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Snaman JM, Chen L, Mazzola E, Helton G, Feifer D, Broden E, McCarthy S, Rosenberg AR, Baker JN, Wolfe J. Family characteristics and childcare patterns associated with early social functioning in cancer-bereaved parents. Cancer 2024; 130:2822-2833. [PMID: 38620040 DOI: 10.1002/cncr.35325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/20/2024] [Accepted: 04/01/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND Bereaved parents experience life-long grief after the death of their child from cancer. Parents who can integrate their grief and maintain their social functioning early in bereavement, even in the setting of concurrent psychosocial distress, have improved outcomes. Identifying the factors associated with bereaved parents' early social functioning can guide future supportive interventions. METHODS The authors surveyed parents of children who died from cancer at two large centers 6-24 months after death, assessing bereavement experiences using validated and pilot tested tools. Univariable and multivariable logistical regression models were used to examine which family and child demographic, treatment, and end-of-life (EOL) factors were associated with maintained parental social functioning (T scores ≥40 on the Patient-Reported Outcomes Measurement Information System Ability to Participate in Social Roles and Activities-Short Form questionnaire). RESULTS One hundred twenty-eight parents of 88 children participated (38% household response rate); most parents identified as female (63%) and White (88%). Parents' median age was 47 years (interquartile range, 10 years); and the median time from the child's death to survey completion was 13 months (interquartile range, 10 months). In multivariate modeling, parents without household material hardship and those who felt prepared for EOL circumstances had increased odds of maintained social functioning (odds ratio, 4.7 [95% confidence interval, 1.6-13.7; p < .004] and 5.5 [95% confidence interval, 1.9-15.9; p < .002], respectively). CONCLUSIONS Parents who felt prepared for their child's EOL and those without household material hardship were more likely to have maintained social functioning in the first 2 years after their child's death. Interventions targeting EOL preparedness and alleviating household material hardship may improve bereavement outcomes.
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Affiliation(s)
- Jennifer M Snaman
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Li Chen
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Emanuele Mazzola
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Gabrielle Helton
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Doctor of Medicine Program, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Deborah Feifer
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Elizabeth Broden
- School of Medicine, Yale University, New Haven, Connecticut, USA
- School of Public Health, Yale University, New Haven, Connecticut, USA
| | - Sarah McCarthy
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Abby R Rosenberg
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Justin N Baker
- Division of Quality of Life and Palliative Care, Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
- Division of Quality of Life and Pediatric Palliative Care, Stanford School of Medicine and Stanford Medicine Children's Health, Palo Alto, California, USA
| | - Joanne Wolfe
- Massachusetts General Hospital for Children, Boston, Massachusetts, USA
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Chan WCH, Yu CTK, Leung GSM, Lin MKY, Leung MMM, Kwok DKS, Wu JKW. Developing a storybook package for bereaved siblings: a pilot study of the effectiveness for enhancing the perceived knowledge and confidence of health and social care professionals in Hong Kong. DEATH STUDIES 2024:1-12. [PMID: 38907952 DOI: 10.1080/07481187.2024.2369889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/24/2024]
Abstract
A pilot randomized controlled trial was conducted to examine the effectiveness of a storybook package for enhancing the perceived knowledge and confidence of health and social care professionals in working with bereaved child siblings and their parents before and after the loss. Open-ended questions were asked to collect feedback, and thematic analyses were conducted to generate the themes. Quantitative findings provided preliminary but not strong evidence of its effectiveness, but qualitative findings showed that participants perceived their knowledge about supporting bereaved siblings and their parents was enhanced and considered the storybook package a useful tool for facilitating their practice. Participants also reflected on how real and specific the stories in the storybook should be. This study is the first step in developing an evidence-based practice tool for health and social care professionals. Future studies are required to further examine its effectiveness for practice.
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Affiliation(s)
- Wallace Chi Ho Chan
- Department of Social Work, Education, Community Wellbeing, Northumbria University, Newcastle Upon Tyne, UK
| | | | | | | | - Miranda Mei Mui Leung
- Retired Advanced Practice Nurse, Pediatric Palliative Care Team, Hong Kong Children's Hospital, Hong Kong, China
| | - Denis Ka Shaw Kwok
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
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Giang C, Alvis L, Oosterhoff B, Kaplow JB. Protective Factors in the Context of Childhood Bereavement: Youth Gratitude, Future Orientation, and Purpose in Life. OMEGA-JOURNAL OF DEATH AND DYING 2024:302228241246919. [PMID: 38621174 DOI: 10.1177/00302228241246919] [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: 04/17/2024]
Abstract
The objective of the study was to examine potential associations between positive youth development constructs (gratitude, future orientation, purpose in life) and psychological functioning (posttraumatic stress symptoms, depressive symptoms, maladaptive grief reactions) among bereaved youth and test whether these associations vary by age. A diverse sample of 197 clinic-referred bereaved youth (56.2% female; M = 12.36, SD = 3.18; 36.1% Hispanic, 23.7% White, 20.1% Black, 11.9% Multiracial, and 8.2% another race/ethnicity) completed self-report measures of psychological functioning and positive youth development constructs. Linear regression models indicated that gratitude and purpose were associated with lower posttraumatic stress and depressive symptoms among bereaved youth. Future orientation was associated with higher posttraumatic stress symptoms. Results were consistent across age. If replicated longitudinally, gratitude and purpose may be important protective factors against negative mental health outcomes in the aftermath of losing a loved one.
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Affiliation(s)
- Christopher Giang
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Lauren Alvis
- The Trauma and Grief Center, Meadows Mental Health Policy Institute, Houston, TX, USA
| | - Benjamin Oosterhoff
- The Trauma and Grief Center, Meadows Mental Health Policy Institute, Houston, TX, USA
| | - Julie B Kaplow
- The Trauma and Grief Center, Meadows Mental Health Policy Institute, Houston, TX, USA
- Department of Psychiatry, Tulane University School of Medicine, New Orleans, LA, USA
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4
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Logan N, Krysinska K, Andriessen K. Impacts of suicide bereavement on men: a systematic review. Front Public Health 2024; 12:1372974. [PMID: 38655522 PMCID: PMC11035897 DOI: 10.3389/fpubh.2024.1372974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/26/2024] [Indexed: 04/26/2024] Open
Abstract
Introduction This systematic review examines the impacts of suicide bereavement on men's psychosocial outcomes relating to suicidality, mental health, substance use, grief, and social functioning. Given the high global incidence of suicide and the substantial number of individuals affected by each suicide, understanding the specific experiences and outcomes for men is crucial, particularly in the context of observed gender differences in suicide rates, grief coping styles and mental health outcomes. Methods Adhering to PRISMA guidelines, this review included peer-reviewed, English-language studies that involved men bereaved by suicide using quantitative, qualitative and mixed-methods designs. Searches were conducted in MEDLINE, Embase, Emcare, PsycINFO, and Scopus. Analysis used narrative synthesis methods due to the heterogeneity of findings. These were categorised based on comparison groups: non-bereaved men, or women bereaved by suicide. Prospero registration: CRD42023437034. Results The review included 35 studies (25 quantitative, 8 qualitative, 2 mixed-methods) published between 1995 and 2023. Compared to non-bereaved men, suicide-bereaved men are more likely to experience adverse psychosocial outcomes included increased suicide mortality, heightened susceptibility to mental health problems such as depression and posttraumatic stress disorder, and challenges in interpersonal relationships and social functioning. The review also identified gender differences in grief responses and coping strategies, with men often exhibiting more pronounced grief reactions and facing unique challenges due to societal expectations and norms regarding masculinity. Discussion The findings of this review underscore the elevated risk of adverse suicide- and mental-health related outcomes for suicide-bereaved men and the need for tailored postvention supports for this cohort. Gender-specific factors, including cultural norms and coping strategies, significantly influence men's experiences of suicide bereavement. Further qualitative and longitudinal quantitative exploration is needed to enhance understanding and effective support for men bereaved by suicide. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023437034.
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Affiliation(s)
- Nina Logan
- Centre for Mental Health and Community Wellbeing, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
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Fisher RS, Dattilo TM, DeLone AM, Basile NL, Kenney AE, Hill KN, Chang HF, Gerhardt CA, Mullins LL. The study of psychosocial outcomes of parents bereaved by pediatric illness: a scoping review of methodology and sample composition. J Pediatr Psychol 2024; 49:207-223. [PMID: 38423530 DOI: 10.1093/jpepsy/jsae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 01/24/2024] [Accepted: 01/26/2024] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVE Parents of children who died of a medical condition experience a range of psychosocial outcomes. The current scoping review aims to summarize the outcomes assessed, methodology, and sample characteristics of recent psychosocial research conducted with this population. METHODS Included studies were limited to peer-reviewed, psychosocial outcomes research published between August 2011 and August 2022, written in English, and including caregiver study participants of children who died of a medical condition. Data sources were scholarly journal articles from 9 electronic databases, including Scopus, Web of Science, Academic Search Primer, ProQuest Research Library, PubMed, Embase, PsycINFO, Psychology & Behavioral Sciences Collection, and Health Source: Nursing/Academic Edition. The Mixed Methods Appraisal Tool-2018 evaluated methodological quality. RESULTS The study sample included 106 studies, most of which were either qualitative (60%) or quantitative (29%). Mixed-methods studies (8%) and randomized clinical trials (2%) were also identified. Study quality was variable, but most studies met all quality criteria (73%). Studies primarily represented cancer populations (58%), White participants (71%), and mothers (66%). Risk-based psychosocial outcomes (e.g., grief) were more commonly assessed than resilience-based outcomes. CONCLUSIONS The current scoping review revealed that recent research assessing the psychosocial outcomes of bereaved parents is limited in the representation of diverse populations, primarily qualitative, of broadly strong methodological quality, and oriented to psychosocial risk. To enhance the state of the science and inform evidence-based psychosocial services, future research should consider varied methodologies to comprehensively assess processes of risk and resilience with demographically and medically diverse populations.
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Affiliation(s)
- Rachel S Fisher
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, Stillwater, OK, United States
| | - Taylor M Dattilo
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, Stillwater, OK, United States
| | - Alexandra M DeLone
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, Stillwater, OK, United States
| | - Nathan L Basile
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, Stillwater, OK, United States
| | - Ansley E Kenney
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, United States
| | - Kylie N Hill
- Center for Biobehavioral Health, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
| | - Hui-Fen Chang
- William E. Brock Memorial Library, Oklahoma State University, Stillwater, OK, United States
| | - Cynthia A Gerhardt
- Center for Biobehavioral Health, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
| | - Larry L Mullins
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, Stillwater, OK, United States
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Hamadeh RR, Alshammari YA. Bereavement and Grief Among Employees in an Arab University Setting: A Cross-Sectional Study. Cureus 2024; 16:e55659. [PMID: 38586729 PMCID: PMC10997206 DOI: 10.7759/cureus.55659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND Several mental health outcomes develop following bereavement. Little research has examined bereavement in the workplace and the associated risk factors, particularly in Arab populations. OBJECTIVES The objectives of this cross-sectional study were to determine the sociodemographic characteristics of bereaved employees, measure the prevalence of their dysfunction, establish the type of closeness and conflict in their relationship with the deceased, determine the available resources to the bereaved, and determine the proportion of bereaved employees who needed help. METHODS A study was conducted on Arabian Gulf University employees (91) in Bahrain. The revised Two Track Bereavement Questionnaire (TTBQ3-CG11) was utilized to assess bereavement outcomes. RESULTS The response rate of the study was 28%. The composition of the study population was as follows: 51.6% males, 37.4% in the age range of 40-49 years, 86.8% married, 39.6% Bahraini, and 51.6% academicians. Over half of the participants had biopsychosocial dysfunction, 35.2% had active relational grief and trauma (ARGT), 36.3% had a conflict with the deceased, and half were close to the deceased. Total TTBQ3-CG11 scores showed that 28.6% of the bereaved had a low score (14-22), 61.5% medium (23-28), and 9.9% high (29 or more), with more females than males in the high category. The majority reported receiving adequate support from the administration and colleagues following their loss. CONCLUSION There is a need to establish bereavement policies and procedures at tertiary educational institutes. This study may inform future policies to advance bereavement services in the educational institutions of the region.
