Mothers and fathers of children with cancer: loss of control during treatment and posttraumatic stress at later follow-up

Shifting perspectives and transformative change: Parent perspectives of an active music engagement intervention for themselves and their child with cancer

BACKGROUND

Children with cancer (ages 3-8 years) and their parents experience significant, interrelated distress associated with cancer treatment. Active music engagement (AME) uses music-based play and shared music-making to mitigate this distress. To advance our understanding about how AME works and its essential features, we interviewed parents who received the AME intervention as part of a multi-site mechanistic trial. The purpose of this qualitative analysis was to describe parents' experiences of AME for themselves and their child and to better understand how the intervention worked to lower parent-child distress.

PROCEDURE

We conducted a total of 43 interviews with parents/caregivers, and purposively analyzed all interviews from underrepresented groups based on race/ethnicity and parent role. We used thematic analysis and achieved thematic redundancy after analyzing 28 interviews.

RESULTS

The following statement summarizes resulting themes: Music therapists skillfully use AME to create a safe and healthy space (Theme 1), where parents/children have transformative experiences (Theme 2) that lead to learning and enactment (Theme 3) of new skills that counteract suffering (Theme 4) through empowerment, connectedness, and sustained relief.

CONCLUSIONS

This work elucidates how AME works to counteract stressful qualities of cancer treatment. As parents witnessed positive and transformative changes in their child, they experienced relief and reported shifts in their perspective about cancer treatment. This led to learning and use of music as a coping strategy that extended beyond therapist-led sessions. Accessible, music-based interventions, like AME, offer a developmentally appropriate and effective way to support parents and young children during treatment.

Importance of Social Support of Parents of Children with Cancer: A Multicomponent Model Using Partial Least Squares-Path Modelling

The purpose of the present study is to build a model combining some variables that have been previously studied separately to improve our understanding on how they relate in parents of children with cancer. A total of 112 parents with an average age of 41 completed the self-assessment questionnaires containing the factors studied: social support received, social support provided, stress, adjustment of parents and life satisfaction. Two models were developed: one for social support received and one for social support provided. Structural equation models based on the variance estimated through partial least squares were used to analyze factors involved in quality of life based on an exploratory model of second order. The estimated model was robust in terms of quality of measurement (reliability and validity). According to results from the structural model, in the model of social support received, the impact of social support received on stress was considerable (β = -0.26; p = 0.02) and it explained 16% of the variance. The impact of social support received by parents on their adjustment (β = -0.56; p < 0.001) was also considerable, explaining 32% of the variance. Finally, adjustment of parents also showed an effect on life satisfaction (β = -0.33; p < 0.001) and it explained 26% of the variance. However, the relation between social support received (β = 0.15; p = 0.11) and life satisfaction, the relation between stress (β = -0.15; p = 0.08) and life satisfaction, and the relation between adjustment of parents (β = 0.20; p = 0.07) and stress were not significant. In the model of social support provided by parents, social support provided (β = 0.35; p < 0.001), and adjustment of parents (β = -0.31; p < 0.01) impacted life satisfaction, explaining 36% of the variance. Social support provided (β = -0.34; p < 0.01) impacted adjustment of parents and it explained 12% of the variance. Adjustment of parents (β = 0.28; p < 0.05) also impacted parents' perception of stress, explaining 14% of the variance. However, the relation between social support provided (β = -0.17; p = 0.06) and stress, and the relation between stress (β = -0.13; p = 0.08) and life satisfaction, were not significant. Social support received showed a strong connection with stress and parents' adjustment. Additionally, social support received showed a decrease in stress and parents' adjustment. Social support provided by parents and the adjustments they experience are linked to their life satisfaction. Additionally, social support provided showed a decrease in adjustment and an increase in parents' life satisfaction. The models can be used to improve parents' situations and it has strong practical implications.

Mediators and Moderators of Active Music Engagement to Reduce Traumatic Stress Symptoms and Improve Well-being in Parents of Young Children With Cancer

OBJECTIVE

This trial examined the effects of proximal/distal mediators and moderators of an Active Music Engagement (AME) intervention on young child/parent distress, quality of life, and family function outcomes.

METHODS

Child/parent dyads (n = 125) were randomized to AME or Audio-storybooks attention control condition. Each group received 3 sessions with a credentialed music therapist for 3 consecutive days with data collection at baseline, post-intervention (T2), and 30-days later (T3). Potential proximal mediators included within session child and parent engagement. Potential distal mediators included changes in perceived family normalcy, parent self-efficacy, and independent use of play materials. Potential moderators included parent/child distress with prior hospitalizations, parent traumatic stress screener (PCL-6), and child age. Outcomes included child emotional distress and quality of life; parent emotion, traumatic stress symptoms (IES-R), well-being; and family function. Mediation effects were estimated using ANCOVA, with indirect effects estimated using the percentile bootstrap approach. Moderation effects were tested by including appropriate interaction terms in models.

