly functioning population. Conclusion: While feasibility was shown, it remains unclear how to contact families with lower psychosocial functioning.

Characteristics of the social networks of families living with parental cancer and support provided

OBJECTIVE

To examine the characteristics of the social networks of families living with parental cancer and the kind of social support they provide compared with what the families report having received.

BACKGROUND

Parental cancers are highly distressing for both parents and children. Among other concerns, families report a severe lack of social support. However, we know little about these families' private social networks, nor support provided and received as reported by network members and the family.

METHODS

Using a descriptive cross-sectional design, 16 families living with parental cancer and 130 of their network members participated. Healthy parents and network members filled out The Assistance Questionnaire-Receivers of support (AQR)/The Assistance Questionnaire-Providers of Support (AQP).

RESULTS

Network members were mainly resourceful friends (44%) and family members (42%). Only 1/3 became supporters at diagnosis, and nearly 50% had to be asked. Supporters provided a variety of types of help, especially emotional support. A match between the perception of the healthy parent and that of the network members was found for provided (p = 0.211) and received (p = 0.741) support. Supporters were satisfied with their provided support, experiencing it as rewarding and associated with few negative aspects. The STROBE checklist for observational studies was followed in reporting the results.

CONCLUSIONS

The social networks, being mainly family and friends, were able to provide different types of help, especially emotional support. A useful suggestion may be to involve supporters at an earlier stage, providing more practical support.

RELEVANCE FOR CLINICAL PRACTICE

Nurses are in a unique position to promote social support for families living with parental cancer by embracing a network focus, by emphasising the importance and potential of social support, by helping families to map their network and by teaching them how to be explicit in their requests for support.

Un dispositif innovant en psycho-oncologie pour accompagner les jeunes enfants endeuillés : La Petite Fille aux allumettes

Objectif : Perdre un parent d’un cancer à un âge précoce est un facteur de risque pour le développement psychique de l’enfant. L’objectif de cette étude qualitative est d’évaluer l’efficacité d’un groupe thérapeutique pour les enfants endeuillés, La Petite Fille aux allumettes.

Méthode : Les outils utilisés pour cette étude sont le Family Adaptation and Cohesion Scales IV pour estimer la cohésion et la flexibilité familiales, l’ERC-vf pour examiner la régulation émotionnelle des enfants avant et après la prise en charge et la théorisation ancrée pour analyser les comptes rendus des séances.

Résultats : Le cas de Tom illustre le poids des caractéristiques familiales dans l’efficacité du dispositif. Le fonctionnement rigide de la famille, avec des règles strictes qui ne peuvent être remises en question, ne favorise pas la communication parent–enfant.

Conclusion : Dans certains cas, une thérapie systémique est recommandée.

Children Navigating Parental Cancer: Outcomes of a Psychosocial Intervention

Research has evidenced a marked increase in the prevalence of cancer among younger people with up to one in five, parenting children under the age of 18 years of age. When a parent is diagnosed with cancer they experience fears and anxieties as they attempt to simultaneously manage their role as a parent, with the illness experience. Parents have expressed difficulties in knowing how to communicate appropriately with their children throughout the illness trajectory as they are primarily focused on protecting or shielding their children from knowledge of the illness. Understandably parents may become overwhelmed with significant parental stress impacting on their psychological well-being. This subsequently affects the well-being of the entire family unit, coupled with changes to routines, roles, and responsibilities. This study was carried out to examine how a group psychosocial intervention Children's Lives Include Moments of Bravery (CLIMB®) helped young children to navigate parental cancer. A qualitative research design utilizing focus group methodology, artwork and individual interviews was used to generate data from 19 participants (parents, children, and health-care professionals). Three key themes emerged from the data, navigating the diagnosis, navigating emotions and changed routines, creating spaces to talk about cancer. The findings evidenced that attending CLIMB® was a positive experience for both children and parents. It gave the children the language and opportunity to express their fears and worries. CLIMB® equipped them with tools and skills to both express and manage their negative emotions, life skills that could be transferred to other challenging life events. All techniques that created spaces to talk and appeared to have a reassuring effect on the children. The parents appreciated the professional support that the structured intervention offered to them and helped them communicate more openly with their children. Creating spaces to talk about cancer reduces mistrust and tension between parents and children, when parental cancer occurs, and hopefully minimizes future psychological and social problems.