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Affiliation(s)
- Randah R Hamadeh
- College of Medicine and Medical Sciences, Arabian Gulf University, Manama, BHR
| | - Yousef A Alshammari
- College of Medicine and Medical Sciences, Arabian Gulf University, Manama, BHR
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Park S, Kim J. The death of an adult child and trajectories of parental depressive symptoms: A gender-based longitudinal analysis. Soc Sci Med 2024; 341:116544. [PMID: 38169181 DOI: 10.1016/j.socscimed.2023.116544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 11/28/2023] [Accepted: 12/20/2023] [Indexed: 01/05/2024]
Abstract
RATIONALE Despite the existing body of research on the impact of child bereavement, little is known about whether time to the death of an adult child is longitudinally associated with changes in depressive symptoms among older parents. OBJECTIVE This study examines (a) trajectories of depressive symptoms before and after the loss of an adult child and (b) whether these trajectories differ across parent-child gender dyads (father-son, father-daughter, mother-son, and mother-daughter). METHODS Using eight waves of the Korean Longitudinal Study of Ageing (KLoSA), this study employs fixed effects models to mitigate potential bias due to unobserved individual-level heterogeneity. Gender-stratified fixed effects models were estimated to investigate potential heterogeneity in the trajectories of depressive symptoms by parent-child gender dyads. RESULTS The result of this study revealed that depressive symptoms increased within the first year following the loss of an adult child among bereaved parents. Within a year of the loss of a child, both mothers and fathers experienced an increase in depressive symptoms. However, only fathers experienced lasting effects for up to two years. Different patterns in psychological adjustment to bereavement were observed across different parent-child gender dyads. Among daughter-bereaved fathers, depressive symptoms surged within the first year and persisted even beyond the fourth year of loss. In contrast, for other dyads, only an immediate rise in depressive symptoms within the first year of loss was observed. CONCLUSIONS The loss of an adult child increases the depressive symptoms of parents. This study highlights the importance of considering the different trajectories of psychological adjustment to bereavement, particularly based on parent-child gender dyads, when formulating policies for providing psychological support to older parents who have experienced the loss of their child.
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Affiliation(s)
- Sujeong Park
- Department of Health Policy and Management, Korea University, Seoul, Republic of Korea; Interdisciplinary Program in Precision Public Health, Korea University, Seoul, Republic of Korea
| | - Jinho Kim
- Department of Health Policy and Management, Korea University, Seoul, Republic of Korea; Interdisciplinary Program in Precision Public Health, Korea University, Seoul, Republic of Korea; Center for Demography of Health and Aging, University of Wisconsin-Madison, Madison, WI, USA.
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Hammer NM, Olsen M, Larsen HB, Wreford Andersen E, Oksbjerg Dalton S, Allerslev Horsbøl T, Envold Bidstrup P. Work-related consequences of losing a child with cancer: A nationwide population-based cohort study. Pediatr Blood Cancer 2024; 71:e30720. [PMID: 37837181 DOI: 10.1002/pbc.30720] [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: 07/03/2023] [Revised: 10/02/2023] [Accepted: 10/03/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Parents who lose a child are at increased risk of impaired mental health, which may negatively affect their work ability. The aims of this study were to examine the risk for reduced labor market affiliation in parents who lost a child with cancer compared to a matched parent cohort, and factors associated with the bereaved parents' labor market affiliation. METHODS We conducted a nationwide population-based cohort study using Danish registry data. We followed bereaved parents (n = 1609) whose child died with cancer at age less than 30 during 1992-2020, and a matched, population-based sample of parents (n = 15,188) of children with no history of childhood cancer. Cox proportional hazard models and fractional logit models were performed separately for mothers and fathers. RESULTS Cancer-bereaved mothers had an overall increased risk of long-term sick leave (hazard ratio [HR] = 1.62; 95% confidence interval [CI]: 1.48-1.77), unemployment (HR = 1.53; CI: 1.37-1.70), and lower odds of working in the first 2 years following the loss (odds ratio [OR] = 0.44; CI: 0.39-0.49), while bereaved fathers had lower odds of working (OR = 0.65; CI: 0.53-0.79), and increased risk of permanently reduced work ability (HR = 1.29; 95% CI: 1.01-1.66), compared to the matched cohort of parents of cancer-free children. Younger parental age, lower education, and being a single parent were identified as the main determinants of the bereaved parents' reduced labor market affiliation. CONCLUSIONS Cancer-bereaved parents are at increased risk of reduced labor market affiliation, compared with a matched, population-based sample of parents. Certain groups of bereaved parents may be at particularly high risk, and targeted bereavement interventions are warranted.
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Affiliation(s)
- Nanna Maria Hammer
- Department of Paediatrics and Adolescent Medicine, Copenhagen Palliative Team for Children and Adolescents, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Paediatrics and Adolescent Medicine, Paediatric Oncology Research Laboratory, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Psychological Aspects of Cancer, Cancer Survivorship, Danish Cancer Institute, Copenhagen, Denmark
| | - Marianne Olsen
- Department of Paediatrics and Adolescent Medicine, Paediatric Oncology Research Laboratory, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Pediatrics and Adolescent Medicine, Section of Pediatric Hematology and Oncology, Aalborg University Hospital, Aalborg, Denmark
| | - Hanne Baekgaard Larsen
- Department of Paediatrics and Adolescent Medicine, Paediatric Oncology Research Laboratory, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Susanne Oksbjerg Dalton
- Cancer Survivorship, Danish Cancer Institute, Copenhagen, Denmark
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Naestved, Denmark
| | - Trine Allerslev Horsbøl
- Cancer Survivorship, Danish Cancer Institute, Copenhagen, Denmark
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Pernille Envold Bidstrup
- Psychological Aspects of Cancer, Cancer Survivorship, Danish Cancer Institute, Copenhagen, Denmark
- Institute of Psychology, University of Copenhagen, Copenhagen, Denmark
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Kim MA, Sang J, Yi J, Sung J, Howey W. Changes in Relationships in Bereaved Families: Perspectives of Mothers Who Lost a Child to Cancer. OMEGA-JOURNAL OF DEATH AND DYING 2023; 88:525-549. [PMID: 34565259 DOI: 10.1177/00302228211047105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The loss of a child greatly affects the dynamics of interpersonal relationships in bereaved families. This study explored the relationships in bereaved Korean families from the perspectives of mothers after the death of a child due to cancer. We conducted in-depth interviews with 15 bereaved mothers of a deceased child with childhood cancer. Thematic analysis identified 12 subthemes related to bereaved mothers' struggles in grief within three significant themes based on family relationships: (a) relationship with husband; (b) relationship with surviving child or children; and (c) relationships with extended family members. Findings highlight bereaved mothers' need to build supportive family relationships while acknowledging bereaved family members' different grieving styles and their own challenges in grieving the loss of a child.
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Affiliation(s)
- Min Ah Kim
- Department of Social Welfare, Sungkyunkwan University, Sungkyunkwan University, Seoul, Republic of Korea
| | - Jina Sang
- School of Social Work and Family Sciences, The University of Akron, Akron, Ohio, United States
| | - Jaehee Yi
- College of Social Work, University of Utah, Salt Lake City, Utah, United States
| | - Jimin Sung
- Department of Social Welfare, Sungkyunkwan University, Sungkyunkwan University, Seoul, Republic of Korea
| | - Whitney Howey
- College of Social Work, University of Utah, Salt Lake City, Utah, United States
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Shin S, Ahn S, Joung J, Kim S. Parents' lived experiences of losing adolescent children in the Korean Ferry Sewol disaster: Lessons through a qualitative meta-synthesis. DEATH STUDIES 2023; 48:584-599. [PMID: 37672392 DOI: 10.1080/07481187.2023.2253764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
This study meta-synthesized qualitative studies on the parents' experiences of losing their adolescent children due to the human-made disaster, Ferry Sewol disaster in Korea, 2014. Five Korean and five international electronic databases were searched. Twenty-one studies were selected and critically appraised. Thematic analysis was employed. Four themes (with 10 subthemes) were derived: screaming in excruciating pain at the unbelievable deaths of children, family love evolving amidst pain and deepening into higher value, relationships collapsed and reformed while experiencing various social perspectives, and transitioning from a life of holding on to a life of progress. Bereaved parents experience psychological, physical, social pain for a long time, but gradually tried not to waste their children's death, forming new values and life goals. There is pressing need to devise sustained recovery strategies that account for distinct characteristics and needs of affected population groups.
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Affiliation(s)
- Soyoung Shin
- College of Nursing, Seoul National University, Seoul, South Korea
| | - Suyoun Ahn
- Department of Nursing, Seoyeong University, Paju, South Korea
| | - Jaewon Joung
- College of Nursing, Research Institute of Nursing Science, Jeonbuk National University, Jeonju, South Korea
| | - Sungjae Kim
- College of Nursing, The Research Institute of Nursing Science, Seoul National University, Seoul, South Korea
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Chen C, Chow AYM. Influencing factors of nurses' short-term bereavement reactions after patient death. DEATH STUDIES 2023; 48:371-382. [PMID: 37463272 DOI: 10.1080/07481187.2023.2230552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
An online cross-sectional survey was performed among 181 nurses in mainland China who experienced their most recent patient death within the last month. Multivariate linear regressions were used following bivariate analysis to identify influencing factors for their short-term professional bereavement reactions. More intensive reactions were associated with the nurse's fewer experiences of patient death; the nurse's employment in the intensive care unit rather than the emergency, oncology, geriatrics, or internal medicine departments; and the patient experiencing more pain in the last few days. Higher reaction scores were also reported by nurses who lost the patient more than 1 week prior.
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Affiliation(s)
- Chuqian Chen
- Department of Medical Humanities, School of Humanities, Southeast University, Nanjing, China
| | - Amy Yin Man Chow
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
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12
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Roaquin L. Participatory Grieving: A Concept Analysis. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231184744. [PMID: 37338900 DOI: 10.1177/00302228231184744] [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: 06/21/2023]
Abstract
Grief is a psychobiological response to loss as manifested by intense feeling of sadness, along with thoughts, mental images and memories of the deceased loved one. In order for the patient to attain successful grieving process, it is fundamental among nurses to recognize and understand the loss or impending loss experienced by the patient and/or its significant others. With the use of Walker and Avant's concept analysis, together with thorough literature review pertaining to bereavement and grieving, the defining attributes, antecedents and consequences of participatory grieving were determined. Furthermore, the results of this concept analysis provide a better view on the significant roles and responsibilities of nurses during the grieving process.
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Affiliation(s)
- Lucky Roaquin
- Master of Arts in Nursing spec, Medical-Surgical Nursing, College of Nursing, Saint Tonis College Inc Dean
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13
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Snaman JM, Mazzola E, Helton G, Feifer D, Morris SE, Clark L, Baker JN, Wolfe J. Early Bereavement Psychosocial Outcomes in Parents of Children Who Died of Cancer With a Focus on Social Functioning. JCO Oncol Pract 2023; 19:e527-e541. [PMID: 36724414 DOI: 10.1200/op.22.00538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The early grief experience of parents of children who died of cancer remains understudied. Understanding psychosocial symptomology and functioning of parents early in their bereavement is essential to developing supportive interventions aimed at offsetting poor mental and physical outcomes. METHODS Parents of children from two centers who died of cancer 6 to 24 months before were mailed a survey that included validated tools and additional Likert scale-based questions. We used correlation and univariate and multiple regression analyses to assess the associations between psychosocial and grief outcomes and parental social functioning. RESULTS One hundred twenty-five parents representing 88 children completed the survey. Most respondents identified as female (63%), White (84%), and non-Hispanic (91%). The mean time since child's death was 14.7 (range, 8-26) months. Bereaved parents' mean score for social functioning was only slightly below normative values, and most parents indicated post-traumatic growth and adaptive coping. Parents had high symptom levels for depression, anxiety, post-traumatic stress, and prolonged grief, with those identifying as female having significantly higher symptom scores. Using multivariate analysis, parental scores for resilience and continuing bonds were associated with higher social functioning scores and parental scores for depressive symptoms and prolonged grief were associated with lower social functioning scores. CONCLUSION Although bereaved parents exhibit resilience and positive coping, they also show high levels of psychosocial distress in the first 2 years after their child's death, which may reflect the typical parental bereavement experience. Screening for low parental social functioning may identify parents who would benefit from additional support early in bereavement.
