Parent Stress and Coping: Waiting for a Child to Receive a Kidney Transplant

Parents' Experiences of Their Child's Solid-Organ Transplant: A Meta-Ethnography of Qualitative Studies

OBJECTIVE

The aim of this paper was to conduct a systematic review and meta-ethnography of qualitative studies examining the experiences of parents adjusting to life after the solid organ transplant (SOT) of their child.

METHODS

A systematic review of the literature was conducted to identify qualitative studies that examined this topic. The search retrieved 4,964 studies to review against inclusion criteria. A total of 21 studies were included in the meta-ethnography. A reciprocal translation was conducted to compare themes identified in each study. A line of argument synthesis was then conducted in order to integrate the similarities and differences between all of the studies into a new interpretative context.

RESULTS

The synthesis identified four themes: (a) adjusting to life after transplant, (b) factors that facilitate adjustment, (c) factors that disrupt adjustment, and (d) changes caused by transplant. As a result of the synthesis, a new interpretation of parents' experiences of adjusting to life after the SOT of their child was constructed. A summary figure is presented.

CONCLUSION

This review found that while parents may struggle to adapt to life post-transplant and the demands of caring for their child, the experience can also result in the development of new skills, a new appreciation for life, and viewing the self in a more positive manner. A better understanding of parental experiences will promote the development of more effective interventions for the adjustment of parents and families to post-transplant life.

The Factor Structure of the Brief Cope: A Systematic Review

The Brief COPE is a widely used measure of coping that contains 28 items on 14 factors. Researchers have shortened the inventory, but the factor structure remains debated. A systematic review of peer-reviewed studies published in English between 1997 and 2021 was conducted to determine if a more parsimonious number of factors could be identified. Cumulative Index for Nursing and Allied Health, PsycINFO, PsycARTICLES, Medline, PubMed, and Scopus databases were searched using keywords "Brief COPE" and "factor, valid*, or psychometric.*" Searching yielded 573 articles; cited references added 38; 85 articles met inclusion criteria. Principal components analysis and confirmatory factor analysis were major analytic strategies used (28% and 27%, respectively). Only eight studies analyzed the original 14-factor structure. Factors identified ranged from 2 to 15, with dichotomous factors most frequently identified (25%; n = 21). A smaller number of factors may be able to represent the Brief COPE. Research is needed to test a condensed instrument.

Increased parental anxiety and a benign clinical course: Infants identified with short-chain acyl-CoA dehydrogenase deficiency and isobutyryl-CoA dehydrogenase deficiency through newborn screening in Georgia

The long-term consequences and need for therapy in children with short-chain acyl-CoA dehydrogenase deficiency (SCADD) or isobutyryl-CoA dehydrogenase deficiency (IBDD) identified via newborn screening (NBS) remains controversial. Initial clinical descriptions were severe; however, while most cases identified through NBS have remained asymptomatic, clinical concerns have been raised in these populations. It is not clear whether these children are asymptomatic because of the success of NBS, or because the normal clinical course of these disorders is relatively benign. To evaluate these possibilities in our program, we evaluated the clinical outcomes of children with SCADD or IBDD identified by the Georgia NBS compared to the health status of a healthy age-matched control group. We also assessed parental anxiety during a phone interview both subjectively and objectively using the Pediatric Inventory for Parents (PIP), a validated measure of illness-related parental stress. The general health of 52 SCADD and nine IBDD cases from 2007 to 2016 were compared to the general health of unaffected control children obtained through the Centers for Disease Control and Prevention (CDC) parent listserv. We also collected statements from parents who participated in a phone survey regarding events they experienced during and after their diagnostic process. Overall, the children with SCADD and IBDD had no major health problems. There was no significant difference in cognitive development (p = .207). We identified a slightly higher incidence of reported neonatal hypoglycemia in the SCADD group; two of these occurred in the context of maternal diabetes. All interviewed parents reported extreme anxiety during the diagnostic period and current feelings of uncertainty about their child's future. PIP scores for all six caregivers who responded to that portion of the survey were consistent with some degree of parental stress. The greatest reported stressor was the unknown long-term impact of the illness. All children with SCADD and IBDD had no significant long-term sequelae. The phone interviews revealed substantial parental anxiety about the identification and follow-up of SCADD and IBDD. Based on our findings, the anxiety parents experience may be unwarranted given that we see no disease-associated morbidity or mortality in these children. Consideration should be given to the removal of these conditions from NBS panels, or if that is not possible, clinicians could educate parents on the benign nature of these diagnoses and release them from follow-up without treatment.