RESULTS

No significant mediation effects were observed. Child distress with prior hospitalizations moderated AME effects for IES-R intrusion subscale scores at T2 (P = .01) and avoidance subscale scores at T3 (P = .007). Traumatic stress screener scores (PCL-6) moderated intervention effects for IES-R hyperarousal subscale scores at T2 (P = .01). There were no moderation effects for child age.

CONCLUSIONS

AME is a promising intervention for mitigating traumatic stress symptoms and supporting well-being in parents of children with cancer, particularly for parents who screen high for traumatic stress and whose children are more highly distressed with hospitalization.

Relation Between Social Support Received and Provided by Parents of Children, Adolescents and Young Adults With Cancer and Stress Levels and Life and Family Satisfaction

Introduction

The present study aims at analysing how social support received and provided by parents of children, adolescents and young adults (AYA) diagnosed with cancer, as well as their sociodemographic and clinical variables, affect those parents’ stress levels and life and family satisfaction.

Materials and Methods

A total of 112 parents of children and AYAs who had been diagnosed with cancer and who received treatment in Malaga participated in the study. In the study, participated all parents who voluntarily agreed to fulfil the questionnaire. The main inclusion criterion was that their child had cancer. Instruments used were Questionnaire on the Frequency of and Satisfaction with Social Support (QFSSS), Paediatric Inventory for Parents (PIP), Life Satisfaction Scale and Family Satisfaction Scale.

Results

In the mean difference analyses, male parents showed 3.38 (SD = 0.56) in social support received and female parents showed M = 3.08 (SD = 0.72). Conversely, in social support provided, female parents showed 3.22 and male parents showed M = 3.55 (p = 0.020). Significant differences were also found in family satisfaction, where female parents (M = 3.64) feel more satisfied than male parents (M = 3.06; p = 0.027). Parents of children aged between 0 and 14 years (M = 3.06) feel more stress than those parents of children aged 15–21 (M = 2.61; p = 0.021). The correlation analysis shows that there is a negative and significant relation between stress levels experienced by parents when facing different situations related to the child’s disease and both types of support, received r = −0.411, p < 0.001 and provided r = −0.282, p < 0.01. There is also a positive and significant relation between life satisfaction and social support received r = 0.292, p < 0.01, and social support provided r = 0.409, p < 0.001. There is a positive and significant relation between family satisfaction and social support received r = 0.330, p < 0.01, in the same way as with social support provided r = 0.222, p < 0.05. The regression analysis related to stress levels of parents indicates that social support received predicts levels of stress significantly p < 0.001, with the variable of number of children being the one that showed to be significant p < 0.05. Social support provided showed the most significant results p = 0.001, meaning that social support provided increased life satisfaction. Social support received explains family satisfaction (p = 0.50), as it increases the family satisfaction of parents of children with cancer.

Discussion

Analysing social support received and provided, as well as sociodemographic and clinical variables, allowed us to broaden the knowledge on the effect social support has on stress levels, life satisfaction and family satisfaction in parents of children and AYAs diagnosed with cancer. This may have relevant practical implications for the design of interventions that would improve parents’ lives.

Psychological Impact of COVID-19 on Parents of Pediatric Cancer Patients

The changes and general alarm of the current COVID-19 pandemic have amplified the sense of precariousness and vulnerability for family members who, in addition to the emotional trauma of the cancer diagnosis, add the distress and fear of the risks associated with infection. The primary objectives of the present study were to investigate the psychological impact of the COVID-19 pandemic on the parents of pediatric cancer patients, and the level of stress, anxiety, and the child's quality of life perceived by the parents during the COVID-19 epidemic. The parents of 45 consecutive children with solid and hematological tumors were enrolled. Four questionnaires (Impact of Event Scale-Revised - IES-R; Perceived Stress Scale - PSS; Spielberger State - Trait Anxiety Inventory - STAI-Y; Pediatric Quality of Life Inventory - PedsQL) were administered to the parents at the beginning of the pandemic lockdown. A 75% of parents exhibited remarkable levels of anxiety, with 60 subjects in state scale and 45 subjects in trait scale having scores that reached and exceeded the STAI-Y cut off. The bivariate matrix of correlation found a significant positive correlation between the IES-R and PSS scores (r = 0.55, P < 0.001). There was a positive correlation between the PSS and PedsQL (emotional needs) scale (P < 0.001) and a negative correlation between IES-R and STAI-Y (P < 0.001). The results confirm that parents of pediatric cancer patients have a high psychological risk for post-traumatic symptoms, high stress levels, and the presence of clinically significant levels of anxiety.