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Affiliation(s)
- Jennifer M Snaman
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA.,Department of Pediatrics, Boston Children's Hospital, Boston, MA
| | - Emanuele Mazzola
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA
| | - Gabrielle Helton
- Doctor of Medicine Program, University of Colorado School of Medicine, Aurora, CO
| | - Deborah Feifer
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA
| | - Sue E Morris
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA.,Department of Psychiatry, Boston Children's Hospital and Brigham and Women's Hospital, and Harvard Medical School, Boston, MA
| | - Lisa Clark
- Division of Quality of Life and Palliative Care, Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
| | - Justin N Baker
- Division of Quality of Life and Palliative Care, Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
| | - Joanne Wolfe
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA.,Department of Pediatrics, Boston Children's Hospital, Boston, MA
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14
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Bourque C, Dumont E, Martisella M, Daoust L, Cantin S, Levasseur MC, de Steur Q, Duval M, Marquis MA, Sultan S. L’expérience à long terme des parents endeuillés en oncologie pédiatrique : une étude rétrospective de 2 à 18 ans après le décès d’un enfant. PSYCHO-ONCOLOGIE 2023. [DOI: 10.3166/pson-2022-0222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Objectifs : Cette étude rétrospective et transversale vise à comprendre l’expérience à long terme des parents endeuillés en oncologie pédiatrique et les différences du deuil parental en fonction du genre.
Matériel et méthodes : Un questionnaire multisectionnel coconstruit avec des cliniciens et intervenants en suivi de deuil a été tenu en ligne en 2018 et 2019. Les participants au sondage étaient des parents dont l’enfant était décédé au service d’hématologie-oncologie du CHU Sainte-Justine 2 à 18 ans auparavant. Des sections spécifiques sur les réactions, les changements et les souvenirs ont fait l’objet d’analyses descriptives.
Résultats : Les réponses de 48 parents ont été analysées. Les résultats indiquent que les mères ont tendance à modifier certaines de leurs activités sociales, alors que les pères cherchent plutôt à retrouver leurs habitudes. Les réactions initialement fortes des parents s’atténuent au fil du temps sans disparaître, en particulier la tristesse et les troubles du sommeil. Les parents ont des souvenirs apaisants des interactions et des soins reçus des intervenants en milieux clinique et communautaire même plusieurs années après le décès de leur enfant.
Conclusion : L’offre de soutien psychosocial communautaire et professionnel à long terme est pertinente, de même aux besoins des couples et aux besoins individuels des parents en fonction du genre.
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15
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Rasouli O, Øglænd IS, Reinfjell T, Eilertsen MEB. Protective and risk factors in the grieving process among cancer-bereaved parents: A qualitative study. DEATH STUDIES 2022; 47:881-890. [PMID: 36352505 DOI: 10.1080/07481187.2022.2142324] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This Norwegian nationwide study explored cancer-bereaved parents' perceptions of protective and risk factors in their grieving process. A total of 162 parents answered two open-ended questions 2-8 years after their child's death due to cancer. Qualitative analysis revealed three main themes: memories of the child's illness and death, going forward in life, and relationships-a resource and a barrier. The results support the perspective of going forward in life and accepting grief as part of life, contrary to the notion of "getting over" or "detaching" from the deceased child. Social support is also crucial for cancer-bereaved parents.
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Affiliation(s)
- Omid Rasouli
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ingvild Svela Øglænd
- Department of Psychology, Faculty of Social and Educational Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Trude Reinfjell
- Department of Psychology, Faculty of Social and Educational Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Mary-Elizabeth Bradley Eilertsen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
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16
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Loxton I, Oxlad M, Perry A. Consulting parents bereaved by childhood cancer: A qualitative study to improve bereavement services. DEATH STUDIES 2022; 47:891-901. [PMID: 36344115 DOI: 10.1080/07481187.2022.2142325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Twelve Australian parents bereaved by childhood cancer were interviewed about their experiences of, and preferences for, bereavement support, to inform recommendations to improve bereavement care. Reflexive thematic analysis resulted in five themes: Care, empathy, and connection assist with bereavement; Communication makes a difference; Early and ongoing support is desired; Gender matters when grieving the loss of a child; and The pull of peer support. Parents can be assisted through empathy, early and ongoing support, enhanced communication, peer support, and care that is inclusive of all genders. Parents in non-metropolitan areas require increased and flexible support options.
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Affiliation(s)
- Isabella Loxton
- School of Psychology, The University of Adelaide, Adelaide, Australia
| | - Melissa Oxlad
- School of Psychology, The University of Adelaide, Adelaide, Australia
| | - Anna Perry
- School of Psychology, The University of Adelaide, Adelaide, Australia
- Childhood Cancer Association, Adelaide, Australia
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17
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Schoonover KL, Yadav H, Prokop L, Lapid MI. Accommodating Bereaved Parents in the Workplace: A Scoping Review. JOURNAL OF LOSS & TRAUMA 2022; 28:348-363. [PMID: 37635848 PMCID: PMC10456992 DOI: 10.1080/15325024.2022.2122221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 09/02/2022] [Indexed: 10/14/2022]
Abstract
Helpful workplace support strategies and accommodations (WSSA) for bereaved parents returning to work was assessed via comprehensive search of databases from 1990-1/21/22. 11 of 45 qualitative articles met inclusion. Bereaved parents often felt returning to work provided a coping strategy for and/or distraction from grief; however, some received insensitive comments by employer/coworkers. Helpful WSSA included flexibility on date to return to work and schedule. In conclusion, due to the intensity of their grief, bereaved parents benefit from a workplace offering individualized time off for bereavement & workplace accommodations to address potential difficulty meeting prior productivity demands.
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Affiliation(s)
| | - Hemang Yadav
- Department of Pulmonary & Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
| | - Larry Prokop
- Department of Education, Mayo Clinic, Rochester, Minnesota
| | - Maria I Lapid
- Center for Palliative Medicine, Mayo Clinic, Rochester, Minnesota
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
- Mayo Clinic Hospice, Mayo Clinic, Rochester, Minnesota
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18
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D'Alton SV, Ridings L, Williams C, Phillips S. The bereavement experiences of children following sibling death: An integrative review. J Pediatr Nurs 2022; 66:e82-e99. [PMID: 35660123 DOI: 10.1016/j.pedn.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/27/2022] [Accepted: 05/06/2022] [Indexed: 10/18/2022]
Abstract
PROBLEM Sibling bereavement is one of the most distressing adverse life events during childhood but has received less attention in research than other forms of childhood bereavement. This integrative review identifies potential risk and protective factors for maladaptive coping following sibling bereavement and the influence of these factors on adjustment to loss. ELIGIBILITY CRITERIA Articles were limited to peer-reviewed studies, published in English in 2000 and beyond. Target population was bereaved siblings 0-18 years, and outcomes examined grief experiences by child self-report or parent-proxy report. SAMPLE The Whittemore and Knafl integrative framework was applied. Multidimensional Grief Theory guided the review with twenty-five studies synthesized across its domains: Separation Distress, Existential/Identity Crisis, and Circumstance-Related Distress. RESULTS Adjustment following sibling death is a complex process associated with a host of risk and protective factors that contribute to the bereavement process for this population. Age, sex, circumstance-related factors, continuing bonds, parental distress, and limited social support were critical influencing factors. CONCLUSION Definitive predictor variables were not identified but a combination of variables that influence the adjustment of bereaved siblings are discussed. IMPLICATIONS Future research is needed to explore the risk and protective factors of maladaptive coping to inform intervention development to promote individual and family adjustment following sibling death.
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Affiliation(s)
- Shannon V D'Alton
- Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas Street, MSC 160, Charleston, SC 29425, United States of America.
| | - Leigh Ridings
- Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas Street, MSC 160, Charleston, SC 29425, United States of America.
| | - Conrad Williams
- Medical University of South Carolina, Department of Pediatrics, 125 Doughty Street, MSC 917, Charleston, SC 29425, United States of America.
| | - Shannon Phillips
- Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas Street, MSC 160, Charleston, SC 29425, United States of America.
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19
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Kim Y, Lee DH, Jeon HJ. A Longitudinal Perspective on Bereaved Parent's Changes in Life Experience after the 2014 Sewol Ferry Sinking. OMEGA-JOURNAL OF DEATH AND DYING 2022; 85:520-553. [PMID: 32772640 DOI: 10.1177/0030222820947238] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This study compared reports of parental life experiences from bereaved parents at two and five years after the death of their adolescent children due to the sinking of the Sewol Ferry in South Korea. Twelve bereaved parents (eight mothers and four fathers from eight families) were interviewed regarding the changes and stabilities they experienced over time at two time points of data collection. Twenty-eight in-depth interviews were transcribed verbatim and analyzed using qualitative content analysis. Outcomes of parental bereavement and changes in life over time may be classified into four main categories: (a) personal changes, (b) changes in perspectives, (c) changes in family relationship, and (d) changes in social relationship and work attitude. This study includes a detailed examination of the phenomenon among the bereaved parents. Discussions and implications are provided based on the results.
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Affiliation(s)
- Yewon Kim
- Department of Education, Traumatic Stress Center, Sungkyunkwan University, Seoul, Republic of Korea
| | - Dong Hun Lee
- Department of Education, Traumatic Stress Center, Sungkyunkwan University College of Education, Seoul, Republic of Korea
| | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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20
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Huo M, Kim K, Wang D. Long-term psychological consequences of parental bereavement prior to midlife: volunteering helps. Aging Ment Health 2022; 27:992-1000. [PMID: 35696362 DOI: 10.1080/13607863.2022.2087209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVES Losing a child prior to midlife may be a uniquely traumatic event that continues to compromise parents' well-being in later life. This study compared psychological well-being between bereaved and non-bereaved parents, and examined whether volunteering protects bereaved parents. Because most families have more than one child, we further explored whether the number of living children parents had differentiated bereaved parents in their well-being. METHODS We analyzed a pooled sample of parents aged 50+ (N = 12,023) from the Health and Retirement Study (2010/2012-2012/2014), including parents who lost a child prior to 50 and those who never lost a child. Two-level linear regression models were estimated to test the associations between child loss, volunteering, and psychological well-being, and examine the moderating effect of number of living children. RESULTS Bereaved parents reported more depressive symptoms and lower life satisfaction than their non-bereaved counterparts, which was more evident among parents with fewer children alive. Among bereaved parents, volunteering, particularly volunteering 100+ hours/year, was associated with better psychological well-being at baseline; yet, volunteering 1-99 hours/year led to a larger increase in life satisfaction over time. The benefits of volunteering held true regardless of the number of living children. CONCLUSION This study adds to our understanding of the lasting effect of parental bereavement and suggests volunteering as a potential intervention aimed at helping bereaved older parents. Findings identify parents with fewer children as a particularly vulnerable population in the face of child loss and calls for more resources allocated to help them.
