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Kittelsen TB, Castor C, Lee A, Kvarme LG, Winger A. "What about me?": lived experiences of siblings living with a brother or sister with a life-threatening or life-limiting condition. Int J Qual Stud Health Well-being 2024; 19:2321645. [PMID: 38404038 PMCID: PMC10898268 DOI: 10.1080/17482631.2024.2321645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/18/2024] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND There is a lack of knowledge regarding siblings' experiences of being a brother or sister of a child with a life-threatening or life-limiting condition. Siblings' perspectives are often expressed through their parents and not by siblings themselves. METHOD This study has a qualitative design within hermeneutic phenomenology. Thirteen siblings (ages 3-29) of children with cancer or genetic conditions participated in semi-structured interviews. Analyses followed a thematic analysis guided by van Manen's lifeexistentials. RESULTS One overall theme, "What about me?", illustrates that siblings of children with LT/LL conditions are dealing with their own challenges and needs in the situation while also struggling to receive attention from their parents. The overall theme derives from three subthemes: living with heavy strains, feeling disregarded, and having needs of one's own. CONCLUSION The study revealed that siblings' own needs compete with the needs of the ill child, resulting in the risk of siblings taking a step back rather than expressing what they might actually need themselves. These findings can inform healthcare professionals on the importance of educating and supporting parents and the surrounding community close to the sibling, for example, by helping schoolteachers understand how to meet siblings' needs.
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Affiliation(s)
- Trine Brun Kittelsen
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | | | - Anja Lee
- Division of Pediatric and Adolescent Medicine, Oslo University Hospital HF, Oslo, Norway
| | - Lisbeth Gravdal Kvarme
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Anette Winger
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
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Rinaldo C, Stenmarker M, Øra I, Pergert P. Living with the threat of losing a child: Parents' experiences of the transplantation process with a severely ill child who received stem cells from a sibling. J Pediatr Nurs 2024; 77:e495-e502. [PMID: 38762421 DOI: 10.1016/j.pedn.2024.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 05/06/2024] [Accepted: 05/08/2024] [Indexed: 05/20/2024]
Abstract
PURPOSE When a child needs a hematopoietic stem cell transplant, the seriousness of the child's illness is highlighted. The purpose of this study was to explore parents' experiences of the transplantation process when two children in the family are involved, one severely ill child as the recipient and the other as the donor. METHODS In this qualitative study, interviews were conducted with 18 parents of 13 healthy minor donors after successful stem cell transplants. Qualitative content analysis was used to explore parents' experiences. FINDINGS The parents described they were living with the threat of losing a child. They lived with an uncertain future as they were confronted with life-changing information. Whether the ill child would survive or not could not be predicted; thus, parents had to endure unpredictability, and to cope with this they chose to focus on positives. Finally, the parents managed family life in the midst of chaos, felt an inadequacy and a perception that the family became a fragmented although close team during hospital stays. They expressed a need for both tangible and emotional support. CONCLUSIONS When a child needs a stem cell transplant, the parents feel inadequate to their healthy children including the donating child. It is obvious that they experience an uncertain future and struggle to keep the family together amid the chaos. PRACTICE IMPLICATIONS Considering these results, psychosocial support should be mandatory for parents in connection with pediatric HSCT, to enable a process where parents can prepare for the outcome, whether successful or not.
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Affiliation(s)
- Carina Rinaldo
- Astrid Lindgren children's hospital, Karolinska University Hospital, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
| | - Margaretha Stenmarker
- Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden; Department of Paediatrics, Futurum Academy of Health and Care, Jönköping, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, Sweden.
| | - Ingrid Øra
- Department of Clinical Sciences, Lund University, Lund, Sweden.
| | - Pernilla Pergert
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
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Sinnathamby A, Lee LY, Ng GMC. " Why Are we Giving up on my Brother?"-The Unmet Needs of the Adolescent Facing End-of-Life Care in a Sibling. J Palliat Med 2024. [PMID: 38905128 DOI: 10.1089/jpm.2023.0395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2024] Open
Abstract
Adolescence is a challenging time at baseline, and a sibling receiving end-of-life care can alter an adolescent's life irrevocably. It is imperative for the medical team to understand the unique needs and perspectives of such an adolescent sibling. This in turn facilitates the anticipation of an adolescent's grief response, and allows for parents to be appropriately guided. However, more can be done to evaluate the needs of adolescent siblings and improve their support. This can be through establishing a validated needs-based questionnaire, empowering families and the multidisciplinary team to engage siblings, and diverting resources toward culturally sensitive support groups for siblings with critical illness. A framework to involve key players in the adolescent's circle is presented.
