Optimism and psychological well-being among parents of children with cancer: an exploratory study

Illness cognitions and parental stress symptoms following a child's cancer diagnosis

Objective

This research aims to explore parents' cognitive beliefs, specifically illness cognitions, in response to their children being diagnosed with cancer. This study is an initial step toward providing regular psychosocial assessment as a standard for psychosocial care for children with cancer and their families in Latvia.

Methods

Data were collected from 120 parents (mostly mothers, n = 109) as an initial evaluation of the psychosocial risks faced by families participating in the support program "Holistic and Multidisciplinary Support for Children with Functional Disabilities and Their Family Members," which was managed by the Children's Hospital Foundation at the Children's Clinical University Hospital in Riga (Latvia) from 2020 to 2023. The patients comprised 66 boys and 54 girls (M age = 7.1, SD = 4.7, range: 0-17 years) with diverse cancer diagnoses. The parents completed the Latvian version of the Psychosocial Assessment Tool [adapted from PAT 3.1], with five subscales included in the data analysis (Social Support, Child Problems, Family Problems, Stress Reactions, and Family Beliefs). The Family Belief subscale was adjusted specifically to address the unique objectives and research questions of the current study.

Results

Significant correlations were found between children's psychological problems (e.g., getting upset about medical procedures, hyperactivity, excessive use of electronic devices, etc.) and parental stress reactions after diagnosis and with self-reported symptoms of anxiety and depression. The associations were statistically significant, even after controlling for sociodemographic and medical factors such as diagnosis. The relationship between children's problems and parental stress reactions was partly mediated by Family Beliefs about illness. The most informative beliefs associated with parental stress symptoms and the family's psychosocial risk level were identified, and significant results were found according to the main component of beliefs (catastrophic vs. optimistic) that explained 42% of the variance in the Family Beliefs subscale.

Implication

Understanding the habitual responses to stress and identifying the thinking patterns of parents that lead to distorted views and maladaptive coping are essential for customizing personalized interventions to enhance treatment compliance. The Latvian version of PAT is a useful psychosocial screening measure in pediatric oncology settings.

Factors associated with changes in the quality of life and family functioning scores of primary caregivers of children and young people with primary brain tumors in Karachi, Pakistan: a prospective cohort study

BACKGROUND

There are limited data available, particularly in low- and middle-income countries (LMICs), on the long-term quality of life (QoL) and family functioning of primary caregivers of children and young people (CYPs) affected by primary brain tumors (PBTs). This study aimed to assess the factors associated with the mean change in QoL and family functioning scores of primary caregivers of CYP patients with PBTs 12 months posttreatment.

METHODS

This prospective cohort study enrolled CYPs aged 5-21 years with newly diagnosed PBTs and their primary caregivers. The study was carried out between November 2020 and July 2023. The primary caregivers of CYPs were recruited from two major tertiary care centers in Karachi, Pakistan. The primary caregivers QoL were assessed by the Pediatric Quality of Life Inventory (PedsQL) Family Impact Module. The assessment was undertaken by a psychologist at the time of diagnosis and 12 months posttreatment. The data were analyzed with STATA version 12.

RESULTS

Forty-eight CYPs with newly diagnosed PBTs and their primary caregivers (46 mothers and 2 fathers) were enrolled. At 12 months posttreatment, 25 (52%) CYPs and their primary caregivers (mothers) were reassessed, and 23 (48%) were lost to follow-up. On multivariable analysis, a significant decrease in mothers' mean 12-month posttreatment QoL and family functioning scores was associated with CYP having posttreatment seizures (beta= -10.2; 95% CI: -18.4 to -2.0) and with the financial burden associated with the CYP's illness (beta= -0.3; 95% CI: -0.4 to -0.1). However, in those cases where CYP had higher posttreatment quality of life scores (beta = 0.4; 95% CI = 0.1, 0.6) and posttreatment higher verbal intelligence scores (beta = 0.1; 95% CI = 0.01, 0.3), the mothers' QoL and family functioning scores were significantly greater.

CONCLUSION

We found a significant decrease in QoL of mothers who had a high financial burden and whose CYP had posttreatment seizures. However, those whose CYPs had higher posttreatment verbal intelligence scores and quality of life scores had significantly greater QoL scores. Identification of the factors that influence primary caregivers QoL has the potential to aid in the development of targeted strategies to alleviate stressors and improve the overall quality of life for primary caregivers and their children who are at high risk.

Sleep and psychological characteristics of children with cancers and type 1 diabetes and their caregivers

OBJECTIVES

Children with chronic illnesses and their parents are more at risk to develop sleep problems, which are linked to worse psychological and physical well-being. This study aimed to assess sleep patterns and their connections with psychological outcomes in children with type 1 diabetes (T1D) and cancer and their caregivers, compared to a control sample. In addition, we explored the associations between caregiver and child's sleep quality across the three groups.

METHODS

We enrolled 56 children with T1D, 33 children with cancer, and 61 healthy children between 7 and 15, and their respective caregivers. Caregivers filled out an ad-hoc survey assessing their sleep disturbances, parenting stress, general well-being, anxiety, and their children's sleep patterns and psychological adjustments.

RESULTS

Children with cancer showed lower sleep quality than the other groups. Moreover, worse psychological adjustment was associated with greater sleep disturbances in both clinical groups. As for caregivers, the cancer group reported the worst sleep quality and greater anxiety compared to the other samples. Greater anxiety was also linked to worse sleep quality. Furthermore, greater sleep problems in children were associated with poorer caregivers' sleep quality in the whole sample and the T1D group.

CONCLUSIONS

A better understanding of sleep patterns and problems for chronically ill children and their parents is fundamental to provide adequate care for these vulnerable populations. Furthermore, an illness-specific approach may better inform and guide the practitioners in clinical practice.

Coping Strategies in Greek Parents of Children with Cancer

INTRODUCTION

Childhood cancer is a life-threatening, chronic condition and treatment may extent for several years. The diagnosis of cancer in children could stress intensely their parents.

AIM

To explore coping strategies utilized by Greek parents who have children with cancer.

MATERIAL AND METHODS

Eighty-five parents of children with cancer, admitted for treatment at the in-patient unit of a Paediatric Hospital in Athens completed a questionnaire with demographic and their children's disease related characteristics and the Family Crisis Oriented Personal Evaluation Scale.

RESULTS

Sixty mothers (70.6%) and 25 fathers (29.4%) completed the questionnaire. A percentage of 29.4% of the parents included in this study considered themselves anxious. Elementary or secondary school graduates scored higher in Seeking Spiritual Support (p = 0.013). Stay-at-home or unemployed parents scored lower in the subscale of Passive Appraisal (p = 0.012). Parents who were very well informed tended to exhibit more frequently passive appraisal behavior (p = 0.004). Parents whose child had Hodgkin's lymphoma scored higher in the subscale of Acquiring Social Support (p = 0.034). Statistical significance was found between parent's strategies of Seeking Spiritual Support and the gender (girls) (p = 0.036), as well as the treatment problems (p = 0.008) of hospitalized children.

