1
|
Sinnathamby A, Lee LY, Ng GMC. " Why Are we Giving up on my Brother?"-The Unmet Needs of the Adolescent Facing End-of-Life Care in a Sibling. J Palliat Med 2024. [PMID: 38905128 DOI: 10.1089/jpm.2023.0395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2024] Open
Abstract
Adolescence is a challenging time at baseline, and a sibling receiving end-of-life care can alter an adolescent's life irrevocably. It is imperative for the medical team to understand the unique needs and perspectives of such an adolescent sibling. This in turn facilitates the anticipation of an adolescent's grief response, and allows for parents to be appropriately guided. However, more can be done to evaluate the needs of adolescent siblings and improve their support. This can be through establishing a validated needs-based questionnaire, empowering families and the multidisciplinary team to engage siblings, and diverting resources toward culturally sensitive support groups for siblings with critical illness. A framework to involve key players in the adolescent's circle is presented.
Collapse
Affiliation(s)
- Annushkha Sinnathamby
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
- Division of Palliative Care, National University Cancer Institute, Singapore, Singapore
| | - Le Ye Lee
- Foundation Healthcare Holdings, Singapore, Singapore
| | | |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Hill KN, Olsavsky A, Barrera M, Gilmer MJ, Fairclough DL, Akard TF, Compas BE, Vannatta K, Gerhardt CA. Factors associated with mental health service use among families bereaved by pediatric cancer. Palliat Support Care 2023; 21:829-835. [PMID: 35938399 PMCID: PMC9905324 DOI: 10.1017/s1478951522001018] [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] [Indexed: 11/06/2022]
Abstract
OBJECTIVES We identified types of interventions used by bereaved family members and examined associations with demographic and medical factors. Furthermore, we examined associations between distress and intervention use among bereaved families. METHODS Bereaved families (n = 85) were recruited from three children's hospitals 3-12 months after their child died of cancer. One eligible sibling (ages 8-17) per family was randomly selected for participation. During home visits 1-year post-death, parents reported on their own and the sibling's intervention use, helpfulness, and dose (self-help books, support groups, therapy, medication), and distress, defined as internalizing, externalizing, and total problems (Adult Self Report, Child Behavior Checklist). RESULTS Fifty percent of mothers used medications (n = 43); utilization was low among fathers (17%, n = 9) and siblings (5%, n = 4). Individuals with more total problems were more likely to use medications (mothers: rpb = 0.27; p = 0.02; fathers: rpb = 0.32; p = 0.02; siblings: rpb = 0.26; p = 0.02). Mothers and siblings with more total problems used more services (r = 0.24; p = 0.03 and r = 0.29; p = 0.01, respectively). Among mothers, the overall regression was significant, R2 = 0.11, F(2, 80) = 4.954, p = 0.01; the deceased child's age at death was significantly associated with total services used (b = 0.052, p = 0.022). Among fathers, the overall regression was significant, R2 = 0.216, F(3, 49) = 4.492, p = 0.007; race and years of education were significantly associated with total services used (b = 0.750, p = 0.030 and b = 0.154, p = 0.010). Among siblings, the overall regression was significant R2 = 0.088, F(2, 80) = 3.867, p = 0.025; greater total problems were significantly associated with total services used (b = 0.012, p = 0.007). SIGNIFICANCE OF RESULTS Although few background factors were related to intervention use, bereaved mothers and siblings may seek services if they have more distress. Healthcare providers should be aware of the types of services that are most often utilized and helpful to bereaved families to connect them with appropriate resources. Future research should investigate other predictors of intervention use and outcomes after the death of a child.
Collapse
Affiliation(s)
- Kylie N. Hill
- The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH
| | - Anna Olsavsky
- The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH
- The Ohio State University College of Medicine, Columbus, OH
| | - Maru Barrera
- The Hospital for Sick Children, Toronto, ON, Canada
| | | | | | | | | | - Kathryn Vannatta
- The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH
| | - Cynthia A. Gerhardt
- The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH
- The Ohio State University College of Medicine, Columbus, OH
| |
Collapse
|
4
|
Wallace Chi Ho C, Grace Suk Man L, Miranda Mei Mui L, Molin Kwok Yin L, Clare Tsz Kiu Y, Jody Ka-Wing W. Facing the loss of siblings in childhood: Interactions and dynamics between bereaved siblings and their parents. J Pediatr Nurs 2022; 66:e1-e8. [PMID: 35817622 DOI: 10.1016/j.pedn.2022.07.003] [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: 03/07/2022] [Revised: 05/23/2022] [Accepted: 07/02/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION The loss of a child in a family is a painful experience. Despite this, most studies focus on the grieving experience of parents. Our understanding of sibling bereavement therefore remains underexplored. This study aims to address this gap by exploring the bereavement experience of younger bereaved siblings from the perspective of the bereaved child and the parents. METHOD This study is a qualitative study conducted in Hong Kong. We recruited eleven bereaved families from 2019 to 2020. Semi-structured interviews were conducted separately with bereaved children and parents. Thematic analyses were performed. FINDINGS Eleven bereaved siblings, aged 5 to 11, and their parents were interviewed. Four themes were generated: Parents' unawareness of bereaved siblings' grief, protecting parents from grief, comparison with the deceased siblings, and learning how to grieve. CONCLUSION Our findings suggest that the family dynamics and interactions in the grieving experience are complex. The impact of grief on the bereaved child could emanate from the loss of the sibling or from the grief of the parents or from family interactions. PRACTICE IMPLICATIONS This study highlights the importance of viewing the sibling bereavement experience in a family context and of enhancing sibling bereavement services. Helping professionals should not only provide more bereavement support to the bereaved siblings individually, but they should also enhance parents' capacity to support their bereaved children.