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Affiliation(s)
- Meng Huo
- Department of Human Ecology, University of California, Davis, CA, USA
| | - Kyungmin Kim
- Department of Child Development and Family Studies, Research Institute of Human Ecology, Seoul National University, Seoul, South Korea
| | - Dahua Wang
- Institute of Developmental Psychology, Beijing Normal University, Beijing, China
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21
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Liang Y, Xu H, Chen F, Liang H, Wu B. Which wound cuts deeper: loss of an only child or loss of a spouse? An examination of bereavement in older adults within a Chinese cultural context. Aging Ment Health 2022; 26:1217-1225. [PMID: 33896295 DOI: 10.1080/13607863.2021.1913473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES This study aimed to examine whether the loss of spouse had similar impacts on psychological well-being as the loss of the only child, and whether the presence of one mitigated the absence of the other. METHODS We used data from a 2013 survey conducted in Shanghai, China. The sample included 1,200 older adults aged 60+, and 200 adults aged 45+ who lost their only child. Psychological well-being consisted of three dimensions: depression, loneliness, and life satisfaction. We applied logistic regression models to assess the impact of loss of spouse or children on psychological well-being. We further tested whether the impact differed by gender and whether social support mediated the relationship. RESULTS Participants who have at least one living child but lost their spouse had less psychological distress than those who have a living spouse but lost their only child. This effect appeared to be stronger in women than in men. Social support mediated the relationship between bereavement and loneliness among women. CONCLUSION The findings suggested the loss of the only child is a more devastating event than the loss of spouse in Chinese adults. The loss of the only child is a major chronic stressor that has cumulative negative effect on psychological well-being.
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Affiliation(s)
- Yan Liang
- School of Nursing, Fudan University, Shanghai, China
| | - Hanzhang Xu
- Medical Center, Duke University, Durham, NC, USA
| | - Feinian Chen
- Department of Sociology, University of Maryland, College Park, MD, USA
| | - Hong Liang
- School of Social Development and Public Policy, Fudan University, Shanghai, China
| | - Bei Wu
- Rory Meyers College of Nursing, New York University, New York, NY, USA
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22
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Love A, Greer K, Woods C, Clark L, Baker JN, Kaye EC. Bereaved Parent Perspectives and Recommendations on Best Practices for Legacy Interventions. J Pain Symptom Manage 2022; 63:1022-1030.e3. [PMID: 35157983 DOI: 10.1016/j.jpainsymman.2022.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 01/31/2022] [Accepted: 02/02/2022] [Indexed: 10/19/2022]
Abstract
CONTEXT Many pediatric hospitals offer legacy interventions for families to promote coping and support grief prior to and following the death of a child. Despite this practice, parent perceptions of the value of legacy activities are not well described, and best practices for offering and creating legacy interventions remain poorly understood. OBJECTIVES To characterize bereaved parents' perspectives on the value of legacy activities; to describe parent recommendations for optimizing provision of legacy activities by child life specialists and music therapists. METHODS In this qualitative study, a purposive sample of 19 bereaved parents of children who died from cancer participated in semi-structured interviews. Interviews were audio-recorded, transcribed, and analyzed inductively using content analysis to identify key concepts and emerging themes. RESULTS Analysis of transcripts revealed bereaved parent insights and recommendations across three core themes: 1) the value of legacy items and interventions; 2) the practical roles, uses, and functions of legacy items, and 3) best practices for offering legacy interventions. Bereaved parents sought meaning and purpose in abstract and concrete manifestations of legacy. Parents often used legacy items in specific ways to promote emotional expression and process their grief. Communication, timing, and creativity significantly influenced parent perceptions of legacy-building. Parents recommended individualized assessments to optimize provision of legacy interventions. CONCLUSION Bereaved parents emphasized the meaningfulness of legacy-building activities and the need for an individualized approach when offering these interventions. Future research should explore the perspectives and recommendations of patients and siblings on legacy activities.
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Affiliation(s)
- Amy Love
- St. Jude Children's Research Hospital, Memphis, TN , USA
| | | | - Cameka Woods
- St. Jude Children's Research Hospital, Memphis, TN , USA
| | - Lisa Clark
- St. Jude Children's Research Hospital, Memphis, TN , USA
| | - Justin N Baker
- St. Jude Children's Research Hospital, Memphis, TN , USA
| | - Erica C Kaye
- St. Jude Children's Research Hospital, Memphis, TN , USA.
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23
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Kingsley J, Taylor M, Bogetz JF, Trowbridge A, Rosenberg AR, Barton KS. Grief Trajectories of Bereaved Parents of Adolescents and Young Adults With Advanced Cancer: A Qualitative Analysis Using Phenomenology. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221101705. [PMID: 35575201 DOI: 10.1177/00302228221101705] [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: 11/17/2022]
Abstract
Different parents grieve differently. However, research directed at understanding the important contextual or individual factors that influence the path each bereaved parent takes is lacking. In this qualitative analysis we seek to understand the array of bereaved parent experiences more completely. By deeply diving into one parent dyad using interpretive phenomenology analysis and situating that story within the conventional content analysis of 13 other bereaved parents of adolescents and young adults (AYAs) who died from advanced cancer, we illustrate the roles of religion/spirituality, maintaining a connection, and fulfilling parental roles as elements of grief processing. Clinicians and investigators should consider similar individualized approaches to understanding and supporting the grief experiences of bereaved parents before and after the death of a child.
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Affiliation(s)
- Jenny Kingsley
- Department of Anesthesiology and Critical Care Medicine, 5150Children's Hospital Los Angeles, CA, USA
| | - Mallory Taylor
- Department of Pediatrics, 12353University of Washington School of Medicine, Seattle, WA, USA
- Palliative Care and Resilience Lab, 145793Seattle Children's Research Institute, Seattle, WA, USA
| | - Jori F Bogetz
- Department of Pediatrics, 12353University of Washington School of Medicine, Seattle, WA, USA
- Palliative Care and Resilience Lab, 145793Seattle Children's Research Institute, Seattle, WA, USA
| | - Amy Trowbridge
- Department of Pediatrics, 12353University of Washington School of Medicine, Seattle, WA, USA
- Palliative Care and Resilience Lab, 145793Seattle Children's Research Institute, Seattle, WA, USA
| | - Abby R Rosenberg
- Department of Pediatrics, 12353University of Washington School of Medicine, Seattle, WA, USA
- Palliative Care and Resilience Lab, 145793Seattle Children's Research Institute, Seattle, WA, USA
| | - Krysta S Barton
- Palliative Care and Resilience Lab, 145793Seattle Children's Research Institute, Seattle, WA, USA
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24
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Dutta O, Tan-Ho G, Low XC, Tan THB, Ganapathy S, Car J, Ho RMH, Miao CY, Ho AHY. Acceptability and feasibility of a pilot randomized controlled trial of Narrative e-Writing Intervention (NeW-I) for parent-caregivers of children with chronic life-threatening illnesses in Singapore. Palliat Care 2022; 21:59. [PMID: 35488270 PMCID: PMC9052453 DOI: 10.1186/s12904-022-00945-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 04/11/2022] [Indexed: 12/01/2022] Open
Abstract
Background Narrative e-Writing Intervention (NeW-I) is a novel psycho-socio-spiritual intervention which aims to bridge gaps in paediatric palliative care by providing anticipatory grief support to parent-caregivers who are looking after their child with a chronic life-threatening illness in Singapore. This is done via a therapist-facilitated smartphone app that focuses on strengths and meaning derived from parents’ caregiving journey. NeW-I is empirically informed by an international systematic review and a Singapore-based qualitative inquiry on the lived experience of parental bereavement and supported by anticipatory grief interventions literature for improving the holistic well-being for parent-caregivers of seriously ill children. NeW-I is implemented in Singapore as an open-label two-armed randomized controlled trial comprising an intervention and control group. Methods This study examined the acceptability (via analysis of participants’ post-intervention qualitative feedback and responses to a post-intervention evaluation survey) and feasibility (via records and memos of therapists’ experience of delivering the intervention) of NeW-I among 26 intervention participants drawn from the larger trial. Results Framework analysis of participants’ post-intervention feedback revealed four themes, namely: (i) Meaningful opportunity for reflection, (ii) Congruity with parent-caregivers’ needs, (iii) Compatibility of online narrative writing and (iv) Sustainability and enhancement recommendations. The post-intervention evaluation survey showed that participants were overall satisfied with their NeW-I experience with a large number of participants acknowledging that NeW-I had improved their spiritual well-being, hopefulness about the future and perception of social support that was available to them, as well as lessened their feelings of sadness and depression, caregiver burden and fear and anxiety about their child’s illness. The research team found it feasible to deliver the intervention in the current setting. Conclusion NeW-I is an innovative e-health tool that could immeasurably value-add to paediatric palliative care services for Asian families in Singapore and around the world. Trial registration ClinicalTrials.gov, ID: NCT03684382, Verified: September 2018.
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Affiliation(s)
- Oindrila Dutta
- School of Social Sciences; School of Computer Science and Engineering; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Geraldine Tan-Ho
- School of Social Sciences; School of Computer Science and Engineering; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | | | - Toh Hsiang Benny Tan
- School of Social Sciences; School of Computer Science and Engineering; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | | | - Josip Car
- School of Social Sciences; School of Computer Science and Engineering; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Ringo Moon-Ho Ho
- School of Social Sciences; School of Computer Science and Engineering; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Chun Yan Miao
- School of Social Sciences; School of Computer Science and Engineering; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Andy Hau Yan Ho
- School of Social Sciences; School of Computer Science and Engineering; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore. .,Palliative Care Centre for Excellence in Research and Education, Singapore, Singapore.
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25
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McNeil MJ, Kiefer A, Woods C, Barnett B, Berry-Carter K, Clark L, Mandrell BN, Snaman J, Kaye EC, Baker JN. "You are not alone": Connecting through a bereaved parent mentor program for parents whose child died of cancer. Cancer Med 2022; 11:3332-3341. [PMID: 35362669 PMCID: PMC9468435 DOI: 10.1002/cam4.4696] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/05/2022] [Accepted: 03/09/2022] [Indexed: 11/26/2022] Open
Abstract
Background Bereavement after the death of a child is devastating and associated with worse physical and psychosocial well‐being in parents. Evidence suggests that parents desire and benefit from support provided by other bereaved parents. To foster this peer support, an institutional peer‐to‐peer mentorship program for bereaved parents was established, through which trained bereaved parent mentors offer support for newly bereaved parents. Methods Using a retrospective cohort design, we describe the characteristics of participants of the Bereaved Parent Mentorship program. Trained bereaved parent mentors documented encounters with newly bereaved parent mentees using a secure internet‐based form. Mentors summarized each encounter including any concerns or need for professional psychosocial support. Descriptive statistics were used to describe mentor and mentee characteristics; free text from encounter summaries was qualitatively analyzed using content analysis. Results A total of 1368 documented encounters occurred between 150 mentees and 39 mentors from January 1, 2014 to February 29, 2020. Only seven encounters (0.5%) were flagged as serious concern necessitating professional psychosocial support. Four key themes in the encounters between mentors and mentees emerged, including: descriptions of the grief experience, ways in which a mentor supported their mentee, challenges the mentor experienced in supporting the mentee, and personal benefit gained by the mentor from supporting their mentee. Conclusion This structured Bereaved Parent Mentorship program fostered rich interactions between bereaved parent participants, with very few encounters requiring professional assistance. Future research will assess the impact of bereaved mentor programs on resilience and psychosocial, physical, and functional well‐being of parents.
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Affiliation(s)
- Michael J McNeil
- Division of Quality and Life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.,Department of Global Pediatric Medicine, St. Jude Children's Research Hospital Memphis, Memphis, Tennessee, USA
| | - Ashley Kiefer
- Children's Hospital New Orleans, New Orleans, Louisiana, USA
| | - Cameka Woods
- Division of Quality and Life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Brittany Barnett
- Department of Family, Guest and Volunteer Services, St. Jude Children's Research Hospital Memphis, Memphis, Tennessee, USA
| | - Kathryn Berry-Carter
- Department of Family, Guest and Volunteer Services, St. Jude Children's Research Hospital Memphis, Memphis, Tennessee, USA
| | - Lisa Clark
- Division of Quality and Life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Belinda N Mandrell
- Department of Pediatrics, Division of Nursing Research, St. Jude Children's Research Hospital Memphis, Memphis, Tennessee, USA
| | - Jennifer Snaman
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Erica C Kaye
- Division of Quality and Life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Justin N Baker
- Division of Quality and Life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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Abstract
Patient activism organizations are formed around and seek legitimacy via both biological and biographical identities (Fassin, in: Theory Cult Soc 26(5):44-60, 2009). In the case of sickle cell disease (SCD) in Brazil, two different modes of suffering authenticate the lived experience-one is based on the disease state, the other is based on the ways in which racial inequalities and disadvantage contribute to its own suffering while also entangled with disease-based suffering. SCD is a rare genetic disorder that affects red blood cells and whose hallmark symptom is pain. This paper places an ethnographic focus on the failed mobilization of suffering by an organization leader in attempts to make claims for inclusion. The leader's social and biological identities of mother, sickle cell trait carrier, middle class, and mulata disrupted biosocial cohesion. This disruption reveals a hierarchy of suffering, where some indices of suffering are delegitimized. This hierarchy illuminates how exclusion and representation work within a patient organization whose membership embody both physical and social distress.