CONCLUSIONS

This study may help health professionals understand Greek families' coping strategies when they have a child with cancer. Appropriate knowledge could significantly help them in the field of planning and implementation of personalized care in order to achieve optimal therapeutic outcomes.

Optimism and symptoms of anxiety and depression among Chinese women with breast cancer: the serial mediating effect of perceived social support and benefit finding

OBJECTIVE

This research examines the direct and indirect relationships between optimism, perceived social support (PSS), benefit finding (BF), and anxiety and depressive symptoms among Chinese women with breast cancer (BC).

METHODS

We recruited 512 patients, aged averagely 47.46(SD = 8.51) years from two hospitals located in Hunan province, China. The variables were assessed using the Optimism-Pessimism Scale (OPS), the Multidimensional Scale of Perceived Social Support (MSPSS), the Benefit Finding Scale (BFS), and the Hospital Anxiety and Depression Scale (HADS). Path analyses were conducted by Amos version 24.0 for Windows to test the hypothesized serial mediation model.

RESULTS

Path analyses suggest a significant negative association between optimism and symptoms of anxiety and depression. The relationship was mediated by BF (β = -0.085, SE = 0.015, 95% CI [-0.126, -0.055]), and by BF together with PSS (β = -0.027, SE = 0.007, 95% CI [-0.047, -0.017]). The difference comparison between the two indirect effects was significant (β = 0.057, SE = 0.015, 95% CI [0.034,0.101]).

CONCLUSIONS

Our findings suggest that PSS, and BF are important mediators through which optimism may buffer symptoms of anxiety and depression among Chinese BC patients. Clinicians and healthcare practitioners should be aware of the importance of patients' emotional health and endeavor to offer emotional support, facilitate their capacity to improve their quality of life.

Depressive and Anxiety Disorders of Parents of Children with Cancer

Every year in Poland there are approximately 1200 new cases of malignant tumours in children and adolescents. Leukaemia, CNS tumours, and lymphomas are the most frequently diagnosed cancers. Coping with a child’s illness is challenging, which is why many parents suffer from anxiety, depression disorders, and even PTSD (post-traumatic stress disorder). The aim of this study is to assess the anxiety and depression levels of carers of children with cancer. Method: The study participants were 101 carers of children suffering from cancer. The study was conducted using standardized questionnaires: the Zung ccale, HADS scale, and Karnofsky scale, and three questionnaires designed by the author. Results: According to the results of the Karnofsky scale, carers’ anxiety and depression levels were negatively affected by their children’s poor performance. The younger age of children significantly correlated with the severity of depression in their parents. HADS and Zung scale anxiety levels were observed to have statistically significant effect on the severity of depressive disorders. Conclusions: Receiving a diagnosis of childhood cancer contributes to the incidence of depression and anxiety disorders among carers. Carers’ anxiety and depression levels were strongly associated with their child’s age and their child’s performance.

Eudaimonic and Hedonic Psychological Well-Being among Parents of Children with Cancer before and during the COVID-19 Pandemic: A Comparative Cross-Sectional Study

The main aim of this study was to analyze the eudaimonic and hedonic well-being of parents of children with cancer by considering the role of a global stressor-the COVID-19 pandemic. One group of parents was assessed during the COVID-19 pandemic, and the other was assessed before it occurred. It was hypothesized that there may be a cumulative effect of stress, with parents expressing lower well-being during the pandemic due to the accumulation of stress related to their child's illness and the pandemic. In total, 310 parents participated in the study. Following propensity score matching, 111 pairs were established. The results of the comparative analyses did not support the hypothesis, as the groups did not differ significantly in their reported levels of either eudaimonic (F (1.93) = 0.11, p = 0.75, ηp2= 0.001) or hedonic well-being (F (1.100) = 0.02, p = 0.89, ηp2 = 0.0001). These findings showed a limited effect of the COVID-19 pandemic on the well-being of parents of children with cancer. The oncological disease of a child is likely to be the central and the strongest factor for the parents, meaning that an additional, global stressor does not cause deeper exacerbation of their well-being.

Readiness for hospital discharge in primary caregivers for children with acute lymphoblastic leukaemia

AIM

To investigate existing status and factors affecting the readiness for hospital discharge in primary caregivers for children with acute lymphoblastic leukaemia in China.

BACKGROUND

Acute lymphoblastic leukaemia is the most common childhood cancer, but there is not enough research on the readiness for hospital discharge.

DESIGN

A cross-sectional study was performed by convenience sampling and questionnaire survey.

METHODS

A self-developed questionnaire of general and clinical characteristics of patients, self-developed questionnaire of general status of family and primary caregivers, questionnaire of readiness of hospital discharge scale and social support rating scale for primary caregivers were delivered to 264 primary caregivers of childhood acute lymphoblastic leukaemia patients. Data collection was carried out 24 h before discharge at bedside. In this study, the STROBE checklist was followed.

RESULTS

In total, 253 patients aged 0-16 years, including their primary caregivers in the hospital, were included from November 2016 to August 2017. Based on the readiness scale, the total mean score of readiness was 157.36. Based on the social support scale, the total mean score was 42.17. According to multivariate analysis, periods of chemotherapy (p < .001), complications (p = .019), family economic situation (p = .023), understanding of leukaemia (p < .001), objective support (p = .004), subjective support (p < .001) and availability of support (p = .045) were the main influencers of readiness.

CONCLUSIONS

The readiness for hospital discharge in primary caregivers for childhood lymphoblastic leukaemia patients is not satisfactory in China.

RELEVANCE TO CLINICAL PRACTICE

This study has implications for public health administration, asking for better community services and disease education. In addition, more effort should be made to provide high-quality family and primary caregiver assessments and discharge education by nurses.

Unveiling the neural underpinnings of optimism: a systematic review

Optimism is a personality trait strongly associated with physical and psychological well-being, with correlates in nonhuman species. Optimistic individuals hold positive expectancies for their future, have better physical and psychological health, recover faster after heart disease and other ailments, and cope more effectively with stress and anxiety. We performed a systematic review of neuroimaging studies focusing on neural correlates of optimism. A search identified 14 papers eligible for inclusion. Two key brain areas were linked to optimism: the anterior cingulate cortex (ACC), involved in imagining the future and processing of self-referential information; and the inferior frontal gyrus (IFG), involved in response inhibition and processing relevant cues. ACC activity was positively correlated with trait optimism and with the probability estimations of future positive events. Behavioral measures of optimistic tendencies investigated through the belief update task correlated positively with IFG activity. Elucidating the neural underpinnings of optimism may inform both the development of prevention and treatment strategies for several mental disorders negatively associated with optimism, such as depression, as well as help to foster new resilience promotion interventions targeting healthy, vulnerable, and mentally ill individuals.