Collapse
Affiliation(s)
| | | | - Leung Miranda Mei Mui
- Fellow of the Hong Kong Academy of Nursing (Hong Kong College of Paediatric Nursing), Hong Kong
| | | | - Yu Clare Tsz Kiu
- Department of Social Work, The Chinese University of Hong Kong, Hong Kong.
| | - Wu Jody Ka-Wing
- Department of Social Work, The Chinese University of Hong Kong, Hong Kong
| |
Collapse
|
5
|
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.
Collapse
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.
| |
Collapse
|
6
|
Hiemeyer RB, Berger T, Braun T, Wagner B. Psychotherapists' rated working alliance in an internet-based intervention for bereaved siblings. DEATH STUDIES 2021; 46:2507-2516. [PMID: 34714217 DOI: 10.1080/07481187.2021.1995533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Bereaved siblings often receive insufficient social support and are at higher risk for mental disorders. This study aimed to examine the role of the therapist-rated working alliance in an online intervention for bereaved siblings. Clients (n = 74, 95% female), aged 17-59 received writing assignments and individual feedback by CBT trained therapists over 6 weeks. Working alliance (Working Alliance Inventory) and treatment outcomes (Inventory of Complicated Grief, Beck Depression Inventory-II) were assessed. Results revealed that the working alliance significantly increased during the course of the treatment and a significant association between working alliance and the change in depression was found.
Collapse
Affiliation(s)
- Rico-Benjamin Hiemeyer
- Department of Clinical Psychology and Psychotherapy, Medical School Berlin, Berlin, Germany
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Tina Braun
- Department of Psychological Research Methods and Evaluation, University of the German Federal Armed Forces, Munich, Germany
| | - Birgit Wagner
- Department of Clinical Psychology and Psychotherapy, Medical School Berlin, Berlin, Germany
| |
Collapse
|
7
|
Roche R, Youngblut JM, Brooten DA. Parent and child perceptions of the child's health at 2, 4, 6, and 13 months after sibling intensive care or emergency department death. J Am Assoc Nurse Pract 2020; 33:793-801. [PMID: 32453089 PMCID: PMC7680088 DOI: 10.1097/jxx.0000000000000429] [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: 12/26/2019] [Accepted: 03/11/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Approximately 50,000 US infants and children die annually, leaving surviving children and families with long-lasting effects. In most studies, children's health is rated by parents, but not the children. PURPOSE To compare the surviving children's self-rated health with parents' ratings at 2, 4, 6, and 13 months after sibling neonatal intensive care unit/pediatric intensive care unit/emergency department death death and identify the related factors. METHODS Children and their parents rated the child's health "now," "now compared with others your age," and "now versus before" the sibling's death. SAMPLE One hundred thirty-two children (58% girls, 72% school-aged, and 50% Black non-Hispanic), 70 mothers, and 26 fathers from 71 bereaved families. CONCLUSIONS Children self-rated their health: "now" as lower than their mothers at 4, 6, and 13 months and their fathers at 2, 4, and 13 months; "now compared with others your age" as lower than their mothers at each time point and fathers at 4, 6, and 13 months; and "now versus before" their sibling's death as higher than their mothers at 4, 6, and 13 months and fathers at 6 months. Ratings did not differ by age, gender, or race/ethnicity. At 6 months, children self-rated their health "now" as higher than their fathers in families with one to two surviving children but lower than their fathers in families with three to eight surviving children. IMPLICATIONS FOR PRACTICE Parents often perceive their children as healthier than children perceive themselves after sibling death, especially in larger families. Talking with children separately can identify the children at risk for emotional and physical illnesses earlier, providing more timely and appropriate interventions and referrals.
