Gender differences of parental distress in children with cancer

Taiwanese fathers' experiences of caring for their children during childhood cancer treatment

PURPOSE

Parents must manage their own stress and help their child with cancer during the treatment process, both physically and emotionally. With the increased involvement of fathers in caring for the family, how fathers adjust to the stress and play a role in care responsibilities is unknown. This study aimed to explore the fathers' experiences of caring for their ill child during the cancer diagnosis and treatment process.

METHOD

This study adopted a qualitative descriptive design and conducted in-depth interviews with 21 fathers with a diagnosed child recruited from a northern Taiwan medical center. Data were managed and analysed using content analysis.

RESULTS

Two main categories in the Taiwanese fathers' experiences of caring for their ill child during the cancer diagnosis and treatment process emerged: 1) the maintainer of family stability, and 2) thoughts and value adjustment. Each main category consists of 3-4 generic categories. They make the necessary adjustments between work and family, actively participate in caring for the entire family, and redefine family values. They convey information about the illness to their children, pay attention to the physical and psychological development of the child with cancer, and cherish the time spent together as a family.

CONCLUSIONS

During the cancer treatment process, fathers play the roles of the protector and maintainer of family stability and adjust their attitudes and thoughts toward the family members and family life. Healthcare professionals can offer the fathers comprehensive support and improve the family's overall well-being during this demanding period.

Pediatrician and parental evaluation of child neurodevelopment at 2 years of age

BACKGROUND

The early identification of infants with a risk for neurodevelopmental disorders in the first few years of life is essential for better developmental outcomes. Screenings should be carried out by combining the family pediatricians' and parents' perspectives, the two fundamental sources of information on children's health. The present study has three aims: (a) to test the feasibility of parent-report instruments to detect warning signs in their children's development; (b) to ascertain whether there is an agreement between the family pediatricians' (FP) clinical judgments of warning signs and the parental perceptions; (c) to determine whether there is a link between parents' distress and child development.

METHODS

Within the NASCITA birth cohort, in addition to the family pediatrician's clinical evaluation with routine tools, the Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R) was completed by parents to assess the child's language, social skills, behavior, and sensory areas. Parents were also asked to complete the Parenting Stress Index, Short Form (PSI-SF) to verify the magnitude of stress in the parent-child system. Univariate and multivariate analyses were performed to evaluate the association between child and parental characteristics and the presence of warning signs.

RESULTS

The follow-up assessment was completed for 435 infants: 69 (15.8%) presented warning signs: 43 in the pediatrician's assessment and 36 in the M-CHAT-R (10 in both). A total of 16 children (14 with warning signs) received a diagnosis after a specialist evaluation. Being male (OR 2.46, 95%CI: 1.23-4.91) and having sleep disorders (OR 2.43, 95% CI 1.17-5.04) was associated with a greater likelihood of warning signs in the multivariate analysis, while reading aloud was a protective factor (not exposed versus exposed (OR = 3.14; 95% CI 1.60-6.17). For 73 children (18.4%), at least one parent tested positive for PSI-SF. An increased prevalence of parental distress was observed in children with warning signs (OR 2.36, 95% CI 1.27-4.37).

CONCLUSIONS

Integrating physician and parental perspectives during well-child visits and in clinical practice appears feasible and can improve the identification of children at risk of developmental disorders.

Parent-reported health-related quality of life in pediatric childhood cancer survivors and factors associated with poor health-related quality of life in aftercare

PURPOSE

Despite advances in cancer treatment, there is a prevalence of pediatric childhood cancer survivors still at risk of developing adverse disease and treatment outcomes, even after the end of treatment. The present study aimed to (1) explore how mothers and fathers assess the health-related quality of life (HRQoL) of their surviving child and (2) evaluate risk factors for poor parent-reported HRQoL in childhood cancer survivors about 2.5 years after diagnosis.

METHODS

We assessed parent-reported HRQoL of 305 child and adolescent survivors < 18 years diagnosed with leukemia or tumors of central nervous system (CNS) with the KINDL-R questionnaire in a prospective observational study with a longitudinal mixed-methods design.

RESULTS

In agreement with our hypotheses, our results show that fathers rate their children's HRQoL total score as well as the condition-specific domains family (p = .013, d = 0.3), friends (p = .027, d = 0.27), and disease (p = .035, d = 0.26) higher than mothers about 2.5 years after diagnosis. Taking variance of inter-individual differences due to family affiliation into account, the mixed model regression revealed significant associations between the diagnosis of CNS tumors (p = .018, 95% CI [- 7.78, - 0.75]), an older age at diagnosis, (p = .011, 95% CI [- 0.96, - 0.12]), and non-participation in rehabilitation (p = .013, 95% CI [- 10.85, - 1.28]) with poor HRQoL in children more than 2 years after being diagnosed with cancer.

CONCLUSION

Based on the results, it is necessary for health care professionals to consider the differences in parental perceptions regarding children's aftercare after surviving childhood cancer. High risk patients for poor HRQoL should be detected early, and families should be offered support post-cancer diagnosis to protect survivors' HRQoL during aftercare. Further research should focus on characteristics of pediatric childhood cancer survivors and families with low participation in rehabilitation programs.

Initial psychometric properties of the Parental Stress Scale examined using a sample of Russian mothers

Parental stress is defined as a personal response to stressors associated with being a parent. In recent studies, parental stress has been viewed as a component of normative parenting. The purpose of this study was to collect initial evidence of the construct validity and reliability of the Russian version of the 18-item Parental Stress Scale (PSS) using a sample of mothers of Russian primary school students. The results are the first wave of a longitudinal study. Mothers (n = 900) of fourth-grade students participated in the study and filled out an online survey. The exploratory and confirmatory factor analyses of the PSS on the Russian mothers indicated two factors: parental stress and parental satisfaction, with good estimates of reliability. The PERMA-Profiler questionnaire was used to examine the convergent and divergent validity of the PSS. The results revealed significant correlations between parental stress and satisfaction and different aspects of well-being among the respondents. The initial investigation of this Russian adaptation of the PSS provides evidence of its reliability and validity. Despite the limitations and the need for further research, this version of the PSS can be recommended for use in studies on modern parenting as well as in psychological support, education, and development of programs promoting positive parent-child relationships by targeting parental needs.

