Communication in families with minor children following the loss of a parent to cancer

Family Coping With COVID-19: Unexpected Parental Loss and Surviving Parent Coping, Grief and Posttraumatic Growth Outcomes Based on Child Age

Guided by the conceptual framework of widowed parenting, the current study takes a relational approach to understand more about how the characteristics of parents of young and adult children relate to coping following the unexpected death of a partner due to COVID-19, and how these variables predict complicated grief and posttraumatic growth. A sample of 81 widowed parents completed self-report measures examining parenting self-efficacy, relationship uncertainty, coping, complicated grief, and posttraumatic growth. Results of hierarchical regression analyses suggest that, when controlling for time since death (1) relationship uncertainty and avoidant coping significantly predict complicated grief for parents in the sample with adult children, and (2) widowed parenting self-efficacy and both problem-focused and emotion-focused coping significantly predict posttraumatic growth for parents in the sample with young children. Results of the current study may inform future practices (e.g., use of Emotionally Focused Family Therapy) to aid families grieving an unexpected loss.

I occasionally wear his huge sweaters… but I often prefer not to think about it: Bereaved children talking and not talking about parental loss

The unique perspective of children communicating about the loss of a parent has rarely been studied. In this qualitative research, we interviewed 12 children aged 7-12 and asked them about their experience communicating their loss. The children's verbal and non-verbal communication was characterized by constant movements away from and closer to various aspects of their loss, illustrated by three main themes: (a) children either talking about the loss or not talking about it; (b) first talking about the loss and then stopping to talk about it; and (c) simultaneously talking and not talking about the loss. Based on Stern's interpersonal relational thinking, our findings indicate that children wish to talk about the loss but also to avoid talking about it. The possibility of choosing to talk and not to talk with themselves and close individuals about the loss allows children to think about and articulate their feelings and thoughts.

Caring Existentially and Spiritually for Young Children and Close Grandchildren of Life-Threatened Cancer Patients in Secularized Denmark

PURPOSE

When children are given opportunities to talk about their existential and spiritual concerns and needs, different health risks related to parents' illness and death may be reduced. The existential and spiritual care and conversations provided during parents' and close grandparents' cancer illness are insufficient. This article presents a practical and theoretical perspective on how to care for the existential and spiritual needs of children at three different age stages.

DATA SOURCES

Data from a research project guided the process of synthesizing the theoretical aspects with the practical. The theoretical perspective comprises Majbrit Guldin's theory of children's age-related grief reactions and James Fowler's three stages about children's spiritual and cognitive development. The empirical study is based on qualitative interviews with 16 children or close grandchildren of cancer patients at hospice.

CONCLUSION

The theoretical and practical perspective function as a guide for existential and spiritual care and conversation with children at three different ages. The preschool child needs adults to support their growing spirituality and help them show, express, and understand their feelings. The school-aged child needs adults who listen to and acknowledge the child's understandings, experiences, and feelings as well as challenge their rigid thinking. The young adult needs adults who are willing to be there for them physically, mentally, socially, and spiritually in a genuine relationship.

IMPLICATIONS FOR NURSING PRACTICE

The perspective might function well for nurses and other health professionals as it is generic and addresses barriers for communication with children found in different healthcare contexts.

A Systematic Review of Educational Interventions to Equip Health and Social Care Professionals to Promote End-of-Life Supportive Care when a Parent with Dependent Children is Dying with Cancer

OBJECTIVES

This systematic review aimed to determine the content, mode of delivery, assessment, and outcomes of educational interventions to equip health and social care professionals when delivering end of life supportive care for parents dying with cancer who have dependent children.

DATA SOURCES

A mixed-methods systematic review was undertaken. Six electronic database were searched from their inception until September 2023 (Medline OVID, CINAHL, EMBASE, PsycINFO, Web of Science, and ERIC), supplemented by citation chaining, grey literature searches using Google Advanced Search and relevant professional bodies. Quality assessment was conducted independently by two researchers on the included studies. A convergent integrated approach was utilised for data synthesis.

CONCLUSION

The review identified two educational interventions; highlighting a dearth of training opportunities to equip health and social care professionals to provide supportive care to families when a parent is at end of life with cancer. Despite health and social care professionals reported need and desire for upskilling in this area of clinical practice, there is a severe lack of evidence-based educational interventions. It is imperative that effective educational interventions are made accessible to professionals.