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Affiliation(s)
- Annushkha Sinnathamby
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
- Division of Palliative Care, National University Cancer Institute, Singapore, Singapore
| | - Le Ye Lee
- Foundation Healthcare Holdings, Singapore, Singapore
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Silva W, Virtanen E, Kajantie E, Sebert S. Cognition, mental health and quality of life amongst siblings of preterm born children: A systematic review. Acta Paediatr 2024; 113:654-669. [PMID: 38216530 DOI: 10.1111/apa.17105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 11/23/2023] [Accepted: 01/03/2024] [Indexed: 01/14/2024]
Abstract
AIM Globally, 1 in 10 babies are born preterm. Families with preterm born infants may suffer strains related to the presence of a preterm child. To date, most evidence focuses on the outcome of children born preterm and of their parents. Our objective was to investigate the evidence on the impact of having a preterm born sibling on cognitive function, mental health and quality of life of term-born siblings and critically appraise the evidence. METHODS We searched five electronic databases, Google Scholar and reference lists. Two reviewers independently conducted screening, data extraction and critical appraisal. RESULTS We retrieved 9121 articles. After duplicates, titles, abstract and full text review, seven studies met the inclusion criteria. One study reported higher anxiety and depression scores on index cases in the term born comparison group, compared to the index cases in the preterm born sibling group. Another study reported more feelings of reduced parental attention, and more interpersonal problems in the preterm born sibling group, than the comparison group. CONCLUSIONS Although two studies reported a difference in outcomes between index cases in preterm born sibling groups and comparison groups, the scarce evidence did not allow us to delineate an effect or lack of it.
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Affiliation(s)
- Wnurinham Silva
- Research Unit of Population Health, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Eeva Virtanen
- Department of Population Health, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Eero Kajantie
- Department of Population Health, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
- Clinical Medicine Research Unit, Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Pediatric Research Centre, Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Sylvain Sebert
- Research Unit of Population Health, Faculty of Medicine, University of Oulu, Oulu, Finland
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Weaver MS, Nasir A, Lord BT, Starin A, Linebarger JS. Supporting the Family After the Death of a Child or Adolescent. Pediatrics 2023; 152:e2023064426. [PMID: 38009001 DOI: 10.1542/peds.2023-064426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 11/28/2023] Open
Abstract
Whether death occurs in the context of a chronic illness or as the sudden loss of a previously healthy infant, child, or adolescent, the death of a child is a highly stressful and traumatic event. Psychosocial support for families after the death of a child embodies core medical values of professional fidelity, compassion, respect for human dignity, and promotion of the best interests of a grieving family. The pediatrician has an important role in supporting the family unit after the death of a child through a family-centered, culturally humble, trauma-informed approach. This clinical report aims to provide the pediatrician with a review of the current evidence on grief, bereavement, and mourning after the loss of a child and with practical guidance to support family caregivers, siblings, and the child's community. Pediatricians have an important role in helping siblings and helping families understand sibling needs during grief. Ways for pediatricians to support family members with cultural sensitivity are suggested and other helpful resources in the community are described.
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Affiliation(s)
- Meaghann S Weaver
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska
- National Center for Ethics in Health Care, Veterans Health Affairs, Washington, District of Columbia
| | - Arwa Nasir
- Department of Pediatrics, University of Nebraska, Omaha, Nebraska
| | - Blyth T Lord
- Courageous Parents Network, Newton, Massachusetts
| | - Amy Starin
- National Association of Social Workers, Washington, District of Columbia
| | - Jennifer S Linebarger
- Department of Pediatrics, Children's Mercy Kansas City, University of Missouri, Kansas City, School of Medicine, Kansas City, Missouri
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Jaaniste T, Chin WLA, Tan SC, Cuganesan A, Coombs S, Heaton M, Cowan S, Potter D, Aouad P, Smith PL, Trethewie S. Parent and Well-Sibling Communication in Families With a Child Who Has a Life-Limiting Condition: Quantitative Survey Data. J Pediatr Psychol 2022; 47:606-616. [PMID: 35552431 DOI: 10.1093/jpepsy/jsab128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 11/18/2021] [Accepted: 11/18/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Living with a child with a life-limiting condition (LLC), for which there is no hope of cure and premature death is expected, places much stress on a family unit. Familial communication has the potential to serve as a buffer when children are faced with stressful situations. The overall aim of the study was to learn more about illness-related communication between parents and well-siblings, giving particular consideration to the amount of illness-related communication, and sibling satisfaction with familial communication. METHODS Participants included 48 well-siblings (aged 6-21 years) of children with LLCs and their parents. Parents and well-siblings independently completed validated measures of familial communication and sibling functioning. Parents also provided demographic information and completed a questionnaire assessing amount of illness-related information provided to well-siblings. RESULTS Parents reported that 47.8% of well-siblings never or rarely initiated conversations about their sibling's illness. Moreover, 52.2% of well-siblings never or rarely spoke about death. Amount of illness-related communication between parents and well-siblings was most strongly predicted by parental resilience and well-sibling age. Parents engaged in significantly more illness-related communication with girls than boys (t(44)=-2.28, p = .028). Well-siblings (p < .01) and parents (p < .05) rated satisfaction with familial communication significantly higher than published norms. The only significant predictor of well-sibling satisfaction with familial communication was greater familial cohesion. Family communication variables were not significantly correlated with measures of sibling functioning (all p's>.05). CONCLUSIONS This study provides new information regarding parent and well-sibling communication in families who have a child with a LLC.