The role of an educational vignette to teach dental students on issues of substance use and mental health disorders in patients at the University of British Columbia: an exploratory qualitative study

BACKGROUND

Inverted classroom approaches and the use of vignettes have been suggested in health care education. The objective of this study was to use an educational vignette to discuss issues of stigma around substance use and mental disorders within undergraduate Doctor of Medicine in Dentistry (DMD) and Bachelor of Dental Science in Dental Hygiene (BDSc-DH) students at the University of British Columbia, Canada. Our research question was "how can an educational vignette, depicting a fictitious patient with a history of substance use and mental health disorders accessing dental care, promote an open dialogue about stigma?"

METHODS

An educational vignette was developed based on individuals' lived-experiences with a variety of substance use and/or mental health disorders. This vignette was used to generate in-class discussion involving all the DMD and BDSc-DH undergraduate students enrolled between 2015/16 and 2018/19 who attended a mandatory 2.5 h didactic session using an inverted classroom approach. Students were also encouraged to provide a post-class voluntary written reflection, between 200 and 300 words, around stigma. The authors took written field notes on students' response to the vignette and used excerpts from students' de-identified reflections to illustrate the impact of such an educational tool.

RESULTS

A total of 323 DMD and BDSc-DH students attended the didactic sessions between 2015/16 and 2018/19, and 148 reflections were submitted over the same time period. The inverted classroom approached showed to be engaging and collaborative. The vignette promoted open dialogue and was determined to be a conducive tool to generate in-class discussion and reflection. Major themes from the textual data included 'exploring power relations' and 'patient-centered care approach to counteract stigma'. The vignette also enabled the discussion of positive experiences characterized by empathy, reassurance and communication, although it might not have prompted all students to participate in class or in writing the reflections.

CONCLUSION

The inverted classroom approach and the vignette seemed to be an effective way to facilitate dialogue and reflection for most students. This study highlighted the need to explore innovative ways in which to continuously prepare current and future oral health care providers to professionally address the needs of patients with a history of substance use and/or mental health disorders.

Caregiver Religious Coping and Posttraumatic Responses in Pediatric Hematopoietic Stem Cell Transplant

OBJECTIVE

Caregivers often experience their child's hematopoietic stem cell transplant (HCT) treatment as traumatic. Although many caregivers develop posttraumatic stress symptoms (PTSS) in response to supporting their child through HCT, other caregivers demonstrate posttraumatic growth (PTG). Religious coping may contribute to these different adjustment trajectories; however, more information is needed to clarify the unique associations of positive versus negative religious coping on caregiver PTSS and PTG in the context of pediatric HCT. This study aimed to examine the relationships between negative and positive religious coping on caregivers PTSS and PTG while controlling for caregiver sex, self-efficacy, and social support.

METHODS

Caregivers (N = 140) of youth admitted to the hospital for their first HCT were asked to complete self-report measures of their use of positive and negative religious coping, PTSS, PTG, social support, and self-efficacy. Two hierarchical linear regressions were conducted to test hypotheses.

RESULTS

Greater positive religious coping, but not negative religious coping, was associated with caregivers reporting more PTG in response to pediatric HCT. More negative religious coping, but not positive religious coping, was associated with caregivers experiencing greater PTSS.

CONCLUSIONS

Engaging in positive religious coping appears to promote better caregiver adjustment to pediatric HCT, whereas negative religious coping may increase caregiver risk for developing PTSS. Screening caregivers' religious beliefs, including the type of religious coping they employ, could inform providers regarding the best approach to supporting caregivers towards a growth trajectory and mitigate PTSS.

Post-Traumatic Stress Symptoms among Lithuanian Parents Raising Children with Cancer

Background and objectives: The study aims to evaluate post-traumatic stress symptom expression among Lithuanian parents raising children with cancer, including social, demographic, and medical factors, and to determine their significance for the risk of developing post-traumatic stress disorder. Materials and methods: The study was carried out in two major Lithuanian hospitals treating children with oncologic diseases. The cross-sectional study included 195 parents, out of which 151 were mothers (77.4%) and 44 were fathers (22.6%). Post-traumatic stress symptoms were assessed using the Impact of Event Scale-Revised. To collect the sociodemographic, childhood cancer, and treatment data, we developed a questionnaire that was completed by the parents. Main study results were obtained using multiple linear regression. Results: A total of 75.4% of parents caring for children with cancer had pronounced symptoms of post-traumatic stress disorder. The female gender (β = 0.83, p < 0.001) was associated with an increased manifestation of symptoms, whilst higher parental education (β = −0.21, p = 0.034) and the absence of relapse (β = −0.48, p < 0.001) of the child’s disease reduced post-traumatic stress symptom expression. Conclusions: Obtained results confirmed that experiencing a child’s cancer diagnosis and treatment is extremely stressful for many parents. This event may lead to impaired mental health and increased post-traumatic stress disorder (PTSD) risk; hence, it is necessary to provide better support and assistance to parents of children with cancer.

