How to support teenagers who are losing a parent to cancer: Bereaved young adults' advice to healthcare professionals—A nationwide survey

Integration of child life into adult oncology: A mixed-methods feasibility study

BACKGROUND

Cancer in a loved one can have negative effects on child health and development. Child Life Specialists (CLSs) specialize in assisting children understand and cope with difficult medical scenarios but are generally not available in adult care facilities to support the needs of patient-families with minor children. We conducted a mixed-methods study of the implementation of a pilot CLS program at a tertiary oncology centre.

METHODS

We collected administrative and clinical data on referred families; encounter data; and patient-reported questionnaire data before and 2 months after engagement with the program.

RESULTS

Over the initial 10 months, 98 families were referred, 91 of whom engaged through a total of 257 clinical encounters. The cancer patient in the family was most commonly a woman with a mean age of 45 years and in the role of mother. Breast cancer was the most common diagnosis (24%) and 78% of patients had stage IV disease. Most families had >1 child at home, and children were most commonly school-aged (5-14y). Phone and Hospital/Clinic visits accounted for the largest portion of CLS time. Interventions ranged from diagnosis education through to bereavement support. Most cancer patients indicated that the program was helpful to them and their families. There were trends of moderate improvements on patient reported outcomes.

CONCLUSION

Our study was able to provide an understanding of the initial CLS program operations to guide program development and future study. Such a program holds promise as an important aspect of adult oncology family-centered care.

A Conceptual Model Depicting How Children Are Affected by Parental Cancer: A Constructivist Grounded Theory Approach

Cancer patients' children are vulnerable to psychosocial and behavioural issues. The mechanisms underlying how children are affected by their parent's diagnosis are unknown, warranting further research. This study investigated how children are affected by their parent's cancer diagnosis and provides a theoretical model conceptualising this experience. Informed by methods of grounded theory, embedded within a social constructivist framework, 38 informants (15 health professionals (HPs); 11 parents; 12 children (5 to 17 years)) were interviewed using a semi-structured format. Three themes were identified: (i) children were worried and distressed because they felt alone, (ii) parents were unable to tend to children's needs because they were overwhelmed by practical factors, and (iii) HPs were not detecting children due to barriers that affected their visibility in clinical settings. The proposed Alexander's Children's Cancer Communication (ACCC) Model and clinical recommendations made can be used to guide the clinical practice and development of future intervention research.

Inclusion and Participation in a Support Programme for Bereaved Adolescents - Relational Perspectives From an Ethnographic Field Study in a Swedish Context

The death of a parent is a life-changing event, and different programmes are developed to support children. This study explored how parental bereaved adolescents were included and (inter)acted in a Swedish support programme. The conducted ethnographic field study included six adolescents, their parents, and eight volunteers. The empirical material was thematically analysed through a theoretical lens inspired by Bourdieu. Three themes emerged: 'Different strategies for adolescents' inclusion in the programme,' 'Medico-psychological understanding of grief and suffering,' and 'Reproduction of the logic of the school.' Adolescents were included in the programme through different strategies, where adults functioned as gatekeepers. The programme reproduced the school logic and was based on a medico-psychological grief/bereavement understanding. Volunteers had pedagogic authority and concomitant symbolic power, ruling adolescents to do what they must do in the meetings, silently socialising them into the medical logic. The adolescents only interacted and communicated with each other during breaks.

Adolescents' and young people's needs and preferences for support when living with a parent with life-threatening cancer: a grounded theory study

BACKGROUND

Living with a parent facing life-threatening illness and losing a mom or dad at a young age can cause both short- and long-term health problems. Without satisfactory support, adolescents' and young people are at risk of developing low self-esteem, behavioural difficulties (e.g., anger and aggression), long-term illness or premature death caused by severe mental illness, substance abuse, self-harm and suicide attempts. The aim of this study was to explore adolescents' and young people's needs and preferences for support as they live with a parent with life-threatening cancer.

METHODS

Qualitative interviews were conducted with 10 respondents (17-24 years) in Norway and Sweden. Data were analysed through grounded theory according to Charmaz.