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Affiliation(s)
- Tiina Jaaniste
- Department of Palliative Care, Sydney Children's Hospital, Australia
- School of Women's and Children's Health, University of New South Wales, Australia
| | - Wei Ling Audrey Chin
- Department of Palliative Care, Sydney Children's Hospital, Australia
- School of Women's and Children's Health, University of New South Wales, Australia
| | - Sarah Caellainn Tan
- Department of Palliative Care, Sydney Children's Hospital, Australia
- School of Women's and Children's Health, University of New South Wales, Australia
| | - Anjali Cuganesan
- Department of Palliative Care, Sydney Children's Hospital, Australia
- School of Women's and Children's Health, University of New South Wales, Australia
| | - Sandra Coombs
- Department of Palliative Care, Sydney Children's Hospital, Australia
| | - Maria Heaton
- Department of Palliative Care, Sydney Children's Hospital, Australia
| | - Sue Cowan
- Department of Palliative Care, Sydney Children's Hospital, Australia
- Bear Cottage, Australia
| | - Denise Potter
- Department of Palliative Care, Children's Hospital at Westmead, Australia
| | - Phillip Aouad
- Department of Palliative Care, Sydney Children's Hospital, Australia
- School of Women's and Children's Health, University of New South Wales, Australia
| | | | - Susan Trethewie
- Department of Palliative Care, Sydney Children's Hospital, Australia
- School of Women's and Children's Health, University of New South Wales, Australia
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Is there a choice when a sibling is ill? Experiences of children and adolescents who donated stem cells to a sibling. Eur J Oncol Nurs 2022; 58:102147. [DOI: 10.1016/j.ejon.2022.102147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 04/04/2022] [Accepted: 04/23/2022] [Indexed: 11/21/2022]
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Uber A, Ebelhar JS, Lanzel AF, Roche A, Vidal-Anaya V, Brock KE. Palliative Care in Pediatric Oncology and Hematopoietic Stem Cell Transplantation. Curr Oncol Rep 2022; 24:161-174. [DOI: 10.1007/s11912-021-01174-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 12/18/2022]
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The Effect of Theraplay on Prolonged Grief and Post-Traumatic Stress Disorder in Bereaved Siblings of Children with Cancer: A Preliminary Study. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2020. [DOI: 10.5812/ijcm.105992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Death of any of siblings is an overwhelming, severe, and prolonged challenge in children development process and is a major risk factor for psychiatric disorders in childhood and later. Interventions for bereaved families following a child’s death have been examined over the last several decades. However, no effective treatment for bereavement siblings prolonged grief disorder (PGD) and post-traumatic stress disorder (PTSD) has been found yet. Objectives: The study aimed at determining the effect of Theraplay on the symptoms of prolonged grief (PG) and post-traumatic stress disorder (PTSD) in siblings of a deceased child with cancer. Methods: In this preliminary study, a multiple baseline single-subject design with a follow-up period was used. The statistical population included siblings and mothers of children aged 6-10 years who had been under treatment at Mahak Child Cancer Hospital and died 1or 2 years ago. From this population, 4 mother-child pairs were selected as the study sample by convenience sampling. Each mother-child pair participated in 15 Theraplay sessions once a week (45-minute section). Assessments were performed using the inventory of prolonged grief for children (IPG-C) and the University of California at Los Angeles Posttraumatic Stress disorder reaction index for DSM-5 (UCLA PTSD-RI) at baseline, intervention sessions and follow-up stages. Visual analysis of graphic displays of level, reliable change index (RCI) and clinical significance were used to analyze the data. Data analysis and drawing graphs were performed in Microsoft Excel 2016. Results: Results of visual and quantitative analysis of data showed that PG symptoms decreased in all 4 participants during the treatment and follow-up. Also, according to the results, Theraplay intervention significantly reduced PTSD in all participants. Conclusions: Theraplay appears to be effective in reducing PG and PTSD in bereaved siblings. However, the reduction rate varied in different subjects. According to the findings, Theraplay helped subjects accept grief and loss and this method can be used to help the mental health of other bereaved children.