Parental Efficacy and Control Questionnaire in Hematopoietic Stem Cell Transplant: Preliminary Validation

OBJECTIVE

Develop and evaluate the preliminary validity of a self-report measure of parents' treatment-related efficacy and control, Parental Efficacy and Control Questionnaire-Hematopoietic Stem Cell Transplant (PECQ-HCT), in a pediatric HCT sample.

METHODS

Participants included 185 parents of children (≤12 years old) receiving HCT participating in a larger, longitudinal study. Parents completed the PECQ-HCT as well as measures of social problem-solving skills, collective family efficacy, family beliefs, and parental distress.

RESULTS

Exploratory factor analysis results indicated that a 37-item four-factor model was the best fitting and most theoretically sound, χ2(df = 1,596) = 14,089.95, p < .01, comparative fit index = 0.92, Tucker-Lewis Index = 0.90, and root mean square error of approximation = 0.07. Preliminary subscale scores demonstrated adequate internal consistency as well as good content and criterion-related validity.

CONCLUSIONS

If replicated using a confirmatory factor analysis in a separate sample, these findings suggest that the four-factor PECQ-HCT measure may be useful for measuring HCT-related parental efficacy and perceived control.

Information Needs Assessment among Parents of Children with Cancer

Background: Parents of children with leukemia should be receiving an extensive amount of information about the care of their child; the aim of this study was to determine the parents’ information needs of children with leukemia. Methods: A cross-sectional study design was used to describe medical, physical, mental and lifestyle information needs among parents of children with leukemia. 209 parents of children diagnosed with leukemia in the west of Iran, during winter 2018, voluntarily participated in individual interviews. Data were analyzed by SPSS version 16 using t-test, One-way ANOVA and bivariate correlations statistical tests at 95% significant level. Results: The mean age of participants was 39.45 years [95% CI: 38.35, 40.55], ranged from 27 to 58 years. Participants achieved 55.6% score of information needs. There was a significant relationship between higher education level (P< 0.001), better economic status (P=0.008) and more family size member (P=0.003) with information needs. Conclusion: Findings suggest that parents of children with leukemia need the information to learn how to take care of their childhood and could be useful for guiding implementers to planning and implement effective programs to promotion information of parents towards children with cancer.

How does mindfulness modulate daily stress response: evidences from ambulatory assessment

OBJECTIVE

Mindfulness has been found to be associated with less adverse stress response. However, little is known about how mindfulness modulates stress response in the real daily life. The current study investigated the relation between daily stress and negative emotions, and explored a mediational link via perceived loss of control, and moderation by dispositional mindfulness, to better understand this association.

DESIGN

A total of 95 college students were recruited to complete a questionnaire and to report on their stress, perceived loss of control and negative emotions in daily life.

MAIN OUTCOME MEASURES

Mindful Attention Awareness Scale (MAAS) was used to assess dispositional mindfulness. Stress, perceived loss of control and negative emotions were assessed by ambulatory assessment.

RESULTS

Stress was positively related with negative emotions at within-person level. Perceived loss of control mediated the relationship between stress and negative emotions. Furthermore, participants with higher levels of dispositional mindfulness showed an attenuated association between stress and anger, and also attenuated associations between perceived loss of control, and anger and fatigue at within-person level.

CONCLUSION

These findings point to perceived loss of control as an important key factor in daily stress effects. Dispositional mindfulness appears to have beneficial effects in that it attenuates the impact of daily stressors on individuals' wellbeing. Clinical implications and limitations are discussed.

Factors That Influence Parental Uncertainty and Health-Related Quality of Life in Children With Cancer: A Framework

The purpose of this paper is to present a conceptual-theoretical-empirical model addressing factors that influence the relation between parental uncertainty and health-related quality of life in children with cancer. The basic concepts identified and defined in the model include parental uncertainty, health-related quality of life, parental trait anxiety, parental depression, and perceived parental social support. The proposed relationships between the concepts are explained with explicit linkages to their empirical indicators. There is limited research in childhood cancer regarding the relation between parental uncertainty and health-related quality of life; therefore, the proposed model will help to better understand this relationship.