RESULTS

Adolescents' and young peoples' needs and preferences for support were described through the main category 'To feel safe and secure and to be prepared' and further broken down into five subcategories 'Relationships in the immediate family-balancing support and protection'; 'The social network-support and normalcy in a carefully selected group'; 'Maintaining everyday life-challenges in school and working life'; 'The right support at the right time-competence, trust and continuity in meeting health care professionals'; and 'Support outside the home-an opportunity for full transparency'.

CONCLUSION

Adolescents' and young peoples' preferences for support when living with a parent facing life-threatening illness are individual and unique, but they share a common need to feel safe and secure and to be prepared. Adolescents and young people express that they primarily want support from parents and friends, but they also want support from health care professionals, especially in situations when the ill parent becomes worse. Therefore, it is of the utmost importance for health care professionals to identify the most vulnerable adolescents and young people by mapping their social networks and paying extra attention to their needs for support when there is deterioration in the parent's illness state. This study also highlights the importance for health care professionals to establish a good relationship with adolescents and young people to meet their needs and preferences for support. In addition, information and support are needed in a timely manner and adapted to the life-threatening ill parent's illness state and individual's needs and preferences to optimise preparedness.

'It's not just all about the fancy words and the adults': Recommendations for practice from a qualitative interview study with children and young people with a parent with a life-limiting illness

BACKGROUND

Healthcare professionals report challenges in supporting dying patients who have dependent children. These parents are often uncertain how to meet the needs of their children and require appropriate support from professionals. There is limited evidence based guidance for professionals around this issue, which is informed by the views and experiences of children themselves.

AIM

To develop an understanding of the perspective of children on living with parental life-limiting illness and inform recommendations for healthcare professionals.

DESIGN

Qualitative semi-structured interviews were conducted, with thematic analysis of the data.

SETTING/PARTICIPANTS

A diverse sample of 32 children aged 6-17, whose parent was living with life-limiting illness, were recruited from across the United Kingdom.

RESULTS

Despite the challenges of living with a parent with a life-limiting illness, the children display agency in their response. The children: feel a responsibility to look after their family; negotiate a relationship with healthcare; employ strategies to maintain some normality; and ensure that the inevitable sadness does not become overwhelming.

CONCLUSIONS

Five recommendations for healthcare professionals were developed from the findings. Clinicians should encourage dying parents to: (1) acknowledge the agency of children; (2) recognise children's caregiving roles; (3) engender children's trust in healthcare; (4) maintain some normality; and (5) discuss emotions with their children. Implementing these recommendations will assist parents with a life-limiting illness to provide evidence-based support to their dependent children.

Adaptation and Psychometric Evaluation of the Parenting Concerns Questionnaire-Advanced Disease

PURPOSE

When patients with advanced cancer have minor children (age < 18), their health-related quality of life is closely linked to their concerns about the impact of progressive illness and death on their children. The Parenting Concerns Questionnaire (PCQ), a validated measure for parents with cancer, does not capture the full range of concerns in advanced cancer. The aim of this was study was to adapt and establish psychometrics for the PCQ for advanced disease (PCQ-AD).

METHODS

After generating an initial item-bank, we conducted concept elicitation interviews with clinicians (n = 8) and cognitive interviews with patients (n = 23) for face validity. New items addressed concerns about impact of parental death, making every moment count, communication, and financial impact of cancer on children. We administered 21 candidate items to 151 parents with advanced cancer. We conducted confirmatory factor analysis (CFA), calculated internal consistency, and assessed convergent and known-groups validity.

RESULTS

We removed 8 redundant items due to residual covariation between items. CFA of the 13-item PCQ-AD demonstrated satisfactory fit (CFI = 0.971, TLI = 0.966, RMSEA = 0.081) and high internal consistency (Cronbach's alpha = 0.94, composite reliability = 0.95). The PCQ-AD demonstrated convergent validity and known-groups validity; patients with poor functional status reported higher scores than patients with better functional status (Cohen's d = 0.56, p = 0.002).