Caring helps: Trait empathy is related to better coping strategies and differs in the poor versus the rich

Coping has been extensively studied in health psychology; however, factors influencing the usage of different coping strategies have received limited attention. In five studies (N = 3702), we explored the relationship between trait empathy and coping strategies, and how subjective socioeconomic status (SES) moderates this relationship. In Studies 1-4, we found that people with higher level of empathic concern use more adaptive coping strategies, seek more social support, and use fewer maladaptive coping strategies. Moreover, higher trait empathy related to more adaptive coping strategies among the poor, and fewer maladaptive coping strategies among the rich. In Study 5, we tested the potential biological basis of the relationship between trait empathy and coping by examining the effect of the oxytocin receptor gene (OXTR) rs53576 polymorphism on coping. We found that individuals with the GG phenotype-who in previous research have been found to be more empathic-were more likely to seek social support than AG or AA individuals. Furthermore, in line with findings in Studies 1-4, amongst people with low SES, individuals with GG genotype used more adaptive coping strategies than AG or AA individuals. Our results highlight the selective role trait empathy plays in influencing coping strategy deployment, depending on the SES of individuals.

Coping, Attributions, and Health Functioning Among Adolescents with Chronic Illness and Their Parents: Reciprocal Relations Over Time

The purpose of the study was to identify bidirectional and longitudinal links between attributions, coping, and health functioning among adolescents with chronic illness and their parents. Religious/spiritual coping, attributional styles, and health functioning were assessed among adolescents with chronic illness at two time points approximately 21 months apart. Parental coping and attributions at both time points were also measured. Longitudinal links between variables were tested using an autoregressive cross-lagged path model; adolescent age and disease differences were evaluated via multigroup modeling. Poorer adolescent health functioning at baseline predicted higher use of parent optimistic attributional style at follow-up. Adolescent optimistic attributional style at baseline predicted more positive and less negative religious/spiritual coping at follow-up; adolescent negative religious/spiritual coping at baseline predicted more positive religious/spiritual coping at follow-up. Parent optimistic attributional style and positive religious/spiritual coping at baseline predicted the same constructs among adolescents at follow-up. With respect to age differences, parental negative religious/spiritual coping at baseline was associated with poorer health functioning among younger, but not older, adolescents at follow-up. There were no disease differences in the model. Important links were identified in this family-based model of coping, attributions, and health functioning. The results highlight specific targets for interventions to improve health functioning and coping among adolescents with chronic illness, including parental religious/spiritual coping and adolescent attributional style.

A brief version of the Pediatric Inventory for Parents (PIP) in Spanish population: Stress of main family carers of chronic paediatric patients

A chronic illness in childhood has a negative impact on the paediatric patient and on family functioning. Psychological stress in parents influences the level of adjustment to the illness of their children. The Pediatric Inventory for Parents (PIP) was designed to measure stress in parents whose child has a chronic illness or requires prolonged medical monitoring. The main objective of this study is to provide a brief version of the Spanish translation of the PIP, across a sample consisting of 465 main familial caregivers (85.2% female, n = 396) between 27 and 67 years old (X¯ = 44.13; SD = 5.35) of paediatric patients between 9 and 18 years old (X¯ = 12.10, SD = 2.20; 56.8% men, n = 264) diagnosed with diabetes mellitus type I (20.9% of the sample; n = 97), short stature (32.5% of the sample; n = 151), or a chronic respiratory disease (asthma, cystic fibrosis, bronchiolitis obliterans and bronchiectasis) (46.6% of the sample; n = 217). After performing several EFAs (Exploratory Factor Analyses) and CFAs (Confirmatory Factorial Analyses), it was decided that 30 items need to be removed. Reliability and validity results suggest that the new 12-item version possesses appropriate psychometric properties. Cronbach’s alpha value ranging between α = .42 and α = .81 and fit values obtained indicate a good fit: χ²/df (88.393/48) = 1.84 (α < .01); S-B χ²(df) = 88.393 (48); CFI = .95; IFI = .95; RMSEA = .05 (.033 - .074) for the frequency scales and χ²/df (72.002/48) = 1.5 (α < .01); S-Bχ²(df) = 72.002 (48); CFI = .97; IFI = .97; RMSEA = .04 (.011 - .063) for the difficulty scales. The PIP also showed predictive ability in regards to anxiety and depression, a positive relationship between the instrument's own scales and a negative relationship with the caregiver's age. Finally, depending on the paediatric patient's diagnosis, differences in stress levels were found.