Somatic symptoms in children who have a parent with cancer: A systematic review

BACKGROUND

This systematic review explored the occurrence and types of somatic symptoms in children (0-20 years) who have experienced parental cancer.

METHODS

We complemented a systematic literature search from PubMed and PsycInfo with a reference search. We identified 1,694 articles, which were independently screened by two authors; they further evaluated potentially relevant papers for quality and extracted the data. We found nine relevant studies (10 publications) on altogether 672 children with a parent who had cancer; four studies included a control group.

RESULTS

The studies typically focused on children's psychosocial reactions on parental cancer rather than somatic complaints, so symptom prevalence cannot be reliably summarized. Several studies were small, and the types of somatic symptoms were only specified in five studies. Somatic symptoms were reported as a measure of emotional reactions in the remaining four studies. Three studies provided longitudinal data. The main types of specific symptoms reported were eating problems, pain, sleeping troubles, and bed-wetting. Children of cancer patients tended to show an increase of unspecified somatic symptoms and pain, but evidence was inconsistent. There was a tendency that somatic complaints were associated with increased emotional distress in the children. The material did not allow for separate analysis by age group or bereavement status.

CONCLUSIONS

Children in families with parental cancer may present with somatic complaints, but the prevalence and significance is not possible to estimate due to very sparse research in this area. Health professionals or counselling providers should not overlook this possible sign of distress. Qualitative studies report significant health anxiety in these children; this may represent a specific topic for counselling in this population. Targeted studies are needed to evaluate the prevalence and significance of somatic symptoms, and especially vulnerable groups need to be identified.

Leaving footprints, not scars: a qualitative pilot study of Hispanic mothers' willingness to communicate with dependent children about an advanced cancer diagnosis

PURPOSE

US Hispanics are more likely to be diagnosed with advanced cancer as parents than their non-Hispanic white counterparts but little is known about Hispanic parents' willingness to discuss a terminal cancer diagnosis with dependent children, potentially resulting in suboptimal child coping. Therefore, we investigated Hispanic mothers' willingness to communicate with dependent children about her actual or hypothetical advanced cancer diagnosis.

METHODS

Two focus groups (n = 6 participants) and three one-on-one interviews (n = 3) were conducted in either Spanish or English among adult, Mexican-American mothers with a current cancer diagnosis of any stage residing in US-Mexico border communities. Participants reported their perceived concerns, parenting challenges, and openness to discussing an incurable cancer diagnosis with a dependent child. Audio files were transcribed into English and qualitatively coded using content analysis.

RESULTS

Participants, most with breast cancer, ranged in age from 25 to 47. Five had considered the possibility of their own death from advanced cancer and three had previously discussed this with their children. While many expected their children would carry on well without them, seven expressed concern for the emotional/spiritual well-being of their children. Mothers anticipated physical and time-based parenting challenges but wanted the opportunity to focus on themselves and their children in advance of death. All but one would be willing to discuss an advance cancer diagnosis with dependent children; four expressed the value of doing so or the potential harm of abdicating this responsibility.

CONCLUSIONS

If faced with an advanced cancer diagnosis, Mexican-American mothers are open to communicating with dependent children.

Disrupted biographies and balancing identities: A qualitative study of cancer patients' communication with healthcare professionals about dependent children

OBJECTIVE

About 14% of cancer patients live with dependent children. Healthcare professionals are well placed to help patients support their children as part of a patient-centred practice. Children tend to appreciate open communication during the course of illness, but patients often find this difficult. However, research is unclear about patients' preferences and their willingness to talk with healthcare professionals about their dependent children.

METHODS

We conducted 15 in-depth interviews with patients from haematological (N = 11) and gynaecological oncology (N = 4). The interviews and subsequent analysis focused on patients' communicative preferences, taking the theoretical framework of "biographical disruption" as a starting point and using Jenkins' concept of identity as a social, relational and dynamic process.

RESULTS

We identified two overall identities at stake for seriously ill patients with parental responsibility: "patient identity" and "parent identity." As "patients," patients were ambivalent about relating to their children, but as "parents" they wanted healthcare professionals to talk about their children.

CONCLUSION

In order to be patient-centred, clinicians should, we suggest, acknowledge that patients have these conflicting perspectives and identities, which surface at various times and situations throughout their illness trajectories. Research is needed to further explore these findings in different illness groups and cultures.