Predictors of Depressive Symptoms Among Parents of Children With Cancer in Ethiopia

Background: The severity of the psychological impact on parents of children with cancer, often depressive symptoms due to mild-to-severe stress, is well documented. The causes are primarily related to their child's cancer diagnosis and treatment, side effects, lack of social support, missing information about their child's disease, and understanding of how to care for their child during treatment. This study assessed predictors of depressive symptoms among parents of children with cancer in one hospital in Ethiopia. Method: The institution-based, cross-sectional design was employed. Parents (n = 126) whose child was admitted at Jimma University Medical Center between February 25 and April 25, 2020, and met inclusion criteria were invited to participate. Results: Questionnaires from 122 parents of children with cancer were included (four had missing data). The prevalence of depressive symptoms was 60.7%. Multivariate regression analysis revealed gender (B = 1.207, p = .033) and higher levels of education (B = 1.019, p < .001) were associated with depressive symptoms in mothers. Receiving information about the child's treatment, however, was negatively associated with depressive symptoms (B = -1.490, p = .031). Monthly income and contact with religious leaders were not significant predictors. Discussion: Mothers of children hospitalized for initial cancer treatment in Jimma, Ethiopia, are at risk for depressive symptoms. It is possible that mothers with higher education are in occupations demanding their time, not allowing them to fulfill responsibilities felt to be essential in the child's treatment journey. Information on the child's treatment nurses have an important role in identifying depressive symptoms in parents but require training to do so.

Neuropsychological features in RASopathies: A pilot study on parent training program involving families of children with Noonan syndrome

Noonan syndrome (NS) is a clinical variable multisystem disorder caused by mutations in genes encoding proteins involved in the RAS/mitogen-activated protein kinase signaling pathway. NS is characterized by a distinctive facies, short stature, and congenital heart defects. Psychomotor delay, learning difficulties, and social deficits are also common. Furthermore, behavioral and attention problems can be reckoned as a key symptom in NS, with functioning resembling the patterns observed in attention deficit hyperactivity disorder (ADHD). The complex behavioral phenotype has great impact on the quality of life and raises demanding management issues also for patients' families. Parent management training (PMT) is recommended as first-line treatment for ADHD; however, no study has been performed to test the efficacy of PMT in NS, thus far. The aim of this pilot study is the implementation and evaluation of a PMT dedicated to NS families. Parents of seven children with NS were recruited and underwent to a 10-session PMT. Three different questionnaires were administered to both parents: Conners Parent Rating Scales, Parenting Stress Index Short Form (PSI-SF), and Alabama Parenting Questionnaire (APQ). Our findings on this first small cohort of families indicate that positive perception and satisfaction about the child and the interaction with him increased in mothers after the intervention, as measured respectively by PSI-SF difficult child (DC) and PSI-SF parent-child dysfunctional interaction (PCDI), while mothers' level of stress decreased after the PMT, as indicated by PSI-SF total scores. Furthermore, APQ positive parenting, which measures behaviors of positive relationship with the child, increased in mothers after the intervention. Statistical analysis on fathers' questionnaires did not show significant differences after the PMT sessions. This pilot study suggests that PMT is a promising intervention for parents of NS children with behavioral and ADHD symptoms. Changes in mothers' attitudes and distress indicate that behaviorally oriented programs may help parents to manage with NS phenotype.

'Like ships in the night': A qualitative investigation of the impact of childhood cancer on parents' emotional and sexual intimacy

BACKGROUND

Childhood cancer is highly distressing for families and can place strain on parents' relationships. Parental functioning and cohesiveness are important predictors of family functioning and adaptation to stress. This qualitative study investigated the perceived impact of childhood cancer on parents' relationship with their partner, with a focus on emotional and sexual intimacy.

METHODS

We conducted semi-structured interviews with 48 parents (42 mothers, six fathers) of children under the age of 18 who had completed curative cancer treatment. We analysed the interviews using thematic analysis.

RESULTS

At interview, parents were on average 40.7 years old (SD = 5.5, range: 29-55 years), and had a child who had completed cancer treatment between 3 months and 10.8 years previously (M = 22.1 months). All participants were living with their partner in a married/de facto relationship. Most parents reported that their child's cancer treatment had a negative impact on emotional and sexual intimacy with their partner, with some impacts extending to the post-treatment period. Reasons for compromised intimacy included exhaustion and physical constraints, having a shifted focus, and discord arising from different coping styles. Some parents reported that their relationship strengthened. Parents also discussed the impact of additional stressors unrelated to the child's cancer experience.

CONCLUSIONS

Parents reported that childhood cancer had a negative impact on aspects of emotional and sexual intimacy, although relationship strengthening was also evident. It is important to identify and offer support to couples who experience ongoing relationship stress, which may have adverse effects on family functioning and psychological wellbeing into survivorship.

Depressive and Anxiety Disorders of Parents of Children with Cancer

Every year in Poland there are approximately 1200 new cases of malignant tumours in children and adolescents. Leukaemia, CNS tumours, and lymphomas are the most frequently diagnosed cancers. Coping with a child’s illness is challenging, which is why many parents suffer from anxiety, depression disorders, and even PTSD (post-traumatic stress disorder). The aim of this study is to assess the anxiety and depression levels of carers of children with cancer. Method: The study participants were 101 carers of children suffering from cancer. The study was conducted using standardized questionnaires: the Zung ccale, HADS scale, and Karnofsky scale, and three questionnaires designed by the author. Results: According to the results of the Karnofsky scale, carers’ anxiety and depression levels were negatively affected by their children’s poor performance. The younger age of children significantly correlated with the severity of depression in their parents. HADS and Zung scale anxiety levels were observed to have statistically significant effect on the severity of depressive disorders. Conclusions: Receiving a diagnosis of childhood cancer contributes to the incidence of depression and anxiety disorders among carers. Carers’ anxiety and depression levels were strongly associated with their child’s age and their child’s performance.

Exploring the beliefs of caregivers about the caregiving experiences of children with acute lymphoblastic leukemia in Malaysia

Background

Cancer is one of the major leading causes of childhood death, and the most common type is acute lymphoblastic leukemia. The survival rate has increased in recent years; however, the long patient trajectory may trigger psychological distress among caregivers as they play an active role in ensuring that the child's basic needs are met. Being in a patient-focused system, the needs of caregivers may be neglected.

Objective

This study aimed to explore the caregivers' beliefs on children with acute lymphoblastic leukemia caregiving experiences in order to promote their well-being.

Methods

Caregivers from thirteen families of children with acute lymphoblastic leukemia participated in this phenomenological study. NVivo 12 was used for the thematic analysis of the data. Consolidated criteria for reporting qualitative research (COREQ) were used in this study.

Results

Overall, five main themes for caregivers' beliefs were identified from their responses: 1) dietary intake with emphasis on its importance in aiding recovery and its potential influence on cancer complications, 2) childcare which emphasized the need to be strong and self-sacrifice, 3) treatment which reflected the use of home or natural remedies and caregivers' negative perception towards chemotherapy, 4) causes of cancer believed to be linked to early childcare choices on food, beverage, and stress imposed on the child, and 5) source of beliefs that included doctors, online platforms, personal encounters and information on food labels.