CONCLUSION

Adaptation of the PCQ yielded the addition of constructs important in advanced cancer. The PCQ-AD appears to be a reliable and valid measure of parenting concerns in advanced cancer, but future studies are needed to examine measure performance in diverse populations and responsiveness of the PCQ-AD to interventions.

Parenting experiences of cancer patients with minor children and their conversations about the possibility of death: a cross-sectional web-based survey for an online cancer community

PURPOSE

Many cancer patients with minor children experience difficulty talking about their illness with their children. This study aimed to investigate the parenting experiences of cancer patients with minor children and their conversations about the possibility of death.

METHODS

A cross-sectional web-based survey was conducted between April and May 2019. Cancer patients with at least one child aged < 18 years were recruited from an online peer support group called "Cancer Parents." The participants were asked to complete a questionnaire about their experiences of talking about their illnesses with their children. The participants were classified into those who disclosed their cancer to their children ("disclosing group"), and those who did not disclose ("non-disclosing group"). The association between whether they talked with their children about their cancer, and whether it included conversations about the possibility of death, was examined.

RESULTS

A total of 370 parents participated (with 80.8% female parents, with a median age of 43.0 years). The disclosing group (n = 274, 74.1%) wanted to know what their child felt, more than the non-disclosing group did (p < 0.001). Members of the non-disclosing group had a greater tendency than those in the disclosing group to report that they did not want their children to see their suffering (p = 0.002) and did not know how to explain their disease status (p < 0.002). Some members of both the disclosing (42.1%) and non-disclosing (6.5%) groups told their children about the possibility of death.

CONCLUSION

This study showed that 74.1% of the patients with minor children disclosed their cancer to their children. The parents' feelings when thinking about interacting with their children differed significantly between the disclosing and non-disclosing groups. It is important for healthcare professionals treating patients with cancer to provide appropriate multidisciplinary support for discussing their diagnosis and prognosis with their children.

Impact of expected parental death on the health of adolescent and young adult children: A systematic review of the literature

BACKGROUND

Few studies of health impacts of parental death focus on the developmental stage of adolescence and young adulthood and in particular, expected parental death from terminal illness.

AIM

To systematically review the health impact of expected parental death on adolescent and young adult children aged 15-25 years and provide a basis for further research and clinical practice.

DESIGN

Systematic review registered on PROSPERO (CRD42017080282).

DATA SOURCES

Pubmed, PsycINFO, CINAHL, MEDLINE and Cochrane databases were searched with no restrictions on publication date with the last search in March 2021. Eligible articles included studies of adolescent and young adult children (defined by age range of 15-25 years) exposed to parental death due to terminal illness, and with reported health outcomes (physical, psychological or social). Articles were reviewed using the QualSyst tool.

RESULTS

Ten articles met the inclusion criteria. Adolescent and young adult children reported poor family cohesion and communication with associated negative psychological outcomes. They reported distrust in the health care provided to their terminally ill parent, increased psychological distress and risk of unresolved grief, anxiety and self-harm. Some experience was positive with posttraumatic growth identified.

CONCLUSIONS

This review specifically analysed the health impact of expected parental death on adolescent and young adult children. It highlights their need for age-appropriate psychosocial support and clear information during parental illness, death and bereavement.

Children and adolescents’ preferences for support when living with a dying parent – An integrative review

Aim

To identify and synthesize the evidence base regarding children and adolescents’ preferences for support when living with a dying parent.

Design

Integrative literature review study.

Methods

Searches were conducted in PubMed, CINAHL, PsycINFO, the Cochrane Library, Sociological Abstracts and Scopus, between 1 October 2019 and May 2021. Data were analysed and synthesized using integrative thematic analysis according to the analysis stages specified by Whittermore and Knafl.

Results

Twenty‐two articles were identified. Children and adolescents’ preferences for support were described through one overarching theme, Striving to achieve control and balance, together with six subthemes; “Involvement in the sick parent's care and treatment”; “Wanting to be with the sick parent but needing respite”; “Information must be continuous and individually adapted”; “emotional and communicative support from parents and family members”; “professional, compassionate and informative support”; and “support in friendships and opportunities to maintain normality.”