Experiences of Inner-City Fathers of Children With Chronic Illness

We aim to explore the experiences of fathers from inner-city families caring for children affected by chronic health conditions or disabilities. A systematic scoping review was conducted using the Arskey and O'Malley framework. Fourteen of the 5114 articles were included in the full review and were qualitatively evaluated in terms of stressors, resources, perception, coping, and adaptation according to the Double ABCX model. Stressors included financial strain and health care access barriers. Resources ranging from immediate to extended family members depended on ethnicity. Fathers' perceptions of their primary caregiver roles depended on ethnicity in the context of cultural gender norms. While inner-city fathers desired information about their children's health, some were uncomfortable asking physicians. They had a higher risk for coping difficulties and maladaptation, including depression. We highlight a need for pediatricians to advocate for additional resources to provide comprehensive care for inner-city fathers caring for their children with chronic health conditions or disabilities.

A systematic review of parent and family functioning in pediatric solid organ transplant populations

The process of pediatric solid organ transplantation (SOT) places new and increased stressors on patients and family members. Measures of family functioning may predict psychological and health outcomes for pediatric patients and their families, and provide opportunity for targeted intervention. This systematic review investigated parent and family functioning and factors associated with poorer functioning in the pediatric SOT population. Thirty-seven studies were identified and reviewed. Studies featured a range of organ populations (eg, heart, liver, kidney, lung, intestine) at various stages in the transplant process. Findings highlighted that parents of pediatric SOT populations commonly report increased stress and mental health symptoms, including posttraumatic stress disorder. Pediatric SOT is also associated with increased family stress and burden throughout the transplant process. Measures of parent and family functioning were associated with several important health-related factors, such as medication adherence, readiness for discharge, and number of hospitalizations. Overall, findings suggest that family stress and burden persists post-transplant, and parent and family functioning is associated with health-related factors in SOT, highlighting family-level functioning as an important target for future intervention.

Parental coping, depressive symptoms, and children's asthma control and school attendance in low-income, racially, and ethnically diverse urban families

OBJECTIVE

Low-income urban children of color are at elevated risk for poor asthma control. This cross-sectional study examined associations among parents' coping (primary control, secondary control, and disengagement), parental depressive symptoms, and children's asthma outcomes (asthma control and school attendance) in a predominantly low-income, racially/ethnically diverse sample of families.

METHODS

Parents (N = 78; 90% female) of children (33% female; 46% Black; 38% Latino) aged 5-17 years (M = 9.5 years) reported on their own coping and depressive symptoms, their child's asthma control, and full and partial days of school missed due to asthma.

RESULTS

Parents' secondary control coping (i.e., coping efforts to accommodate/adapt to asthma-related stressors) was negatively correlated, and disengagement coping (i.e. coping efforts to avoid/detach from stressors) was positively correlated, with their depressive symptoms. Secondary control coping was also correlated with fewer partial days of school missed. Primary control coping (i.e., coping efforts to change stressors) was not associated with depressive symptoms or asthma outcomes. Parents' depressive symptoms were also positively correlated with poorer asthma control and partial days of school missed. Regression models showed direct and indirect effects of secondary control and disengagement coping on asthma outcomes via depressive symptoms, after controlling for demographic factors.

