Demographic, medical, and psychosocial predictors of benefit finding among caregivers of childhood cancer survivors

The impact of social support on benefit finding among patients with advanced lung cancer and their caregivers: based on actor-partner interdependence mediation model

PURPOSE

Advanced lung cancer and its treatment serve as a sudden stressful event that profoundly impacts the psychological experience of both the patients and their primary caregiver. This study used dyadic analyses to explore the dyadic effects of social support on benefit finding and whether hope level mediates the patient-caregiver dyads in advanced lung cancer.

METHODS

Two hundred ninety-five pairs of patients with advanced lung cancer and primary caregivers completed the Social Support Rating Scale (SSRS), the Herth Hope Index (HHI), and the Benefit Finding Scale (BFS). Dyadic analyses were conducted using structural equation modelling based on the actor-partner interdependence mediation model.

RESULTS

The results indicated that for both patients (B = 0.259, 95% CI = 0.135-0.423, P < 0.001) and their primary caregivers (B = 0.596, 95% CI = 0.403-0.838, P < 0.001), hope level mediated the actor effect of social support on benefit finding; social support was positively associated with hope level and further enhanced benefit finding. Regarding partner effects (B = 0.242, 95% CI = 0.119-0.404, P < 0.001), primary caregivers' social support significantly indirectly affected patients' benefit finding through patients' hope level.

CONCLUSION

There is an interaction between social support, hope level, and benefit finding in patients with advanced lung cancer and their primary caregivers. Healthcare professionals ought to be vigilant in recognizing patients and caregivers who are vulnerable, have limited social support, and possess diminished hope levels. At the same time, nurses should provide timely psychological support and counseling to patients and their caregivers, encourage them to actively participate in social activities, and inspire their confidence and hope in life, thus improving their benefit findings.

Home experiences of parents of children undergoing hematopoietic stem cell transplantation: A qualitative study

PURPOSE

This study aimed to describe the home experiences of parents of children undergoing hematopoietic stem cell transplantation.

DESIGN AND METHODS

This study was conducted using a descriptive qualitative research design. The study sample consisted of 12 parents with a child treated with hematopoietic stem cell transplantation (HSCT) at a university hospital in Turkey. Semi-structured individual interviews and researcher observations were used for data collection. The interview transcripts of the study were analyzed using content analysis.

RESULTS

Five main themes were obtained, each of which had associated sub-themes: difficulties faced in home experiences, changes in family life, feelings about home experiences, parents' ways of coping with difficulties, and parents' suggestions.

CONCLUSIONS

Parents faced various difficulties in their own home experiences, and they felt fear, anxiety and stress during this period. Following the child's HSCT, there were changes in health, physical, psychological and social aspects of family life. Some parents used distraction techniques, and the support of their spouses and health professionals to cope with difficulties.

PRACTICE IMPLICATIONS

For pediatric nurses to comprehensively assess and support the home care needs of the child and parents, they should understand the difficulties parents face in home experiences, as well as their feelings, changes in their lives, suggestions regarding home experiences, and ways of coping. Regular health screening and psychosocial support can be provided for parents of children after HSCT, and regular training can be given for parents' management of care-related problems and increasing their self-efficacy for this management.

Social support experiences of hispanic/latino parents of childhood cancer survivors in a safety-net hospital: a qualitative study

PURPOSE

To describe the social support experiences of Hispanic/Latino parents while caregiving for childhood cancer survivors.

RESEARCH APPROACH

Semi-structured one-on-one interviews were conducted among 15 caregivers from a safety-net hospital in Los Angeles. A thematic analysis approach was used to analyze data.

FINDINGS

The positive influence of social support throughout their caregiving experience included (1) sharing information-enhanced knowledge, (2) receiving comfort and encouragement, (3) receiving tangible assistance reducing the caregiving burden, and (4) enhancing caregiving empowerment/self-efficacy. Sub-themes regarding the lack of social support included (1) being a single parent and (2) family and friends withdrawing after the child's cancer diagnosis.

CONCLUSION

We found Hispanic/Latino parents strongly value social support as it enables them to have essential resources that support caregiving for their child and themselves. Efforts should ensure that caregivers are routinely screened to identify their supportive needs so that support services for caregivers can be optimized and tailored, as those with a lack of social support may experience excessive caregiver burden.

Predictors of Post-traumatic Stress Symptoms (PTSS), Depression, and Anxiety among Caregivers of Children with Acute Lymphoblastic Leukaemia (ALL)

OBJECTIVE

The caregivers of children diagnosed with acute lymphoblastic leukaemia (ALL) are believed to experience post-traumatic stress symptoms (PTSS), depression and anxiety. This present study endeavoured to explore the prevalence and predictors of PTSS, depression, and anxiety among the caregivers of children with ALL.

METHODS

Purposive sampling was used to select the 73 caregivers of children with ALL who participated in this cross-sectional study. The Post-traumatic Stress Disorder Checklist for DSM-5 (PCL-5), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) were used to measure psychological distress.

RESULT

There was a low prevalence (11%) of post-traumatic stress disorder (PTSD) among the participants. Although all the criteria for PTSD were not met, a few post-traumatic symptoms remained, suggesting that PTSS was likely present. Most of the participants reported minimal symptoms of depression (79.5%) and anxiety (65.8%). Anxiety, depression, and ethnicity predicted the PTSS scores (R2 = .77, p =.000). Subsequently, depression predicted the PTSS scores (R2 = 0.42, p =0.000). Participants of 'Other' or 'Indigenous' ethnicity had lower PTSS scores and higher anxiety scores (R2 = 0.75, p =0.000) than participants of Malay ethnicity.