Parental terminal cancer and dependent children: a systematic review

BACKGROUND

When a parent has terminal cancer, their children are part of that experience. Parents often want to protect their children from their disease and prognosis. Knowledge of dependent children's experience will help ensure they receive appropriate support. To date, there is lack of synthesis of this evidence examining children's perspectives.

OBJECTIVES

To systematically search and synthesise the qualitative literature exploring the experiences of dependent children when their parent has terminal cancer.

METHODS

Databases of MEDLINE, Embase, PsycINFO, CINAHL, Assia and the Cochrane library were searched systematically from inception to July 2020 to determine eligible studies. Included studies were appraised for quality and thematically synthesised using Thomas and Harden's thematic synthesis framework.

RESULTS

Fourteen studies were included, which interviewed children about their experiences (n=654 children aged 4-18 years at the time of parental death), from six countries. Five descriptive themes were identified, further categorised into two broad themes: (1) finding out about parental cancer and its impact on the family and (2) coping with life with parental cancer, death and beyond.

CONCLUSION

Children want to be involved in their parent's cancer experience and to help support the family. Healthcare professionals are ideally placed to support and encourage parents to include their children. They should reassure parents that children can cope well and that maintaining normality will help, and explain the benefits of honest and open communication and how they can include dependent children from diagnosis and beyond.

Talking about death when a parent with dependent children dies of cancer: A pilot study of the Family Talk Intervention in palliative care

This study focused on families with dependent children who participated in the Family Talk Intervention (FTI) and lost a parent during the intervention or directly thereafter. The aim was to explore how they perceived information and communication about the imminent death during the illness trajectory and after the loss. Seven families from palliative homecare settings in Sweden participated. This study suggests that it is important to support family communication when a parent is dying, since communication in this situation is unlike everyday family communication, as they enter a complex and existentially unfamiliar area, hard to initiate on their own.

Remembering Friends: Exploring the Bereavement Support Needs of Teenagers and Young Adults Experiencing the Death of a Friend in the Cancer Setting

Introduction: Bereavement is often difficult for adolescents to cope with particularly when the death experienced is a friend due to cancer, while the young person is undergoing their own cancer treatment. There is limited research on this specific type of bereavement. The Teenage & Young Adult (TYA) team at The Christie in Manchester recognized the complicated nature of bereavement in this cohort and identified the need to research this area further. Methods: A mixed method research strategy was used to explore bereavement experiences of young people, gathering qualitative and quantitative data from a TYA bereavement advisory group and an online survey. Inductive thematic analysis was used to establish themes from the qualitative data. Results: Data from the advisory group and survey elicited four main themes: prevalence and emotional impact; maintaining and valuing friendships; communication and conversations; and support and space to grieve. Young people experienced multiple exposures to death, long-term emotional reactions, reflections on mortality, and fears of making new friendships. How a death was communicated was difficult, and bereavement support was lacking. Young people want a formalized bereavement service, provided by specially trained staff, and their own "space" to grieve. Conclusion: Young people in this study highlight the complicated nature of bereavement when their friend dies, while undergoing their own cancer treatment. Bereavement support is essential at the time of a death. TYA services bring young people together for peer support so more emphasis needs to be focused on providing bereavement support to reduce the risk of young people experiencing long-term psychological difficulties and negative outcomes later in life.

Acute and long-term grief reactions and experiences in parentally cancer-bereaved teenagers

Background

Previous research shows that many cancer-bereaved youths report unresolved grief several years after the death of a parent. Grief work hypothesis suggests that, in order to heal, the bereaved needs to process the pain of grief in some way. This study explored acute grief experiences and reactions in the first 6 months post-loss among cancer-bereaved teenagers. We further explored long-term grief resolution and potential predictors of having had “an okay way to grieve” in the first months post-loss.