Bringing close others to the emergency department for an acute coronary event is associated with increased patient perception of threat

OBJECTIVE

Relationship quality is one of the most consistent psychosocial predictors of physical and mental health. Yet, little research examines relationship types or support within the immediate context of acute health events. We tested the unexplored role that close others play in patients' experience of threat during evaluation for acute coronary syndrome (ACS) in the Emergency Department (ED), as well as the indirect effect of close others on ACS-induced posttraumatic stress disorder (PTSD).

METHOD

Participants were 871 patients evaluated for ACS at an urban academic ED (60.86 years old; 54.08% male; 56.37% Hispanic, 19.86% Black, 16.65% White). Threat perceptions were assessed in-ED and median 3 days later. ACS-induced PTSD was assessed median 41 days later using the PTSD checklist cued to a specific stressor. Non-overlapping categories were created representing close others in the ED (i.e., spouse/significant other, child), non-close others (e.g., neighbor), or no one.

RESULTS

Patients who brought close others recalled experiencing greater threat in the ED: vs. no one, b = 0.11, p = .072; vs. non-close others, b = 0.16, p = .030. There was no direct effect of close others on ACS-induced PTSD; however, recalled threat mediated the effect of close others on development of ACS-induced PTSD, ps < .05.

CONCLUSIONS

Close others were associated with recalling greater threat during ED evaluation, which predicted ACS-induced PTSD. ACS-induced PTSD is associated with medication nonadherence, event recurrence, and mortality, highlighting the need to develop a greater understanding of the impact stressful medical environments have on patients and close others.

Exploring Lived Experiences of Married Pakistani Women Post-Mastectomy

Objective:

This qualitative descriptive exploratory study aimed to explore the lived experiences of married Pakistani women, 2 years post-mastectomy.

Methods:

Twelve participants were recruited through purposive sampling from outpatient oncology clinic from a tertiary care hospital in Pakistan. Interviews were audio-taped and transcribed, and then themes and sub-themes were identified.

Results:

Women verbalized a range of their experiences throughout the span from diagnosis to mastectomy. One over arching theme, quality of life and four main themes and their subthemes emerged from the data. Following are the themes; from history to diagnosis, worries, coping strategies, and recommendations.

Conclusions:

The study findings revealed that effective coping strategies were beneficial for these women, as these women coped well after being diagnosed with breast cancer. Strong recommendations were made by the participants for the formulation of support groups, which could help them reduce their anxiety through information exchange.

The role of depression and emotion regulation on parenting stress in a sample of mothers with cancer

PURPOSE

The aim of the current study was to investigate if and to what extent depression and emotional regulation strategies (namely, cognitive reappraisal and expressive suppression) might lead to parenting stress in a sample of mothers with cancer and in a sample of healthy mothers.

METHODS

A sample of mothers with cancer (clinical group; n = 64) and a sample of healthy mothers (control group; n = 80) were administered self-report questionnaires investigating parenting stress (the parenting stress index), depressive symptoms (the Zung depression self-rating scale) and emotion regulation strategies (the emotion regulation questionnaire).

RESULTS

Depressive levels represented the most significant predictor of maternal parenting stress in both groups (p < .001). In addition, cognitive reappraisal (p < .05) but not expressive suppression significantly predicted parenting stress exclusively in the group of mothers with cancer. Finally, cognitive reappraisal was negatively and significantly associated with time since cancer diagnosis to survey.

CONCLUSIONS

This study highlights that depressive levels and cognitive reappraisal may play a significant role in parenting stress. The systematic assessment of these variables in women with an oncological diagnosis might help mental health professionals to identify those mothers at risk of developing higher levels of parenting stress ensuring adequate support and preventing negative effects on the parent-child relationship.

The challenges on the family unit faced by younger couples affected by prostate cancer: A qualitative study

OBJECTIVE

The number of younger men being diagnosed with prostate cancer (PCa; aged ≤65) is increasing. It is recognised that PCa and treatment side effects can have a significant impact on quality of life. This study explores the challenges faced by younger couples affected by PCa with dependent children (under 18 years) or young adults (18-29 years) in their families.

METHODS

Twenty-three men with PCa and their partners were interviewed (separately) by telephone. Participants were recruited from respondents to the life after prostate cancer diagnosis (LAPCD) national survey. Men were 3 to 5 years postdiagnosis, and following a range of treatment pathways. Data were analysed using the Framework Approach.