CONCLUSIONS

Parents' secondary control and disengagement coping are related to children's asthma outcomes. Secondary control coping may support parents' mental health and children's asthma control in low-income urban families.

Pediatric solid organ transplant recipients: transition to home and chronic illness care

Pediatric SOT recipients are medically fragile and present with complex care issues requiring high-level management at home. Parents of hospitalized children have reported inadequate preparation for discharge, resulting in problems transitioning from hospital to home and independently self-managing their child's complex care needs. The aim of this study was to investigate factors associated with the transition from hospital to home and chronic illness care for parents of heart, kidney, liver, lung, or multivisceral recipients. Fifty-one parents from five pediatric transplant centers completed questionnaires on the day of hospital discharge and telephone interviews at three wk, three months, and six months following discharge from the hospital. Care coordination (p = 0.02) and quality of discharge teaching (p < 0.01) was significantly associated with parent readiness for discharge. Readiness for hospital discharge was subsequently significantly associated with post-discharge coping difficulty (p = 0.02) at three wk, adherence with medication administration (p = 0.03) at three months, and post-discharge coping difficulty (p = 0.04) and family management (p = 0.02) at six months post-discharge. The results underscore the important aspect of education and care coordination in preparing patients and families to successfully self-manage after hospital discharge. Assessing parental readiness for hospital discharge is another critical component for identifying risk of difficulties in managing post-discharge care.

Waiting for transplant: physical, psychosocial, and nutritional status considerations for pediatric candidates and implications for care

The waiting period for an organ transplant has been described as a time of tremendous uncertainty and vulnerability, posing unique challenges and stressors for pediatric transplant candidates and their families. It has been identified as the most stressful stage of the transplant journey, yet little attention has been given to the physical, psychological, or social impact of the waiting period in the literature. In this review, we discuss the physical, nutritional, and psychosocial implications of the waiting period for child and adolescent transplant candidates and the impact on their parents and siblings. We identify areas for future research and provide recommendations for clinical practice to support children, adolescents, and families during the waiting period.

The relationship between socio-demographic characteristics, family environment, and caregiver coping in families of children with cancer

The factors that influence caregiver coping mechanism preferences after a child's diagnosis with cancer are not fully understood. This study examines the relationship between caregivers' socio-demographic characteristics and the coping strategies they use to adapt to childhood cancer. Sixty caregivers of pediatric cancer patients completed a socio-demographic questionnaire, the Family Environment Scale, and the COPE inventory. There were no significant differences in family environment by income or education. Caregiver educational attainment was positively associated with use of planning and active coping styles, while income was not associated with caregiver coping style. Mothers were more likely than fathers to use active coping, instrumental support, religious coping, and emotional support. Men with lower education engaged in greater substance use coping and lower planning. The findings show that educational attainment and caregiver gender influence caregiver coping styles following a pediatric cancer diagnosis and suggest that educational attainment rather than financial resources drive the association between SES and coping. Programs that address educational gaps and teach caregivers planning and active coping skills may be beneficial for parents with lower educational attainment, particularly men.

Development of a measure of caregiver burden in paediatric chronic kidney disease: The Paediatric Renal Caregiver Burden Scale

To inform the development of a measure of caregiver burden for carers of children with chronic kidney disease, interviews were conducted with 16 caregivers and 10 renal healthcare professionals. A pool of 97 items generated from interviews was reduced to 60 items following review. A piloting exercise provided evidence for the usability, readability and relevance of items and informed further adaptations resulting in the 51-item Paediatric Renal Caregiver Burden Scale. Further to assessment of its psychometric properties, it is hoped that that the Paediatric Renal Caregiver Burden Scale will serve as a useful measure of caregiver burden in paediatric chronic kidney disease.