Methods

We used a population-based nationwide, study-specific survey to investigate acute and long-term grief experiences in 622 (73% response rate) bereaved young adults (age > 18) who, 6–9 years earlier, at ages 13–16 years, had lost a parent to cancer. Associations were assessed using bivariable and multivariable logistic regression.

Results

Fifty-seven per cent of the participants reported that they did not have a way to grieve that felt okay during the first 6 months after the death of their parent. This was associated with increased risk for long-term unresolved grief (odds ratio (OR): 4.32, 95% confidence interval (CI): 2.99–6.28). An association with long-term unresolved grief was also found for those who reported to have been numbing and postponing (42%, OR: 1.73, 95% CI: 1.22–2.47), overwhelmed by grief (24%, OR: 2.02, 95% CI: 1.35–3.04) and discouraged from grieving (15%, OR: 2.68, 95% CI: 1.62–4.56) or to have concealed their grief to protect the other parent (24%, OR: 1.83, 95% CI: 1.23–2.73). Predictors of having had an okay way to grieve included being male, having had good family cohesion, and having talked about what was important with the dying parent.

Conclusion

More than half of the cancer-bereaved teenagers did not find a way to grieve that felt okay during the first 6 months after the death of their parent and the acute grief experiences and reaction were associated with their grief resolution long-term, i.e. 6–9 years post-loss. Facilitating a last conversation with their dying parent, good family cohesion, and providing teenagers with knowledge about common grief experiences may help to prevent long-term unresolved grief.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12904-021-00758-7

The perspectives of children and young people affected by parental life-limiting illness: An integrative review and thematic synthesis

BACKGROUND

Although the death of a parent during childhood is relatively commonplace, the voices of children affected by parental life-limiting illness are under-represented in research evidence. Guidance for healthcare professionals is largely based upon professional opinion rather than the experience of children themselves.

AIM

To synthesise and appraise the literature from primary research with children about their experience of having a parent with a life-limiting illness.

DESIGN

Integrative review and thematic synthesis. Registered on PROSPERO (CRD42019094581).

DATA SOURCES

PsychINFO, Medline, Embase, Scopus and Web of Science were searched, supplemented by searches of grey literature and systematic reviews. There were no restrictions on publication date, and study quality was appraised using the Hawker checklist. Studies reporting the findings of primary research with participants under 18, whose parent has a life-limiting illness, were eligible for inclusion.

RESULTS

Twenty-one papers met the inclusion criteria (n = 13 qualitative; n = 8 quantitative), reporting on n = 18 studies from high-income countries. Findings reveal that throughout parental life-limiting illness, children strive for agency, but are often shielded and excluded by adults. The experience of living with a dying parent is emotionally demanding for children and involves significant caregiving responsibilities. However these children are not passive, developing strategies to cope with the situation and wanting to be involved.

CONCLUSIONS

The review has enabled the voices of children affected by parental life-limiting illness to be heard and will inform the development of guidance for parents and professionals.

Much is left unspoken: Self-reports from families in pediatric oncology

BACKGROUND

Communication about illness-related subjects is complex and difficult. To support entire families in pediatric oncology, health care professionals need to know what family members think, but leave unspoken. The aim of this study was to explore how families in pediatric oncology experienced illness-related information and communication with professionals and within the family.

PROCEDURE

A cross-sectional web survey was used. Families were recruited from one pediatric oncology center in Sweden, 2-3 months after diagnosis. One hundred eighteen family members (ill children, siblings, and parents) representing 27 families filled out age-adapted surveys.

RESULTS

Eighty-six percent of the parents and 71% of the siblings reported that they had not received enough or any information about how the cancer and its treatment could affect the child's psychological health. The families reported that they did not dare ask professionals questions about psychosocial issues and future-related subjects. Nor did they talk with one another, even though 55% of the parents and 24% of the children wanted to reveal more about how they felt to someone in the family. The parents reported the lowest family communication, and few families had all members reporting the same perception of family communication.

CONCLUSIONS

Much is still left unspoken in pediatric oncology and the needs of the families are prominent. Assessments of each family member's needs might form a basis for professionals to give each person adequate information and family support. An increased awareness in families about family members' different needs might lead to mutual understanding.