The Physical Health of Caregivers of Children With Life-Limiting Conditions: A Systematic Review

CONTEXT

Parental caregiving for a child with a life-limiting condition (LLC) is complex physical and mental work. The impact of this caregiving on parents' physical health is unknown.

OBJECTIVES

(1) To review existing evidence on the physical health of parents caring for a child with a LLC and (2) to determine how physical health of parents is measured.

DATA SOURCES

Medline, Embase, PsycINFO, and Cumulative Index of Nursing and Allied Health Literature were searched.

STUDY SELECTION

Peer-reviewed articles were included if they reported primary data on the physical health of a caregiver of a child with a LLC. Studies were excluded if they described only the caregiver's mental health or if the caregivers were bereaved at the time of data collection.

DATA EXTRACTION

Of 69 335 unique citations, 81 studies were included in the review.

RESULTS

Caregiver health was negatively impacted in 84% of studies. Pain and sleep disturbance were the most common problems. Ways of measuring the physical health of caregiver varied widely. We found an absence of in-depth explorations of the social and economic contexts, which could potentially mitigate the impact of caregiving. Furthermore, we find health interventions tailored to this group remain largely unexplored.

LIMITATIONS

Studies were heterogenous in methodology, making comparisons of results across studies difficult.

CONCLUSIONS

These findings support the need for improving access to interventions aimed at improving physical health in this population. The rate of health-seeking behaviors, preventive health care access and screening for health conditions is understudied and represent important directions for further research.

Otimismo e ganho percebido em cuidadores de crianças com câncer

Com o objetivo de analisar as relações entre otimismo e ganho percebido em cuidadores de crianças com câncer, constituiu-se uma amostra de conveniência de 60 cuidadores, com média de idade de 36,5 anos (DP=9,17), 81,7% de mulheres, em um hospital de referência. Utilizaram-se os instrumentos: Teste de Orientação da Vida, Inventário de Desenvolvimento Pós-Traumático, e questionário sociodemográfico e clínico. Após análise estatística descritiva e inferencial, verificou-se correlação positiva entre otimismo e ganho percebido (percepção de recursos e competências pessoais). Otimismo e ganho percebido também se associaram às variáveis clínicas e sociodemográficas: cuidadores casados e com crianças fora de quimioterapia referiram maior ganho percebido; e cuidadores cujos filhos tinham mais tempo de tratamento, se mostraram mais otimistas e com maior ganho percebido. Conclui-se que características individuais e clínicas devem ser consideradas em intervenções com foco na ressignificação da experiência de ter um filho com câncer e o crescimento frente à adversidade.

Predictors of Resilience Among Parents of Children with Cancer: Cross-Sectional Study

Purpose

Resilience is an ability to overcome adversities in response to a potentially traumatic event. It relieves parents’ discomfort and builds personal capacity when facing a stressful situation like childhood cancer. Therefore, the study’s objective is to assess the magnitude of resilience and its predictors among the parents of children with cancer at Jimma medical center, Ethiopia, 2020.

Methods

The institutional-based cross-sectional design was employed on 126 parents of children with cancer at Jimma Medical Center. All study populations who attend the hospital from February 25 to April 25, 2020, and fulfill the inclusion criteria were included. Data were entered into Epi data version 4.6.0.2 and analyzed by SPSS version 25. Descriptive analysis was used to describe the study variables. Furthermore, linear regression analysis was calculated to assess predictors of resilience.

Results

The level of resilience among parents’ children with cancer were a mean scored 51.41±12.02. In this study, factors associated with resilience were receiving support from friends (β=5.67, 95% CI=1.58, 9.77; P=0.007), attend recreational activities (β=13.8, 95% CI=5.32, 22.37; P=0.03) and receiving health information from health care professionals (β=6.37; 95% CI= (1.75, 11.00), P=0.007), parents depression (β= −0.827, 95% CI= (−1.619,-0.034), P=0.041) and parents stress (β =−0.88,95% CI (−1.54,-0.23), P=0.031).

Conclusion

The magnitude of resilience among parents of children with cancer was low relative to other studies. Support from friends, attending recreational activities, and receiving health information from health care professionals were positively associated with resilience. In contrast, parents’ depression and stress were negatively associated with resilience.

A Systematic Mixed-Studies Review of Hope Experiences in Parents of Children With Cancer

BACKGROUND

Hope is negatively associated with parental psychosocial distress and psychological maladjustment as well as an important aspect of emotional well-being and coping for adults with cancer and their caregivers. Yet, little is known about hope experiences of parents of children with cancer.

OBJECTIVE

The aim of this study was to comprehensively describe hope experiences in parents of children with cancer using a systematic mixed-studies review.

INTERVENTION/METHODS

Psych INFO, PubMed, Academic Search Premier, and CINAHL databases were used to retrieve articles published in English between January 2005 and October 2019. Using the systematic mixed-studies review convergent design, qualitative and quantitative data were collected and extracted followed by qualitative synthesis. Seventeen articles met the inclusion criteria. Exclusion criteria were systematic reviews, nonresearch articles, case reports, and abstracts.

RESULTS

Hope is a fundamental source of strength and inner guidance for parents. Findings suggest that hope is negatively correlated with parental psychological distress symptoms and coping dysfunctions. Religiosity, spirituality, and adequate provider-parent communication may strengthen hope in parents.

CONCLUSION

Parental hope may help minimize psychological distress and maladjustment after a child's cancer diagnosis. Open communication channels between providers and parents are critical in preserving hope. An understanding of religiosity, spirituality, optimism, and sociodemographic variables may inform parental psychosocial interventions.

IMPLICATIONS FOR PRACTICE

Early identification of parents with psychological distress is critical as they may struggle more in the absence of hope. Targeted psychosocial interventions may help parents of children with cancer cope better. Ongoing assessments of spiritual needs may be important in sustaining hope.

Well-being in parents of children with cancer: The impact of parental personality, coping, and the child's quality of life

The aim of the study was to investigate the impact of parental personality, coping, and the child's quality of life on the well-being of parents of children treated for cancer. The study included 99 parents (63 mothers and 36 fathers), 41 parents during child's intensive treatment, 23 parents whose child completed intensive treatment, and 25 parents of children who completed treatment at least five years ago. The results of multivariate study have confirmed the predictive role of parental personality (especially Neuroticism); emotion-focused coping styles, and the child's quality of life (especially physical functioning) on parental well-being. About 60% of the variance in parental well-being can be attributed to the predictors. Assessing parental personality functioning and coping styles can help us identify those parents who are less emotionally stable, more prone to emotionally focused coping styles, and most likely to experience poorer well-being. Improved assessment may contribute to the development of further psychological interventions.