How religious coping is used relative to other coping strategies depends on the individual's level of religiosity and spirituality

Results from empirical studies on the role of religiosity and spirituality in dealing with stress are frequently at odds, and the present study investigated whether level of religiosity and spirituality is related to the way in which religious coping is used relative to other coping strategies. A sample of 616 university undergraduate students completed the Brief COPE (Carver in Int J Behav Med 4:92-100, 1997) questionnaire and was classified into groups of participants with lower and higher levels of religiosity and spirituality, as measured by the WHOQOL-SRPB (WHOQOL-SRPB Group in Soc Sci Med 62:1486-1497, 2006) instrument. For participants with lower levels, religious coping tended to be associated with maladaptive or avoidant coping strategies, compared to participants with higher levels, where religious coping was more closely related to problem-focused coping, which was also supported by multigroup confirmatory factor analysis. The results of the present study thus illustrate that investigating the role of religious coping requires more complex approaches than attempting to assign it to one higher order factor, such as problem- or emotion-focused coping, and that the variability of findings reported by previous studies on the function of religious coping may partly be due to variability in religiosity and spirituality across samples.

Families with children with diabetes: implications of parent stress for parent and child health

OBJECTIVE

To examine the relation of parent stress to parent mental health and child mental and physical health.

METHODS

We interviewed children with type 1 diabetes (n = 132; mean age 12 years) annually for 5 years and had one parent complete a questionnaire at each assessment. Parents completed measures of general life stress, stress related to caring for a child with diabetes, benefit finding, and mental health. Child outcomes were depressive symptoms, self-care behavior, and glycemic control. Multilevel modeling was used to examine concurrent and longitudinal relations.

RESULTS

Greater parent general stress and greater parent diabetes-specific stress were associated with poorer parent mental health. Overall, greater parent general stress was associated with poorer child outcomes, whereas greater parent diabetes-specific stress was associated with better child outcomes.

CONCLUSIONS

Families with high levels of general life stress should be identified as they are at risk for both poor parent and child health outcomes.

How ready are they? Parents of pediatric solid organ transplant recipients and the transition from hospital to home following transplant

Poor discharge transition is evidence of a gap between evidence-based practices and current health care delivery. Pediatric SOT recipients are a vulnerable population at risk of complications during the discharge transition. The aim of this study was to investigate factors associated with the transition care from hospital to home. We studied the transition experience of parents of heart, liver, or kidney recipients to identify opportunities for improvement in discharge and post-discharge care processes and outcomes. Thirty-seven parents from three different pediatric transplant centers completed questionnaires on the day of hospital discharge and three wk following hospital discharge. Care coordination was associated with readiness for hospital discharge. Readiness for hospital discharge was subsequently associated with post-discharge coping difficulty, adherence difficulty with medical follow-up, and family impact. Identifying parents who are not ready to go home provides an opportunity to offer additional support services so parents can effectively manage their child's recovery and continuing care at home.

Health-related quality of life, psychosocial strains, and coping in parents of children with chronic renal failure

Health-related quality of life (HRQOL) in parents of children suffering from renal disease is often diminished by the illness burden experienced in daily life and by unfavorable ways of coping. Our aim was to examine the relationship between psychosocial strains perceived by parents, their ways of coping, and HRQOL. In an anonymous cross-sectional study, parents completed a questionnaire concerning psychosocial strains, coping strategies, and HRQOL, as well as sociodemographic and illness parameters. Study participants were recruited in two outpatient dialysis centers. Participating in the study were 195 parents (105 mothers, 90 fathers; age 43 +/- 8 years; representing 108 families) of children suffering from renal disease (age 12 +/- 5 years). Parents of children with chronic renal failure reported moderate HRQOL with parents of children undergoing dialysis experiencing more limitations in quality of life than parents of children living with a kidney graft and parents of children undergoing conservative treatment. Mothers experienced lower HRQOL and higher psychosocial strains than fathers. HRQOL was predicted by the coping strategies "focusing on child" (beta = -0.25), "improving marital relationship" (beta = 0.24), "seeking social support" (beta = -0.22) and "self-acceptation and growth" (beta =0 .19) as well as parents' perceived limitation by illness in daily life (beta = -0.15; explained variance 57%). In the comprehensive care for families with a child suffering from a renal disease, screening for psychosocial strains and ways of coping, along with applying interventions to strengthen adaptive coping strategies, may be a preventative means of improving parents' quality of life.