Collapse
Affiliation(s)
- Rosa Roche
- Florida International University Nicole Wertheim College of Nursing & Health Sciences, Miami, FL
| | - JoAnne M. Youngblut
- Florida International University Nicole Wertheim College of Nursing & Health Sciences, Miami, FL
| | - Dorothy A. Brooten
- Florida International University Nicole Wertheim College of Nursing & Health Sciences, Miami, FL
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
DeMuth M, Taggi-Pinto A, Miller EG, Alderfer MA. Bereavement Accommodations in the Classroom: Experiences and Opinions of School Staff. THE JOURNAL OF SCHOOL HEALTH 2020; 90:165-171. [PMID: 31957037 DOI: 10.1111/josh.12870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 01/19/2019] [Accepted: 01/24/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Bereaved children often struggle in the school environment and school personnel often feel inadequately prepared to support them. This pilot study explored the experiences and opinions of school staff regarding approaches to addressing the needs of bereaved students in the classroom. METHODS Teachers/school personnel (N = 29) completed written open-ended questions about their experiences with bereaved students and opinions regarding a bereavement-focused accommodation (ie, 504) plan. Responses were summarized using qualitative content analysis. RESULTS Most participants (93%) reported interacting with bereaved students and: (1) providing emotional support; (2) making classroom accommodations; (3) collaborating with the family/community; and (4) referring the student for counseling. Many (72%) expressed interest in a templated bereavement plan (21% did not respond; 7% said no) with education/resources for school personnel and suggested accommodations for students. CONCLUSIONS Teachers encountering grieving students would welcome a templated bereavement plan to help meet students' needs. Such a plan would allow staff to become more knowledgeable about grief and provide guidance for developing specific strategies to accommodate grieving students both emotionally and academically.
Collapse
Affiliation(s)
- Michele DeMuth
- Sidney Kimmel Medical College at Thomas Jefferson University, 1025 Walnut Street, Philadelphia, PA, 19107
| | - Alison Taggi-Pinto
- Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803
| | - Elissa G Miller
- Sidney Kimmel Medical College at Thomas Jefferson University, Chief, Division of Palliative Medicine, Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803
| | - Melissa A Alderfer
- Sidney Kimmel Medical College at Thomas Jefferson University, Center Director (Delaware Valley) and Principal Research Scientist, Center for Healthcare Delivery Science, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803
| |
Collapse
|
10
|
Abstract
BACKGROUND Limited research has examined the impact of a child's death from cancer on siblings. Even less is known about how these siblings change over time. OBJECTIVE This study compared changes in siblings 1 (T1) and 2 (T2) years after the death of a brother or sister from cancer based on bereaved parent and sibling interviews. METHODS Participants across 3 institutions represented 27 families and included bereaved mothers (n = 21), fathers (n = 15), and siblings (n = 26) ranging from 8 to 17 years old. Participants completed semistructured interviews. Content analysis identified emerging themes and included frequency counts of participant responses. McNemar tests examined differences in the frequency of responses between T1 and T2 data. RESULTS Participants reported similar types of changes in bereaved siblings at both time points, including changes in sibling relationships, life perspectives, their personal lives, and school performance. A new theme of "openness" emerged at T2. Frequencies of responses differed according to mother, father, or sibling informant. Overall, participants less frequently reported changes at T2 versus T1. Compared with findings in the first year, participants reported greater sibling maturity at follow-up. CONCLUSION Overall changes in bereaved siblings continued over 2 years with less frequency over time, with the exception of increases in maturity and openness. IMPLICATIONS FOR PRACTICE Providers can educate parents regarding the impact of death of a brother or sister over time. Nurses can foster open communication in surviving grieving siblings and parents as potential protective factors in families going through their grief.
Collapse
|
11
|
Ing V, Patterson P, Szabo M, Allison KR. Interventions available to adolescents and young adults bereaved by familial cancer: a systematic literature review. BMJ Support Palliat Care 2019; 12:e632-e640. [PMID: 31422375 DOI: 10.1136/bmjspcare-2019-001959] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 07/22/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To assess the availability and efficacy of interventions open to adolescents and young adults (AYAs; 15-25 years) bereaved by a parent's or sibling's cancer. METHODS A systematic review of peer-reviewed literature on interventions available to AYAs bereaved by a parent's or sibling's cancer was conducted through searches of six online databases (PsycINFO, Medline, Scopus, Embase, SWAB and Web of Science Core Collection). RESULTS Database and reference searches yielded 2985 articles, 40 of which were included in the review. Twenty-two interventions were identified that were available for bereaved young people. However, only three were specific to young people bereaved by familial cancer, and none were specific to AYAs. Interventions primarily provided opportunities for participants to have fun, share their experiences and/or memorialise the deceased; psychoeducation about bereavement, grief and coping was less common. Only six interventions had been satisfactorily evaluated, and no intervention targeted or analysed data for AYAs separately. Overall, some evidence suggested that interventions (especially those that were theoretically grounded) had positive effects for bereaved young people. However, benefits were inconsistently evidenced in participants' self-reports and often only applied to subgroups of participants (eg, older youths and those with better psychological well-being at baseline). CONCLUSIONS Considering the very limited number of interventions specific to bereavement by familial cancer and the lack of interventions targeting AYAs specifically, it is unclear whether currently available interventions would benefit this population. The population of AYAs bereaved by familial cancer is clearly under-serviced; further development and evaluation of interventions is needed.