Recognition of Insufficient Competence-Nurses' Experiences in Direct Involvement With Adolescent Children of Cancer Patients

BACKGROUND

A parent's cancer may have disruptive impact on his/her adolescent children. Currently, nurses have been regarded as central actors in direct involvement with patients' minor children. Development of an extended nursing role has become a pertinent issue.

OBJECTIVE

Adolescents' needs tend to be overlooked by nurses because of inexperience with this population. The aim of this study was to explore nurses' experiences of direct involvement with these adolescents, to get a deeper understanding about this phenomenon.

METHODS

Using a constructivist grounded theory approach, 12 interviews were conducted among Norwegian nurses within the cancer care context. The category insufficient competence was explored through analyzing participants' experiences of direct involvements with adolescents.

RESULTS

The recognition of insufficient competence became visible as nurses experienced being involved with a population about whom they held inadequate and limited knowledge. Adolescents were perceived as unpredictable and rejecting nurses' approaches. Consequently, nurses feared involvement and experienced failing on their assignments. After completing more or less failed attempts to establish good relationships with adolescents, the nurses request for more knowledge and experience in order to support this group.

CONCLUSIONS

Nurses are recognizing insufficient competence in direct involvement with adolescents, which calls for extended competence. Because nurses are not the only responsible actors performing in this field, building competence requires a broadened attention at both an individual and organizational level, across several healthcare disciplines, as well as through user participation.

IMPLICATIONS FOR PRACTICE

Competence building should be considered in light of organizational frameworks, collective learning possibilities across disciplines, and opportunities for involving adolescents/young adults as user participants.

Children's experiences of the family talk intervention when a parent is cared for in palliative home care-A feasibility study

The aim of this study was to explore the feasibility of the family talk intervention (FTI) and its acceptability to dependent children when a parent is cared for in palliative home care. The main goal of FTI is to increase family communication about the illness. The present paper derives from a pilot study and is based on 25 children's reports, involving both questionnaires and interviews, after participation. A majority of the children appreciated the structure and content of FTI. They felt seen, heard, and acknowledged by the interventionists and recommended FTI to other children in similar situations.

Children's Views Are Not Taken Into Account in Accordance With Article 12 of the United Nations Convention on the Rights of the Child in the Family Talk Intervention When a Parent Is Cared for in Palliative Care

Having a parent with a life-threatening illness is challenging throughout the illness trajectory, and for some also in bereavement. Article 12 of the United Nations Convention on the Rights of the Child states a child's right to express their opinion and have it respected in processes that affect them. The aims of this paper were to explore the child's active participation in a family support programme, the Family Talk Intervention, in accordance with Article 12, when having a parent cared for in palliative care. Twenty families with 50 children participated. Fieldnotes were taken during the programme and later analysed with interpretive descriptions. The study shows that all children were listened to, but only a quarter reached the minimum point required in Article 12, where their views were taken into account. The Family Talk Intervention in palliative care would benefit from implementing a child-centred approach in order for all children to be active participants.

How psychosocial interventions meet the needs of children of parents with cancer: A review and critical evaluation

INTRODUCTION

The aim of this study was to evaluate how psychosocial interventions for children aged 0-18 years of a parent with cancer meet their needs, using key needs as consumer-based "standards."

METHODS

A systematic literature review was conducted. Fifteen interventions met inclusion criteria and were assessed against six key needs identified by Ellis et al. (Eur. J. Cancer Care, 26, 2017, e12432): (1) provide children with age-appropriate information about their parent's cancer; (2) support family communication; (3) normalise and reduce feelings of isolation through peer support; (4) provide a space to share feelings; (5) individually tailor support; and (6), where appropriate, provide specialised bereavement support.

RESULTS

No intervention clearly met all six needs, but each partially addressed at least two needs, and three clearly met at least four needs. The most commonly addressed need was supporting family communication, and the least addressed need was bereavement support.