RESULTS

Younger couples affected by PCa felt challenged by issues relating to their parental role and the dynamics within the family. Five main themes emerged: difficult conversations about PCa diagnosis; parental perceptions of the impact of diagnosis on children; parental responses to the impact of PCa on the family; shielding, coping, and normalising strategies; and levels of support.

CONCLUSIONS

A diagnosis of PCa can cause significant disruption to the family unit and the quality of life of its members. Support programmes offering guidance to children/young adults affected by PCa in their family, and addressing the concerns of parents may help families to better adapt. Encouraging clinical professionals to initiate conversations with younger couples about their children may be a way forward in directing appropriate support. Further research is needed to elucidate appropriate, effective supportive interventions.

Parental psychological distress and cancer stage: a comparison of adults with metastatic and non-metastatic cancer

PURPOSE

Parents with cancer have unique and often under-recognized psychological distress about the impact of their illness on their children. Relatively little is known about how parenting concerns may differ among patients by cancer stage.

METHODS

This is a secondary data analysis of 203 adults with cancer who had children < 18 years old from two geographically distinct areas. We used an analysis of covariance to estimate the mean differences in PCQ, depression symptom severity and anxiety symptom severity (Hospital Anxiety and Depression Scale, HADS) scores between participants with metastatic and non-metastatic disease, and Pearson's correlation coefficients to assess associations between HADS and PCQ scores by cancer stage.

RESULTS

Seventy-two percent of participants (n = 146) had metastatic solid tumor cancer. In adjusted analyses, mean PCQ scores did not significantly differ between parents with metastatic and non-metastatic disease (2.0 vs. 2.2, p = 0.06). Differences in mean PCQ scores were driven by a single question concerning the impact of death on children (2.3 vs. 2.9, p = 0.004). Mean HADS scores did not significantly differ between groups, although PCQ scores explained a greater amount of variance in HADS scores for the metastatic group as compared to the non-metastatic group.

CONCLUSIONS

With the exception of concerns about death, intensity of parenting concerns, as measured by the PCQ, was similar between parents with metastatic and non-metastatic cancer. However, parenting concerns may be more strongly linked to overall psychological distress in patients with metastatic disease. Further research is needed to clarify how parenting concerns uniquely relate to advanced stage illness.

Psychological distress, role, and identity changes in mothers following a diagnosis of cancer: A systematic review

OBJECTIVE

To systematically review findings of the impact of cancer diagnosis and treatment on mothers' psychological well-being, roles, and identity and to explore the psychosocial factors that contribute to mothers' psychological well-being.

METHODS

Six databases were searched for research articles and theses exploring the association between the impact of cancer diagnosis and treatment on mothers' psychological well-being, identity, and role, and the psychosocial factors contributing to mothers' psychological distress regardless of their cancer type and stage. The Mixed-Method Appraisal Bias Tool was used to assess the selected studies' methodological quality.

RESULTS

A total of 30 qualitative, quantitative, and mixed-method studies were deemed eligible for inclusion. Most studies reported that mothers experienced significant psychological distress, changes to or loss of parenting efficacy, maternal identity, and role. Psychosocial factors that contributed to mothers' distress included mothers' young age, presence of metastases, lower parenting efficacy, fear of cancer recurrence, higher illness intrusiveness, and lack of appropriate support. Four main themes emerged from the qualitative studies: psychological impact of cancer on mothers, changes in maternal identity and role, relationship changes and concerns for their children, and meaning-making in cancer experience.

CONCLUSIONS

Changes in mothers' psychological well-being, role, and identity occurred across cancer diagnoses, treatment, and recovery trajectories. The evidence suggests that mothers may benefit from continued and tailored psychosocial support to cope with these challenges, even after treatment is completed. Further studies with improved methodological quality are needed to explore these issues in depth.

Scoping clinicians' perspectives on pre-treatment multidisciplinary care for young women with breast cancer

BACKGROUND

Young women with breast cancer (YWBC) experience worse medical and psychosocial outcomes than their older counterparts. Early input from a multidisciplinary team via pre-treatment multidisciplinary cancer conferences (pMCCs) may be important for addressing the complex needs of YWBC. However, pMCCs are not common. This study has two parts: a survey and workshop aimed at assessing clinicians' perspectives on pMCCs, including the importance of pMCCs in the care of YWBC, as well as barriers to, and strategies for supporting their implementation.