CONCLUSION

The caregivers of children with ALL experience post-traumatic stress symptoms (PTSS), depression, and anxiety. These variables co-exist and may have different trajectories in different ethnic groups. Therefore, healthcare providers should take ethnicity and psychological distress into consideration when providing paediatric oncology treatment and care.

Profiles of Resilience, Distress, and Posttraumatic Growth in Parents of Children with Cancer and the Relation to Subsequent Parenting and Family Functioning

OBJECTIVE

The aim of this study was to identify patterns of distress and growth in parents of children with cancer and examine associations with subsequent parenting, parent-child relationship, and family environment.

METHODS

Participants included children with cancer history (8-17 years) stratified by time since diagnosis and their parent. At enrollment, parents (n = 254) reported depression and anxiety, and post-traumatic stress symptoms, posttraumatic growth (PTG), and benefit finding in relation to their child's cancer. Three years later, children (n = 214) reported parenting behavior, parent reactions to their distress, and family environment. Parents reported their reaction to children's distress and qualities of the parent-child relationship.

RESULTS

Latent profile analysis empirically identified 3 cross-sectional profiles using baseline data: "Resilience, High Growth" (50%), characterized by the lowest distress and the highest PTG/benefit finding; "Moderate Distress with Growth" (33%), characterized by relatively high levels of all indicators; and "Resilience, Low Growth" (17%), characterized by relatively low distress with low PTG/benefit finding. Membership in profiles was associated with parent gender; parents' stressful life events; socioeconomic status; and child diagnosis, on versus off treatment status, and treatment intensity. Parent membership in the Moderate Distress with Growth profile was generally linked with poorer parenting behavior, parent-child relationship quality, and family functioning.

CONCLUSION

The majority of parents exhibited resilience and growth. However, a subset of parents displaying moderate distress may be at risk for subsequent parenting and family functioning challenges. Findings further highlight the importance of screening for even moderate parent distress and the possible impact of parent psychosocial interventions indirectly on parenting and family functioning.

Validation of the Benefits of Being a Caregiver Scale (BBCS) - further development of an independent characteristic of informal caregiving

BACKGROUND

Although larger amounts of scientific attention have been directed toward the concept of positive aspects of caregiving (PAC) in recent years, a globally uniform definition and a suitable, scientifically valid questionnaire for all informal caregivers have yet to be developed. On the basis of the questionnaires that already exist for measuring PAC, the authors aimed to (a) concretize the concept and (b) develop a new scale by focusing only on items that show that family caregivers experience a benefit for themselves and that the benefit they experience is the result of their caregiving activities.

METHODS

The Benefits of Being a Caregiver Scale (BBCS) was validated on data from 961 informal caregivers. Cronbach's alpha was calculated to assess the internal consistency of the items, and a factor analysis was conducted to determine the structure of the BBCS. The discriminatory power and item difficulties were examined. Construct validity was established by testing four hypotheses.

RESULTS

The factor analysis confirmed the single-factor structure of the BBCS. Cronbach's alpha for the total scale was 0.922. One of the 15 items did not show good to very good discriminatory power and was excluded from the final version of the scale. A higher BBCS score was observed if the caregiver experienced more positive aspects of caregiving and tended to have better general coping skills and a positive relationship with the care-receiver. The BBCS score was not associated with the subjective burden of the caregiver. Results confirmed the validity of the BBCS.

CONCLUSION

The BBCS is a valid assessment instrument for measuring the benefits that caregivers experience from their caregiving work and can easily be used in research and practice. The BBCS is available free of charge in English and German ( http://www.caregiver-benefits.de ).

Challenges and positive impact of rare cancer caregiving: A mixed-methods study of caregivers of patients with Erdheim-Chester disease and other histiocytic neoplasms

BACKGROUND

The importance of deriving benefit and meaning has been identified among cancer caregivers, but this has yet to be examined in the context of rare cancers. We sought to characterize unmet needs and experiences of caregivers of patients with Erdheim-Chester disease (ECD) and other histiocytic neoplasms (HN) and to identify factors associated with finding benefit and meaning-making in providing care for patients with rare cancers.

METHODS

Caregivers of patients with ECD and other HN completed quantitative surveys. Linear univariable regression modeling examined associations between unmet needs, social and family support, and intolerance of uncertainty with benefit finding and meaning-making. A subset participated in qualitative interviews assessing experiences of rare cancer caregiving that were analyzed with applied thematic analysis (NCT039900428).

FINDINGS

Of caregivers (N = 92, M = 54 years old, 68% female) of patients with ECD (75%) and other HN (25%), 78% reported moderately or severely unmet support needs, most frequently informational (58%) and psychological/emotional (66%) needs. Caregivers with unmet informational, psychological/emotional, and social support needs, difficulty tolerating uncertainty, a longer duration of the patient's illness, lower social support, more family conflict, and higher anxiety and depression symptoms demonstrated less benefit finding and meaning-making (ps <.05). Qualitative interviews (N = 19) underscored information and support needs and the capacity to derive meaning from caregiving.

INTERPRETATION

Rare cancer caregivers report numerous unmet information and support needs, needs that arise from disease rarity itself and which are associated with diminished capacity for deriving benefit and meaning from caregiving. Findings highlight targets for interventions to improve support for caregivers with HN and other rare cancers.

FUNDING

NIH P30 CA008748 (PI: Craig Thompson, MD), NIH T32 CA009461 (H.M.; PI: Jamie Ostroff, PhD), Frame Family Fund (E.L.D.), Applebaum Foundation (E.L.D.).