CONCLUSION

Interventions identified in this review addressed some needs of children impacted by a parent's cancer. This research provides a framework to inform the creation, modification and implementation of psychosocial support interventions that best meet the needs of these children, thereby mobilising consumer-focused service provision.

Children's Self-Reports About Illness-Related Information and Family Communication When a Parent Has a Life-Threatening Illness

Children's experiences of information and family communication when a parent has a life-threatening illness have been sparsely studied, though such information is important for the child's wellbeing. The aim of this study was to explore children's reports of illness-related information and family communication when living with a parent with a life-threatening illness. Forty-eight children, aged 7 to 19 years, were recruited from four specialized palliative home care units in Stockholm, Sweden. All but one child reported that someone had told them about the parent's life-threatening illness; however, two thirds wanted more information. A quarter of the teenagers reported that they had questions about the illness that they did not dare to ask. Half of the children, aged 8 to 12, reported that they felt partially or completely unable to talk about how they felt or show their feelings to someone in the family. Interventions are needed that promote greater family communication and family-professional communication.

Challenges and support needs of parents and children when a parent is at end of life: A systematic review

BACKGROUND

Preparing children for the death of a parent is challenging. Parents are often uncertain if and how to communicate and support their children. Many parents feel it is protecting their children by not telling them about the prognosis. Children less prepared for parental death from a terminal illness are more susceptive to later adversities. To facilitate coping and moderate for such adversities, there is a need to gain insight and understand the experience and challenges confronted by families.

AIM

This review synthesised evidence on the experiences of parents and children when a parent is at end of life to discern their challenges, support needs and factors that facilitated good practice.

DESIGN

Mixed-methods systematic review.

DATA SOURCES

Four electronic databases (CINAHL, PubMed, PsycINFO and Ovid MEDLINE) using MeSH terms and word searches in October 2018. Studies were not limited by year of publication, language or country. Grey literature searches were also completed on Google Scholar and OpenGrey.

RESULTS

In all, 7829 records were identified; 27 qualitative and 0 quantitative studies met the inclusion criteria. Eight descriptive themes were identified, further categorised into two broad themes: (1) barriers and facilitators in sharing the news that a parent is dying and (2) strategies to manage the changing situation.

CONCLUSION

Lack of understanding in relation to the parent's prognosis, denial and feeling ill-equipped were suggested as barriers for parents to share the news with their children. Engagement with social networks, including extended family relatives and peers, and maintaining routines such as attending school were suggested supportive by parents and children. Findings are limited primarily to White, middle-class two-parent families. A number of areas for future research are identified.

What young people need when a family member dies of cancer

PURPOSE

This study uses the newly developed Bereaved Cancer Needs Inventory to identify the unmet psychosocial needs of adolescents and young adults who have experienced the death of a parent or sibling to cancer, and to explore the relationship between unmet needs and psychological distress.

METHODS

In total, 278 bereaved offspring and 38 bereaved siblings (12-25 years) completed the 58-item Bereaved Cancer Needs Inventory (BCNI) and the Kessler psychological distress scale (K10).

RESULTS

Bereaved offspring reported 27 unmet needs on average (SD = 16.87, range: 0-58); 94% indicated at least one unmet need, with 80% indicating 10 or more needs. Bereaved siblings reported 23 unmet needs on average (SD = 17.30, range: 0-57); 97% indicated at least one unmet need, with 68% indicating 10 or more needs. For both bereaved offspring and siblings, the needs for "support from other young people" and "time out and recreation" were most frequently reported as unmet. Approximately half of all participants reported high to very high levels of psychological distress. There was a significant positive relationship between the number of unmet needs and the psychological distress score on the K10 for both groups.

CONCLUSIONS

Bereaved offspring and bereaved siblings report unmet psychosocial needs across many domains, which are associated with their levels of psychological distress. Findings suggest the BCNI may be used by healthcare professionals to identify unmet needs and direct clients to the appropriate services, resources, or support; with the intent to reduce their risk of mental illness and psychological distress.