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27
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Examining the Experiences and Support Needs of Bereaved Parents After the Death of a Child During Early Adulthood From Cancer. Cancer Nurs 2021; 45:E719-E727. [PMID: 34483281 DOI: 10.1097/ncc.0000000000000998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Parents experience unique grief, which may be experienced differently by mothers and fathers. A lack of knowledge about the particular bereavement experiences of the parents of young adults exists. OBJECTIVE The aim of this study was to investigate experiences and support needs of parents after the death of a child (aged 16-29 years) from cancer, exploring changes over time. METHODS The study used a Charmazian constructivist grounded theory approach. Semistructured interviews were conducted with 11 parents (7 mothers and 4 fathers) purposefully sampled and bereaved between 15 months and 7 years. Data were analyzed inductively using the constant comparative approach for category development. RESULTS "Living with continual loss" emerged as the core category central to parents' experiences of bereavement. Feelings of continual loss were compounded by parents' lack of information ("grieving in the dark") and a perceived lack of understanding from families and friends ("grieving alone"). Parents discovered strategies to manage the feeling of loss: "changing routines," "preserving the meaning of home," "maintaining memories and presence," and "sharing experiences." CONCLUSIONS This is the first study focusing solely on the experiences and support needs of bereaved parents of young adults who have died of cancer. Parents live with a continual sense of loss irrespective of the length of bereavement, and a lack of bereavement information and empathetic emotional support can exist. IMPLICATIONS FOR PRACTICE The need for improved information giving and development of peer support for bereaved parents has been identified. Cancer centers have a continuing role in developing and providing this support.
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Effectiveness of Theraplay in Internalizing and Externalizing Problems in Bereaved Siblings of Children with Cancer. IRANIAN JOURNAL OF PSYCHIATRY AND BEHAVIORAL SCIENCES 2021. [DOI: 10.5812/ijpbs.103992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Sibling relationships are very significant relationships, and their termination due to death will have profound long-term effects on the life of the surviving children. Objectives: The purpose of the current study was to determine the effectiveness of theraplay on internalizing and externalizing problems in bereaved siblings. Methods: This study was carried out using a single-subject multiple baseline design with follow-up. The statistical population included siblings and mothers of children aged 6 - 10 years who were on treatment at Mahak Pediatric Cancer Hospital and died one or two years ago. From this population, four 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-min sessions). The assessments were carried out using the Child Behavior Checklist (CBCL) at baseline and in the intervention sessions and follow-up. Visual analysis of graphic displays of level, Reliable Change Index (RCI), and clinical significance were used to analyze the data. Data analysis and drawing the graphs were performed in Microsoft Excel 2016. Results: The results of the visual and quantitative data analysis showed a significant reduction in the four participants' internalizing problems during therapy. The reduction in the scores of this subscale in participants 1, 2, and 3 continued into the follow-up period and was noticeable. The results also showed that theraplay reduced the externalizing problems of most participants. A large proportion of these results persisted into the follow-up period. Conclusions: Theraplay appears to effectively reduce the internalizing and externalizing problems of bereaved siblings.
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Helton G, Morris SE, Dole OR, Wolfe J, Snaman JM. Parental Perceptions of Hospital-Based Bereavement Support Following a Child's Death From Cancer: Room for Improvement. J Pain Symptom Manage 2021; 61:1254-1260. [PMID: 33197525 DOI: 10.1016/j.jpainsymman.2020.11.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/29/2020] [Accepted: 11/10/2020] [Indexed: 11/26/2022]
Abstract
CONTEXT The death of a child from cancer is a devastating event, placing bereaved parents at risk for both physical and psychosocial morbidities. Despite growing awareness of these outcomes and increased hospital-based support, bereaved parents continue to express a desire for additional assistance. OBJECTIVES We examined parental perceptions of bereavement support from the clinical teams and institution and suggested modifications to hospital support strategies. METHODS We explored the answers to four questions on the bereavement support provided from the care team and institutional mailings from a larger survey, querying parents of children who died from cancer 6 to 24 months prior to participation. Answers were Likert scale based with additional free-text responses. RESULTS Forty-nine parents completed the survey (response rate 36%). The respondents were predominantly white (N = 43, 88%), female (N = 32, 65%), and non-Hispanic/Latino (N = 43, 88%). The mean length of time from child's death to completion was 13 months. Twenty-seven (55%) and 26 (53%) parents indicated that contact with care team and mailings, respectively, were at least a little helpful in their grief experience. In free-text responses, parents identified support outside the hospital (28 respondents), groups and events hosted by the hospital or hospice (8), contact with care team (3), and hospital mailings (1) as the most helpful. Findings support modifications to hospital support strategies. CONCLUSIONS Bereaved parents request additional supportive services. Using the parents' perspective and recommendations, we outline options to augment support and provide a variety of supportive resources for bereaved parents to access in their own time.
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Affiliation(s)
- Gabrielle Helton
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Sue E Morris
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA; Department of Psychiatry, Boston Children's Hospital and Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | - Olivia R Dole
- Department of Family Services Boston Children's Hospital, Boston, MA, USA
| | - Joanne Wolfe
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA; Department of Pediatrics Boston Children's Hospital, Boston, MA, USA
| | - Jennifer M Snaman
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA; Department of Pediatrics Boston Children's Hospital, Boston, MA, USA.
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McNeil MJ, Baker JN, Snyder I, Rosenberg AR, Kaye EC. Grief and Bereavement in Fathers After the Death of a Child: A Systematic Review. Pediatrics 2021; 147:peds.2020-040386. [PMID: 33648950 DOI: 10.1542/peds.2020-040386] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/22/2020] [Indexed: 11/24/2022] Open
Abstract
CONTEXT The death of a child is devastating, and complicated grief adversely impacts parental physical and psychosocial well-being. Most research currently is centered on bereaved mothers, and the experiences of fathers remains underexplored. OBJECTIVE We systematically reviewed the literature to characterize the grief and bereavement experiences of fathers after the death of a child. DATA SOURCES We searched Medline, PsycInfo, Embase, and Cumulative Index to Nursing and Allied Health Literature using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. STUDY SELECTION Inclusion criteria encompassed English language articles published between 2007 and 2019 that evaluated the grief and bereavement experiences of fathers after the death of their child. We excluded studies describing paternal bereavement after the death of a child aged older than 21 years, stillbirth, miscarriage, or studies that did not specify age of death. DATA EXTRACTION Extracted domains included study design, demographics, findings, and quality assessment. RESULTS We screened 1848 deduplicated titles and abstracts and 139 full articles, yielding 21 articles for inclusion in this analysis. Fathers often avoided discussing their grief with others, returned to work earlier, and used goal-oriented tasks as coping strategies. Intense grief reactions and posttraumatic psychological sequelae diminished over time in mothers yet persisted in fathers. LIMITATIONS Included studies were primarily descriptive in nature, without ability to ascertain causality. Limited paternal data exists in the literature compared with maternal data. CONCLUSIONS Despite evolving gender roles, many fathers navigate loss through stoicism, self-isolation, and hard work. For some fathers, these coping mechanisms may be inadequate for navigating grief.
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Affiliation(s)
- Michael J McNeil
- Division of Quality and Life and Palliative Care, Department of Oncology St. Jude Children's Research Hospital, Memphis, Tennessee;
| | - Justin N Baker
- Division of Quality and Life and Palliative Care, Department of Oncology St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Ian Snyder
- University of Tennessee Health Science Center, Memphis, Tennessee
| | - Abby R Rosenberg
- Palliative Care and Resilience Laboratory, Seattle Children's Research Institute, Seattle, Washington; and.,Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington
| | - Erica C Kaye
- Division of Quality and Life and Palliative Care, Department of Oncology St. Jude Children's Research Hospital, Memphis, Tennessee
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Postavaru GI, Swaby H, Swaby R. A meta-ethnographic study of fathers' experiences of caring for a child with a life-limiting illness. Palliat Med 2021; 35:261-279. [PMID: 33339475 PMCID: PMC7897781 DOI: 10.1177/0269216320979153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is a growing body of qualitative studies examining parents' experiences of caring for a child with a life-limiting condition, coinciding with recent evidence that indicates an increasing incidence of paediatric life-limiting conditions. However, research focusing on fathers' needs remains sparse and is often diluted among a predominant 'mother's voice', raising questions about whether practices in clinical settings meet fathers' needs. AIM To provide an in-depth assembly of the current state of knowledge around fathers' experiences of caring for their children diagnosed with life-limiting conditions and understand the implications for healthcare services and policies. DESIGN A meta-ethnography was conducted to synthesise findings from existing qualitative studies exploring fathers' experiences of caring. DATA SOURCES Four electronic databases (PubMed, PsycINFO, CINAHL and Science Direct) were searched up until April 2020. Qualitative studies exploring fathers' care experience and published in English language were included. The Critical Appraisal Skills Programme (CASP) checklist was employed for study quality appraisal. No temporal limits were used. RESULTS Sixty-three studies met the inclusion criteria. Thirty life-limiting conditions were included. Based on responses from 496 fathers, a conceptual model was developed which translates key experiences within the fathers' caregiving journeys. The overarching concepts identified were: the paradox of support, challenges in the caring process, 'nobody thinks of men', impact on family life and the fall of the curtain: an irrevocably altered world. These and associated sub-concepts are discussed, with recommendations for future research and practice provided. CONCLUSION The findings indicate the value of a family-oriented approach to develop psychosocial interventions and support channels for fathers, thus empowering them whilst reducing the care-giving burden on the family unit.
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Affiliation(s)
| | | | - Rabbi Swaby
- Nottingham University Hospitals NHS Trust, Nottingham, UK
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Das MK, Arora NK, Gaikwad H, Chellani H, Debata P, Rasaily R, Meena KR, Kaur G, Malik P, Joshi S, Kumari M. Grief reaction and psychosocial impacts of child death and stillbirth on bereaved North Indian parents: A qualitative study. PLoS One 2021; 16:e0240270. [PMID: 33503017 PMCID: PMC7840017 DOI: 10.1371/journal.pone.0240270] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 12/10/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Grief following stillbirth and child death are one of the most traumatic experience for parents with psychosomatic, social and economic impacts. The grief profile, severity and its impacts in Indian context are not well documented. This study documented the grief and coping experiences of the Indian parents following stillbirth and child death. METHODS This exploratory qualitative study in Delhi (India) included in-depth interviews with parents (50 mothers and 49 fathers), who had stillbirth or child death, their family members (n = 41) and community representatives (n = 12). Eight focus group discussions were done with community members (n = 72). Inductive data analysis included thematic content analysis. Perinatal Grief Scale was used to document the mother's grief severity after 6-9 months of loss. RESULTS The four themes emerged were grief anticipation and expression, impact of the bereavement, coping mechanism, and sociocultural norms and practices. The parents suffered from disbelief, severe pain and helplessness. Mothers expressed severe grief openly and some fainted. Fathers also had severe grief, but didn't express openly. Some parents shared self-guilt and blamed the hospital/healthcare providers, themselves or family. Majority had no/positive change in couple relationship, but few faced marital disharmony. Majority experienced sleep, eating and psychological disturbances for several weeks. Mothers coped through engaging in household work, caring other child(ren) and spiritual activities. Fathers coped through avoiding discussion and work and professional engagement. Fathers resumed work after 5-20 days and mothers took 2-6 weeks to resume household chores. Unanticipated loss, limited family support and financial strain affected the severity and duration of grief. 57.5% of all mothers and 80% mothers with stillbirth had severe grief after 6-9 months. CONCLUSIONS Stillbirth and child death have lasting psychosomatic, social and economic impacts on parents, which are usually ignored. Sociocultural and religion appropriate bereavement support for the parents are needed to reduce the impacts.