IMPLICATIONS FOR NURSING PRACTICE

There is an imminent need for robust educational interventions to be developed, as health and social care professionals often lack the knowledge, skills and confidence on how best to support families when a parent of dependent children is at end of life. Health and social care professionals engagement with high-quality, evidence-based and theory-driven educational interventions has the potential to impact professionals' provision of family-centred cancer care at end of life. This could lead to better mental and physical outcomes for the whole family at end of life and in bereavement.

The Relationship Between Perceived Parental Competence and Bereavement Outcomes in Widows With Young Children

Adjustment to bereavement, while a normative life experience, is one that impacts every aspect of life. Widows with young children face the unique challenge of managing both their grief and the grief of their child while also redefining roles, responsibilities, and resources. This study used a cross-sectional survey method to explore the relationship between perceived parental competence and bereavement outcomes in widows with young children (n = 232). Participants completed study measures including a demographic survey, the Revised Grief Experience Inventory, and the Parental Sense of Competence Scale. Results indicate that the constructs of competence, parenting self-efficacy and parental satisfaction, were directly correlated to decreased grief experiences. Additionally, grief experiences were found to be higher in widows reporting lower levels of education, those who were not currently in a relationship, and those who had more children to care for. This study highlights the potential that perceived parental competence has to influence the grief experience for widows and their bereaved children.

Parental death: a systematic review of support experiences and needs of children and parent survivors

BACKGROUND

Bereaved people need a supportive response from those around them. Knowing children's and surviving parents' needs following parental death is the first step to ensuring a supportive response. However, no systematic review has reported on this phenomenon.

AIM

To systematically identify and synthesise qualitative literature exploring support experiences of parentally bereaved children and surviving parents.

METHODS

Systematic review with thematic synthesis, following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. MEDLINE, Embase, PsycINFO, CINAHL and the British Nursing Database were searched for relevant papers to September 2021. Included studies were appraised for quality and thematically synthesised using Thomas and Harden's thematic synthesis framework.

RESULTS

Fifteen qualitative studies from nine countries were included. There were four analytical themes from the children's perspectives (1) Openness of communication with children about death and dying, (2) Children's challenges of managing change, (3) Navigating emotions, and (4) Children's acceptability, access and engagement with support. There were three analytical themes from the parents' perspectives: (1) Adjusting as a parent, (2) Supporting their children, and (3) Parent's acceptability, access and engagement with support.

CONCLUSIONS

Following a parental death, open and honest communication and involvement in what is happening within the family will help children cope. Both children and parents suppress emotions and avoid conversations to protect each other and those around them. A taboo around death exists and constrains the support some families receive. Childhood bereavement is a public health issue, with a need for professionals and communities to better understand and respond to the needs of bereaved families.CRD42020166179.

The Function of Connection: Examining Social Supports in the Lives of Parentally Bereaved Youth

Through reflexive thematic analysis, this study explored three forms of social support in the lives of parentally bereaved youth: support derived from one's spirituality, caregiver support via parent-child communication, and therapist support from grief counseling (N = 30 youth, Mage = 12.5 years, SD = 2.8 years). Results showed that these sources of support serve varied and vital functions in the lives of parentally bereaved youth. Namely, the benefits of grief counseling and spirituality were consistently identified by youth as critical in facilitating their coping with the loss of a parent; while parent-child communication regarding the deceased varied widely, highlighting the need for additional supports beyond their surviving caregiver. Findings also revealed differences among these supports across youth gender, race, ethnicity, and age. Adolescents were more likely to disengage from counseling services and reported less parental and spiritual support. Males and minoritized youth experienced more benefits from spiritual and therapist supports.

Is the family talk intervention feasible in paediatric oncology? An evaluation of a family-based psychosocial intervention

AIM

To examine the feasibility of a family-based psychosocial intervention, Family Talk Intervention (FTI), in paediatric oncology in terms of recruitment, retention, delivery, response rate and acceptability from the parents' perspective.

METHODS

This study involved 26 families affected by childhood cancer. FTI encompasses six family meetings, with the main goal being to facilitate family communication about illness-related subjects. Meeting 5 is preferably moderated by the parents. Extra meetings (7-11) can be held if needed. This paper includes observational data and surveys, and interviews with parents.

RESULTS

All families who started FTI underwent the full intervention and the survey response rate varied between 100% and 71% over time. Extra meetings were held with most families. The parents stated that FTI filled a gap of support to the family as a unit and described FTI as a map they could follow. Since FTI was conducted at home, this created a safe environment, which contributed to their participation. The parents valued the children's perspectives being considered, but some felt uncomfortable moderating 'the family talk' (meeting 5).