Benefit Finding and Related Factors of Patients with Early-Stage Cancer in China

(1) Background: Although the research on benefit finding (BF) in China has increased in recent years, it remains in its infancy. Few previous studies have focused on early-stage cancer patients. Therefore, this research study aimed to explore BF and its influencing factors for early-stage cancer patients in China. (2) Methods: From April to August 2019, 319 patients with early-stage cancer in the treatment period were selected by the convenience sampling method and evaluated using the Benefit Finding of Cancer Patients Scale-Chinese (BFS-C), Perceived Social Support Scale (PSSS), and Medical Coping Modes Questionnaire (MCMQ). (3) Results: The mean BF score was 47.57 (SD = 12.26). The results of the correlation analysis show that benefit finding was positively correlated with social support, but negatively correlated with acceptance-resignation. In addition, social support was negatively correlated with avoidance and acceptance-resignation. The results of the multiple linear regression indicate that the variables of self-assessment of disease severity, exercise time, coping mode (acceptance-resignation), and social support, affect BF. Finally, social support was shown to exert an intermediary effect on acceptance-resignation and BF. (4) Conclusions: In this study, the score of BF of patients with early-stage cancer was low. Medical staff should be more aware of the health behavior of patients with early-stage cancer, guide them to actively face the disease, and fully mobilize the social support of patients’ friends and family, so as to help patients increase their disease BF.

Benefit finding: understanding the impact and public health factors among COVID-19 patients in China

BACKGROUND

This study aimed to determine the level of benefit finding among COVID-19 patients in a hospital in mainland China, and to identify its associated impact and public health factors.

METHODS

Using a cross-sectional design, a total of 288 COVID-19 patients were recruited in Huoshenshan Hospital in Wuhan, China to complete a survey on benefit finding. The level of benefit finding evaluated by the Benefit Finding Scale (BFS), mental resilience evaluated by the Connor-Davidson Resilience Scale (CD-RISC), social support evaluated by the Multidimensional Scale of Perceived Social Support (MSPSS), medical coping modes evaluated by the Medical Coping Modes Questionnaire (MCMQ), and general information was collected by self-designed questionnaires. T-test and chi-square test were used for single-factor analyses. For multiple factor analyses, multivariate regression analyses were performed.

RESULT

The mean BFS score of 288 participants was 61.26±10.25. Multivariate regression analysis showed that the factors associated with the level of benefit finding among COVID-19 patients in China included education level, having experienced major event, social support, optimism, confrontive coping and resigned coping mode.

CONCLUSIONS

In general, the patients with COVID-19 in this study had a middle level of benefit finding. Health professionals should take measures to identify the influencing factors on the quality of the life and take targeted intervention measures.

Resilience measurement scale in family caregivers of children with cancer: Multidimensional item response theory modeling

BACKGROUND

Currently, information about the psychometric properties of the Resilience Measurement Scale (RESI-M) in family caregivers of children with cancer according to item response theory (IRT) is not available; this information could complement and confirm the findings available from classical test theory (CTT). The objective of this study was to test the five-factor structure of the RESI-M using a full information confirmatory multidimensional IRT graded response model and to estimate the multidimensional item-level parameters of discrimination (MDISC) and difficulty (MDIFF) from the RESI-M scale to investigate its construct validity and level of measurement error.

METHODS

An observational study was carried out, which included a sample of 633 primary caregivers of children with cancer, who were recruited through nonprobabilistic sampling. The caregivers responded to a battery of tests that included a sociodemographic variables questionnaire, the RESI-M, and measures of depression, quality of life, anxiety, and caregiver burden to explore convergent and divergent validity.

RESULTS

The main findings confirmed a five-factor structure of the RESI-M scale, with RMSEA = 0.078 (95% CI: 0.075, 0.080), TLI = 0.90, and CFI = 0.91. The estimation of the MDISC and MDIFF parameters indicated different values for each item, showing that all the items contribute differentially to the measurement of the dimensions of resilience.

CONCLUSION

That regardless of the measurement approach (IRT or CTT), the five-factor model of the RESI-M is valid at the theoretical, empirical, and methodological levels.

Religious and Spiritual Practices Used by Children and Adolescents to Cope with Cancer

This study consists of an integrative review of the scientific literature that aimed to know the religious and spiritual practices used by children and adolescents to cope with cancer. From searches in the databases/libraries CINAHL, PsycINFO, PubMed, SciELO and Lilacs (2009-2019), the final sample consisted of 20 articles. Prayers were the most widely used practices, followed by sacred books and objects, going to sacred places and the use of music. Improvements in well-being, physical and emotional health have been reported. It is concluded that such practices should be recognized as important resources in coping with cancer illness in this population.

Social Support in Parents of Children With Cancer: A Systematic Review

OBJECTIVES

Parents of children with cancer (PCCs) experience stress as they navigate managing their child's illness. Arguably, social support is critical to PCCs' well-being. This review examines the literature on social support in PCCs.

METHODS

Studies of social support in PCCs were collected from PsycINFO, CINHAL, and MEDLINE. Data were extracted from 37 studies published between January 2010 and May 2021 related to the conceptualization, measurement, and availability of social support in PCCs. Relationships between PCCs' social support, well-being, and unique parent and child factors were also synthesized. Risks of biases were assessed using domains of the Effective Public Health Practice Project.