Conclusion

Caregivers' beliefs are varied and nuanced, formed in a multicultural social background of Malaysia. These findings provide knowledge for future supportive cancer care for patients, their caregivers, and the treatment outcome in the Malaysian context. Nurses, who play an essential role between healthcare professionals and patients and/or their caregivers, can be empowered to provide psychological support, early detection of psychological distress, and exploration of caregiver beliefs, given that the number of clinical psychologists in Malaysia is lacking, and there is greater preference for care to be provided by doctors or nurses.

The Needs of Parents of Children Suffering from Cancer—Continuation of Research

Background: Parents experience many healthcare needs when caring for their sick children. Research shows that parents of oncological children have a high level of unmet needs, including psychosocial, emotional, physical, informational, financial, educational, and spiritual needs. To date, little quantitative research has been carried out on the specific needs of parents of children with cancer, which creates uncertainty about what areas should be addressed in care. This study investigated the prevalence of unmet needs among parents of children with cancer. Methods: A population survey was conducted between 2015 and 2020. Caregivers of children diagnosed with cancer were invited to participate in the study to assess their problems and needs. Results: The analysis found that 97% of the participants experienced some level of need for one or more items, and 73% of the respondents reported a moderate or high need for one or more items. In the field of medical information, 70% of respondents had moderate or high needs, 55% of parents reported a moderate or high level of need for help in the psychological or emotional field, and 30% in the financial domain. The prevalence of moderate or high need in the remaining domains ranged from 10% to 15%. Conclusions: Parents of children with cancer experience a high level of needs, especially psychological, emotional, and information. These data suggest that the existing healthcare system does not meet the needs of parents of sick children. The results show the need to investigate the mechanisms by which healthcare providers can use the healthcare system to identify and meet needs.

Stress levels and coping strategies among Jordanian parents caring for newly diagnosed children with leukemia: A cross sectional descriptive correlational study

The purpose of this study was to describe the stress experienced and coping approaches exhibited by Jordanian parents of children recently diagnosed with leukemia.

This cross-sectional study collected data from parents of children who had been diagnosed with leukemia within the previous three months (N = 130; 57 fathers (43.8%) and 73 mothers (56.2%), age (Mean = 37.5, SD = 8.4)). The Parenting Stress Index-Short Form was used. Similarly, parents' coping approaches were assessed with the Coping Health Inventory for Parents.

Parents' mean total stress and coping strategies scores were 108 (± 26.8) and 93.9 (± 15.6), respectively. There were significant negative relationships between parents' stress levels and age (r = -0.46, p = .01), education level (f = 28.5, p < .05), and income (r = -0.65, p = .01). Additionally, there were significant positive relationships between parents' coping strategies and age (r = 0.34, p = .01) and income (r = 0.53, p < .01). There were non-significant differences between fathers' and mothers' stress levels and coping strategies.

Parents of children with leukemia experienced high stress. The findings also confirmed the negative relationship between parents' stress, age, education level, and income; and the positive relationship between parents' coping strategies, age, and income.

Several strategies are needed to manage said stress; for example, respite care for parents who spend long hours at the hospital. Volunteers to care for children at home or hospital might also relieve parents' stress.

Psychological Impact of COVID-19 on Parents of Pediatric Cancer Patients

The changes and general alarm of the current COVID-19 pandemic have amplified the sense of precariousness and vulnerability for family members who, in addition to the emotional trauma of the cancer diagnosis, add the distress and fear of the risks associated with infection. The primary objectives of the present study were to investigate the psychological impact of the COVID-19 pandemic on the parents of pediatric cancer patients, and the level of stress, anxiety, and the child's quality of life perceived by the parents during the COVID-19 epidemic. The parents of 45 consecutive children with solid and hematological tumors were enrolled. Four questionnaires (Impact of Event Scale-Revised - IES-R; Perceived Stress Scale - PSS; Spielberger State - Trait Anxiety Inventory - STAI-Y; Pediatric Quality of Life Inventory - PedsQL) were administered to the parents at the beginning of the pandemic lockdown. A 75% of parents exhibited remarkable levels of anxiety, with 60 subjects in state scale and 45 subjects in trait scale having scores that reached and exceeded the STAI-Y cut off. The bivariate matrix of correlation found a significant positive correlation between the IES-R and PSS scores (r = 0.55, P < 0.001). There was a positive correlation between the PSS and PedsQL (emotional needs) scale (P < 0.001) and a negative correlation between IES-R and STAI-Y (P < 0.001). The results confirm that parents of pediatric cancer patients have a high psychological risk for post-traumatic symptoms, high stress levels, and the presence of clinically significant levels of anxiety.

Predictors of parenting stress in parents of children with cancer

PURPOSE

In the present study, we investigated the parenting stress experienced by parents of children with cancer and the influencing factors.

METHOD

This was a cross-sectional and descriptive correlational study that consisted of parents of 136 children in the age group of 0-18 years who were followed up for cancer in the outpatient clinics and services of a university hospital in Turkey. Parenting Stress Index, Burden Interview, Multidimensional Scale of Perceived Social Support, Marital Life Satisfaction Scale, and Ways of Coping Questionnaire were used to collect the data.

RESULTS

No statistically significant difference was found between the parenting stress mean scores and gender of the parents of children with cancer (t = -0.350; P = 0.727). The results of the present study showed that the economic status (t = -4.16; P = 0.000), parents' physical (t = 3.606; P = 0.000) and mental health status after the child is diagnosed (t = 5.647; P = 0.000), accompanying mental health problems of the child (t = 2.567; P = 0.011), and diagnosis of children at a young age (t = -2.776; P = 0.006) increased the parenting stress of the parents.

CONCLUSIONS

Nursing interventions can reduce parental stress by providing sufficient care and support during the disease process.

Fear of progression in parents of childhood cancer survivors: prevalence and associated factors

PURPOSE

Recent research demonstrated that fear of progression (FoP) is a major burden for adult cancer survivors. However, knowledge on FoP in parents of childhood cancer survivors is scarce. This study aimed to determine the proportion of parents who show dysfunctional levels of FoP, to investigate gender differences, and to examine factors associated with FoP in mothers and fathers.

METHODS

Five hundred sixteen parents of pediatric cancer survivors (aged 0-17 years at diagnosis of leukemia or central nervous system (CNS) tumor) were consecutively recruited after the end of intensive cancer treatment. We conducted hierarchical multiple regression analyses for mothers and fathers and integrated parent-, patient-, and family-related factors in the models.

RESULTS

Significantly more mothers (54%) than fathers (41%) suffered from dysfunctional levels of FoP. Maternal FoP was significantly associated with depression, a medical coping style, a child diagnosed with a CNS tumor in comparison to leukemia, and lower family functioning (adjusted R² = .30, p < .001). Paternal FoP was significantly associated with a lower level of education, depression, a family coping style, a child diagnosed with a CNS tumor in comparison to leukemia, and fewer siblings (adjusted R² = .48, p < .001).