Collapse
Affiliation(s)
- Veronica Ing
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Pandora Patterson
- CanTeen Australia, Newtown, New South Wales, Australia .,Cancer Nursing Research Unit, Sydney Nursing School, The University of Sydney, Sydney, NSW, Australia
| | - Marianna Szabo
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | | |
Collapse
|
12
|
Baird H, Patterson P, Medlow S, Allison KR. Understanding and Improving Survivorship Care for Adolescents and Young Adults with Cancer. J Adolesc Young Adult Oncol 2019; 8:581-586. [PMID: 31268400 DOI: 10.1089/jayao.2019.0031] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Purpose: To explore and highlight the opportunities and challenges that underlie the development of survivorship care for adolescent and young adult cancer. Methods: A multimethod approach was used, with perspectives of survivors, relatives, and health care professionals elicited through an online survey, focus group, and semistructured interviews. Results: Four themes were identified using thematic analysis: adjusting to life after cancer, transition to community-based care, ongoing change and reform of health care, and supporting survivorship services. Adolescents and young adults (AYAs) and their families struggled with the transition from active treatment, which was complicated by ongoing disease/treatment impacts and a collective dearth of knowledge and resources on how to support AYAs during this time. Limited confidence and communication in patient-general practitioner relationships complicated the transition to community-based care, with treatment summaries and survivorship care plans an underused resource. A growing movement toward integrated, holistic, and equitable survivorship care was identified, but progress has been fragmented and under-resourced. Further research, funding, and advocacy are needed to support ongoing survivorship initiatives. Conclusions: Although some survivorship concerns are common across age groups, others are specific to AYAs' developmental stage, emphasizing the need for integrated, age-appropriate, and targeted survivorship services for AYAs. The transition from active treatment to longer term survivorship presents challenges for ongoing clinical care and support; change is needed at individual, service, and system levels to provide quality, sustainable, and integrated care to AYA cancer survivors.
Collapse
Affiliation(s)
- Hannah Baird
- Research, Evaluation and Social Policy, CanTeen Australia, Sydney, Australia
| | - Pandora Patterson
- Research, Evaluation and Social Policy, CanTeen Australia, Sydney, Australia.,Cancer Nursing Research Unit, The University of Sydney, Sydney, Australia
| | - Sharon Medlow
- Wellbeing Health & Youth, Centre of Research Excellence in Adolescent Health, The University of Sydney, Sydney, Australia.,Discipline of Child & Adolescent Health, The Children's Hospital at Westmead, Sydney, Australia
| | - Kimberley R Allison
- Research, Evaluation and Social Policy, CanTeen Australia, Sydney, Australia
| |
Collapse
|
13
|
Dias N, Hendricks-Ferguson VL, Wei H, Boring E, Sewell K, Haase JE. A Systematic Literature Review of the Current State of Knowledge Related to Interventions for Bereaved Parents. Am J Hosp Palliat Care 2019; 36:1124-1133. [DOI: 10.1177/1049909119858931] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Aims: The purpose of this systematic literature review is to describe the interventions for bereaved parents, evaluate intervention effectiveness through study methodology rigor, replicability, and theoretical foundations. Methods: We searched MEDLINE via PubMed (1966-2018), CINAHL (1937-present), PsycINFO (1887-present), and Embase (1947-present) using various search words and MeSH terms related to the study purpose. A blinded screening of title/abstract was performed, with conflicting inclusion decisions resolved through group discussions. Matrices for remaining articles were created and discussed among the team. The levels of evidence of the 9 records were rated from very low to high based on the Grading of Recommendations Assessment, Development, and Evaluation guidelines. Results: Our initial pool included 1025 articles. After the screening of titles/abstracts, 63 articles were retained for full-text reviews. Evaluated based on the inclusion/exclusion criteria, 9 records met the review criteria. Of the 9 records, 1 was graded as very low, 3 low, and 5 low to moderate. The interventions for bereaved parents varied from using single-model interventions such as expressive arts therapy and telephone support to multimodal interventions that combined resources (ie, peer support, resource packets, and health-care support). Only 1 study explicitly illustrated how its bereavement intervention was designed based on the proposed theoretical model. Conclusions: This review highlights the need for individualized, well-tested, and effective bereavement care interventions to support bereaved parents. In summary, the state of the science on interventions for bereaved parents is poor and much work needs to be done to effectively address the needs of bereaved parents, including both their physical and emotional health needs.