A narrative analysis of the stories of mothers who have parented a child with Hodgkin lymphoma who is currently in early survivorship

AIMS AND OBJECTIVES

To explore the lived experience of mothers of children who have survived Hodgkin lymphoma, from diagnosis, through treatment and recovery as she has lived it and in her own words and to discuss the self-reported experiences in the context of the theoretical propositions of Attachment Theory and birth order as it applies to the mother-child dyad with this life experience.

BACKGROUND

While much has been written about childhood cancer survivors and their parents independently, there are unique struggles that a mother and a childhood cancer survivor face as a dyad. Examining the dyadic relationship over time offers a unique perspective to understanding the parenting experience with a child whose fate is uncertain.

DESIGN AND METHOD

Narrative Inquiry was utilised to explore the bonds the mother has with her child before he or she is diagnosed with cancer, the relationship during treatment and the subsequent relationship when the child has entered survivorship. Most specifically, the research explored the attachment of the mother to her child as it relates to the Caregiving System. A purposive sample of 13 mothers of children diagnosed with Hodgkin lymphoma representing children from each birth order category (youngest child, middle child, oldest child and only child) was chosen. The interviews were analysed through thematic analysis with final themes identified.

RESULTS

Several core themes emerged from the narratives regardless of birth order. The most significant was the "need to protect." Additional themes were "things will never be the same," "unique bond," "shifting priorities" and "lost innocence."

CONCLUSIONS AND RELEVANCE TO PRACTICE

The research shows activation of the Caregiving Behavioral Response System as it relates as a reciprocal to Attachment Theory.

The Pediatric Inventory for Parents - Swedish Translation and Psychometric Testing

The Pediatric Inventory for Parents (PIP) measures parental stress related to caring for a child with an illness. However, no Swedish translation is available.

PURPOSE

This study reports a Swedish translation of the PIP and psychometric properties of the instrument.

DESIGN AND METHODS

This is a descriptive/methodological paper. The PIP was translated and culturally adapted to Swedish, and comprehensibility was tested. Data were collected twice from 48 parents of children with different illnesses, and initial psychometric properties of the instrument were examined. The IES-R (Impact of Event Scale-Revised) was used for concurrent validity.

RESULTS

The Swedish version of the PIP demonstrated good correlations with the IES-R, and temporal changes were similar. Endorsement frequencies and test-retest were also satisfactory. When comparing groups of parents, the parents of children with cancer were statistically significantly more distressed, both on total score and for emotional distress and role function. Discriminative validity was demonstrated by comparing parents of children with cancer with parents of children with other diseases.

CONCLUSIONS

The Swedish version of the PIP seems to be a valid and reliable instrument. However, as we used relatively small sample, for the future, we suggest further testing with larger samples.

PRACTICE IMPLICATIONS

Clinicians and researchers seeking to measure parental distress in chronic illness could use the Swedish version of the PIP.

Stigma of addiction and mental illness in healthcare: The case of patients' experiences in dental settings

OBJECTIVE

To explore the ways in which stigma is experienced in healthcare and dental settings by patients with a history of addiction and mental illness.

METHODS

Audio-recorded, semi-structured interviews with a purposefully selected convenience sample of residents from two community treatment centres in Vancouver, Canada were conducted. The interview guide contained questions about experiences while seeking health and dental care and was based on an existing framework of labeling, stereotyping, exclusion, discrimination, and power imbalance. Interviews were transcribed verbatim for coding and thematic analysis.

RESULTS

Twenty-five participants between 23 and 67 years of age were interviewed; 17 were males. Most had a self-reported history of depression combined with use of alcohol and crack-cocaine; most of them only sought dental care for emergency purposes. Textual analysis of more than 300 pages of transcribed interviews revealed that participants perceived stigma when they were negatively stereotyped as 'unworthy', labeled as 'different', excluded from the decision-making process, discriminated against, 'treated unfairly', and felt powerless when interacting in the heath and dental care systems. Conversely, positive experiences were characterized by empathy, reassurance and good communication, which were empowering for patients.

CONCLUSIONS

When associated with stigma, mental illness and addictions have negative implications for accessing health and dental care. From our participants' perspectives, it seems that the lack of understanding about their life conditions by the healthcare professionals was the origin of stigma. We suggest that an increased social awareness of these health issues be enhanced among current and future health and dental care professionals to help improve care experiences for this marginalized population.

Pilot Randomized Trial of Active Music Engagement Intervention Parent Delivery for Young Children With Cancer

Objectives

To examine the feasibility/acceptability of a parent-delivered Active Music Engagement (AME + P) intervention for young children with cancer and their parents. Secondary aim to explore changes in AME + P child emotional distress (facial affect) and parent emotional distress (mood; traumatic stress symptoms) relative to controls.