RESULTS

Social support in PCCs is conceptualized as (a) perceived availability and satisfaction with social support and (b) social support seeking as a coping strategy. Parents of children with cancer report receiving as much or more support than typical adults, but PCCs engage in less social support seeking. Family and significant others are the most prevalent sources of support, and emotional support is the most received type of social support. Social support is positively related to well-being and negatively related to distress, anxiety, and posttraumatic stress. Findings related to social support differences based on parent and child unique factors were minimal and present opportunities for future research. The risk of bias was generally low, with caution that most studies cannot demonstrate directionality of findings due to cross-sectional study designs.

CONCLUSIONS

Given the consistent positive association between social support and well-being in PCCs, clinicians should assess and encourage social support for this vulnerable population.

Factors associated with caregiver burden for mothers of children undergoing Acute Lymphocytic Leukemia (ALL) treatment

OBJECTIVE

The present study examined the extent to which social support (SS) availability and satisfaction could predict the extent of caregiver burden (CB) among mothers of children with Acute Lymphocytic Leukemia (ALL).

METHOD

The study was a cross-sectional, descriptive-correlative study. It was conducted on a sample of 117 mothers whose children were undergoing treatment in a public hospital in Bam, Iran. The Norbeck Social Support Scale and the Caregiver Burden Scale were used to measuring study variables. The data were analyzed using Pearson's correlations, t-tests, ANOVAs, and linear regressions.

RESULTS

Significant correlations were observed between CB and SS availability (r = -0.499, p < 0.001), SS satisfaction (r = -0.543, p < 0.001), the age of the child with cancer (r = -0.22, p = 0.01), and duration of treatment (r = 0.336, p < 0.001). Married mothers experienced less CB than those that were widowed or divorced. Within the regression equation, SS satisfaction, SS availability, marital status, and duration of treatment were the predictors of CB.

SIGNIFICANCE OF RESULTS

Based on the results of the current study, mothers who have less SS, especially those who are single mothers, with younger children, and who have taken care of their child for an extended duration should be given special attention. Furthermore, it appears that there are distinct cultural variations amongst Iranian mothers which suggest that culture may impact upon SS availability. Results also suggest a need for interventions that enhance nurses' ability to provide support to caregivers and the broader family unit as a whole. Nurses in cancer care need to have psychological competencies to help family members of cancer patients especially mothers and more so those that are single mothers. As integral members of the patient care experience, nurses may be uniquely positioned to provide this needed psychosocial support.

Association of psychological distress and religious coping tendencies in parents of children recently diagnosed with cancer: A cross-sectional study

PURPOSE

Parents of children with cancer exhibit high levels of psychological distress. Parents of children with serious illness report religion and spirituality are important coping resources. We sought to describe characteristics of religion, religious coping, social support, and resiliency in parents of children newly diagnosed with cancer and examine associations between psychological distress and self-reported religious coping, religiosity, resiliency, and social support.

PATIENTS AND METHODS

Cross-sectional observational study of 100 parents of 81 unique children recently diagnosed with cancer. Parents provided demographic information and completed measures of psychological distress, importance of religion, religious coping, resiliency, and social support. Patients' type of tumor and intensity of treatment were collected by medical record abstraction.

RESULTS

Compared to nationally reported data for adults, parents of children with cancer reported high scores for psychological distress but similar levels of religiosity, religious coping, and resiliency. Negative religious coping (feelings of negativity related to the divine) was associated with higher levels of psychological distress. This effect was most prominent in parents who reported the highest levels of religiosity. Positive religious coping, religiosity, and social support were not associated with levels of psychological distress.

DISCUSSION

Findings confirm high levels of distress for parents of children with cancer. Negative religious coping was associated with higher levels of psychological distress but positive religious coping, religiosity, and other coping factors were not found to be significantly associated with distress. Further assessment of negative religious coping to inform interventions to promote resiliency is warranted as they may impact parental decision-making and care.

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.

Roles of Reexamination of Core Beliefs and Rumination in Posttraumatic Growth Among Parents of Children With Cancer: Comparisons With Parents of Children With Chronic Disease

BACKGROUND

Studies have indicated that the impact of a traumatic experience can be negative and can provide the opportunity to experience psychological growth, known as posttraumatic growth (PTG).

OBJECTIVE

To evaluate the role of cognitive processing in PTG among parents of childhood cancer survivors (CCSs) based on the PTG theoretical model. We compared the model between parents of SCC and parents of children with chronic disease (CCDs) to determine how the role of cognitive processing in PTG is different depending on the children's illness.

METHODS

Final sample consisted of 78 parents of CCSs and 44 parents of CCDs. The survey included standardized measurements assessing reexamination of core beliefs, intrusive and deliberate rumination, posttraumatic stress symptoms, and PTG. The hypothetical relationships among the variables were tested by covariance structure analysis.

RESULTS

Posttraumatic growth among parents of CCSs had significantly strong association with reexamination of core beliefs, but not with deliberate rumination. Reexamination of core beliefs was significantly more likely to foster PTG among parents of CCSs, whereas deliberate rumination was significantly more likely to be associated with PTG among parents of CCDs.

CONCLUSIONS

For parents of CCSs, reexamination of core beliefs had a greater impact on PTG than deliberate rumination. Our results suggest that support should focus on the process of reexamining core beliefs in facilitating PTG among parents of CCSs.

IMPLICATIONS FOR PRACTICE

Nurses should provide parents of CCSs with reassurance regarding their experiences of the reexamination of core beliefs, which will likely lead to PTG.

Longitudinal predictors of caregiver resilience outcomes at the end of childhood cancer treatment

OBJECTIVE

Caregiver resilience in the context of childhood cancer treatment has been described using cross-sectional and retrospective studies, but little is known about prospective predictors of resilience outcomes. We examined associations of demographics, cancer-related variables, and intrapersonal and interpersonal factors at diagnosis (family psychosocial risk, perceived social support, and healthcare self-efficacy) and psychosocial services provided during treatment with caregiver resilience outcomes at the end of treatment.