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Affiliation(s)
| | | | - Harsha Gaikwad
- Department of Obstetrics and Gynaecology, Safdarjung Hospital and Vardhman Mahavir Medical College, New Delhi, India
| | - Harish Chellani
- Department of Pediatrics, Safdarjung Hospital and Vardhman Mahavir Medical College, New Delhi, India
| | - Pradeep Debata
- Department of Pediatrics, Safdarjung Hospital and Vardhman Mahavir Medical College, New Delhi, India
| | - Reeta Rasaily
- Division of Division of Reproductive Biology Maternal and Child Health, Indian Council of Medical Research, New Delhi, India
| | - K. R. Meena
- Department of Pediatrics, Safdarjung Hospital and Vardhman Mahavir Medical College, New Delhi, India
| | | | | | - Shipra Joshi
- The INCLEN Trust International, New Delhi, India
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Experiences of Parental Suicide-Bereavement: A Longitudinal Qualitative Analysis Over Two Years. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020564. [PMID: 33440875 PMCID: PMC7826588 DOI: 10.3390/ijerph18020564] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/07/2021] [Accepted: 01/08/2021] [Indexed: 02/06/2023]
Abstract
Limited research exists on the experiences of parents bereaved by suicide. Our earlier qualitative analysis examined the experiences of parents’ suicide bereavement at 6 and 12 months after their loss. The current study aimed to extend the analysis over 24 months, outlining the key themes of parents’ suicide bereavement experience. In the frames of a longitudinal study of suicide bereavement in Queensland, Australia, parents were interviewed at 6, 12, and 24 months after their loss. Thematic analysis was used to further explore new themes and three key themes identified in earlier analyses: searching for answers and sense-making, coping strategies and support, and finding meaning and purpose. Results at 24 months revealed a clearer differentiation between strategies adopted by mothers and fathers. Anger and blame had changed towards feelings of depression. A polarization was observed between parents still oscillating in brooding rumination and those who have shifted towards sense-making. The former more frequently reported depression symptoms, and the latter reported a more positive attitude towards life and acceptance of their loss. Consistent with the dual-process model, parents managed to reach acceptance after oscillating between sense-making and meaning making. Findings provide insights how suicide loss affects parents, with implications for postvention.
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Robertson EG, Wakefield CE, Tsoli M, Kellie SJ, Alvaro F, Gifford AJ, Weber MA, Rodriguez M, Kirby M, Ziegler DS. Parents' experiences of postmortem tumor donation for high-grade gliomas: benefits and suggested improvements. Neurooncol Adv 2021; 3:vdab087. [PMID: 34458732 PMCID: PMC8386242 DOI: 10.1093/noajnl/vdab087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Pediatric high-grade glioma is a devastating diagnosis. There has been no improvement in outcomes for several decades, with few children surviving 2 years postdiagnosis. Research progress has been hampered by a lack of tumor samples, which can be used to develop and test novel therapies. Postmortem tumor donations are therefore a valuable opportunity to collect tissue. In this study, we explored Australian parents' experiences of donating their child's tumor for research after their child had died. METHODS We collected qualitative data from 11 bereaved parents who consented to donate samples of their child's high-grade glioma for research postmortem. We asked parents about their perceived benefits/burdens of the autopsy, recommendations for improving consent discussions, and decision regret. RESULTS Parents hoped that their donation would help to find a cure for future children with high-grade glioma. They described feeling comforted knowing that their child's suffering may help others. Some parents also felt that the donation would help them better understand their child's tumor. Although some parents described discomfort about procedures leading up to the autopsy, parents reported minimal regret regarding their decision to donate their child's tumor. Parents provided recommendations to improve consent discussions, such as providing more information about the autopsy logistics and why the donation was needed. CONCLUSION Parents consented to autopsy for altruistic reasons, although donation may also assist parents in their grieving. There is a strong need to improve access to tumor donations for any family who wishes to donate.
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Affiliation(s)
- Eden G Robertson
- School of Women’s and Children’s Health, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Sydney, New South Wales, Australia
| | - Claire E Wakefield
- School of Women’s and Children’s Health, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Sydney, New South Wales, Australia
| | - Maria Tsoli
- School of Women’s and Children’s Health, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Children’s Cancer Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Stewart J Kellie
- Children’s Cancer Centre, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
| | - Frank Alvaro
- Children’s Cancer and Blood Disorders, John Hunter Children’s Hospital, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Andrew J Gifford
- School of Women’s and Children’s Health, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Children’s Cancer Institute, UNSW Sydney, Sydney, New South Wales, Australia
- Anatomical Pathology, NSW Health Pathology East (Prince of Wales Hospital), Sydney, New South Wales, Australia
| | - Martin A Weber
- Anatomical Pathology, NSW Health Pathology East (Prince of Wales Hospital), Sydney, New South Wales, Australia
- School of Medical Sciences, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Michael Rodriguez
- Anatomical Pathology, NSW Health Pathology East (Prince of Wales Hospital), Sydney, New South Wales, Australia
| | - Maria Kirby
- Department of Haematology and Oncology, Women’s and Children’s Hospital, Adelaide, South Australia, Australia
| | - David S Ziegler
- School of Women’s and Children’s Health, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Children’s Cancer Institute, UNSW Sydney, Sydney, New South Wales, Australia
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick, New South Wales, Australia
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Carreño-Moreno S, Chaparro-Díaz L, López-Rangel R, Cardenas-Fandiño M, Carrillo-González M, Gómez-Ramírez O. Experiencia del cuidador familiar ante la muerte del niño con cáncer. REVISTA LATINOAMERICANA DE BIOÉTICA 2020. [DOI: 10.18359/rlbi.3841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
En este estudio se trazó como objetivo la descripción de la experiencia del cuidador familiar ante la muerte del niño con cáncer. Para ello, se utilizó como método un estudio cualitativo con enfoque fenomenológico descriptivo bajo la perspectiva de Colaizzi, en el que se incluyeron 18 participantes que cumplieron con los criterios de inclusión de ser padre o madre de un niño con cáncer que haya fallecido en un periodo de 5 meses a 5 años. Se realizaron entrevistas a profundidad hasta lograr saturación teórica. Como resultados, se obtuvieron seis temas que describen la experiencia del cuidador: idealización del niño fallecido, batalla perpetua, vínculo inquebrantable, pérdida de sentido, levantarse y seguir, y lucha espiritual; estos representan la percepción y vivencia de los cuidadores en el duelo. Como conclusiones se consideró que las expresiones de dolor, incertidumbre y vacío son sentimientos y sensaciones descritas por los cuidadores, que hacen parte del proceso de duelo, pero también describen su paso hacia la aceptación y trascendencia, en la que dan importancia al ser espiritual del niño como una forma de creer que sigue junto a ellos.
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Eli B, Zhou Y, Liang Y, Fu L, Zheng H, Liu Z. A profile analysis of post-traumatic stress disorder and depressive symptoms among Chinese Shidu parents. Eur J Psychotraumatol 2020; 11:1766770. [PMID: 33029310 PMCID: PMC7472999 DOI: 10.1080/20008198.2020.1766770] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 04/21/2020] [Accepted: 05/01/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Due to the one-child policy implemented in China, most families have only one child. When parents experience the death of their only child, these parents receive the label 'Shidu parents'. Shidu is a major public health issue in China. However, the patterns of post-traumatic stress disorder (PTSD) and depressive symptoms that are present in this population remain unclear. OBJECTIVE This study aims to identify profiles of PTSD and depressive symptoms among Shidu parents and to explore the predictors of profile membership. METHODS A total of 363 participants (M age = 61.5 years, SD = 7.5) were asked to complete questionnaires assessing PTSD, depressive symptoms, perceived social support, and demographic information. Latent profile analyses and multivariate logistic regressions were used. RESULTS Three distinct profiles were identified: low (39.4%), moderate (32.8%), and high symptoms (27.8%). Parents who were younger and perceived lower levels of support from family and significant others were more likely to experience higher levels of PTSD and depressive symptoms. CONCLUSIONS These results indicate that the severity of PTSD and depressive symptoms tightly cohere, providing evidence for the co-occurrence of PTSD and depressive symptoms after bereavement. The findings provide valuable information for the development of tailored professional interventions for bereaved parents.
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Affiliation(s)
- Buzohre Eli
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yueyue Zhou
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yiming Liang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Lin Fu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Hao Zheng
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Zhengkui Liu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
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Ho AHY, Dutta O, Tan-Ho G, Tan THB, Low XC, Ganapathy S, Car J, Ho RMH, Miao CY. A Novel Narrative E-Writing Intervention for Parents of Children With Chronic Life-Threatening Illnesses: Protocol for a Pilot, Open-Label Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e17561. [PMID: 32623367 PMCID: PMC7380996 DOI: 10.2196/17561] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/29/2020] [Accepted: 03/29/2020] [Indexed: 12/28/2022] Open
Abstract
Background A novel evidence-based Narrative e-Writing Intervention (NeW-I) has been developed and tested in Singapore to advance psychosociospiritual support for parents of children with chronic life-threatening illnesses. NeW-I is informed by an international systematic review and a Singapore-based qualitative inquiry on the lived experience of parental bereavement and supported by literature on anticipatory grief interventions for improving the holistic well-being of parent caregivers of seriously ill children. Objective This study's aim was to provide an accessible platform, NeW-I—which is a strengths- and meaning-focused and therapist-facilitated mobile app and web-based counseling platform—that aims to enhance quality of life, spiritual well-being, hope, and perceived social support and reduce depressive symptoms, caregiver burden, and risk of complicated grief among parents of children with chronic life-threatening illnesses. Methods The NeW-I therapist-facilitated web-based platform comprises a mobile app and a website (both of which have the same content
and functionality). NeW-I has been implemented in Singapore as a pilot open-label randomized controlled trial comprising intervention and control groups. Both primary and secondary outcomes will be self-reported by participants through questionnaires. In collaboration with leading pediatric palliative care providers in Singapore, the trial aims to enroll 36 participants in each group (N=72), so that when allowing for 30% attrition at follow-up, the sample size will be adequate to detect a small effect size of 0.2 in the primary outcome measure, with 90% power and two-sided significance level of at least .05. The potential effectiveness of NeW-I and the accessibility and feasibility of implementing and delivering the intervention will be assessed. Results Funding support and institutional review board approval for this study have been secured. Data collection started in January 2019 and is ongoing. Conclusions NeW-I aspires to enhance holistic pediatric palliative care services through a structured web-based counseling platform that is sensitive to the unique cultural needs of Asian family caregivers who are uncomfortable with expressing emotion even during times of loss and separation. The findings of this pilot study will inform the development of a full-scale NeW-I protocol and further research to evaluate the efficacy of NeW-I in Singapore and in other Asian communities around the world. Trial Registration ClinicalTrials.gov NCT03684382; https://clinicaltrials.gov/ct2/show/NCT03684382 International Registered Report Identifier (IRRID) DERR1-10.2196/17561
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Affiliation(s)
- Andy Hau Yan Ho
- Psychology Program, School of Social Sciences, Nanyang Technological University, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Palliative Care Centre for Excellence in Research and Education, Singapore, Singapore
| | - Oindrila Dutta
- Psychology Program, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
| | - Geraldine Tan-Ho
- Psychology Program, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
| | - Toh Hsiang Benny Tan
- School of Computer Science and Engineering, Nanyang Technological University, Singapore, Singapore
| | - Xinyi Casuarine Low
- Psychology Program, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
| | | | - Josip Car
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Ringo Moon-Ho Ho
- Psychology Program, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
| | - Chun Yan Miao
- School of Computer Science and Engineering, Nanyang Technological University, Singapore, Singapore
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Wilson DM, Rodríguez-Prat A, Low G. The potential impact of bereavement grief on workers, work, careers, and the workplace. SOCIAL WORK IN HEALTH CARE 2020; 59:335-350. [PMID: 32510280 DOI: 10.1080/00981389.2020.1769247] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 04/05/2020] [Accepted: 05/08/2020] [Indexed: 06/11/2023]
Abstract
Bereavement grief is typically very painful and often highly consequential. People who are working could be significantly impacted by the death of someone they care about. A qualitative study sought an understanding of the lived experience of bereavement on the mourner's ability to work and their work-related experiences following the death of a loved one. Three themes emerged: (a) grief is universal but individually impactful, (b) accommodation is needed to assist the return to work and to regain work abilities, and (c) there are many impediments to working again. These themes highlight the potential for bereavement grief to substantially effect mourners and thus their work, careers, and the workplace. Older workers could be particularly disadvantaged because of workplace ageism. Societal and other changes appear to be needed for the health and wellbeing of mourning workers, and to address related work and bereavement issues. Bereavement grief is highly relevant to the social work profession, given its involvement in providing information, developing supportive services, and making referrals.