Bereavement stressors and psychosocial well-being of young adults following the loss of a parent - A cross-sectional survey

PURPOSE

The knowledge about young adults who have lost a parent to cancer is limited, and to reach a broader understanding about this group, this study used the Dual Process Model of Coping with Bereavement (Stroebe and Schut, 1999) as a theoretical framework. The purpose of this study was to describe loss- and restoration-oriented bereavement stressors and psychosocial wellbeing of young adults following the loss of a parent to cancer.

METHOD

This survey used baseline data from a longitudinal study. Young adults, aged 16-28 years, who lost a parent to cancer more than two months earlier and agreed to participate in support groups held at three palliative care services in Sweden, responded to a comprehensive theory-based study-specific questionnaire.

RESULTS

Altogether, 77 young adults (64 women and 13 men) answered the questionnaire an average of five-to-eight months after the loss. Twenty percent (n = 15) had not been aware of their parent's impending death at all or only knew a few hours before the death, and 65% (n = 50) did not expect the death when it occurred. The young adults reported low self-esteem (n = 58, 76%), mild to severe anxiety (n = 55, 74%), mild to severe depression (n = 23, 31%) and low life satisfaction.

CONCLUSION

Young adults reported overall poor psychosocial wellbeing following bereavement. The unexpectedness and unawareness of the parent's imminent death, i.e., loss-oriented bereavement stressors, might influence psychosocial wellbeing. Despite these reports, restoration-oriented stressors, such as support from family and friends, helped them to cope with the loss.

Parents' advice to healthcare professionals working with children who have spinal muscular atrophy

AIM

To explore parents' advice to healthcare professionals working with children with spinal muscular atrophy (SMA).

MATERIALS AND METHODS

This study derives from a Swedish nationwide survey and uses content analysis to make inferences from answers to an open-ended question concerning parent's advice to healthcare professionals. Of eligible parents who had a child born in Sweden between 2000 and 2010, diagnosed with SMA type 1 or 2, and for whom respiratory support was considered in the first year of life, 61 participated in the study (response rate: 87%). Of these, 51 parents answered the question about advice to healthcare professionals working with children with SMA.

RESULTS

More than half of the advice from parents was related to professional-family relations. The second most frequent type of advice related to two aspects of knowledge about SMA: desire that healthcare professionals possess knowledge, and desire that they provide knowledge. The parents also had advice concerning support in daily life, both to the parents and to the affected child. Other pieces of advice were related to organization of care and the parents' desire to be involved in the child's care.

CONCLUSIONS

Parents advised healthcare professionals to increase their disease-specific knowledge, to treat the parents as experts on their child, and to treat the family with respect, particularly in situations where the child's case is used as an opportunity to improve healthcare professionals' competence. Increased practical support in daily life and a case coordinator is also among parents' advice to healthcare professionals.

Young people's perspectives on open communication between family members when a parent is dying

Objective:

Living with a parent who is approaching the end of life is profoundly troubling for young people. Research indicates that family communication about life-limiting parental illness can influence how young people manage living with dying. In particular, open communication between family members has been shown to be helpful. This paper reports on a study of young people's experiences of family interaction when a parent is dying and considers the practice of open communication in the context of young people's involvement in giving and receiving family care.

Methods:

A narrative approach was employed based on in-depth semistructured interviews with 10 young people (aged 13–21) living with a parent thought to be in the last year of life.

Results:

Young people's attitudes toward open communication between family members were more ambivalent and ambiguous than previous research suggests. Parental attempts at open communication were sometimes overlooked by young people, indicating that there may be differences between knowledge given and young people's acknowledgment of sensitive information. Some young people valued open communication as a signifier of the close relationships between family members, while others wanted to exercise more control over what they knew, when, and how. Young people's accounts challenged the positioning of young people as passive recipients of information. Young people were active in shaping family communication in their everyday lives, and deliberative acts of speaking or remaining silent were one way in which young people exercised care for themselves and others.

Significance of Results:

This study extends research on communication within families when a parent has a life-limiting illness and suggests that supporting young people's agency in determining how they receive information may be more beneficial than promoting open communication between family members.