CONCLUSIONS

FoP represents a great burden for parents of pediatric cancer survivors. We identified associated factors of parental FoP. Some of these factors can be targeted by health care professionals within psychosocial interventions and others can provide an indication for an increased risk for higher levels of FoP.

IMPLICATIONS FOR CANCER SURVIVORS

Psychosocial support targeting FoP in parents of childhood cancer survivors is highly indicated.

Primary and secondary caregiver depressive symptoms and family functioning following a pediatric cancer diagnosis: an exploration of the buffering hypothesis

OBJECTIVE

After diagnosis, caregivers of children with cancer, particularly mothers or primary caregivers (PCs), often show elevated depressive symptoms which may negatively impact family functioning. We tested PC and secondary caregiver (SC) depressive symptoms as predictors of family, co-parenting, and marital functioning and whether having a non-depressed SC buffers against potential negative effects of PC depressive symptoms.

METHODS

Families (N = 137) were recruited from two major children's hospitals following a diagnosis of pediatric cancer. Caregivers completed self-report measures of depressive symptoms (Center for Epidemiological Studies-Depression Scale; Depression, Anxiety, and Stress Scale) and marital functioning (Dyadic Adjustment Scale) at 1-month post-diagnosis. A subset of families (n = 75) completed videotaped interaction tasks at approximately 3-months post-diagnosis that were coded for family and co-parenting interactions.

RESULTS

Higher PC depressive symptoms at 1-month post-diagnosis was associated with higher adaptability and lower conflict in family functioning. PC depressive symptoms were also associated lower dyadic consensus and lower dyadic satisfaction. SC depressive symptoms were not significantly associated with any family/co-parenting/marital functioning variables. Significant interaction analyses suggested that SC depressive symptoms moderated the effect of PC depressive symptoms on family cohesion, withdrawn parenting, and affective expression in the marriage, such that the relationship between PC depressive symptoms and poorer functioning was attenuated when SC depressive symptoms were at low or average levels.

CONCLUSIONS

Having a nondepressed SC buffered against negative effects of PC depressive symptoms on certain domains of family, coparenting, and marital functioning. SCs may play a protective role for families of children with cancer.

Patient and sibling adjustment to pediatric cancer: the roles of parental relationship adjustment and depressive symptoms

PURPOSE

Pediatric cancer may impact parents' partner relationship and increase patient, parent, and sibling distress. This study examined parents' reports of their relationship adjustment and depressive symptoms and their association with their ratings of patients' and siblings' emotional/behavioral problems in families of recently diagnosed pediatric cancer patients.

DESIGN

Cross-sectional questionnaire study.

SAMPLE

A total of 31 parents (87% female; 71% Latino) of pediatric cancer patients.

METHODS

Parents reported on their relationship adjustment, depressive symptoms, and the patients' and siblings' emotional/behavioral problems.

FINDINGS

Poorer relationship adjustment was correlated with more parent depressive symptoms and patient emotional/behavioral problems. Parent depressive symptoms were positively correlated with emotional/behavioral problems in patients and siblings. After accounting for child age and parent depressive symptoms, relationship adjustment remained significantly associated with patient, but not sibling, problems.

CONCLUSIONS

When parents have poorer relationship adjustment following diagnosis, children with cancer may be at increased risk for emotional/behavioral problems.

IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS OR POLICY

Interventions targeting the partner relationship may be relevant to supporting family adjustment following diagnosis.

Post-traumatic stress spectrum symptoms in parents of children affected by epilepsy: Gender differences

PURPOSE

To investigate psychopathological reaction to traumatic stress, addressing in particular gender difference, in parental couples of children affected by epilepsy.

METHODS

50 mothers and 50 fathers, paired for one's child, of children followed at the Pediatric Unit of a major Italian University Hospital with a diagnosis of epilepsy were enrolled, screened by means of the Semi-structured Clinical Interview for DSM-5 (SCID-5) and filled the Trauma and Loss Spectrum Self-Report (TALS-SR), an international instrument to evaluate post-traumatic stress symptomatology.

RESULTS

25 % of the total sample presented a diagnosis of PTSD with a statistically higher prevalence of mothers (36 % and 14 %, respectively; p = .021). Furthermore, 44 % (48 % mothers and 40 % fathers) presented a partial PTSD. Important gender differences emerged also for all cluster dimensions of the TALS-SR except for the Avoidance. Finally, the analysis of the single items of the TALS-SR evidenced that in mothers subgroup prevail cognitive symptoms of fear and sadness as well as somatic manifestations.

CONCLUSIONS

Our results point out the differences between mothers and fathers in trauma response and underline the need to develop gender targeted models of healthcare prevention and assistance.

Emotional symptoms and family functioning in caregivers of children with newly diagnosed leukemia/lymphomas and solid tumors: Short-term changes and related demographic factors

BACKGROUND

Pediatric oncology diagnoses are distressing to caregivers. However, researchers have not investigated the impact that the type of cancer diagnosis has on caregiver anxiety, depression, distress, and family functioning. The purpose of this study was to longitudinally investigate the early trajectory of caregiver psychological symptoms of anxiety, depression, distress, and family functioning near diagnosis and 6 months later by cancer type, and to examine the demographic factors that may be associated with caregiver emotional and family functioning outcomes.

METHODS

Caregivers (n = 122) of children with a recent diagnosis of leukemia/lymphoma or solid tumor completed self-report measures of psychological and family functioning (Hospital Anxiety and Depression Scale, Distress Thermometer, and Family Environment Scale).

RESULTS

In general, caregivers endorsed elevated psychological symptoms at the time of diagnosis, which decreased 6 months later. Caregivers of children with solid tumors endorsed greater anxiety across time than caregivers of children with leukemia/lymphoma did. In addition to caring for a child with a solid tumor, female sex, non-White ethnicity, and non-English language spoken in the home were factors associated with anxious and depressive symptoms and poorer family functioning.

CONCLUSION

When creating psychosocial interventions for families of children with cancer, the unique demands of solid tumor treatments, the caregiver's sex, and cultural characteristics must be considered to promote coping, resiliency, and problem-solving skills around the time of diagnosis, particularly in more vulnerable families.

Childrens' and Parents' Willingness to Join a Smartphone-Based Emergency Response Community for Anaphylaxis: Survey

BACKGROUND

Medical emergencies such as anaphylaxis may require immediate use of emergency medication. Because of the low adherence of chronic patients (ie, carrying anti-anaphylactic medication) and the potentially long response time of emergency medical services (EMSs), alternative approaches to provide immediate first aid are required. A smartphone-based emergency response community (ERC) was established for patients with allergies to enable members to share their automatic adrenaline injector (AAI) with other patients who do not have their AAI at the onset of anaphylactic symptoms. The community is operated by a national EMS. In the first stage of the trial, children with food allergies and their parents were invited to join.