Collapse
Affiliation(s)
- Nancy Dias
- College of Nursing/Department of Nursing Science, East Carolina University, Greenville, NC, USA
| | | | - Holly Wei
- College of Nursing/Department of Nursing Science, East Carolina University, Greenville, NC, USA
| | - Elizabeth Boring
- Hope in Healing Pediatric Bereavement Program, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Kerry Sewell
- College of Nursing/Department of Nursing Science, East Carolina University, Greenville, NC, USA
| | - Joan E. Haase
- The IUPUI Research in Palliative and End-of-Life Communication and Training (RESPECT), Indiana University School of Nursing, Indianapolis, IN, USA
| |
Collapse
|
14
|
Lee DH, Khang M. Parenting school-aged children after the death of a child: A qualitative study on victims' families of the Sewol ferry disaster in South Korea. DEATH STUDIES 2018; 44:1-11. [PMID: 30285553 DOI: 10.1080/07481187.2018.1515794] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 06/20/2018] [Accepted: 07/02/2018] [Indexed: 06/08/2023]
Abstract
This study aims to identify parenting experiences after the death of a child. Using interpretive phenomenological analysis, we mapped the experiences of 16 parents with school-aged surviving children after the death of their sibling to the 2014 Sewol ferry disaster in South Korea. Interviews illuminate five master themes of parenting surviving children following a child's death: (a) parental anxiety, (b) conflicts and obstacles in the parent-child relationship, (c) changes in parenting style, (d) striving to support children's grief, and (e) seeking outside help for parenting. Implications for supporting grieving parents and their children are discussed in light of the findings.
Collapse
Affiliation(s)
- Dong Hun Lee
- Department of Education, Sungkyunkwan University, Seoul, South Korea
| | - Minsoo Khang
- Department of Education, Sungkyunkwan University, Seoul, South Korea
| |
Collapse
|
15
|
Khang M, Lee DH, Kim Y. Parental Perceptions of Surviving Sibling Grief Responses to an Adolescent's Violent and Sudden Death by the Sewol Ferry Disaster in South Korea. OMEGA-JOURNAL OF DEATH AND DYING 2018; 81:454-474. [PMID: 29909736 DOI: 10.1177/0030222818777340] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to provide empirical descriptions of responses to the death of a sibling to the sinking of the Sewol ferry in South Korea. 16 bereaved parents are interviewed regarding their surviving children's grief responses at approximately 2 years after the death. The surviving siblings described by the bereaved parents are 14 in total, including 8 teens in their 10s and 4 young adults in their 20s. Interviews were transcribed verbatim and analyzed using a qualitative content analysis method. The following themes emerged: (a) negative behavioral changes, (b) expressions of grief, (c) change in relationship with parents, (d) school adjustment problems, and (e) social changes. Unique aspects of the grief responses among the surviving siblings in this study are noted. Discussions and implications are provided based on the results.
Collapse
Affiliation(s)
- Minsoo Khang
- Traumatic Stress Center, Department of Education, Sungkyunkwan University, Seoul, South Korea
| | - Dong Hun Lee
- Traumatic Stress Center, Department of Education, Sungkyunkwan University, Seoul, South Korea
| | - Yewon Kim
- Traumatic Stress Center, Department of Education, Sungkyunkwan University, Seoul, South Korea
| |
Collapse
|
16
|
Long KA, Lehmann V, Gerhardt CA, Carpenter AL, Marsland AL, Alderfer MA. Psychosocial functioning and risk factors among siblings of children with cancer: An updated systematic review. Psychooncology 2018; 27:1467-1479. [DOI: 10.1002/pon.4669] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 01/18/2018] [Accepted: 01/29/2018] [Indexed: 12/23/2022]
Affiliation(s)
| | - Vicky Lehmann
- Department of Pediatrics and Psychology; Ohio State University; Columbus OH USA
- Center for Biobehavioral Health Research Institute at Nationwide Children's Hospital; Columbus OH USA
| | - Cynthia A. Gerhardt
- Department of Pediatrics and Psychology; Ohio State University; Columbus OH USA
- Center for Biobehavioral Health Research Institute at Nationwide Children's Hospital; Columbus OH USA
| | | | | | - Melissa A. Alderfer
- Nemours Children's Health System/A.I. duPont Hospital for Children; Wilmington DE USA
- Sidney Kimmel Medical College; Thomas Jefferson University; Philadelphia PA USA
| |
Collapse
|
17
|
Eaton Russell C, Widger K, Beaune L, Neville A, Cadell S, Steele R, Rapoport A, Rugg M, Barrera M. Siblings' voices: A prospective investigation of experiences with a dying child. DEATH STUDIES 2018; 42:184-194. [PMID: 28541834 DOI: 10.1080/07481187.2017.1334009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Sibling relationships reflect a unique childhood bond, thus the impact on a sibling when a child is seriously ill or dying is profound. We conducted a prospective, longitudinal, qualitative study over 2 years using interpretive descriptive methodology to understand siblings' perspectives when a brother or sister was dying at home or in hospital. The insights from the 10 siblings revealed complex experiences, both personal and with the ill child, their families, and peers. These experiences were paradoxically sources of strain and of support, revealing the importance of validation and normalization in assisting siblings to successfully navigate the experience.