METHODS

For a study validating a family psychosocial risk screener, 314 primary caregivers completed the measures at diagnosis of their child (aged 0-17 years) and when cancer treatment ended. Resilience outcomes were ratings of distress, posttraumatic stress, and posttraumatic growth. Multiple regression analyses evaluated the relative contribution of hypothesized predictors.

RESULTS

Caregivers endorsed clinically significant distress, moderate posttraumatic growth, and low posttraumatic stress based on norms. Posttraumatic growth was not associated with posttraumatic stress or distress, which were significantly associated with each other. Over and above resilience at diagnosis, family psychosocial risk was associated with resilience at the end of treatment. Perceived social support, healthcare self-efficacy, and psychosocial services provided demonstrated associations with resilience in univariate analyses, but demographics and cancer-related variables did not.

CONCLUSIONS

Resilience and family psychosocial risk at diagnosis were the strongest predictors of caregiver resilience outcomes at the end of the treatment. Intrapersonal and interpersonal predictors were weaker and varied by resilience measure. Consistent with psychosocial standards of care, broad evaluation of caregiver risks, resources, and resilience processes and outcomes is recommended at diagnosis and through the treatment trajectory including the end of treatment.

Finding the silver linings: Psychosocial correlates of posttraumatic growth among husbands of Chinese breast cancer survivors

OBJECTIVES

Caregiving does not have to be a totally negative experience for the husband caregivers of breast cancer survivors (BCS). There are growing interests in exploring the positive psychological changes (aka posttraumatic growth; PTG) among husbands of BCS. Western studies have shown that coping resources, cognitive appraisal, and coping strategies are associated with PTG among caregivers of BCS. Studies in the Chinese context are limited. This study examined the psychosocial correlates of PTG among husbands of Chinese BCS.

METHODS

Husbands of Chinese BCS (N = 176) were recruited from two hospitals in Weifang, China to complete a cross-sectional survey. Their levels of caregiving burden, marital satisfaction, cognitive appraisals, coping strategies, and PTG were measured.

RESULTS

After controlling for covariates, hierarchical regression results indicated that higher caregiving burden (β = .29), marital satisfaction (β = .27), challenge appraisal (β = 016), and social support seeking (β = .23) were associated with higher PTG (Ps < .05). Additionally, a significant interaction between caregiving burden and positive reframing emerged in explaining PTG (β = .17, P < .05). Positive reframing was only associated with higher PTG among those with higher caregiving burden (β = .25, P = .03), but not those with lower caregiving burden (β = -.09, P > .05).

CONCLUSIONS

Stress and coping variables significantly contributed to PTG among husbands of Chinese BCS. Our findings implied that addressing those husband caregivers' marital satisfaction, challenge appraisal toward the impact of breast cancer, and social support seeking could be intervention strategies to facilitate their PTG. Among husbands having higher caregiving burden, positive reframing may also facilitate their PTG.

Psychosocial Factors Predicting Resilience in Family Caregivers of Children with Cancer: A Cross-Sectional Study

Chronic diseases in childhood can affect the physical and mental health of patients and their families. The objective of this study was to identify the sociodemographic and psychosocial factors that predict resilience in family caregivers of children with cancer and to define whether there are differences in the levels of resilience derived from these sociodemographic variables. Three hundred and thirty family caregivers of children with cancer, with an average age of 32.6 years were interviewed. The caregivers responded to a battery of tests that included a questionnaire of sociodemographic variables, the Measuring Scale of Resilience, the Beck Depression Inventory, the Inventory of Quality of Life, the Beck Anxiety Inventory, an interview of caregiver burden and the World Health Organization Well-Being Index. The main findings indicate that family caregivers of children with cancer reported high levels of resilience, which were associated positively with quality of life, psychological well-being and years of study and associated negatively with depression, anxiety and caregiver burden. The variables that predicted resilience in families of children with cancer were quality of life, psychological well-being, depression and number of children. Family caregivers who were married and Catholic showed higher resilience scores. We conclude that being a caregiver in a family with children with cancer is associated with symptoms of anxiety and with depressive episodes. These issues can be overcome through family strength, well-being, quality of life and positive adaptation processes and mobilization of family resources.

Impact of individualized intervention on the psychological status of patients with localized small cell lung cancer complicated with pleural effusion

To explore the intervention effects of individualized measures on the psychological status of patients with localized small cell lung cancer complicated with pleural effusion (LSCLC-PE). A total of 79 LSCLC patients were selected for comparing the source of psychological control and psychological distress between the patients with combined (group LSCLC-PE, n = 38) and non-combined pleural effusion (group LSCLC, n = 41). LSCLC-PE patients were randomly sub-divided into the control group (CON, for conventional intervention) and the observation group (OBS, for individualized intervention) for evaluating the intervention effects between these two subgroups using the SCL-90 scale. The PHLC score, psychological pain score, and sources of psychological pain (proportion of dyspnea, etc.) in group LSCLC-PE were higher than group LSCLC, but the IHLC and CHLC scores were lower; after intervention, the somatization, obsessive-compulsive symptoms, and total average score in subgroup OBS were statistically lower than subgroup CON. LSCLC-PE patients have poor psychological status, and intervention can improve their psychological status.

Different Reaction Patterns of Caregivers of Children With Imperforate Anus: A Latent Profile Analysis

AIM

This study aimed to explore how different dimensions of caregivers' reaction shape their caring experience, and the factors associated with different reaction patterns.