Methods

A pilot two-group randomized trial was conducted with parents/children (ages 3-8 years) receiving AME + P ( n  =  9) or attention control ( n  =  7). Feasibility of parent delivery was assessed using a delivery checklist and child engagement; acceptability through parent interviews; preliminary outcomes at baseline, postintervention, 30 days postintervention.

Results

Parent delivery was feasible, as they successfully delivered AME activities, but interviews indicated parent delivery was not acceptable to parents. Emotional distress was lower for AME + P children, but parents derived no benefit.

Conclusions

Despite child benefit, findings do not support parent delivery of AME + P.

Bidstrup P. FAMily-Oriented Support (FAMOS): development and feasibility of a psychosocial intervention for families of childhood cancer survivors

BACKGROUND

We developed and tested the feasibility of a manualized psychosocial intervention, FAMily-Oriented Support (FAMOS), a home-based psychosocial intervention for families of childhood cancer survivors. The aim of the intervention is to support families in adopting healthy strategies to cope with the psychological consequences of childhood cancer. The intervention is now being evaluated in a nationwide randomized controlled trial (RCT).

METHODS AND DESIGN

FAMOS is based on principles of family systems therapy and cognitive behavioral therapy, and is delivered in six sessions at home. Families were recruited from all four pediatric oncology departments in Denmark after the end of intensive cancer treatment. We evaluated the feasibility of the intervention and of a RCT design for comparing the intervention with usual care. The evaluation was conducted among families enrolled in the study by tracking procedures and parents' evaluations.

RESULTS

A total of 68 families (68 mothers, 60 fathers, 68 children with cancer and 73 siblings) were enrolled, with a participation rate of 62% of families. Fathers were highly represented (88% of families); also families with single parents (12%) and parents with basic education (7-12 years of primary, secondary, and grammar school education) were represented (12%). The dropout rate was 12% of families (all in the control group), and two families did not complete the intervention because of relapse. Evaluation by parents in the intervention group showed overall satisfaction with the format, timing, and content of the intervention.

CONCLUSION

The results indicate that the FAMOS intervention is feasible in terms of recruitment, retention, and acceptability. The effects of the intervention on post-traumatic stress, depression, anxiety, family functioning, and quality of life will be reported after the nationwide RCT has been completed.

Parent illness appraisals, parent adjustment, and parent-reported child quality of life in pediatric cancer

Psychosocial distress is a salient construct experienced by families of children with newly diagnosed cancer, but little is known about parental appraisal of the child's illness and the subsequent impact this may have on child and parent functioning. The goal of the present study was to examine the interrelationships among multiple parent illness appraisals, parent adjustment outcomes, and parent-reported child quality of life in parents of children diagnosed with cancer. Parents completed measures of illness appraisal (illness uncertainty and attitude toward illness), parent adjustment (general distress, posttraumatic stress, parenting stress), and child quality of life (general and cancer-related). Path analysis revealed direct effects for parent illness uncertainty and illness attitudes on all 3 measures of parent adjustment. Illness uncertainty, but not illness attitudes, demonstrated a direct effect on parent-reported child general quality of life; parenting stress had direct effects on general and cancer-related quality of life. Exploratory analyses indicated that parent illness uncertainty and illness attitudes conferred indirect effects on parent-reported general and cancer-related quality of life through parenting stress. Negative parent illness appraisals appear to have adverse impacts on parents' psychosocial functioning and have implications for the well-being of their child with cancer.

Parents' Lived Experiences During Their Children's Radiotherapy

BACKGROUND

The aim of radiotherapy is to provide a cure and/or symptomatic relief for children with cancer. Treatment is delivered on a daily basis, 5 days per week, over the course of 5 to 35 days. Many parents find that leaving their children alone during treatment and exposing them to radiation is a challenging experience. To gain an understanding of parents' lived experiences, 10 parents were asked to keep a diary while their children underwent radiotherapy.

METHODS

A descriptive inductive design with a hermeneutic-phenomenological approach was chosen to analyze the diaries. The parents were asked to write down their lived experiences while their children underwent radiotherapy. Daily notes, both short and long, were desirable.

FINDINGS

The parents described radiotherapy as a balancing act involving a constant attempt to maintain a balance between coercing and protecting their children in order to improve their children's chances of survival. Meanwhile, the parents themselves were struggling with their own despair and feelings of powerlessness. While protecting their children, they experienced a sense of hope and felt that they had gained control.

CONCLUSION

Parents' daily written reflections are important for clinical practice and provide vital knowledge. Parents need support when focusing on coercing and protecting their children and help with information and routines that enable them gain control.