Collapse
Affiliation(s)
- Ceilidh Eaton Russell
- a Dr. Jay Children's Grief Centre , Research & Evaluation , Toronto , Ontario , Canada
| | - Kimberley Widger
- b Lawrence S. Bloomberg Faculty of Nursing , University of Toronto , Toronto , Ontario , Canada
- c The Hospital for Sick Children , Paediatric Advanced Care Team , Toronto , Ontario , Canada
| | - Laura Beaune
- d Department of Social Work , The Hospital for Sick Children , Toronto , Ontario , Canada
| | - Alexandra Neville
- e Department of Psychology, University of Calgary , Calgary , Alberta , Canada
| | - Susan Cadell
- f School of Social Work , Renison University College , Waterloo , Ontario , Canada
| | - Rose Steele
- g School of Nursing, Faculty of Health , York University , Toronto , Ontario , Canada
| | - Adam Rapoport
- h Paediatric Advanced Care Team , The Hospital for Sick Children , Toronto , Ontario , Canada
- i Department of Family and Community Medicine , University of Toronto , Toronto , Ontario , Canada
- j Emily's House Children's Hospice , Paediatric Advanced Care Team , Toronto , Ontario , Canada
| | - Maria Rugg
- k St. Joseph's Health Centre , Medicine and Seniors Care , Toronto , Ontario , Canada
| | - Maru Barrera
- l Department of Psychology, Division of Hematology/Oncology , The Hospital for Sick Children , Toronto , Ontario , Canada
- m Institute of Medical Sciences and DLSPH , University of Toronto , Toronto , Ontario , Canada
| |
Collapse
|
18
|
Spirituality and religious coping are related to cancer-bereaved siblings' long-term grief. Palliat Support Care 2017; 17:138-142. [PMID: 29258632 DOI: 10.1017/s1478951517001146] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Many bereaved siblings have still not come to terms with their grief many years after the loss, but few studies have focused on what can help. The aims of this study were to identify cancer-bereaved adolescents' and young adults' ways of coping with grief after loss of a sibling, and examine whether these ways of coping were related to their experience of having worked through their grief. METHOD This nationwide survey of 174 cancer-bereaved siblings (73% participation rate) is based on one open-ended question about coping with grief ("What has helped you to cope with your grief after your sibling's death?") and one closed-ended question about siblings' long-term grief ("Do you think you have worked through your grief over your sibling's death?"). The open-ended question was analyzed with content analysis; descriptive statistics and Fisher's exact test were used to examine the relation between type of coping and siblings' long-term grief. RESULT The siblings described four ways of coping: (1) thinking of their dead brother/sister and feeling and expressing their grief; (2) distracting or occupying themselves; (3) engaging in spiritual and religious beliefs/activities; and (4) waiting for time to pass. One of these categories of coping with grief, namely, engaging in spiritual and religious beliefs and activities, was associated with siblings' experience of having worked through their grief two to nine years after the loss (p = 0.016). SIGNIFICANCE OF RESULTS Those siblings who had used spirituality, religious beliefs, and activities to cope were more likely to have worked through their grief than those who had not.
Collapse
|
19
|
Dynamic and heterogeneous effects of sibling death on children's outcomes. Proc Natl Acad Sci U S A 2017; 115:115-120. [PMID: 29255028 DOI: 10.1073/pnas.1709092115] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
This paper explores the effects of experiencing the death of a sibling on children's developmental outcomes. Recent work has shown that experiencing a sibling death is common and long-term effects are large. We extend understanding of these effects by estimating dynamic effects on surviving siblings' cognitive and socioemotional outcomes, as well as emotional and cognitive support by parents. Using the Children of the National Longitudinal Survey of Youth 1979 (CNLSY79), we find large initial effects on cognitive and noncognitive outcomes that decline over time. We also provide evidence that the effects are larger if the surviving child is older and less prominent if the deceased child was either disabled or an infant, suggesting sensitive periods of exposure. Auxiliary results show that parental investments in the emotional support of surviving children decline following the death of their child.