DESIGN

A second analysis of a multisite cross-sectional study were conducted. Caregivers of children with imperforate anus (IA) were enrolled in three tertiary children's hospitals in Eastern China between November 2018 and February 2019.

METHODS

The caregiver's experience, stigma feeling, social support level and perception of uncertainty were assessed by Caregiver Reaction Assessment, Parent Stigma Scale, Social Support Scale and Parent's Perception of Uncertainty Scale accordingly. The demographic information of caregivers as well as the children's clinical data were collected. Latent profile analysis was conducted to determine different patterns of caregiver's reaction, and logistics analysis was used to explore the associated factors of the reaction pattern.

FINDINGS

A total number of 229 caregivers (median age = 30, quartiles: 28, 36) were included. Three distinguishable caregiving reaction types were identified (Class 1: low burden and high benefit, 4.8%; Class 2: moderate burden and benefit, 48.9%; Class 3: high burden and low benefit, 46.3%). In logistics analysis, the Class 1 and Class 2 were combined as one group due to the low population in Class 1. The marital status of caregiver (OR = 0.067, 95% CI: 0.006, 0.700, P = 0.024), IA type (OR = 1.745, 95% CI: 1.198, 2.541, P = 0.004), children aged > 2 years (OR = 3.219, 95% CI: 1.364, 7.597, P = 0.008), social support (OR = 0.907, 95% CI: 0.865, 0.951, P < 0.001) and perception of uncertainty (OR = 1.054, 95% CI: 1.026, 1.083, P < 0.001) were associated with different caregiver reaction patterns.

CONCLUSION

Nearly half of the caregivers of children with IA experience reaction of high burden and low benefit, but considerable proportion of caregivers could benefit from the caregiving rather than burden from. Married caregivers may have more negative reaction, especially when children > 2 years and diagnosed with intermediate or high type of IA. However, increasing caregiver's social support and reducing perception of uncertainty may have the potential to modify their reaction pattern.

The psychosocial profile of family caregivers of children with chronic diseases: a cross-sectional study

Background

A family caregiver is defined as a person who has a significant emotional bond with the patient; this caregiver is a family member who is a part of the patient’s family life cycle; offers emotional-expressive, instrumental, and tangible support; and provides assistance and comprehensive care during the chronic illness, acute illness, or disability of a child, adult, or elderly person. The objectives of this study were to identify the psychosocial profiles of family caregivers of children with chronic diseases and to establish the relationship between these profiles and sociodemographic variables.

Methods

A cross-sectional study was conducted involving 401 family caregivers of children with chronic diseases at the National Institute of Health in Mexico City. The participants responded to the Sociodemographic Variables Questionnaire (Q-SV) for research on family caregivers of children with chronic disease and a battery of 7 instruments that examined anxiety, caregiver burden, family support, depression, resilience, parental stress, and the World Health Organization Well-Being Index.

Results

A hierarchical cluster analysis and its confirmation through a nonhierarchical cluster analysis confirmed two profiles of caregivers of pediatric patients with chronic diseases. Profile 1, called Vulnerability of family caregivers, is characterized by high levels of anxiety, depression, parental stress and caregiver burden, accompanied by low levels of family support, resilience, and well-being. Profile 2, called Adversity of family caregivers, shows an inverse pattern, with high levels of family support, resilience, and well-being and low levels of anxiety, depression, parental stress and caregiver burden. The sociodemographic characteristics are similar for both profiles, with the exception of the caregiver’s family type. Profile 1 shows more single-parent caregivers, while profile 2 includes more caregivers with a nuclear family. However, the type of family did not reach significance for predicting the caregiver’s profile in a bivariate logistic regression model.

Conclusions

The psychosocial profile of family caregivers of children with chronic diseases can be structured according to their psychosocial characteristics. Although no causal factors were detected that define criteria for belonging to one or another profile, the characteristics identified for each indicate the need for specific and differentiated intervention strategies for families facing adversity, risk and vulnerability during a child’s disease.

Psychosocial assessment of families caring for a child with acute lymphoblastic leukemia, epilepsy or asthma: Psychosocial risk as network of interacting symptoms

The purpose of this study is to assess psychosocial risk across several pediatric medical conditions and test the hypothesis that different severe or chronic pediatric illnesses are characterized by disease specific enhanced psychosocial risk and that risk is driven by disease specific connectivity and interdependencies among various domains of psychosocial function using the Psychosocial Assessment Tool (PAT). In a multicenter prospective cohort study of 195 patients, aged 5–12, 90 diagnosed with acute lymphoblastic leukemia (ALL), 42 with epilepsy and 63 with asthma, parents completed the PAT2.0 or the PAT2.0 generic version. Multivariate analysis was performed with disease as factor and age as covariate. Graph theory and network analysis was employed to study the connectivity and interdependencies among subscales of the PAT while data-driven cluster analysis was used to test whether common patterns of risk exist among the various diseases. Using a network modelling approach analysis, we observed unique patterns of interconnected domains of psychosocial factors. Each pathology was characterized by different interdependencies among the most central and most connected domains. Furthermore, data-driven cluster analysis resulted in two clusters: patients with ALL (89%) mostly belonged to cluster 1, while patients with epilepsy and asthma belonged primarily to cluster 2 (83% and 82% respectively). In sum, implementing a network approach improves our comprehension concerning the character of the problems central to the development of psychosocial difficulties. Therapy directed at problems related to the most central domain(s) constitutes the more rational one because such an approach will inevitably carry over to other domains that depend on the more central function.