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Affiliation(s)
- Donna M Wilson
- Faculty of Nursing, University of Alberta , Edmonton, AB, Canada
| | | | - Gail Low
- Faculty of Nursing, University of Alberta , Edmonton, AB, Canada
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Raharjo CV, Hetherington K, Donovan L, Fardell JE, Russell V, Cohn RJ, Morgan NL, Siddiqui J, Wakefield CE. An Evaluation of By My Side: Peer Support in Written Form is Acceptable and Useful for Parents Bereaved by Childhood Cancer. J Pain Symptom Manage 2020; 59:1278-1286. [PMID: 32006611 DOI: 10.1016/j.jpainsymman.2020.01.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 01/17/2020] [Accepted: 01/17/2020] [Indexed: 11/20/2022]
Abstract
CONTEXT Cancer is the leading cause of nonaccidental death in childhood, with the death of a child representing a devastating loss for families. Peer support offers a valuable way to support parents' adjustment in bereavement. The By My Side book provides written peer support by sharing bereaved parents' stories to normalize grief experiences and reduce parents' isolation. It is available free of charge. OBJECTIVES This project evaluated the acceptability, relevance, emotional impact, and usefulness of By My Side. DESIGN Bereaved parents and health care professionals (HCPs) provided feedback via a questionnaire. We used descriptive statistics and qualitative analysis of open-ended responses to analyze the data. SETTING/PARTICIPANTS We mailed a study invitation and evaluation questionnaire to parents and HCPs who ordered a copy of By My Side. RESULTS About 24 bereaved parents and seven HCPs provided feedback. Parents thought the book's length (91.7%) and amount of information (83.3%) was just right. About 75% of parents reported that the book made them feel that their reactions to their child's death were normal and/or appropriate. Parents reported positive and negative emotional reactions to the book (e.g., 87.5% felt comforted, 87.5% felt sadness). All parents and HCPs reported that the book provided useful information about grief. About 83.4% of parents and 85.7% of HCPs would recommend it to others. CONCLUSION By My Side was acceptable and useful to bereaved parents and HCPs. Results suggest that peer support in written form may help normalize aspects of grief and comfort parents bereaved by childhood cancer.
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Affiliation(s)
- Callista V Raharjo
- School of Women's and Children's Health, UNSW Sydney, Kensington, New South Wales, Australia; Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Kate Hetherington
- School of Women's and Children's Health, UNSW Sydney, Kensington, New South Wales, Australia; Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia.
| | - Leigh Donovan
- School of Women's and Children's Health, UNSW Sydney, Kensington, New South Wales, Australia; Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia; Paediatric Palliative Care Service, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Joanna E Fardell
- School of Women's and Children's Health, UNSW Sydney, Kensington, New South Wales, Australia; Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Vera Russell
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia; Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Richard J Cohn
- School of Women's and Children's Health, UNSW Sydney, Kensington, New South Wales, Australia; Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia; Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | | | | | - Claire E Wakefield
- School of Women's and Children's Health, UNSW Sydney, Kensington, New South Wales, Australia; Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
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Tager J, Battles H, Bedoya SZ, Gerhardt CA, Young-Saleme T, Wiener L. Participation in Online Research Examining End-of-Life Experiences: Is It Beneficial, Burdensome, or Both for Parents Bereaved by Childhood Cancer? J Pediatr Oncol Nurs 2020; 36:170-177. [PMID: 30977432 DOI: 10.1177/1043454219836963] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
It is important for the health care community to understand the impact of a child's death on parent functioning. Yet involving bereaved parents in research that enquires about such a stressful time in their life can potentially bring harm to them. The current study examines the perceived benefit and burden of parents participating in a survey exploring their perceptions of their child's end-of-life (EoL) and bereavement experiences. Parents whose child died from cancer or complications of cancer treatment were invited to complete a survey developed by pediatric psychosocial oncology professionals with input from bereaved parent advocates through a closed social media (Facebook) group. One hundred seventy-eight parents of children aged 0 to 37 years at death (median age 12 years) participated. More than three quarters of parents reported at least "a little benefit" and half reported at least "a little burden" associated with participation. Less burden was perceived by younger and female parents, parents of younger children, those who had felt prepared to meet their children's emotional needs at EoL, and those not using bereavement services at the time of the survey. With the increasing use of social media as a source for bereaved parents to receive and provide emotional support, it is important for clinicians and researchers to understand the perceived benefits and risks of participating in research about EoL experiences via online recruitment. Our findings suggest that the benefit and burden of online research participation may vary for bereaved parents, but further research is necessary to replicate the findings and explore ways to optimize the use of this approach.
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Affiliation(s)
- Julia Tager
- 1 National Cancer Institute, Center for Cancer Research, National Institutes of Health, Bethesda, MD, USA.,2 University of Massachusetts Amherst, MA, USA
| | - Haven Battles
- 1 National Cancer Institute, Center for Cancer Research, National Institutes of Health, Bethesda, MD, USA
| | - Sima Zadeh Bedoya
- 1 National Cancer Institute, Center for Cancer Research, National Institutes of Health, Bethesda, MD, USA
| | - Cynthia A Gerhardt
- 3 The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | | | - Lori Wiener
- 1 National Cancer Institute, Center for Cancer Research, National Institutes of Health, Bethesda, MD, USA
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Dutta O, Tan-Ho G, Choo PY, Low XC, Chong PH, Ng C, Ganapathy S, Ho AHY. Trauma to Transformation: the lived experience of bereaved parents of children with chronic life-threatening illnesses in Singapore. BMC Palliat Care 2020; 19:46. [PMID: 32252753 PMCID: PMC7137327 DOI: 10.1186/s12904-020-00555-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 03/25/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2016, over 6.6 million children died globally, and 245 children died in Singapore. Chronic illnesses are prevalent causes of child mortality around the world. Despite growing research that examines the lived experience of parents bereaved by their child's chronic life-threatening illness, there is no such study within the Asian context. METHODS To bridge this knowledge gap, meaning-oriented, strength-focused interviews were conducted with 25 parental units (i.e. 6 couples, 13 lone mothers, 4 lone fathers, and 2 primary parental figures) who lost their child to chronic life-threatening illness in Singapore (N = 31), including those of Chinese (n = 17), Malay (n = 10) and Indian ethnicities (n = 4), between August 2017 and April 2018. RESULTS Data analysis adhering to the grounded theory approach revealed 7 themes and 25 sub-themes that were organized into a Trauma-to-Transformation Model of Parental Bereavement. This model shows the major milestones in participants' lived experience of their child's chronic life-threatening illness and death, starting from the diagnosis of their child's chronic life-threatening illness and the subsequent emotional turmoil (Theme 1), the mourning of their child's death and the losses which accompanied the death (Theme 3) and participants' experience of posttraumatic growth through reflection of their journey of caregiving and child loss (Theme 5). The model further describes the deliberate behaviors or 'rituals' that helped participants to regain power over their lives (Theme 2), sustain an intimate bond with their child beyond death (Theme 4), and transcend their loss by deriving positive outcomes from their experience (Theme 6). Finally, the model denotes that the lived experiences and well-being of participants were embedded within the health-and-social-care ecosystem, and in turn impacted by it (Theme 7). CONCLUSION These themes and their corresponding sub-themes are discussed, with recommendations for enhancing culturally sensitive support services for grieving Asian parents around the globe.
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Affiliation(s)
- Oindrila Dutta
- Psychology Programme, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
| | - Geraldine Tan-Ho
- Psychology Programme, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
| | - Ping Ying Choo
- Psychology Programme, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
| | - Xinyi Casuarine Low
- Psychology Programme, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
| | | | - Carolyn Ng
- Children's Cancer Foundation, Singapore, Singapore.,Portland Institute for Loss and Transition, Portland, Oregon, USA
| | | | - Andy Hau Yan Ho
- Psychology Programme, School of Social Sciences, Nanyang Technological University, Singapore, Singapore. .,Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore. .,Palliative Care Centre for Excellence in Research and Education, Singapore, Singapore.
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Howard Sharp KM, Meadows EA, Keim MC, Winning AM, Barrera M, Gilmer MJ, Akard TF, Compas BE, Fairclough DL, Davies B, Hogan N, Vannatta K, Gerhardt CA. The Influence of Parent Distress and Parenting on Bereaved Siblings' Externalizing Problems. JOURNAL OF CHILD AND FAMILY STUDIES 2020; 29:1081-1093. [PMID: 33343178 PMCID: PMC7748062 DOI: 10.1007/s10826-019-01640-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES Bereaved siblings experience more externalizing problems compared to non-bereaved peers and norms; however, the mechanisms explaining this phenomenon have not been empirically examined. This study tested the serial indirect effects of sibling bereavement on adolescents' externalizing problems through parent distress (i.e., internalizing symptoms) and parenting (i.e., parenting behaviors, parent-adolescent communication). METHODS During home visits, 72 bereaved adolescents (ages 10-18) whose brother/sister died from cancer and 60 comparison peers reported about their externalizing problems and their mothers' and fathers' parenting behaviors (warmth, behavioral control, psychological control) and parent-adolescent communication (open communication, problematic communication). Mothers and fathers reported their own internalizing symptoms. RESULTS Bereaved siblings reported more externalizing problems (p =.048) and bereaved mothers reported more internalizing symptoms relative to the comparison group (p =.015). Serial multiple mediation models indicated that elevated externalizing problems were partially explained by both bereaved mothers' internalizing symptoms and parenting and communication (less warmth [CI: 0.04, 0.86], more psychological control [CI: 0.03, 0.66], and more problematic mother-adolescent communication [CI: 0.03, 0.79]), with a significant indirect effect also emerging for open mother-adolescent communication [CI: 0.05, 1.59]. Bereaved fathers did not significantly differ in internalizing symptoms from comparison fathers (p =.453), and no significant indirect effects emerged for fathers. CONCLUSIONS Elevated externalizing problems in bereaved siblings may result from mothers' distress and the impact on their parenting and communication. Targeting adjustment and parenting in bereaved mothers following a child's death may reduce externalizing problems in bereaved siblings. Research to evaluate family-centered interventions is needed.