OBJECTIVE

This study aimed to identify the factors that influence the willingness to join an ERC for a group of patients at risk of anaphylaxis.

METHODS

The willingness to join an ERC was studied from different perspectives: the willingness of children with severe allergies to join an ERC, the willingness of their parents to join an ERC, the willingness of parents to enroll their children in an ERC, and the opinions of parents and children about the minimum age to join an ERC. Several types of independent variables were used: demographics, medical data, adherence, parenting style, and children's autonomy. A convenience sample of children and their parents who attended an annual meeting of a nonprofit organization for patients with food allergies was used.

RESULTS

A total of 96 questionnaires, 73 by parents and 23 by children, were collected. Response rates were approximately 95%. Adherence was high: 22 out of 23 children (96%) and 22 out of 52 parents (42%) had their AAI when asked. Willingness to join the community was high among parents (95%) and among children (78%). Willingness of parents to enroll their children was 49% (36/73). The minimum age to join an ERC was 12.27 years (SD 3.02) in the parents' opinion and 13.15 years (SD 3.44) in the children's opinion.

CONCLUSIONS

Parents' willingness to join an ERC was negatively correlated with parents' age, child's age, and parents' adherence. This can be explained by the free-rider effect: parents who carried an AAI for their young child, but had low adherence, wanted to join the ERC to get an additional layer of emergency response. Children's willingness to join the community was positively correlated with age and negatively correlated with the child's emotional autonomy. Parents' willingness to enroll their children in an ERC was positively correlated with child's age and negatively correlated with parents' adherence: again, this can be explained by the aforementioned free-rider effect. Parents' and children's opinions about the minimum age to join an ERC were negatively correlated with protective parenting style and positively correlated with monitoring parenting style.

Gender-specific differences in parental health-related quality of life in childhood cancer

BACKGROUND

Parents of children with cancer are at risk for impaired health-related quality of life (HRQoL). Most prior research has focused on the HRQoL of mothers. The aim of this study is to describe HRQoL in mothers and fathers, and determine the influence of sociodemographic, medical, and psychosocial factors.

PROCEDURE

In a cross-sectional study, both parents completed questionnaires on sociodemographics, distress, and HRQoL. Parental HRQoL was compared to healthy population values. Differences between mothers and fathers were evaluated with multilevel analysis. Gender-specific HRQoL determinants were assessed via multiple linear regression analysis.

RESULTS

Parents (202 mothers, 150 fathers; comprising 121 couples) of 231 children with different cancer diagnoses (mean time since diagnosis 3.3 ± 1.4 years, 90% posttreatment) participated. Compared to healthy women and men, mothers and fathers reported significantly impaired HRQoL on the following domains: cognitive functioning, sleep, daily activities, and vitality (Cohen's d = 0.3-0.9). Additionally, maternal HRQoL was reduced on the domains gross motor functioning, pain, social functioning, sexuality, and depressive emotions. Mothers scored worse than fathers on six of 12 domains. Risk factors for adverse outcomes in both parents were higher distress, emotional and parenting problems, little social support, medication use, and active treatment of the child. Other determinants in mothers were non-Dutch background and unemployment, while lower HRQoL in fathers was predicted by their child's diagnosis type, shorter time since diagnosis, and treatment intensity.

CONCLUSION

These outcomes illustrate the need for family-centered care. Future interventions aimed at improving parental functioning should take into account gender-specific differences in HRQoL to reach optimal efficacy.

Resilience, life satisfaction, care burden and social support of mothers with a child with acute lymphoblastic leukaemia: a comparative study

The study aimed to make comparison between the resilience, life satisfaction, care burden and social support of mothers with a child with acute lymphoblastic leukaemia (ALL) and those with a healthy child. The study was carried out using the comparative and descriptive methods, and the study group included mothers with ALL children hospitalised in the Paediatric Haematology Clinic of a university hospital (n = 51) and those with healthy children who applied to a family health centre (n = 53). While collecting the data, Personal Information Form, Resilience Scale for Adults, Life Satisfaction Scale, Zarit Care Burden Scale and Multidimensional Scale of Perceived Social Support Scale were used. The data were statistically analysed using the SPSS program, percentages, mean scores, standard deviations, Mann-Whitney U test and pearson correlation. For the comparison of the personal information about the mothers with ALL children and about those with healthy children, chi-square or student t test for independent groups depending on the data set was used. When the mothers with ALL children were compared with those with healthy children, it was found that the methods with ALL children had statistically lower mean scores for life satisfaction (13.92 ± 6.26, p < 0.001) and resilience (17.90 ± 7.09, p < 0.001) and statistically higher mean scores for care burden (42.23 ± 16.54, p < 0.05). In this study, when the mothers of ALL children were compared with those of healthy children, it was found that the former had lower levels of resilience and life satisfaction and higher levels of care burden.

Psychological trajectories of mothers and fathers following their child's diagnosis of a life-threatening illness or injury: A longitudinal investigation

OBJECTIVE

Explore the mental health trajectories of parents following their child's life-threatening illness/injury.

METHODS

Participants were 217 parents (mean age: 34.9-40.0; 66 fathers) of 165 children who presented to a tertiary hospital with a life-threatening illness/injury. Parents completed questionnaires about their mental health and psychosocial stressors within 4 weeks of the child's illness/injury (T1), and 4 months (T2), 7 months (T3), and 19 months (T4) postdiagnosis.

RESULTS

For both mothers and fathers, mental health symptoms were elevated at diagnosis declining to normal levels by T3, with a pattern of increase at T4. Fathers demonstrated a faster decline in symptoms between T1 and T2, and fathers, but not mothers, experienced a relapse in depressive symptoms at T4. Fathers reported higher rates of work changes.

CONCLUSIONS

These findings have important implications for the design and timing of parental interventions to support families of children with life-threatening disease/injury.

Resilience and its Predictors among the Parents of Children with Cancer: A Descriptive-Correlational Study

Context:

As a common debilitating illness, cancer is among the leading causes of child mortality in developed and developing countries. Cancer diagnosis for children is considerably stressful for their parents. Resilience is a key factor behind effective coping with cancer-related problems. This study evaluated resilience and its predictors among the parents of children with cancer.

Aim:

This study evaluated resilience and its predictors among the parents of children with cancer.

Settings and Design:

This cross-sectional descriptive-analytical study was conducted in 2017 on 400 parents of children with cancer in Tabriz Children's Hospital, Iran.

Methods:

A demographic questionnaire and the Connor-Davidson Resilience Scale were used to collect the data. Parents were conveniently recruited from Tabriz Children's Hospital.

Statistical Analysis:

Data were analyzed using the SPSS for Windows program (v. 16) via descriptive and inferential statistical methods.