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Abstract
BACKGROUND Limited research has examined the impact of a child's death from cancer on siblings. Even less is known about how these siblings change over time. OBJECTIVE This study compared changes in siblings 1 (T1) and 2 (T2) years after the death of a brother or sister from cancer based on bereaved parent and sibling interviews. METHODS Participants across 3 institutions represented 27 families and included bereaved mothers (n = 21), fathers (n = 15), and siblings (n = 26) ranging from 8 to 17 years old. Participants completed semistructured interviews. Content analysis identified emerging themes and included frequency counts of participant responses. McNemar tests examined differences in the frequency of responses between T1 and T2 data. RESULTS Participants reported similar types of changes in bereaved siblings at both time points, including changes in sibling relationships, life perspectives, their personal lives, and school performance. A new theme of "openness" emerged at T2. Frequencies of responses differed according to mother, father, or sibling informant. Overall, participants less frequently reported changes at T2 versus T1. Compared with findings in the first year, participants reported greater sibling maturity at follow-up. CONCLUSION Overall changes in bereaved siblings continued over 2 years with less frequency over time, with the exception of increases in maturity and openness. IMPLICATIONS FOR PRACTICE Providers can educate parents regarding the impact of death of a brother or sister over time. Nurses can foster open communication in surviving grieving siblings and parents as potential protective factors in families going through their grief.
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Silvén Hagström A, Toft T. "TOGETHER WE ARE UNBEATABLE": young sisters' narration of a sibling's cancer in personal blogs on the internet. Int J Qual Stud Health Well-being 2019; 14:1586625. [PMID: 30915907 PMCID: PMC6442083 DOI: 10.1080/17482631.2019.1586625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose: Siblings of children and young people diagnosed with cancer are commonly reluctant to talk about their experiences due to the circumstances of the illness situation. This article aims to bring voice to experience and inform practice by investigating what and how three young sisters narrate about their illness experiences in personal blogs on the Internet. Methods: A narrative methodology for the analysis of life storytelling was applied primarily to investigate the sister’s coping strategies and support needs. Results: The results show how the sisters constructed their own space for narration, with the main aims of expressing their feelings about the illness and seeking social support. The telling of their experiences along with encouraging comments from a supportive audience enabled a change in position from feeling neglected and silenced to being a recognized agent and caring sister. In addition, through their narrative coping the sisters went from powerless to powerful in their position in relation to cancer. Conclusion: The results highlight the need for siblings to be able to narrate experience in a supportive context, where the processing of their relationship with the ill sister/brother should be understood as an important element of their coping with cancer and death.
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Affiliation(s)
- Anneli Silvén Hagström
- a Faculty of Health and Occupational Studies/Department of' Social Work and Psychology , University of Gävle , Gävle , Sweden
| | - Teolinda Toft
- b Clinical Psychology in Healthcare, Department of Children's and Women's Health , Uppsala University , Uppsala , Sweden
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Toft T, Alfonsson S, Hovén E, Carlsson T. Feeling excluded and not having anyone to talk to: Qualitative study of interpersonal relationships following a cancer diagnosis in a sibling. Eur J Oncol Nurs 2019; 42:76-81. [PMID: 31450042 DOI: 10.1016/j.ejon.2019.07.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 06/17/2019] [Accepted: 07/28/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE To explore experiences related to interpersonal relationships following a cancer diagnosis in a sibling. METHODS Respondents (n = 7 females) were recruited by means of convenience sampling during a camp for children affected by childhood cancer and their siblings. Data from children and adolescents with a sibling diagnosed with cancer was collected through individual face-to-face interviews and analyzed using systematic text condensation. RESULTS Two categories portrayed the experiences related to interpersonal relationships following a cancer diagnosis in a sibling. Feeling excluded while wanting to maintain a relationship with their ill sibling and be involved in the care portrayed that trying to be involved in the care of their ill sibling was a stressful and difficult experience, since they were simultaneously expected to also manage household chores and attend school. Feeling stigmatized and exposed in social contexts while needing an allowing space to talk about their experiences portrayed the emotional difficulties evoked by social situations and behaviors of others, which left respondents feeling exposed and mistreated. Having the possibility to talk about their experiences and receiving social support was described as essential in order to cope with the situation. CONCLUSIONS Health professionals need to take into consideration the emotional difficulties and vulnerable situation that children and adolescents who have a sibling diagnosed with cancer are at risk of experiencing. Stigmatization and social exposure present a risk of psychological distress. Having an allowing space to communicate feelings and experiences is desired. Interventions may be necessary to help these individuals psychologically cope.
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Affiliation(s)
- Teolinda Toft
- Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
| | - Sven Alfonsson
- Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Stockholm County Council, Norra Stationsgatan 69, SE-113 64 Stockholm, Sweden
| | - Emma Hovén
- Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Tommy Carlsson
- Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Department for Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
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