Progressive Muscle Relaxation and guided imagery as techniques to enhance the way of coping of parents of children with malignancies: Findings from a randomized controlled trial

PURPOSE

The aim of this study was to test the effectiveness of relaxation techniques in altering the coping strategies that were employed by the parents of children with malignancy on active treatment.

METHODS

It was a randomized non-blinded controlled trial, including pre - and post assessments, comparing a 3-week relaxation intervention with the standard psychological care. Participants were recruited consecutively from two Public Pediatric Oncology - Hematology Departments in Cyprus and Greece. Fifty four parents of children hospitalized with a malignancy, were randomly assigned either to the intervention group (n = 29), receiving the Progressive Muscle Relaxation (PMR) and Guided Imagery (GI) Relaxation Techniques or to the control group (n = 25) receiving only the Standard Psychological Care by nurses and psychologists. Data were collected with the Questionnaire of 'Ways of Coping Checklist' (WofCC).

RESULTS

The results showed that the intervention did not have an impact on the coping strategies that parents employed as these are reflected on the WofCC' factors. The results showed that parents in both intervention and control group prefer using positive ways of coping in stressful situations: positive approach, positive re-evaluation and prayer/daydreaming.

CONCLUSIONS

The findings did not support the utilization of PMR and GI as coping strategies altering interventions in this clinical context. However, these findings should be interpreted in light of the short duration of the intervention that under these specific circumstances might have required a more lengthy approach for coping strategies to be altered. Furthermore, the stress relieving properties of these interventions could fortify (although not altering) existing coping strategies.

Parental Uncertainty: Parents' Perceptions of Health-Related Quality of Life in Newly Diagnosed Children With Cancer

BACKGROUND

Parents of children with cancer are predisposed to psychological distress symptoms, such as anxiety, depression, and uncertainty. This vulnerability may exacerbate underlying mood disturbances, including trait anxiety and depression, and influence parents' perception of health-related quality of life (HRQOL) in their children.

OBJECTIVES

This study examined the relationship between parental uncertainty and parent proxy reports of HRQOL in newly diagnosed children with cancer.

METHODS

A longitudinal descriptive approach was used to examine the relationship between parental uncertainty and parent proxy reports of HRQOL in 55 parent-child dyads. Parental trait anxiety, depression, and perceived social support were evaluated as potential predictor variables.

FINDINGS

Parents of newly diagnosed children with cancer reported lower parent proxy HRQOL scores. Parental uncertainty was prevalent and affected parents' perceptions of HRQOL three months following diagnosis; however, higher social support scores buffered these negative effects.

Effect of the Promoting Resilience in Stress Management Intervention for Parents of Children With Cancer (PRISM-P): A Randomized Clinical Trial

IMPORTANCE

Parents of children with serious illness, such as cancer, experience high stress and distress. Few parent-specific psychosocial interventions have been evaluated in randomized trials.

OBJECTIVE

To determine if individual- or group-based delivery of a novel intervention called Promoting Resilience in Stress Management for Parents (PRISM-P) improves parent-reported resilience compared with usual care.

DESIGN, SETTING, AND PARTICIPANTS

This parallel, phase 2 randomized clinical trial with enrollment from December 2016 through December 2018 and 3-month follow-up was conducted at Seattle Children's Hospital. English-speaking parents or guardians of children who were 2 to 24 years old, who had received a diagnosis of a new malignant neoplasm 1 to 10 weeks prior to enrollment, and who were receiving cancer-directed therapy at Seattle Children's Hospital were included. Parents were randomized 1:1:1 to the one-on-one or group PRISM-P intervention or to usual care. Data were analyzed in 2019 (primary analyses from January to March 2019; final analyses in July 2019).

INTERVENTIONS

The PRISM-P is a manualized, brief intervention targeting 4 skills: stress management, goal setting, cognitive reframing, and meaning making. For one-on-one delivery, skills were taught privately and in person for 30 to 60 minutes approximately every other week. For group delivery, the same skills were taught in a single session with at least 2 parents present.

MAIN OUTCOMES AND MEASURES

Participants completed patient-reported outcome surveys at enrollment and at 3 months. Linear regression modeling evaluated associations in the intention-to-treat population between each delivery format and the primary outcome (Connor-Davidson Resilience Scale scores, ranging from 0 to 40, with higher scores reflecting greater resilience) and secondary outcomes (benefit finding, social support, health-related quality of life, stress, and distress) at 3 months.

RESULTS

In total, 94 parents enrolled, were randomized to 1 of the 3 groups, and completed baseline surveys (32 parents in one-on-one sessions, 32 in group sessions, and 30 in usual care). Their median (interquartile range) ages were 35 to 38 (31-44) years across the 3 groups, and they were predominantly white, college-educated mothers. Their children had median (interquartile range) ages of 5 to 8 (3-14) years; slightly more than half of the children were boys, and the most common cancer type was leukemia or lymphoma. One-on-one PRISM-P delivery was significantly associated with improvement compared with usual care in parent-reported outcomes for resilience (β, 2.3; 95% CI, 0.1-4.6; P = .04) and for benefit finding (β, 0.5; 95% CI, 0.2-0.8; P = .001). No significant associations were detected between either platform and other parent-reported outcomes.

CONCLUSIONS AND RELEVANCE

When delivered individually, PRISM-P was associated with improved parent-reported resilience and benefit finding. This scalable psychosocial intervention may help parents cope and find meaning after their child receives a diagnosis of a serious illness.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT02998086.

A Qualitative Study Exploring Coping Strategies in Chinese Families During Children's Hospitalization for Cancer Treatment

PURPOSE

To explore how Chinese families cope with children's hospitalization for cancer treatment.

DESIGN AND METHODS

A descriptive qualitative inquiry was employed. Semi-structured interview was conducted in four pediatric oncology departments in four hospitals from November 2017 to June 2018. The interviews focused on how families cope with the challenges resulting from their children's hospitalization for cancer treatment. Twenty one parents participated into the study.

RESULTS

Four categories related to family coping strategies emerged from the data, including increasing family strength, maintaining optimistic thoughts, seeking external support, and not disclosing the unfavorable information.

CONCLUSIONS

Families had adopted multiple coping strategies to handle the challenges caused by children's hospitalization for cancer treatment. The influences of Chinese culture on family coping should be taken into consideration during family-centered interventions development. Further studies could analyze whether the spouse perspectives are independent from one another and whether the coping strategies change as the time of hospitalization.