Results:

The mean score of parents’ resilience was 66.83 ± 14.28. Fathers obtained significantly higher resilience scores than mothers (P < 0.001). The predictors of parents’ resilience were financial status, parents’ gender, fathers’ employment status, and children's gender.

Conclusion:

The parents of cancer-afflicted children, particularly their mothers, have low resilience and therefore may be at risk for different physical and mental health problems. Health-care providers need to identify at-risk parents and provide them with greater psychological and educational support.

Relationship Between Coping Strategies, Religious Attitude, and Optimism of Mothers of Children With Cancer

INTRODUCTION

The purpose of this study was to examine the relationship between coping strategies, religious attitude, and optimism of mothers of children with cancer.

METHOD

The sample was 97 mothers of children with cancer. To collect data, the Coping Strategy Questionnaire, Religious Attitude Scale, and Life Orientation were used.

RESULTS

There were positive correlations between the total score of Coping Strategy Questionnaire and emotional scores of Religious Attitude Scale ( r = 0.170, p = .04). The correlation relationship between mothers' coping, religious tendencies, and optimism tendencies was not significant ( p > .05). There were also positive correlations between Coping Strategy Questionnaire Social Support Seeking subscale and the total scores of Religious Attitude Scale ( r = 0.189, p = .03) and Life Orientation Test ( r = 0.183, p = .03).

DISCUSSION

Mothers with a higher religious attitude had bettter social support and were more optimistic. These results will contribute to understanding the influence of religion in different cultures.

Predicting parental distress among children newly diagnosed with craniopharyngioma

BACKGROUND

Childhood brain tumor diagnoses are stressful for families. Children diagnosed with craniopharyngioma (Cp) present with particularly challenging medical and cognitive problems due to tumor location and associated biophysiologic comorbidities. This study examined parental distress in a sample of families of patients with Cp treated with proton beam therapy to identify factors for targeting psychological intervention.

PROCEDURE

Prior to (n = 96) and 1 year after (n = 73) proton therapy, parents of children diagnosed with Cp (9.81 ± 4.42 years at baseline; 49% male) completed a self-report measure of distress, the Brief Symptom Inventory (BSI). Children completed cognitive assessment measures at baseline; medical variables were extracted from the study database.

RESULTS

At baseline, t-tests revealed parents reported higher levels of distress than normative expectations on Anxiety, Depression, Global Severity, and Positive Symptom Distress BSI scales (P < 0.05). Linear mixed effects models revealed parent report measures of child executive dysfunction and behavioral issues were more predictive of parental distress than patients' cognitive performance or medical status (P < 0.05). Models also revealed a significant reduction only in Anxiety over time (t = -2.19, P < 0.05). Extensive hypothalamic involvement at baseline predicted this reduction (P < 0.05).

CONCLUSION

Parents experience significant distress before their child begins adjuvant therapy for Cp, though parental distress appears largely unrelated to medical complications and more related to parent perceptions of child cognitive difficulties (vs. child performance). Importantly, this may be explained by a negative parent reporting style among distressed parents. Knowledge of socio-emotional functioning in parents related to patient characteristics is important for optimization of psychological intervention.

In good times and in bad: what strengthens or challenges a parental relationship during a child's cancer trajectory?

OBJECTIVES

To identify events during a child's cancer trajectory when parents perceived their marriage/partnership to be most strengthened and/or challenged.

RESEARCH APPROACH

Using a cross-sectional qualitative design, participants completed a self-administered questionnaire addressing changes in their relationship during their child's cancer trajectory, including events perceived to strengthen/challenge their relationship, and recommendations for other parents.

PARTICIPANTS

192 parents of pediatric oncology patients across three institutions. Data were analyzed using qualitative content analysis.

FINDINGS

Themes included relationship-specific, illness experience-related, and external supports/stressors that impacted the relationship. Dyadic strategies, empathic communication, and supportive behaviors strengthened the couple's relationship, whereas physical and emotional distance most commonly challenged the relationship. Recommendations to other parents included open communication, couple's connectedness, and use of external supports.

INTERPRETATION

Offering psychosocial support and helping parents anticipate when their relationship can be strengthened/challenged can be an important part of ongoing care. Implications for psychosocial providers: Teaching communication and dyadic coping strategies can help parents manage stress and build cohesion.

Trajectories of child and caregiver psychological adjustment in families of children with cancer

OBJECTIVE

To describe the trajectory of patient and caregiver mental health from diagnosis through the first year of treatment for pediatric cancer and assess whether rates of clinically relevant symptoms were elevated compared with norms. We examined mean levels of internalizing and externalizing symptoms and posttraumatic stress symptoms (PTSS) in children with cancer, and depression, anxiety, and PTSS in caregivers during the first year of treatment; the proportion of patients and caregivers that scored in the clinical range at each time point; and the typical trajectory of symptoms in patients and caregivers and whether trajectories differed between individuals.

METHOD

Families (N = 159) of children newly diagnosed with cancer (Mage = 5.6 years; range = 2-18 years) participated in a short-term prospective study. Primary caregivers provided monthly reports of their own and their children's psychological adjustment.

RESULTS

On average, children were well-adjusted. However, compared with norms, there was a higher than expected proportion of children with clinically relevant internalizing symptoms around the time of diagnosis. On average children's symptoms declined over time, though variability was observed. Caregivers were less well-adjusted on average, with a high proportion reporting clinically relevant symptoms over time for depression and anxiety. Caregiver symptoms also declined over time, though considerable variability was observed.

CONCLUSION

Although most children remain well-adjusted during the first year of treatment, many caregivers experience clinically relevant symptoms of psychological distress. Implications for development of interventions targeting at-risk patients and caregivers are discussed. Identifying processes that predict between-family variability in trajectories of psychopathology is an important next step. (PsycINFO Database Record

Parents' Perspectives of Changes Within the Family Functioning After a Pediatric Cancer Diagnosis: A Multi Family Member Interview Analysis

Pediatric cancer is a life-threatening disease that challenges the life of the diagnosed child, the parents, and possible siblings. Moreover, it also places considerable demands on family life. The aim of this study was to explore changes in the family functioning after a pediatric cancer diagnosis. Ten couples who had a child with leukemia or non-Hodgkin lymphoma were interviewed individually about their experiences. Interviews were semistructured, and the data were analyzed using Multi Family Member Interview Analysis. Three themes emerged from the data: (a) Family Cohesion: Strengthened Versus Fragmented; (b) Educational Norms and Values: Overindulgence Versus Being Stricter, and (c) Normality: Loss Versus Preservation. The conflicting dynamics present in these emerging themes exemplify the complexity of this process of family adaptation. This study illustrates the need to take into account the family level, as well as the conflicting feelings parents may experience after a pediatric cancer diagnosis.