CONCLUSION

Family talk intervention was valued by parents, but it would benefit from being slightly modified before a large trial can be developed.

The Impact of Parental Bereavement on Young People: A Thematic Analysis of Using Online Web Forums as a Method of Coping

A qualitative approach was used to explore how online web forums might facilitate recovery and the process of coping. Ten online web forums written by young people who have personally experienced the death of a parent formed the data of this study. Previous research suggests forum users do not receive the supportive reactions from face-to-face interactions that they desire. Thematic analysis found that forums created an environment where young people can process the bereavement of a parent. Forums allowed young people to use their experience of bereavement to positively support others with similar experiences. The findings imply that the process of using forums can positively impact individuals who have experienced the loss of a parent. This supports recommendations by professionals, to consider online forums as a coping strategy. This study presents one of the few analyses of web forums written by young people who have experienced parental bereavement.

Psychological symptoms in widowed parents with minor children, 2-4 years after the loss of a partner to cancer

OBJECTIVES

This study aimed to explore psychological symptoms in widowed parents with minor children, 2-4 years after the death of their partner. A second aim was to examine the associations between psychological symptoms and nonmodifiable and modifiable illness and healthcare-related factors.

METHODS

A cross-sectional survey study on widowed parents with minor children after the loss of a partner to cancer. In total, 42 parents completed an online questionnaire including instruments for assessing symptoms of anxiety, depression, grief rumination, prolonged grief, and posttraumatic stress. Descriptive statistics, Spearman's correlation coefficients, Mann-Whitney U tests and Kruskal-Wallis tests were used to analyze differences in symptomology based on modifiable and nonmodifiable factors.

RESULTS

Parents reported moderate-severe symptoms of anxiety, posttraumatic stress, and depression. Reporting having received more information during the partner's illness regarding how the illness could affect the partner's somatic and psychological health and where to turn for support were associated with fewer psychological symptoms.

CONCLUSIONS

A substantial proportion of widowed parents with minor children reported a moderate-severe symptom burden regarding depression, anxiety, and posttraumatic stress, and less so with prolonged grief symptoms. This study also highlighted the value of receiving information from healthcare personnel regarding the somatic and psychological effects of a partner's illness and where widowed parents can turn for support.

Sources of social support and its importance for cancer-bereaved spouses and their minor children: A cross-sectional study

The aim of this study was to evaluate the sources from which bereaved families with minor children reported receiving social support after the death of a parent/partner and which sources they perceived as important. Using an online platform, 23 adolescents, 42 parents, and 27 parent proxies for children aged 4-11 years, completed questionnaires. Family and friends were valued as the most important sources of social support, while social support from societal institutions, such as health care and school, was considered less important, and insufficient.

Adaptation of a Grief and Communication Family Support Intervention for Parentally Bereaved Families in Sweden

This article aims to describe the adaptation of the evidence-based Family Bereavement Program to a Swedish context. Empirical support indicating that family communication is a protective factor for parentally bereaved children was used to motivate the focus of the intervention. Modules from the Family Bereavement Program manual were translated, culturally adapted, and modified to fit a family format. The manual for the Grief and Communication Family Support Intervention was pilot-tested with two families, which resulted in minor modifications being made to the manual. Therapists reported that they could follow the manual and adapt it to children's varying ages.

Family Communication and Psychological Health in Children and Adolescents Following a Parent’s Death From Cancer

Parentally bereaved children and adolescents are at risk of developing psychological health problems. Evidence for a correlation between communication and broad measures of psychological health exists in other populations. The aim of this study was to examine associations between family communication and specific aspects of psychological health for children and adolescents following a parent’s death from cancer using parent-proxy and adolescent self-reports. Parent-proxy reports for children and adolescents, and adolescent self-reports for Parent–Adolescent Communication, Strengths and Difficulties Questionnaire, and Prolonged Grief-13 child were analyzed using descriptive statistics and Spearman’s correlation. Parents rated communication as moderate in quality and reported good psychological health for children and adolescents. Adolescent self-reports indicated low-quality communication with their parent and poor psychological health. Significant associations between Parent–Adolescent Communication subscales and Strengths and Difficulties Questionnaire subscales were found for each group. Prolonged grief was associated with emotional problems but not communication for all three groups.