PRACTICE IMPLICATIONS

This study has reminded nurses' to become more concerned about the influences of culture on families' coping strategies during this challenging period. Other nurses in the world could understand how to enhance family coping strategies of Chinese clients.

Parent and Child Preferences and Styles of Communication About Cancer Diagnoses and Treatment

Communication challenges frequently occur among families and health care providers of children with life-threatening conditions. These obstacles compound concerns related to children’s diagnoses and treatment, the family’s quality of life, and delivery of care. Developmentally appropriate and validated methods of addressing the communication preferences of families with chronically ill children are limited. This study used six focus groups to determine child and parent preferences and styles of communication centering on new diagnoses and changes in prognosis. Hypothetical situations were used to minimize feelings of self-consciousness among school-aged and adolescent participants. Qualitative analyses (interrater reliability 75%) of child and parent responses revealed 3 categories and 11 subcategories or themes. The category of Characteristics of Communication Exchange included (1) how to tell, (2) who should tell, (3) when to tell, (4) who should be included, and (5) what to tell. The Knowledge and Understanding category included themes of (1) side effects of treatment, (2) what children understand, and (3) questions when being diagnosed. The category of Feelings and Emotions included themes of (1) feelings about changes in prognosis, (2) children’s feelings on being informed, and (3) coping and emotional regulation. Results reveal a need for developmentally appropriate, evidence-based education to inform parents on how, what, and when to communicate information concerning their child’s disease, as well as instructions around facilitating those discussions. Moreover, a need for professional education and training programs for providers is demonstrated by some parental dissatisfaction with bedside manner and disclosure of information. The data collected from this study lay a foundation for future research in communication as a principal factor in quality of life for pediatric patients and their families.

Stress-mediated quality of life outcomes in parents of disabled children: A case-control study

BACKGROUND

The purpose of the present study was to resolve whether caregiving for a child with disability influences the physical and mental health of the caregivers and whether stress is related to the quality of life of the caregivers.

METHODS

The Parental Stress Scale questionnaire for the assessment of parental stress and the Short Form-12 version 2 questionnaire for the assessment of physical and mental health quality of life were distributed among 69 parents of developmentally disabled children and 137 parents of healthy children (control group). Various sociodemographic factors were also included.

RESULTS

A significant difference was seen between the two groups in terms of employment, presence of disabled sibling, smoking, and physical activity. Parents of developmentally disabled children had significantly higher stress levels and worse mental health-related quality of life. Overall physical health quality of life was similar between cases and controls. Stress had a negative correlation with both mental and physical health quality of life of the parents.

CONCLUSION

Stress related to raising a child with disability negatively influences the parental quality of life. Stress management aiming at its prevention and reduction might be significant aspects of intervention for the improvement of the quality of life of the caregivers.

Health satisfaction and family impact of parents of children with cancer: a descriptive cross-sectional study

BACKGROUND

The impact on parents of coping with a child who has cancer can be both severe and multifarious. Considerable distress persists throughout the treatment phase, persisting even after completion of treatment with heightened anxiety and stress associated with thoughts of recurrence or relapse.

AIM

The purpose was to investigate the links between parents' satisfaction with the health care offered to their child with cancer and the impact on families of caring for such a child (including their health-related quality of life) in a Middle Eastern country.

STUDY DESIGN

A descriptive, correlational, cross-sectional design was adopted. Arabic versions of parent-completed, validated instruments were completed by 113 parents whose child had cancer.

RESULTS

Family relationship was found to be the best functioning domain, and daily activities were seen to be the poorest. In general, parents expressed satisfaction with their child's health care, but inadequate attention had been paid to their emotional needs. Cases in which children were reported to exhibit more emotional and behavioural problems correlated with greater negative impact on the family and disrupted family functioning.

DISCUSSION

Parental quality of life was more severely affected than family quality of life. This results from mothers taking up most of the caregiver burden, and the impact on mothers was significantly greater than that on fathers. Children were protected from stress and anxiety by their mother. This burden on mothers resulted in deficits in emotional, social and physical functioning.

PRACTICE AND POLICY IMPLICATIONS

Nurses and other health professionals should redress the balance between family-centred care strategies and child-centred approaches. Effort is needed to provide psychological support to parents by ensuring adequate preparation of staff, especially nurses, to recognise need and provide support in a therapeutic environment. Support may be needed for years after the diagnosis. This is a health professional role that may currently be neglected, and for which training is essential.

Relationship Between Coping Strategies, Religious Attitude, and Optimism of Mothers of Children With Cancer

INTRODUCTION

The purpose of this study was to examine the relationship between coping strategies, religious attitude, and optimism of mothers of children with cancer.

METHOD

The sample was 97 mothers of children with cancer. To collect data, the Coping Strategy Questionnaire, Religious Attitude Scale, and Life Orientation were used.

RESULTS

There were positive correlations between the total score of Coping Strategy Questionnaire and emotional scores of Religious Attitude Scale ( r = 0.170, p = .04). The correlation relationship between mothers' coping, religious tendencies, and optimism tendencies was not significant ( p > .05). There were also positive correlations between Coping Strategy Questionnaire Social Support Seeking subscale and the total scores of Religious Attitude Scale ( r = 0.189, p = .03) and Life Orientation Test ( r = 0.183, p = .03).

DISCUSSION

Mothers with a higher religious attitude had bettter social support and were more optimistic. These results will contribute to understanding the influence of religion in different cultures.

Correlates of Positive Aspects of Caregiving Among Family Caregivers of Patients with Acute Myeloblastic Leukaemia

To evaluate the positive aspects of caregiving and its sociodemographic and clinical correlates in family caregivers of patients with Acute Myeloblastic Leukaemia (AML). A total of 30 caregivers of the patients with AML were evaluated on the Scale for Positive Aspects of Caregiving Experience (SPACE), Family Burden Interview (FBI) and Schedule and Caregiver Strain Index (CSI). On the SPACE, the mean score was highest for the domain of motivation for the caregiving role, followed by the domain of 'caregiving personal gains', 'caregiver satisfaction' and least score was seen in the domain of 'self-esteem and social aspect of caring'. All the SPACE domains were negatively correlated with financial burden, disruption of routine family activities, disruption of family interaction, physical health and subjective burden domains of FBI. Effect on physical health of others domain of FBI correlated negatively with all domains of SPACE except 'self esteem and social aspect of caregiving'. FBI total objective burden was negatively correlated with motivation for caregiving role, caregiver satisfaction and total SPACE score. All SPACE domains were negatively correlated with adaptation and inconvenience domains and total CSI score. Lower level of positive caregiving experience is reported by caregivers who experience high level of caregiver burden.