Collapse
|
20
|
Funk AM, Jenkins S, Astroth KS, Braswell G, Kerber C. A Narrative Analysis of Sibling Grief. JOURNAL OF LOSS & TRAUMA 2017. [DOI: 10.1080/15325024.2017.1396281] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Amy M. Funk
- School of Nursing, Illinois Wesleyan University, Bloomington, Illinois, USA
| | - Sheryl Jenkins
- Mennonite College of Nursing, Illinois State University, Normal, Illinois, USA
| | - Kim Schafer Astroth
- Mennonite College of Nursing, Illinois State University, Normal, Illinois, USA
| | | | - Cindy Kerber
- Mennonite College of Nursing, Illinois State University, Normal, Illinois, USA
| |
Collapse
|
21
|
Lövgren M, Sveen J, Nyberg T, Eilegård Wallin A, Prigerson HG, Steineck G, Kreicbergs U. Care at End of Life Influences Grief: A Nationwide Long-Term Follow-Up among Young Adults Who Lost a Brother or Sister to Childhood Cancer. J Palliat Med 2017; 21:156-162. [PMID: 28949788 DOI: 10.1089/jpm.2017.0029] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND A majority of cancer-bereaved siblings report long-term unresolved grief, thus it is important to identify factors that may contribute to resolving their grief. OBJECTIVE To identify modifiable or avoidable family and care-related factors associated with unresolved grief among siblings two to nine years post loss. DESIGN This is a nationwide Swedish postal survey. MEASUREMENTS Study-specific questions and the standardized instrument Hospital Anxiety and Depression Scale. Primary outcome was unresolved grief, and family and care-related factors were used as predictors. SETTING/PARTICIPANTS Cancer-bereaved sibling (N = 174) who lost a brother/sister to childhood cancer during 2000-2007 in Sweden (participation rate 73%). Seventy-three were males and 101 females. The age of the siblings at time of loss was 12-25 years and at the time of the survey between 19 and 33 years. RESULTS Several predictors for unresolved grief were identified: siblings' perception that it was not a peaceful death [odds ratio (OR): 9.86, 95% confidence interval (CI): 2.39-40.65], limited information given to siblings the last month of life (OR: 5.96, 95% CI: 1.87-13.68), information about the impending death communicated the day before it occurred (OR: 2.73, 95% CI: 1.02-7.33), siblings' avoidance of the doctors (OR: 3.22, 95% CI: 0.75-13.76), and lack of communication with family (OR: 2.86, 95% CI: 1.01-8.04) and people outside the family about death (OR: 5.07, 95% CI: 1.64-15.70). Depressive symptoms (OR: 1.27, 95% CI: 1.12-1.45) and time since loss (two to four years: OR: 10.36, 95% CI: 2.87-37.48 and five to seven years: OR: 8.36, 95% CI: 2.36-29.57) also predicted unresolved grief. Together, these predictors explained 54% of the variance of unresolved grief. CONCLUSION Siblings' perception that it was not a peaceful death and poor communication with family, friends, and healthcare increased the risk for unresolved grief among the siblings.
Collapse
Affiliation(s)
- Malin Lövgren
- 1 Department of Caring Sciences, Palliative Research Centre, Ersta Sköndal University College , Stockholm, Sweden .,2 Departments of Women's and Children's Health, Karolinska Institute , Stockholm, Sweden
| | - Josefin Sveen
- 1 Department of Caring Sciences, Palliative Research Centre, Ersta Sköndal University College , Stockholm, Sweden
| | - Tommy Nyberg
- 3 Department of Oncology-Pathology, Karolinska Institute , Stockholm, Sweden .,4 Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, University of Cambridge , Cambridge, United Kingdom
| | | | - Holly G Prigerson
- 6 Weill Cornell Medicine, Center for Research on End-of-Life Care , New York, New York
| | - Gunnar Steineck
- 3 Department of Oncology-Pathology, Karolinska Institute , Stockholm, Sweden .,7 Department of Oncology, Sahlgrenska Academy , Gothenburg, Sweden
| | - Ulrika Kreicbergs
- 1 Department of Caring Sciences, Palliative Research Centre, Ersta Sköndal University College , Stockholm, Sweden .,2 Departments of Women's and Children's Health, Karolinska Institute , Stockholm, Sweden
| |
Collapse
|
22
|
Brooten D, Youngblut JM, Roche RM. Adolescents' Experiences 7 and 13 Months Following the Death of a Brother or Sister. J Hosp Palliat Nurs 2017; 19:247-255. [PMID: 28845135 PMCID: PMC5568690 DOI: 10.1097/njh.0000000000000336] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This qualitative study used semi-structured interviews to describe adolescents' responses at 7 and 13 months to siblings' NICU/PICU/ED death. At 7 months, adolescents were asked about events around the sibling's death; at 7 and 13 months, about concerns/fears, feelings, and life changes. Seventeen adolescents participated (13-18 years; M=15); 65% Black, 24% Hispanic, 11% White. Themes included death circumstances, burial events, thinking about the deceased sibling, fears, and life changes. Adolescents reported shock and disbelief that the sibling died; 80% knew the reason for the death; many had difficulty getting through burials; all thought about the sibling. From 7 - 13 months fears increased including losing someone and thoughts of dying. Adolescents reported more changes in family life and greater life changes in them (more considerate, mature) by 13 months; some felt friends abandoned them after the sibling's death. Girls had more fears and changes in family life and themselves. Adolescent's responses to sibling death may not be visually apparent. One recommendation from this study is to ask adolescents how they are doing separately from parents since adolescents may hide feelings to protect their parents, especially their mothers. Older adolescents (14-18 years) and girls may have more difficulty after sibling death.