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Affiliation(s)
- Katianne M Howard Sharp
- The Research Institute at Nationwide Children's Hospital, The Ohio State University, Columbus, OH
| | | | | | | | | | | | | | | | | | | | | | - Kathryn Vannatta
- The Research Institute at Nationwide Children's Hospital, The Ohio State University, Columbus, OH
| | - Cynthia A Gerhardt
- The Research Institute at Nationwide Children's Hospital, The Ohio State University, Columbus, OH
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Snaman J, McCarthy S, Wiener L, Wolfe J. Pediatric Palliative Care in Oncology. J Clin Oncol 2020; 38:954-962. [PMID: 32023163 DOI: 10.1200/jco.18.02331] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Pediatric palliative care aims to alleviate suffering and improve the quality of life of children with serious disease and increase support for their parents and other family members. Integration of palliative care into the routine care of children, adolescents, and young adults with cancer has resulted in improved outcomes in patients and their families. The field of pediatric palliative oncology-encompassing primary palliative care provided by the multidisciplinary oncology team as well as subspecialty palliative care provided by the palliative care team for more complex cases-is unique from palliative care in adults given its focus on care of the child and the larger family. In this review, we focus on advancements in the specific domains within pediatric palliative oncology care including family-centered communication, assessment and management of physical symptoms and distress, psychosocial concerns, and spiritual considerations of the patient, parents, and siblings.
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Affiliation(s)
- Jennifer Snaman
- Dana-Farber Cancer Institute, Boston, MA.,Boston Children's Hospital, Boston, MA
| | | | - Lori Wiener
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Joanne Wolfe
- Dana-Farber Cancer Institute, Boston, MA.,Boston Children's Hospital, Boston, MA
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Prevalence and associated factors of prolonged grief disorder in Chinese parents bereaved by losing their only child. Psychiatry Res 2020; 284:112766. [PMID: 31951871 DOI: 10.1016/j.psychres.2020.112766] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 12/13/2019] [Accepted: 01/04/2020] [Indexed: 01/10/2023]
Abstract
In China, parents who have lost their only child and remained childless are labelled Shidu () parents. Previous research suggests high levels of psychological distress in this population, yet little is known regarding the prevalence of prolonged grief disorder (PGD) based on the new ICD-11 formulation. The present study examined prevalence rates and associated factors of prolonged grief disorder in this population. 1030 Chinese Shidu parents (381 male, 643 female) who were recruited through convenient sampling completed questionnaires assessing grief severity. Multiple linear regression models were used to examine socio-demographic, loss-related and self-reported number of chronic physical conditions associated with PGD symptoms. Results showed prevalence rate was 35.5% based on the ICD-11 PGD criteria, which was almost twice as that of Prigerson et al. (2009) criteria. Younger age of parents, being a mother, living in a rural place, lower monthly income per capital, shorter time since loss and more comorbid chronic physical conditions were related to severer PGD symptoms. The present findings revealed high rates of PGD experienced by Chinese Shidu parents and identified key risk factors which can be used for future prevention or intervention designs in this population.
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Nicholas D, Beaune L, Belletrutti M, Blumberg J, Ing S, Rapoport A, Barrera M. Engaging Fathers in Pediatric Palliative Care Research. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2020; 16:42-56. [PMID: 31951504 DOI: 10.1080/15524256.2019.1703877] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Fathers are under-represented in pediatric palliative care research despite frequently playing a key role in the lives of their children. The purpose of this study was to identify factors that affected paternal study invitation and participation. A secondary mixed-methods evaluation design guided examination of interview and focus group data as well as field notes from a qualitative study that examined the experiences and support needs of fathers of children with a life-limiting illness. Facilitators of paternal participation in the study consisted of: fathers' desire to gain from study participation either for themselves or others, perception of the study's importance, sense of appreciation for the study's focus on fathers and an established relationship with recruiting health care providers. Barriers to study participation included: recruiting health care providers' appraisal of fathers' lack of well-being, bereaved fathers' self-reported poor coping and the inability to locate and contact fathers, particularly after a child's death. Strategies for improving the engagement of fathers into research entailed: educating recruitment personnel, designing "father-focused" studies, communicating the value of the research to recruitment personnel and potential participants, and ensuring that child health records are accurate and include fathers' contact information.
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Affiliation(s)
- David Nicholas
- Faculty of Social Work, University of Calgary, Edmonton, Alberta, Canada
| | - Laura Beaune
- Faculty of Social Work, University of Calgary, Edmonton, Alberta, Canada
| | - Mark Belletrutti
- Stollery Children's Hospital, Edmonton, Alberta, Canada
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Jonathan Blumberg
- The Hospital for Sick Children Family Advisory Network, Toronto, Ontario, Canada
| | - Stanley Ing
- Health, Safety, and Wellness at Municipality of Chatham-Kent, Chatham, Ontario, Canada
| | - Adam Rapoport
- Emily's House Children's Hospice, Toronto, Ontario, Canada
- Departments of Paediatrics and Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Maru Barrera
- The Hospital for Sick Children, Toronto, Ontario, Canada
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Reconsidering early parental grief following the death of a child from cancer: a new framework for future research and bereavement support. Support Care Cancer 2019; 28:4131-4139. [DOI: 10.1007/s00520-019-05249-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 12/12/2019] [Indexed: 02/04/2023]
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Ho AHY, Dutta O, Tan-Ho G, Choo PY, Low XC, Chong PH, Ng C, Ganapathy S. Thematic analysis of spousal interaction patterns among Asian parents of children with chronic life-threatening illness. BMJ Open 2019; 9:e032582. [PMID: 31748309 PMCID: PMC6887006 DOI: 10.1136/bmjopen-2019-032582] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE This is the first known study which examines the evolutionary nature of spousal interaction patterns among Asian parents of children with chronic life-threatening illness, from the time of providing care to their child through bereavement. This study is informed by earlier findings that when a child is diagnosed with a chronic life-threatening illness, parents are faced with multiple stressors, leaving them with little time to invest in their spousal relationship. PARTICIPANTS AND SETTING A constructivist-phenomenological research paradigm was adopted and meaning-oriented interviews were conducted with 20 parental units (i.e., 6 couples, 12 lone mothers and 2 lone fathers) of Chinese, Malay and Indian ethnicities who lost their child to chronic life-threatening illness in Singapore. RESULTS Qualitative thematic analysis of the data revealed four themes, which describe the evolutionary nature of spousal interaction patterns among Asian parents of children with chronic life-threatening illness, from caregiving through bereavement. Findings reveal participants' tendency to concentrate on pragmatic, solution-focused communication during the period of caregiving (pragmatic interaction), avoid discussion about their emotional pain as a means of protecting their spouse (partner-oriented self-regulation), respect and acknowledge their spouse's personal coping strategies (empathic responding) and show greater appreciation and emotional expression within the spousal relationship after their child's death (affective appreciation). CONCLUSION Engaging in pragmatic discussions, deferring emotion-focused and potentially distressing conversations, and acknowledging their spouse's need for personal space are important coping strategies for Asian couples facing their child's chronic life-threatening illness and in the immediate aftermath of his/her death. Bereaved couples who have processed their grief individually feel ready to share their reflections with their spouse, deriving meaning and greater relational closeness through such disclosure. These findings are discussed from a cultural lens, with recommendations for healthcare professionals working with Asian parents of children with chronic life-threatening illness.
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Affiliation(s)
- Andy Hau Yan Ho
- Psychology, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
- Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- The Palliative Care Centre for Excellence in Education and Research (PalC), Singapore, Singapore
| | - Oindrila Dutta
- Psychology, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
| | - Geraldine Tan-Ho
- Psychology, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
| | - Ping Ying Choo
- Psychology, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
| | - Xinyi Casuarine Low
- Psychology, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
| | | | - Carolyn Ng
- Portland Institute for Loss and Transitiom, Portland, Oregon, USA
- Children's Cancer Foundation, Singapore, Singapore
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Donovan LA, Wakefield CE, Russell V, Fardell J, Mallitt KA, Hetherington K, Cohn R. Variables associated with grief and personal growth following the death of a child from cancer: A mixed method analysis. DEATH STUDIES 2019; 45:702-713. [PMID: 31656129 DOI: 10.1080/07481187.2019.1682087] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This mixed method study explored parent and child characteristics that impact grief and personal growth in parents (n = 119) after a child dies from cancer in Australia. Medical components of a child's cancer care including radiation treatment, referral to palliative care, and location of death had a significant impact on levels of grief. Parents' gender, religious affiliation, and education level had a significant impact on levels of personal growth. This study further enhances our understanding of the impact of specific parent and child characteristics throughout a child's cancer treatment and end of life that may influence their families' experience of bereavement.
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Affiliation(s)
- Leigh A Donovan
- Department of Social Work, Welfare and Indigenous Health Liaison, Children's Health Queensland Hospital and Health Service, Queensland Children's Hospital, South Brisbane, Australia
- Kids Cancer Centre, Sydney Children's Hospital Randwick, Randwick, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Claire E Wakefield
- Kids Cancer Centre, Sydney Children's Hospital Randwick, Randwick, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Vera Russell
- Kids Cancer Centre, Sydney Children's Hospital Randwick, Randwick, Australia
| | - Joanna Fardell
- Kids Cancer Centre, Sydney Children's Hospital Randwick, Randwick, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Kylie-Ann Mallitt
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Kate Hetherington
- Kids Cancer Centre, Sydney Children's Hospital Randwick, Randwick, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Richard Cohn
- Kids Cancer Centre, Sydney Children's Hospital Randwick, Randwick, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
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Kim MA, Yi J, Sang J, Jung D. A photovoice study on the bereavement experience of mothers after the death of a child. DEATH STUDIES 2019; 45:390-404. [PMID: 31418648 DOI: 10.1080/07481187.2019.1648333] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This study explored the bereavement experience of mothers after losing a child to cancer in Korea, using photovoice. The mothers took photos reflecting five subject areas they selected: (a) if I had one more day with my child, (b) memories with my child, (c) dreaming of my child's healthy future, (d) what gave me strength, and (e) fulfilling my child's wishes for the future. The findings show that mothers who lost a child to cancer need bereavement care to promote well-being. This study can help pediatric oncology providers develop bereavement interventions that address parental grief and improve quality of life.
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Affiliation(s)
- Min Ah Kim
- Department of Social Welfare, Sungkyunkwan University, Seoul, Republic of Korea
| | - Jaehee Yi
- College of Social Work, University of Utah, Salt Lake City, Utah, USA
| | - Jina Sang
- School of Social Work, The University of Akron, Akron, Ohio, USA
| | - Daehee Jung
- Department of Social Work, Seoul National University Hospital, Seoul, Republic of Korea
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Wang E, Hu H, Shi Z, Liu H, Zhang C, Jiang H, Xia L, Li S, He Y. Gender Differences in Mental Health of Bereaved Parents in an Only-Child Society: Evidence From China. OMEGA-JOURNAL OF DEATH AND DYING 2019; 83:525-544. [DOI: 10.1177/0030222819853934] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study examined gender differences in mental health of bereaved parents related to the gender of deceased only child in China, an only-child society with traditional culture of son preference, using data drawn from the China Family Planning Survey on Vulnerable Households in 2017. The findings indicated that parents with deceased only child suffered from more negative mental health symptoms than nonbereaved parents. For only-child-death families, there were no statistically significant gender differences in mental health of parents, and the gender of the deceased only child was basically unrelated to maternal/paternal mental health. Due to the implementation of one-child policy in China, both sons and daughters are highly prized and equally relied on by aging parents owing to the irreplaceability of the only child, which might moderate the effects of traditional culture of son preference on bereaved parental mental health.
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Affiliation(s)
- Enjian Wang
- School of Humanities and Social Sciences, North China Electric Power University, Baoding, P.R. China
| | - Hongwei Hu
- School of Public Administration and Policy, Renmin University of China, Beijing, P.R. China
| | - Zhenzhen Shi
- School of Public Administration and Policy, Renmin University of China, Beijing, P.R. China
| | - Hongting Liu
- School of Humanities and Social Sciences, North China Electric Power University, Baoding, P.R. China
| | - Chu Zhang
- School of Public Administration and Policy, Renmin University of China, Beijing, P.R. China
| | - Haixia Jiang
- Institute of Population Research, Peking University, Beijing, P.R. China
| | - Lu Xia
- School of Humanities and Social Sciences, North China Electric Power University, Baoding, P.R. China
| | - Sisi Li
- School of Humanities and Social Sciences, North China Electric Power University, Baoding, P.R. China
| | - Yongjia He
- School of Humanities and Social Sciences, North China Electric Power University, Baoding, P.R. China
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