Differences in illness perception between children with cancer and other chronic diseases and their parents

BACKGROUND

The purpose of this study was to explore the differences in illness perception between children with cancer and other chronic diseases. A secondary aim was to examine the similarities and differences between the illness perception of these children and their parents.

METHODS

The Revised Illness Perception Questionnaire (IPQ-R) was used to measure the children's and parents' illness perceptions. In this study, 184 children (ages 8-18 years) and their caregivers completed the questionnaires.

RESULTS

This study shows that children with cancer feel that they have greater control over their treatment compared to the other two groups. The children's parents have more pessimistic views of the illness than their children.

CONCLUSION

Examinations of illness perceptions among paediatric cancer patients and their families are essential in designing psychosocial interventions for these families. The clinical value of our results can help better understand the cancer-specific features of illness perceptions.

Attachment orientations and psychological adjustment of parents of children with cancer: A matched-group comparison

OBJECTIVE

To investigate the impact of childhood cancer on parents' adult attachment, social support, marital adjustment, anxiety, and depression.

METHODS

30 parents of children with childhood cancer and 30 matched controls completed the following questionnaires: Experiences in Close Relationships-Revised, Dyadic Adjustment Scale-4, Multidimensional Scale of Perceived Social Support, State-Trait Anxiety Inventory - form Y, and Beck Depression Inventory.

RESULTS

Parents of children with childhood cancer had a significantly lower dyadic adjustment than controls, and higher levels of insecure-avoidant attachment, state anxiety, and depression.

CONCLUSION

It is important for health-care personnel to take into account these parents' propensity to show increased levels of avoidant attachment during children's treatment to foster effective communication and supportive relationships between clinicians, pediatric patients, and parents.

Psychological Adjustment of Parents of Children Born with Atypical Genitalia 1 Year after Genitoplasty

PURPOSE

We examined the psychological adjustment of parents of children born with moderate to severe genital atypia 12 months after their child underwent genitoplasty.

MATERIALS AND METHODS

Parents were recruited longitudinally from a multicenter collaboration of 10 pediatric hospitals with specialty care for children with disorders/differences of sex development and/or congenital adrenal hyperplasia. Parents completed measures of depressive and anxious symptoms, illness uncertainty, quality of life, posttraumatic stress and decisional regret.

RESULTS

Compared to levels of distress at baseline (before genitoplasty) and 6 months after genitoplasty, data from 25 mothers and 20 fathers indicated significant improvements in all psychological distress variables. However, a subset of parents continued endorsing clinically relevant distress. Some level of decisional regret was endorsed by 28% of parents, although the specific decision that caused regret was not specified.

CONCLUSIONS

Overall the majority of parents were coping well 1 year after their child underwent genitoplasty. Level of decisional regret was related to having a bachelor's level of education, increased levels of illness uncertainty preoperatively and persistent illness uncertainty at 12 months after genitoplasty but was unrelated to postoperative complications.

Post Traumatic Stress Disorder in Parents of Children With Cancer in Jordan

AIM

To investigate levels of post traumatic stress disorder (PTSD) of those parenting children with cancer and make a comparison between mothers and fathers.

BACKGROUND

Parenting a child with cancer is traumatic. Maternal and paternal roles and responsibilities change after the cancer diagnosis of their child, adding more stress to the lives of all concerned. The gender of the parent may have an effect on their PTSD. However, there is a lack of studies in Arabic countries on the differences between parents in their PTSD levels.

METHODS

A sample of 416 biological parents (comprising 207 mothers and 209 fathers) of children with cancer in Jordan completed a demographic checklist and the PTSD Checklist Civilian (PCLC).

RESULTS

There was a significant difference in PTSD levels between mothers and fathers, with mothers having significantly higher PTSD levels than fathers. The mean PTSD levels for mothers was (M=59.68, SD=4.86) compared to (M=52.76, SD=5.81) for fathers. The magnitude of the differences in the means was very large (eta squared=0.29). Additionally, results indicated that there was a significant negative correlation between parental PTSD levels with their age and the time since their child was diagnosed with cancer (r=-0.68, r=-0.62 respectively and p<0.001). An increase in parental PTSD levels was associated with a decrease in parental age and short time duration since the cancer diagnosis of the child.

CONCLUSION

The study concluded that parenting children with cancer is traumatic and mothers were at higher risk of PTSD than fathers. Risk of PTSD was found to decrease with time.

IMPLICATIONS FOR NURSING EBP

Investigating differences in PTSD between mothers and fathers in Jordan may be helpful when designing interventions to reduce the risk of PTSD. An individual parental support program is important, taking into consideration that mothers are at higher risk of PTSD, and both parents need thorough attention and care.

The perceived influence of childhood cancer on the parents' relationship

OBJECTIVE

When a child is diagnosed with cancer, parents are faced with many practical and emotional challenges that can significantly affect their relationship. This study explores how having a child with cancer affects the quality of the parents' relationship, categorizes time points and events during the child's treatment when the relationship becomes most stressed and/or strengthened, identifies factors that help couples remain emotionally engaged throughout their child's cancer treatment, and assesses parental interest in a counseling intervention.

METHODS

This is a cross-sectional, multicenter study conducted via a semistructured self-administered questionnaire that included the Revised Dyadic Adjustment Scale.

RESULTS

One hundred ninety-two parents of children diagnosed between the ages of 1 and 21 participated. Forty percent felt their relationship moved in a negative direction. Diagnosis and relapse of disease were cited as the most individually stressful time points in the disease trajectory, with hospitalizations and relapse being most stressful on the relationship. Participants felt most emotionally connected at diagnosis and least emotionally connected at the start and end of treatment. The majority of couples indicated interest in counseling to address ways to support their relationship. Soon after diagnosis and during treatment was reported as the preferred time to offer these interventions.

CONCLUSION

This study identified specific events and parent behaviors that strain the couples' relationship during the childhood cancer trajectory. This information can inform the development of a couple's intervention. Prospective research is needed to better understand how childhood cancer affects caregivers' partnerships through survivorship and beyond.

Prevalence and Levels of Depression Among Parents of Children with Cancer in Basrah, Iraq

OBJECTIVES

Cancer in a family member can be a major source of psychological disorders, especially for the parents of children diagnosed with cancer. This study aimed to determine the prevalence and levels of depression among parents of children with cancer in Basrah, Iraq.

METHODS

This cross-sectional study was conducted between November 2014 and April 2015 at the Specialist Paediatric Hospital in Basrah City, Iraq. One parent each of 384 children with cancer admitted to the hospital for treatment or follow-up during the study period were invited to participate in the study. Age, gender, years of education, occupation, monthly income, place of residence and the overall number of children in a family were recorded. The Center for Epidemiologic Studies Depression Scale was used to identify depression and assess levels of depression.