Spiritual assessment and spiritual care offerings as a standard of care in pediatric oncology: A recommendation informed by a systematic review of the literature

Children with cancer and their families experience shifts in spiritual wellness from diagnosis through treatment and survivorship or bereavement. An interdisciplinary team conducted a systematic review of quantitative and qualitative research on spiritual assessments, interventions, and outcomes in childhood cancer following PRISMA guidelines using a PROSPERO registered protocol. Thirty-nine well-designed studies were included in the final analysis. The findings from this systematic review indicate the need for early spiritual assessment with offering of continued support for the spiritual functioning of children with cancer and their families as a standard of care.

Psychosocial factors related with caregiver burden among families of children with chronic conditions

BACKGROUND

The impact of looking after children who live with complex chronic conditions is a growing public health issue. However, it is unclear whether sociodemographic and psychosocial variables can be used to predict the burden on the caregiver and how the profiles of families of children with chronic diseases are defined and structured. The objective of this study was to identify multivariate sociodemographic and psychosocial variables as well as sociocultural and familial factors to analyze the caregiver burden of family caregivers of children with chronic diseases.

METHODS

A cross-sectional study was conducted involving 416 family caregivers of children with chronic diseases at the National Institute of Health in Mexico City. The participants responded to a questionnaire on sociodemographic variables and a battery of 7 instruments that examined caregiver burden, family support, parental stress, anxiety, support networks, family functioning, historic-psycho-socio-cultural premises and the World Health Organization Well-Being Index.

RESULTS

A multivariate analysis using hierarchical multiple regression models showed that the variables included in the psychosocial and sociodemographic profile as a whole explained 40% of the variance in caregiver burden, taking sociocultural historical premises, stressors and anxiety into account as positive individual predictors. Negative individual predictors for caregiver burden included upper secondary education, social support networks, family support, family functioning and well-being. The sociodemographic profiles of family caregivers were as follows: female (81.7%); mean age, 31.7 years (standard deviation [SD], 8 years); married (79.3%); nuclear family (60%); basic education (62.7%); unpaid work (66.3%); and a daily household income of approximately 4 USD (61.1%).

CONCLUSIONS

The caregiver burden of family caregivers of children with chronic diseases is defined and structured based on personal, family, and sociocultural factors. These features provide evidence to conduct research and implement intervention strategies with regard to families facing adversity, risk and vulnerability during a child's disease.

Validity and reliability of the Beck Depression Inventory II (BDI-II) in family caregivers of children with chronic diseases

BACKGROUND

Information on the psychometric properties of the Beck Depression Inventory II (BDI-II) in family caregivers of children with chronic diseases is currently unavailable, indicating a significant gap in the literature. Therefore, we investigated 1) which of the five evaluated measurement models had the best fit, 2) the scale's reliability, and 3) the scale's convergent validity.

METHODS

In 2018, a cross-sectional ex post facto study with non-probability convenience sampling was conducted in 446 family caregivers of children with chronic diseases at the National Institute of Health in Mexico City; the family caregivers responded to the BDI-II and a battery of instruments measuring anxiety, caregiver burden, parental stress, well-being, and quality of life. A confirmatory factor analysis was conducted to determine the fit of the five models. Cronbach's alpha and composite reliability were calculated to assess the scale's reliability, and Spearman´s rank correlation was used to investigate the scale's convergent validity.

RESULTS

This study provided evidence that the two-factor somatic-affective and cognitive model had the best fit. The BDI-II demonstrated adequate reliability and evidence of convergent validity, as the BDI-II factors were positively correlated with anxiety, caregiver burden, and parental stress and negatively correlated with well-being and quality of life.

CONCLUSIONS

The findings reveal that the BDI-II is a valid, reliable, and culturally relevant instrument to measure depression in family caregivers of children with chronic diseases.

Exploring the associations between spiritual well-being, burden, and quality of life in family caregivers of cancer patients

OBJECTIVE

The spiritual dimension is important in the process of coping with stress and may be of special relevance for those caring for cancer patients in the various phases of caregivership, although current attention is most prevalent at the end of life. This study explores the associations among spiritual well-being (SWB), caregiver burden, and quality of life (QoL) in family caregivers of patients with cancer during the course of the disease.

METHOD

This is a cross-sectional study. All participants (n = 199) underwent the following self-report questionnaires: the SWB-Index, the Medical Outcomes Study Short Form, and the Caregiver Burden Inventory (CBI). SWB scores were dichotomized at a cutoff corresponding to the 75th percentile. Statistical analyses were made using the Student t or by chi-square test to compare high and low SWB groups.ResultThe high SWB group reported significantly better Medical Outcomes Study Short Form scores in bodily pain (p = 0.035), vitality (p &lt; 0.001), social activities (p = 0.001), mental health (p &lt; 0.001), and in standardized mental component subscales (p &lt; 0.001) than the low SWB group. No significant differences were detected between the two SWB groups in physical activity, physical role, general health, emotional status, and standardized physical component scale. The high SWB group also had better CBI scores in the physical (p = 0.049) and developmental burden (p = 0.053) subscales. There were no significant differences in the other CBI scores (overall and sections).Significance of resultsThis study points out that high SWB caregivers have a more positive QoL and burden. Knowledge of these associations calls for more attention on the part of healthcare professionals toward spiritual resources among family cancer caregivers from the moment of diagnosis and across the entire cancer trajectory.