Benefit Finding and Quality of Life in Caregivers of Childhood Cancer Survivors: The Moderating Roles of Demographic and Psychosocial Factors

BACKGROUND

Benefit finding, or finding positive outcomes in the face of adversity, may play a role in predicting quality of life (QoL) among caregivers, but mixed results suggest that other factors may moderate this relationship.

OBJECTIVE

This study examined demographic and psychosocial moderators of the association between benefit finding and QoL among caregivers of childhood cancer survivors.

METHODS

Caregivers of childhood cancer survivors (n = 83) completed measures of benefit finding, QoL, coping, optimism, social support, caregiving demand, posttraumatic stress, and demographics.

RESULTS

The relationship between benefit finding and QoL was moderated by caregiver age, marital status, socioeconomic status, geographic location, acceptance and emotion-focused coping, optimism, caregiving demand, and posttraumatic stress. Benefit finding was more strongly related to QoL among caregivers with fewer demographic/psychosocial resources.

CONCLUSIONS

Results suggest that finding benefits in the cancer experience may have a greater positive impact for caregivers with relatively fewer demographic and psychosocial resources and may have less of an impact for caregivers with relatively greater resources. Findings further point to the complex nature of QoL among caregivers of childhood cancer survivors.

IMPLICATIONS FOR PRACTICE

Results may aid clinicians in identifying caregivers at particular risk for low QoL. They may be counseled to find benefits in their experience or provided with resources to strengthen other factors that impact QoL.

Assessing the Needs of Parents of Children Diagnosed With Cancer in China: A Psychometric Study Developing a Needs Assessment Tool

The psychosocial well-being of parents remains integral to the treatment and recovery of children diagnosed with cancer. However, limited research addresses the unique needs of this population. To better understand the supportive care needs of parents of children with cancer, this study tested the reliability and stability of the factorial structure of a revised version of the Cancer Patient Needs Questionnaire (rCPNQ) with Chinese parents of children who have cancer. Analysis of the generalizability of the rCPNQ with this population was determined through principle components analysis with varimax rotation. Reliability coefficient and split sample analyses were performed to determine reliability and stability of the resulting factors. The principal components analysis resulted in a 6-dimension, 8-factor, 29-item survey. Each of the factors had Cronbach’s α ≥ .74, indicating satisfactory internal consistency and reliability of the survey with the Chinese population. Similar loadings on splitting of the samples reflects the stability of the factors. Study results provided a preliminary understanding of the needs of Chinese parents of children with cancer and demonstrated that the rCPNQ offers a reliable measure for nurses and other health care providers to partner with Chinese parents throughout their children’s treatment and survivorship to determine areas for support.

A Qualitative Study of the Impact of Cancer on Romantic Relationships, Sexual Relationships, and Fertility: Perspectives of Canadian Adolescents and Parents During and After Treatment

PURPOSE

We sought to gain insight into perspectives around core domains of adolescent development--romantic relationships, sexual relationships, and fertility--from the vantage point of Canadian adolescents and parents during and after cancer treatment.

METHODS

Twenty adolescents (12-17 years old at interview) and 20 parents (who may or may not have had an adolescent interviewed) participated in this study. Using a semistructured guide, adolescents and parents were interviewed separately. All interviews were audio-recorded and transcribed. Transcribed interview data were independently coded according to the study objectives by two trained analysts. Codes were organized into categories that reflected emerging themes. Discrepancies in coding were resolved through discussion with the lead investigator.

RESULTS

Qualitative analysis revealed main themes for adolescents and parents related to: (1) romantic relationships (opinions on the importance of dating in the context of cancer, expectations that cancer will impact future relationships, dating as a source of moral support, and limited opportunities to engage with partners); (2) sexual relationships (thoughts related to the impact of cancer on future sexual relationships); (3) fertility (initiating treatment as a primary concern and fear of infertility and perceived consequences); and (4) recommendations for care (access to knowledge and support through adolescent-friendly and accessible means).

CONCLUSION

Findings from this study highlight cancer-specific relationship and fertility issues faced by adolescents and provide important direction to the development of interventions that may ultimately improve the psychosocial health of adolescents during and after cancer treatment.

Granting wishes of seriously ill children: Effects on parents’ well-being

We investigated whether a positive intervention (i.e. granting a wish) in children with a chronic illness could promote positive psychological responses in their parents. Hospitalized children were randomly assigned to either the wish group or to a waiting-list control group. Mothers and fathers’ responses ( N = 86 and 38, respectively) were studied. Parents from the wish group showed higher levels of positive emotions and beliefs in a benevolent world than the control group. Mothers from the wish group reported higher benefit finding, gratitude, and love than those in the control group. Given that the child’s illness inevitably affects their parents, it is important to promote studies that include parents’ well-being dimensions.

A systematic review on factors and consequences of parental distress as related to childhood cancer

The literature including correlates of parental distress as related to childhood cancer is abundant. It is important to identify predictive factors and outcomes of this distress in parents. The objective of this review was to update previous syntheses on factors of distress and to identify outcomes of parents' distress in the recent literature (2007-2012). We performed a systematic review to identify all quantitative studies including measures of parental distress and associated factors during the study period. We found 56 eligible studies, of which 43 had a Low risk of bias (Cochrane guidelines). Forty-two reports included potential predictive factors. Significant relationships were found with clinical history of the child, sex of the parent, coping response and personal resources, pre-diagnosis family functioning, but not education/income or marital status. Twenty-five reports studied potential consequences of distress and focused on psychological adjustment in parents and children. Compared to past periods, a higher proportion of studies included fathers. Measures used to evaluate distress were also more homogeneous in certain domains of distress. This review underscores the need for appropriate methods for selecting participants and reporting results in future studies. Appropriate methods should be used to demonstrate causality between factors/consequences and distress.

Caregivers reflecting on the early days of childhood cancer

Much research examining primary caregivers of children with cancer has focused on their distress levels and coping strategies. Drawing on qualitative data from semi-structured interviews with 38 Australian primary caregivers, this article examines their experiences through their child's cancer diagnosis and early treatment period. However, it does so retrospectively with their child in remission (a minimum of 5 years post diagnosis). This methodology gave caregivers the time to evaluate and reflect on their experiences through their child's cancer. Interviews with caregivers were recorded, transcribed verbatim and analysed using a grounded constant comparison approach. The concept of neo-normal was developed to represent caregivers' responses to having a child with cancer - characterised by the existential threat of cancer, the shattering of notions of control and certainty in their capacity to protect their child's well-being and reliance on medical intervention. Paradoxically, conceding to this disempowered position facilitated new ways to be a caregiver of a child with cancer. The findings illustrate the social processes and cultural context in which caregivers construct new normalising strategies as they transition through their child's illness. The study also gives recognition to the vital care, advocacy and pseudo-nursing contributions that caregivers bring to the paediatric oncology setting.