RESULTS

A total of 336 parents participated in the study (response rate: 87.5%). Of these, 70.5% were depressed, 54.1% of which had major depression. Depression was significantly more common (77.2% versus 57.1%) and more severe (60.7% versus 41.1%) among mothers compared to fathers (P = 0.001). Parents with fewer years of education were more likely to be depressed; this association was significant for mothers but not fathers (P = 0.001 and 0.814, respectively). Depression was significantly inversely associated with monthly income (P = 0.001).

CONCLUSION

The prevalence of depression among the parents of children with cancer was high. Depression was significantly more severe among mothers compared to fathers and among mothers who were less educated. Income also had a significant association with levels of depression among parents.

A 2-year dyadic longitudinal study of mothers' and fathers' marital adjustment when caring for a child with cancer

OBJECTIVE

Studies examining interrelationships within parental couples confronted with pediatric cancer are scarce. This study explored dyadic longitudinal associations between both partners' family functioning and mood at diagnosis, and marital adjustment 2 years later.

METHOD

Parents of children (n = 47 couples) with acute lymphoblastic leukemia (ALL) completed the Family Well-Being Assessment and Profile of Mood States-Bipolar Form at diagnosis, and the Locke-Wallace Marital Adjustment Test 2 years post diagnosis. Multilevel linear models using the actor-partner interdependence model (APIM) and controlling for baseline marital adjustment were conducted to evaluate within subject and dyadic longitudinal effects.

RESULTS

For mothers, better marital adjustment 2 years post diagnosis was associated with perception of greater family support and less role conflict and role overload at diagnosis. For fathers, better marital adjustment 2 years post-diagnosis was associated with perception of less role conflict, greater role ambiguity, and being more tired at diagnosis, as well as their partner's perception of less role conflict at diagnosis.

CONCLUSIONS

These findings highlight the importance of considering both partners' perspectives in understanding marital adjustment across treatment phases in parents of children with ALL. Early interventions for couples should be tailored to meet each partner's needs in order to foster resilience within the couple.

The Supportive Care Needs of Parents With a Child With a Rare Disease: A Qualitative Descriptive Study

There are few studies that exist which focus specifically on parents with a child with a rare disease. The purpose of this study was to better understand the lived experiences and supportive care needs (SCN) of parents caring for a child across a spectrum of rare diseases. A qualitative descriptive approach was used to guide the research, and four semi-structured focus group interviews were conducted with 23 parents (17 mothers and 6 fathers). Participants described 'feeling boxed-in outside the box' due to a number of limitations unique to their child's disease, daily practical challenges in providing care and the various relational impacts of caring for a child with a rare disease were discussed. The results from this study help to give clearer direction for health professionals on where to focus future efforts in better meeting the supportive care needs of parents and their child with a rare disease.

Standards of Psychosocial Care for Parents of Children With Cancer

Parents and caregivers of children with cancer are both resilient and deeply affected by the child's cancer. A systematic review of published research since 1995 identified 138 studies of moderate quality indicating that parent distress increases around diagnosis, then returns to normal levels. Post-traumatic symptoms are common. Distress may be impairing for vulnerable parents and may impact a child's coping and adjustment. Moderate quality evidence and expert consensus informed a strong recommendation for parents and caregivers to receive early and ongoing assessment of their mental health needs with access to appropriate interventions facilitated to optimize parent, child, and family well being.

Investigating Parenting Stress across Pediatric Health Conditions - A Systematic Review

The stress parenting responsibilities place on parents increases in situations involving pediatric illness, and therefore can potentially interfere with the normal family life. The present review examines sources of parenting stress across a wide spectrum of illnesses, using three illness groups as exemplars: Congenital heart disease, pediatric cancer, and Autism Spectrum Disorder. A systematic review of the literature using PubMed, CINAHL, Scopus, and PsycINFO databases yielded 66 observational studies investigating sources of parenting stress in parents of young children with congenital heart defects, cancer, and Autism Spectrum Disorder. Quality assessment, using the STROBE and COREQ quality indexes, was further conducted for the included studies. Stressors were categorized, and then analyzed in light of the diagnostic characteristics of the populations in focus. Findings indicate that parents across all illness groups experience increased levels of parenting stress. Several categories were identified in accordance to the parenting stress model as follows: illness-related factors, parental factors, child characteristics, familial factors, and social factors. Further analysis has revealed distinct parental concerns within the groups deriving from the diagnostics, care demands, or social responses specific to each group. Theoretical and practical implications for Family-Systems Nursing Practice were further discussed. Future research and assessment of parenting stress should account for the illness course and address family needs within the specific context of the illness.

Cancer: a family at risk

The diagnosis of cancer is a family experience that changes the lives of all its members, bringing an immense amount of stress and many challenging situations. The daily routine, common activities and distribution of duties all have to change. Family members follow the phases of the disease, very often suffering comparable or greater distress than the patient. They use various coping methods which aim at helping both the sick relative and themselves. These methods, together with emotional responses, change over time according to the phase of the disease.

Cancer puts the family at risk since it imposes an alternation in the relations among family members. It affects the couple's relationship, their sex life, and it can also be a cause of major trauma among their children and adolescents. The diagnosis of cancer brings also individual risks for the family members in terms of psychological and physical health impairment.

Family caregivers often feel overloaded with the additional obligations and roles they have to pick up. They find it increasingly burdening to care full-time for the household and provide emotional support for the patient. The family's problems and the way family members regard the disease may be also a result of the family system they are in.

This article describes the nature of caregiving to a patient with cancer and the biggest concerns for the family.

Providing care to a child with cancer: a longitudinal study on the course, predictors, and impact of caregiving stress during the first year after diagnosis

OBJECTIVE

This study investigated the course, predictors, and impact of caregiving stress on the functioning of primary caregivers of children with cancer during the first year after a child's cancer diagnosis.

METHODS

Primary caregivers (N = 95, 100% mother, 86% response rate) of consecutive newly diagnosed paediatric cancer patients (0-18 years) completed measures of caregiving stress, depressive symptoms, anxiety, and self-reported health at diagnosis, and 3, 6, and 12 months thereafter.

RESULTS

Results indicated a significant decrease in caregiving stress (especially during the first 3 months after diagnosis). Caregiving stress was predicted by single marital status and the ill child being the mother's only child. Multilevel analyses, controlled for socio-demographic and medical covariates, showed that, over time, the decline in caregiving stress was accompanied by a reduction in depressive symptoms and anxiety. The amount of variance explained by caregiving stress was 53% for depressive symptoms, 47% for anxiety, and 3% for self-reported health.

CONCLUSIONS

The present study suggests that caregiving stress is an important factor in understanding parental adjustment to childhood cancer. This offers possibilities for developing interventions aimed at preventing caregiving stress, and strengthening mothers' confidence in their ability to provide good care.