Person-centred information to parents in paediatric oncology (the PIFBO study): A study protocol of an ongoing RCT

BACKGROUND

Parents of children with cancer experience a demanding situation and often suffer from psychological problems such as stress. Trying to coping with the complex body of information about their child's disease is one factor that contributes to this stress. The aim of this study is to evaluate an intervention for person-centred information to parents of children with cancer that consists of four sessions with children's nurses trained in the intervention method.

METHODS/DESIGN

This is a multi-centre RCT with two parallel arms and a 1:1 allocation ratio. The primary outcome is illness-related parental stress. Secondary outcomes are post-traumatic stress symptoms, anxiety, depression, satisfaction with information, expected and received knowledge, and experiences with health care providers. A process evaluation is performed to describe experiences and contextual factors. Data are collected using web questionnaires or paper forms according to the parents' preference, audio recording of the intervention sessions, and qualitative interviews with parents and the intervention nurses.

DISCUSSION

Few studies have evaluated information interventions for parents of children with cancer using large multi-centre RCTs. This intervention is designed to be performed by regular staff children's nurses, which will facilitate implementation if the intervention proves to be effective.

TRIAL REGISTRATION

Clinical trials NCT02332226 (December 11, 2014).

Self-distancing Buffers High Trait Anxious Pediatric Cancer Caregivers against Short- and Longer-term Distress

Pediatric cancer caregivers are typically present at their child's frequent, invasive treatments, and such treatments elicit substantial distress. Yet, variability exists in how even the most anxious caregivers cope. Here we examined one potential source of this variability: caregivers' tendencies to self-distance when reflecting on their feelings surrounding their child's treatments. We measured caregivers' self-distancing and trait anxiety at baseline, anticipatory anxiety during their child's treatment procedures, and psychological distress and avoidance three months later. Self-distancing buffered high (but not low) trait anxious caregivers against short- and long-term distress without promoting avoidance. These findings held when controlling for other buffers, highlighting the unique benefits of self-distancing. These results identify a coping process that buffers vulnerable caregivers against a chronic life stressor while also demonstrating the ecological validly of laboratory research on self-distancing. Future research is needed to explicate causality and the cognitive and physiological processes that mediate these results.

Satisfaction with support versus size of network: differential effects of social support on psychological distress in parents of pediatric cancer patients

OBJECTIVE

This study examined the direct and buffering effects of social support on longer-term global psychological distress among parents coping with pediatric cancer. In both sets of analyses, we examined whether these effects depended on the dimension of social support provided (i.e., satisfaction with support versus size of support network).

METHOD

Participants were 102 parents of pediatric cancer patients. At study entry, parents reported their trait anxiety, depression, and two dimensions of their social support network (satisfaction with support and size of support network). Parents subsequently reported their psychological distress in 3- and 9-month follow-up assessments.

RESULTS

Parents' satisfaction with support had a direct effect on longer-term psychological distress; satisfaction was negatively associated with distress at both follow-ups. In contrast, size of support network buffered (moderated) the impact of trait anxiety and depression on later distress. Parents with smaller support networks and higher levels of trait anxiety and depression at baseline had higher levels of psychological distress at both follow-ups; for parents with larger support networks, there was no relationship.

CONCLUSION

Social support can attenuate psychological distress in parents coping with pediatric cancer; however, the nature of the effect depends on the dimension of support. Whereas interventions that focus on increasing satisfaction with social support may benefit all parents, at-risk parents will likely benefit from interventions that ensure they have an adequate number of support resources.

Development of the family symptom inventory: a psychosocial screener for children with hematology/oncology conditions

A growing body of literature has begun to underscore the importance of integrating family-based comprehensive psychological screening into standard medical care for children with oncology and hematology conditions. There are no known family-based measures designed to screen for clinically significant emotional and behavioral concerns in pediatric oncology and hematology patients. The aim of this study was to develop and evaluate the Family Symptom Inventory (FSI), a brief screener of patient and family member psychological symptoms. The FSI also screens for common comorbid physical symptoms (pain and sleep disturbance) and is designed for use at any point during treatment and follow-up. A total of 488 caregivers completed the FSI during regular hematology/oncology visits for 193 cancer, 219 sickle cell disease, and 76 hematology pediatric patients. Exploratory factor analysis, confirmatory factor analysis, and tests of reliability and preliminary validity were conducted. Exploratory factor analysis suggested a 34-item, 4-factor solution, which was confirmed in an independent sample using confirmatory factor analysis (factor loadings=0.49 to 0.88). The FSI demonstrated good internal reliability (α's=0.86 to 0.92) and good preliminary validity. Regular psychosocial screening throughout the course of treatment and follow-up may lead to improved quality of care for children with oncology and hematology conditions.