Standards of Psychosocial Care for Parents of Children With Cancer

Parents and caregivers of children with cancer are both resilient and deeply affected by the child's cancer. A systematic review of published research since 1995 identified 138 studies of moderate quality indicating that parent distress increases around diagnosis, then returns to normal levels. Post-traumatic symptoms are common. Distress may be impairing for vulnerable parents and may impact a child's coping and adjustment. Moderate quality evidence and expert consensus informed a strong recommendation for parents and caregivers to receive early and ongoing assessment of their mental health needs with access to appropriate interventions facilitated to optimize parent, child, and family well being.

Psychological distress and coping strategies in parents of children with cancer in Lebanon

OBJECTIVES

To determine the prevalence of psychological distress (PD) among parents of Lebanese children with cancer and to investigate the associated stressors and coping strategies.

METHODS

A cross-sectional study conducted at the American University of Beirut Medical Center-Children Cancer Center of Lebanon in 2012. Parents of all children with cancer admitted for treatment were eligible participants. The General Health Questionnaire (GHQ-12) was used to estimate the prevalence of PD. Coping strategies were measured via the Coping Health Inventory for Parents (CHIP). Bivariate and multiple regression analyses were conducted to evaluate the relationship between GHQ-12 (scores 0-36), stressors, family/social support, and coping strategies.

RESULTS

One hundred fourteen parents (68.2%) completed the anonymous questionnaire. Based on GHQ-12, significant PD was considered among 56.0% of the parents. It was found to be significantly positively associated with the degree of family financial problems and significantly negatively associated with the child's disease duration. A significant negative relationship was also found between PD and Coping (CHIP) scale, coping pattern I (Maintaining Family Integration and an Optimistic Outlook for the Situation), pattern II (Seeking Social Support), yet not with pattern III (Seeking Information).

CONCLUSIONS

PD is prevalent among parents of Lebanese children hospitalized because of cancer. Screening for PD in the latter population is feasible, would identify those who are at risk for disruptive PD, and facilitate the provision of support towards better adjustment and coping. Alleviating parental PD may facilitate the realization of optimal health outcomes.

Illness cognitions and family adjustment: psychometric properties of the Illness Cognition Questionnaire for parents of a child with cancer

PURPOSE

Illness cognitions are an important mediator between disease and psychological adjustment. This study assessed the psychometric properties of the Illness Cognition Questionnaire (ICQ), adjusted for the parents of an ill child.

METHODS

Participants were recruited from two multicenter studies: sample 1 included 128 parents of a child diagnosed with acute lymphoblastic leukemia (ALL) (response rate 82 %) and sample 2 included 114 parents of a child diagnosed with cancer (response rate 74 %). Parents completed an adapted version of the ICQ (Illness Cognition Questionnaire-Parent version (ICQ-P)), together with the Profile of Mood States (POMS; sample 1) or the Hospital Anxiety and Depression Scale (HADS; sample 2). The factor structure of the ICQ-P was examined by means of principal component analysis. Cronbach's alpha for each subscale and correlations between the ICQ-P scales and the HADS and POMS were calculated. The illness cognitions of parents with and without psychological distress were compared.

RESULTS

Factor analysis confirmed the hypothesized structure of the ICQ-P in our sample (n = 242). The three scales Helplessness, Acceptance, and Perceived Benefits explained 9.8, 31.4, and 17.9 % of the variance, respectively. Cronbach's alpha showed adequate internal consistency (.80-.88). Concurrent and criterion-related validity were appropriate.

CONCLUSIONS

The results confirm that the ICQ-P reliably assesses the illness cognitions of the parents of a child with cancer. Psychologically distressed parents showed less acceptance and more helplessness. The availability of a short and valid illness cognition questionnaire will help clinicians gain insight into parental cognitions regarding the illness of their child, information that might be helpful for targeting interventions.

Internet-based guided self-help for parents of children on cancer treatment: a randomized controlled trial

Objective

The aim of the study was to investigate the feasibility and preliminary efficacy of an Internet‐based guided self‐help intervention for posttraumatic stress symptoms (PTSS) and related symptoms in parents of children on cancer treatment.

Methods

Parents of children on cancer treatment, who fulfilled the modified symptom criteria on the PTSD Checklist, were randomly allocated to the intervention or to a wait‐list control condition. The intervention group accessed a 10‐week guided self‐help program via the Internet based on principles from cognitve behavior therapy. The primary outcome PTSS and the secondary outcomes depression and anxiety were assessed by self‐report preintervention and postintervention.

Results

Seven hundred forty‐seven parents were approached and informed about the study, 92 were assessed for eligibility, and 58 were included and randomized to the intervention (n = 31) or wait list (n = 27). Eightteen participants completed the intervention. Intention‐to‐treat analyses indicated a significant effect of the intervention on PTSS with a large between‐group effect size at postassessment (Cohen's d = 0.88). The intervention group reported reductions in PTSS with a large within‐group effect size (d = 1.62) compared with a minimal reduction in the wait‐list group (d = 0.09). There was a significant intervention effect on depression and anxiety and reductions in the intervention group with large within‐group effect sizes (d = 0.85–1.09).

Conclusions

Findings indicate a low enrollment rate and considerable attrition but also that Internet‐based guided self‐help shows promise for parents of children on cancer treatment who report a high level of PTSS and would like to take part in an Internet‐based intervention. © 2015 The Authors. Psycho‐Oncology published by John Wiley & Sons, Ltd.

Hopelessness and depression levels of parents of children with cancer

The purpose of this descriptive study was to determine the hopelessness and depression levels of parents of children diagnosed with cancer and undergoing cancer treatment and factors affecting these levels. The study was carried out with parents of 44 children receiving treatment in a paediatric haematology clinic of a university hospital. Data were collected using a survey form, the Beck Hopelessness Scale (BHS) and the Beck Depression Scale (BDS). The mean BDS score of the mothers and fathers was 18.3 ± 11.30 and 15.2 ± 11.33, respectively. The mean BHS score of the mothers was 6.45 ± 4.40, whereas the mean BHS score of the fathers was 5.88 ± 4.27. The results showed that the levels of hopelessness and depression among the mothers were higher than among the fathers (p<0.001). There was a positive relationship between the hopelessness and depression scores of the mothers and the fathers (p<0.05), and the levels of hopelessness and depression scores of the fathers increased as those of the mothers increased. A weak financial situation of the family increased the hopelessness and depression levels of the fathers. The hopelessness and depression levels of the mothers who were supported by their families and relatives were decreased compared to those without such support (p<0.05). The results show that the parents of children with cancer face many psychosocial and spiritual problems. Using simple screening tools, nurses can identify at-risk parents and direct them to support services. We conclude that actively encouraging families to avail themselves of support resources and supporting them financially would positively affect the levels of depression and hopelessness of parents of children with cancer.