METHODS

Survey results highlight variability across sites in the delivery of multidisciplinary care in general. However, both survey and workshop results emphasize clinicians' agreement on the importance of pMCCs and suggest that numerous practical and systems levels barriers be addressed before pMCCs can be implemented.

CONCLUSIONS

pMCCs have the potential to improve surgical treatment and psychosocial outcomes for YWBC. A combined practical and policy approach to their implementation, which sees extension of existing standards to include pMCCs, may support their adoption and subsequent audit practices to assess the effect of pMCCs on outcomes for YWBC.

Differences in Coping with Breast Cancer Between Lesbian and Heterosexual Women: A Life Course Perspective

Background: We tested a theoretical framework to explain differences in coping responses to breast cancer between lesbian and heterosexual women. Materials and Methods: Breast cancer survivors were recruited through cancer registries and community-based sampling. Cross-sectional telephone surveys were completed among self-identified lesbian (n = 330) and heterosexual (n = 595) women who were diagnosed with breast cancer. Five subscales from the Mini-Mental Adjustment to Cancer (Mini-MAC) Scale were used to measure coping with breast cancer among women post-treatment. Mediation analysis was used to examine the explanatory power of life course factors (e.g., parenting and education) in explicating the association between sexual identity and coping responses. Results: Lesbian women had lower mean scores on the anxious preoccupation and cognitive avoidance subscales (p < 0.05). These differences were moderated by age at diagnosis, with differences in anxious preoccupation and cognitive avoidance greater among women diagnosed with breast cancer before 45 years of age. Having children mediated the association between lesbian identity and anxious preoccupation, but only among women diagnosed at younger ages. College education mediated the association between lesbian identity and cognitive avoidance among women diagnosed at older ages. Conclusions: Despite previous evidence of suboptimal cancer care and gaps in supportive services, lesbian women with breast cancer demonstrate adaptive coping. This study calls for an increased focus on life course factors, both in the empirical and theoretical literature, which may partially explain some of this resiliency. Identifying mechanisms that lead to active coping can inform supportive care for both lesbian and heterosexual women.

Oregon's Familias en Acción replicates benefits for underserved cancer co-survivors through Un Abrazo Para la Familia

OBJECTIVE

Our goal in this study was to determine if we could replicate initial findings when providing the intervention, Un Abrazo Para La Familia ("Abrazo"). Abrazo is a community-focused psychoeducational preventive intervention addressing the cancer information and coping needs of low-income, underserved family members of cancer survivors, developed and first implemented in Tucson, Arizona.

METHODS

We used a preintervention and postintervention evaluation design to assess the effectiveness of replicating the Abrazo intervention with underserved Hispanic/Latino family members facing cancer as co-survivors. We describe lessons learned in an expansion of Abrazo from one region of the United States to another.

RESULTS

Portland promotoras demonstrated that when the Abrazo intervention is provided via a culturally congruent, accessible format, the significant gains in cancer knowledge and self-efficacy reported by underserved co-survivors can be replicated. This is important because Oregon represents a US region different from Abrazo's origins in the Southwest.

CONCLUSION

Our replication study provides a useful roadmap for others focusing on the psychosocial needs of Hispanic/Latino cosurviving family members of cancer. A manualized 12-hour training program based on the initial discovery and efficacy work was developed to train promotoras as a part of this study. The manual provides a clear protocol for others to replicate our intervention and evaluation procedures. Abrazo may be particularly important for family-centered care if the family does not have the cancer knowledge or self-confidence needed to fully participate.

Spousal Problems and Family-to-Work Conflict Among Employed US Adults

Using data from the 2011 National Survey of Midlife Development in the United States Refreshed Sample (N = 980), this paper examines how three types of spousal problems-poor physical health, poor mental health, and behavioral disorders-are related to respondents' family-to-work conflict (FWC) among employed adults aged 25-61. Results suggest that all three types of their spouses' problems were related to respondents' higher FWC, with their spouses' poor mental health having the strongest association. These associations were not significant after controlling for respondents' role overload, financial strain, and relationship strain. There were few variations by respondents' gender and parental status in these associations. Relationship strain played the primary role as a mediator, which was stronger for men than women. These findings support the idea of stress proliferation, suggesting that one's problems can be linked to a series of other stressors including one's spouse's FWC.