The Impact of a Web-Based Educational and Support Intervention on Parents’ Perception of Their Children’s Cancer Quality of Life

The purpose of this exploratory study was to (1) describe the development of an evidence-based web educational and support intervention for families of children with cancer and (2) assess the favorability of the website, and whether there was any impact on the cancer communication aspect of the quality of life instrument. In the study, 38 persons participated—15 mothers, 12 fathers, and 11 children. The favorability score of the website was found to be very high. The mothers rated the website most favorable, followed closely by the fathers. Furthermore, even though it was not significant, an increase was found in the mothers’ evaluation of cancer communication based on the Pediatric Quality of Life Questionnaire (PedsQL) after the intervention as compared with before. The findings suggest that the use of an evidence-based website is feasible, appears to enhance cancer knowledge and might, in that way, contribute to better management of the cancer situation for the families.

Living an Everyday Life Through a Child’s Cancer Trajectory

The aim of this study was to illuminate the lived experiences of families where a child had survived 7 years from a diagnosis of childhood cancer. This article describes one part of an inductive and longitudinal research project that included 17 families. Four families whose child was diagnosed with cancer 7 years previously were interviewed using a hermeneutical phenomenological approach. The families lived experience was described in one essential theme, “Living an everyday life through the child’s cancer trajectory,” further illuminated in 3 related themes: “Leaving the disease behind yet feeling its presence,” “Being the same yet always different,” and “Feeling stronger yet vulnerable.” The results suggest that family members feel vulnerable even if a long period of time has passed since completion of treatment. To varied degrees they still may need support. When moving forward in life, the family members are helped if they can reconcile their memories and experiences derived from the childhood cancer trajectory.

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.

Longitudinal study of parent caregiving self-efficacy and parent stress reactions with pediatric cancer treatment procedures

BACKGROUND

Pain/distress during pediatric cancer treatments has substantial psychosocial consequences for children and families. We examined relationships between parents' caregiving self-efficacy, parents' affect in response to their children's cancer-related treatment procedures, and parents' symptoms of post-traumatic stress at follow-up.

METHODS

Participants were 75 pediatric cancer patients and parents. On the day of each of three procedures (i.e., port-start, lumbar puncture, or bone marrow aspiration), parents rated their self-efficacy for six caregiving goals. Parents also self-reported their negative affect (i.e., state anxiety, negative mood, and distress) in response to each procedure. Three months after the last procedure, parents reported their level of post-traumatic stress symptoms (PTSS).

RESULTS

Higher parent self-efficacy about keeping children calm before treatment and/or keeping children calm during the procedure was associated with lower state anxiety. Self-efficacy for keeping the child calm during procedures was significantly correlated with distress in parents at the time of procedures, and self-efficacy for keeping the child calm before procedures was significantly correlated with PTSS. All three negative affect measures significantly mediated the effects of parents' caregiving self-efficacy for both goals on parents' PTSS 3 months later.

CONCLUSIONS

Parents' caregiving self-efficacy influences their immediate and longer-term distress reactions to their children's treatment procedures. These findings provide a more nuanced understanding of how parents' cognitions contribute to their ability to cope with their children's treatment and suggest the benefit of an intervention that targets parents' procedure-specific caregiver self-efficacy.

Influencia del apoyo social sobre el estrés y la satisfacción vital en padres de niños con cáncer desde una perspectiva multidimensional

Objetivo: El presente estudio se plantea como objetivo principal analizar cómo la percepción de apoyo de los padres de niños diagnosticados con enfermedad oncológica influye en la percepción de estrés y la satisfacción vital. Método: Participaron 112 padres de niños con patología oncológica que recibían tratamiento en Málaga y pertenecían a una asociación de padres de niños afectados por esta enfermedad. Resultados: Respecto a las fuentes analizadas la percepción de apoyo familiar disminuye la frecuencia del estrés, el apoyo de los amigos y de las asociaciones disminuye el esfuerzo relacionado con el estrés y el apoyo de la pareja aumenta la satisfacción vital de los progenitores. Respecto a los tipos de apoyo, el apoyo instrumental es el que más reduce la frecuencia del estrés de los progenitores, el apoyo informacional reduce el estrés relacionado con el esfuerzo que los padres deben realizar y es la satisfacción con el apoyo emocional la variable que mejor predice la satisfacción vital. Conclusión: El análisis multidimensional del apoyo social ha permitido analizar con mayor profundidad la complejidad de las relaciones de apoyo social que acontecen durante la enfermedad oncológica de los hijos. Del estudio se derivan importantes implicaciones prácticas.