Spiritual and religious coping and depression among family caregivers of pediatric cancer patients in Latin America

OBJECTIVE

Several studies have shown that spiritual/religious beliefs are associated with mental health and quality of life. However, so far, no study assessed the relationship between spiritual/religious coping (SRC) and depressive symptoms in family caregivers (FCs) of pediatric cancer patients, particularly in Latin America. This study aimed to investigate whether Positive and Negative SRC strategies are associated with depressive symptoms in FCs of pediatric cancer patients in Brazil.

METHODS

We conducted a cross-sectional study comprising 77 FCs of pediatric cancer patients from one Brazilian Pediatric Oncology Institute. Spiritual/religious coping was assessed using the Brief SRC scale, and depressive symptoms were evaluated by the Beck Depression Inventory. Multiple regression models were performed to identify factors associated with SRC of FCs and their depressive symptoms.

RESULTS

In the unadjusted linear regression models, depressive symptoms were positively associated with Negative SRC (B = 0.401; P < .001; Adjusted R²  = 16.1%) but not with Positive SRC (B = 0.111; P = .334). After adjusting for socio-demographics, religious practice/faith, and health, Negative SRC remained associated with depressive symptoms (B = 3.56; P = .01; Adjusted R²  = 37.8%). In the logistic regression models, depressive symptoms were positively associated with Negative SRC (OR = 3.68; 95% CI, 1.46-9.25; P = .006), but not with Positive SRC (OR = 1.49; 95% CI, .69-3.22; P = .309). After adjustments, Negative SRC remained significant (OR = 4.01; 95% CI, 1.21-13.33; P = .023).

CONCLUSIONS

Negative SRC was associated with depressive symptoms in FCs of pediatric cancer patients. Health professionals must be aware of the use of Negative SRC strategies in oncology care.

The Search for Balance: Prolonged Uncertainty in Parent Blogs of Childhood Cancer

Illness blogs are the online narrative expression of the experience of illness and its treatment. The purpose of the present research was to explore, describe, and analyze blog narratives created by parents during their child's cancer experience in the hope that knowledge generated would amplify the voices of these vulnerable families. The study aimed to answer this question: What themes are evident in illness blogs created by a parent when a child has cancer? The purposive sample of 14 parent blogs included publicly accessible, English language narratives that contained descriptions of life with a child who had undergone treatment for acute lymphocytic leukemia (ALL; five blogs analyzed) or neuroblastoma (nine blogs analyzed) in the previous 5 years or who was currently undergoing treatment for these types of cancer. Analysis resulted in discovery of new knowledge of the uncertainty inherent in daily family life during illness and treatment. The parents' vivid depictions of the quest for balance while living with prolonged uncertainty during the illness experience suggested new ways to understand experiences of parents of children with cancer.

Threat of biographical disruption: the gendered construction and experience of infertility following cancer for women and men

BACKGROUND

Infertility is a major concern for people with cancer and their partners. There have been calls for further research on the gendered nature of psychosocial, emotional and identity concomitants of fertility post-cancer across women and men.

METHOD

The gendered construction and experience of infertility following cancer was examined through a survey of 693 women and 185 men, and in-depth one-to-one interviews with a subsample of survey respondents, 61 women and 17 men, purposively selected across cancer types and age groups. Thematic decomposition was used to examine the open ended survey responses and interviews. The chi square test for independence was used to test for group differences between women and men on closed survey items.

RESULTS

In the thematic decomposition, infertility was identified as providing a 'Threat of Biographical Disruption' which impacted on life course and identity, for both women and men. Subthemes identified were: 'Parenthood as central to adulthood'; 'Infertility as a threat to gender identity'; ' Unknown fertility status and delayed parenthood'; 'Feelings of loss and grief'; 'Absence of understanding and support'; 'Benefit finding and renegotiation of identity'. In the closed survey items, the majority of women and men agreed that they had always 'wanted to be a parent' and that 'parenthood was a more important life goal than a satisfying career'. 'It is hard to feel like a true adult until you have a child' and impact upon 'my feelings about myself as a man or a woman' was reported by both women and men, with significantly more women reporting 'I feel empty because of fertility issues'. Many participants agreed they 'could visualise a happy life without a child' and there is 'freedom without children'. Significantly more men than women reported that they had not discussed fertility with a health care professional.

CONCLUSION

The fear of infertility following cancer, or knowledge of compromised fertility, can have negative effects on identity and psychological wellbeing for both women and men, serving to create biographical disruption. Support from family, partners and health care professionals can facilitate renegotiation of identity and coping.

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.

Caregiver-reported religious beliefs and complementary and alternative medicine use among children admitted to an epilepsy monitoring unit

Complementary and alternative medicine (CAM) includes a wide range of practices and products that are generally outside the use of conventional medicine as practiced in Western cultures. Use of CAM in persons with epilepsy is high, even compared to individuals with other chronic health conditions. In this study, we surveyed caregivers of children admitted to a regional epilepsy monitoring unit (EMU) in the southeast United States to assess CAM use among patients (N=225). Thirteen percent of respondents indicated current use of CAM by their child, 16% reported past use, and 43% reported interest in future use, most commonly in marijuana as a potential treatment (23%). Over 25% of respondents expressed interest in CAM use related to side effects of anti-epileptic medications. Regarding prayer as a form of CAM, a large majority of respondents in this sample identified as Christian and actively prayed for their child's illness, revealing a high prevalence of spiritual practices in this population. Eighty-one percent of respondents reported that they had not discussed CAM use with their doctor. Discussing CAM use with a health care provider was significantly related to past CAM use (p<.02), but not current use or willingness to try CAM in the future (p>.05). These results have important implications for future practice and support increased communication and patient education, as many anti-epileptic medications interact with certain herbs and supplements, posing a potential health risk and treatment barrier in this population.