Experiences of nursing students in caring for pediatric cancer patients

BACKGROUND

This study was performed to determine the experiences of nursing students in caring for paediatric cancer patients and their families.

MATERIALS AND METHODS

This qualitative survey was carried out with 14 students studying in the nursing department of the Faculty of Health Sciences of a university in Edirne, Turkey. Data were obtained through focus group interviews and evaluated based on a qualitative content analysis.

RESULTS

It was determined that students, for the most part, experienced problems related to communication, sadness, helplessness, fear, anxiety, resentment and anger. In addition, the students were affected most often by effects of the disease and invasive procedures on paediatric cancer patients and their families during the process of caring for them in the oncology clinic.

CONCLUSIONS

It would be useful to inform nursing students, prior to clinical practice, about the special needs of paediatric cancer patients and families who stay in oncology clinics, and to follow up with appropriate guidance during the clinical practices.

The challenge of quality care for family caregivers in pediatric cancer care

OBJECTIVES

To discuss the needs and potential interventions for parental caregivers of children with cancer.

DATA SOURCES

Published articles between 2002 and 2012.

CONCLUSION

In general, parents do adjust and cope with their child's cancer, but a significant majority experience post-traumatic stress symptoms. Families also report that the shift to parenting a child with cancer is very disruptive to identity and family structure and can cause negative outcomes for mothers, father, and siblings. There is growing evidence of post-traumatic growth and resilience in parents of children with cancer. Recent studies have suggested that targeted interventions may relieve distress.

IMPLICATIONS FOR NURSING PRACTICE

Nurses can support families in the difficult transition to having a child with cancer and may be able to intervene to reduce long-term distress in families.

Correlates of physiological and psychological stress among parents of childhood cancer and brain tumor survivors

OBJECTIVE

First, we sought to determine if parents of children with cancer or a brain tumor had greater stress compared to parents of healthy children and to evaluate the correlates of stress among parents of children with cancer or brain tumors. Second, we sought to examine the relationship between perceived stress and symptoms of stress and how that relationship may differ for parents of children with cancer.

METHODS

In-person, interviewer-assisted surveys were administered to 73 case dyads (children with cancer or a brain tumor and their parents) and 133 comparison dyads (children without health problems and their parents from a community sample). Descriptive analyses and multivariable logistic regressions were performed for case-comparison and case-only analyses to distinguish correlates of parental stress.

RESULTS

Parents of children with cancer exhibited higher levels of physiological symptoms of stress than parents of healthy children. Poor sleep quality and greater social stress (negative social interactions) were significant correlates of increased levels of stress in parents of children with cancer (odds ratio 4.23, 95% confidence interval 1.15-15.60; and odds ratio 1.07, 95% confidence interval 1.00-1.14, respectively). A subset of parents reported symptoms of stress but not perceived stress, and this discordance was more pronounced among cancer caregivers.

CONCLUSIONS

Implementation of screening tools that include symptoms of stress may help clinicians to comprehensively identify parents of children with cancer who are in need of additional services. Targeted stress-reduction interventions that address sleep quality and negative social interactions may mitigate the deleterious effects of caregiving, improving the psychosocial well-being of both parents and children with cancer.

A pilot trial of a stress management intervention for primary caregivers of children newly diagnosed with cancer: preliminary evidence that perceived social support moderates the psychosocial benefit of intervention

OBJECTIVES

(1) To examine the acceptability and feasibility of a stress management intervention for caregivers of children recently diagnosed with cancer. (2) To explore whether caregivers with lower baseline perceived social support derive greater benefit from the intervention than those with higher perceived support.

METHODS

45 primary caregivers were randomly assigned to intervention or standard care. Of these, 37 completed measures of social support, depression, anxiety, and perceived stress at both pre-intervention (T1; mean = 24 days post-diagnosis) and post-intervention time points (T2; mean = 165 days post-diagnosis).

RESULTS

Enrollment, retention, and satisfaction data support feasibility and acceptability of the intervention. There was no overall significant impact of participation in the intervention on levels of distress at T2. However, T1 social support moderated intervention response, with caregivers who perceived lower T1 support showing greater psychological benefit from the intervention.

CONCLUSIONS

Primary caregivers with lower levels of perceived social support may benefit from preemptive stress management intervention.

The lived experiences of parents of children diagnosed with cancer in Iran

Threatening nature of childhood cancer and the aggressiveness of prescribed treatments place enormous stress on the family of children suffering from cancer. This study was conducted to better understand the lived experiences of parents of children suffering from cancer and to document their account of such experiences. The aim of this research was to describe the lived experiences of parents of children diagnosed with cancer in Iran. This hermeneutic phenomenological study was conducted between June 2008 and May 2009. Data were generated from 15 parents using in-depth interviews to capture their experiences of having children with cancer. Analysis is based on the framework of Diekelmann enabled data interpretation and elaboration of shared themes. One constitutive pattern 'Feeling trapped in the cancer dead end' and four related themes, namely 'Contradiction in reconciliation with situation', 'Doomed to accept', 'Isolation from others' and 'Devastated life', were identified. The results of this study showed that parents feel as if they are trapped by their child's disease. They are affected by several mental, social and familial issues while trying to tolerate their child's illness and conform to the new order of life.

Parental anxiety and stress during children's hospitalisation: the StayClose study

The aims of this pilot study were to assess anxiety and stress in parents of children admitted to hospital and identify influencing factors, and assess the feasibility and acceptability of the methodology to parents and hospital staff. Parents of 28 children hospitalised for at least 3 days completed questionnaires assessing psychological functioning after admission, 16 and 13 of whom completed questionnaires at discharge and 3 months after discharge, respectively. Almost two-thirds of parents scored in the borderline/clinical range for anxiety at baseline and discharge. Higher anxiety scores were associated with the use of self-blame, lower optimism scores, higher levels of illness-related uncertainty and a greater number of previous hospital stays. Three months after discharge, 38% had borderline/clinical levels of anxiety, with scores significantly correlated with those at baseline and discharge. Although parents were willing to participate, and the questionnaires were acceptable, this pilot study identified some practical and logistical difficulties that will be addressed in the next phase of the study. Parents experience substantial stress and anxiety when their child is hospitalised. Screening for those at high risk for anxiety and implementing interventions to reduce uncertainty and maladaptive coping strategies may be beneficial.