Collapse
Affiliation(s)
- Dorothy Brooten
- Nicole Wertheim College of Nursing & Health Sciences, Florida International University, 11200 SW 8th St., AHC3, Rm 221, Miami, FL 33199
| | - JoAnne M Youngblut
- Nicole Wertheim College of Nursing & Health Sciences, Florida International University, 11200 SW 8th St., AHC3, Rm 221, Miami, FL 33199
| | - Rosa M Roche
- Nicole Wertheim College of Nursing & Health Sciences, Florida International University, 11200 SW 8th St., AHC3, Rm 221, Miami, FL 33199
| |
Collapse
|
23
|
Kasahara-Kiritani M, Kikuchi R, Ikeda M, Kamibeppu K. Relationships in Families after a Family Member’s Death: A Qualitative Metasynthesis. JOURNAL OF LOSS & TRAUMA 2017. [DOI: 10.1080/15325024.2017.1310494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Mami Kasahara-Kiritani
- Department of Family Nursing, The University of Tokyo, Japan
- Department of Learning, Informatics, Management, and Ethics, Karolinska Institute, Stolna, Sweden
| | - Ryota Kikuchi
- Department of Family Nursing, The University of Tokyo, Japan
| | - Mari Ikeda
- School of Nursing at Tokyo Women’s Medical University, Tokyo, Japan
| | | |
Collapse
|
24
|
Carreño Moreno S, Chaparro Díaz L, López Rangel R. Encontrar sentido para continuar viviendo el reto al perder un hijo por cáncer infantil: revisión integrativa. PERSONA Y BIOÉTICA 2017. [DOI: 10.5294/pebi.2017.21.1.4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
La experiencia de perder un hijo por cáncer representa para los padres una carga emocional de alto impacto individual, familiar y social que no finaliza con la muerte. Esta revisión integrativa tuvo como objetivo identificar aspectos clave en la experiencia de perder un hijo como consecuencia del cáncer infantil. Los resultados mostraron un patrón (búsqueda de sentido) que rodea seis momentos del proceso de duelo, que pueden ser elementos de intervención para acompañar el proceso de afrontamiento de los padres. Se concluye que este patrón es un fenómeno importante para el desarrollo del área de cuidado paliativo al final de la vida y posterior.
Collapse
|
25
|
Greenwald N, Barrera M, Neville A, Hancock K. Feasibility of group intervention for bereaved siblings after pediatric cancer death. J Psychosoc Oncol 2016; 35:220-238. [PMID: 27786614 DOI: 10.1080/07347332.2016.1252823] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study evaluated the feasibility (acceptability, recruitment, retention rates, treatment fidelity, and outcome measures) of implementing a manualized group intervention for bereaved siblings after pediatric cancer death. A convenience sample of 10 siblings participated. The intervention consisted of eight 2-hour sessions that focused on strategies for coping with grief, relationships, and emotional growth. Positive outcomes were obtained with respect to acceptability, recruitment, retention rates, and treatment fidelity. Preliminary outcomes were mixed. Parent pre- and post-intervention outcomes suggested improvements in siblings' overall emotional and social quality of life. Siblings' self-reports reflected no improvements. These data support the feasibility of conducting this intervention and suggest beneficial outcomes based on parental reports. Further research is recommended to evaluate the group intervention efficacy with a large sample using a randomized controlled trial to address the needs of bereaved siblings.
Collapse
Affiliation(s)
- Naomi Greenwald
- a The Hospital for Sick Children, University of Toronto , Toronto , Ontario , Canada
| | - Maru Barrera
- a The Hospital for Sick Children, University of Toronto , Toronto , Ontario , Canada
| | - Alexandra Neville
- a The Hospital for Sick Children, University of Toronto , Toronto , Ontario , Canada.,b Department of Psychology , University of Calgary , Calgary , Alberta , Canada
| | - Kelly Hancock
- a The Hospital for Sick Children, University of Toronto , Toronto , Ontario , Canada
| |
Collapse
|
26
|
Morris AT, Gabert-Quillen C, Friebert S, Carst N, Delahanty DL. The Indirect Effect of Positive Parenting on the Relationship Between Parent and Sibling Bereavement Outcomes After the Death of a Child. J Pain Symptom Manage 2016; 51:60-70. [PMID: 26387829 DOI: 10.1016/j.jpainsymman.2015.08.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 08/14/2015] [Accepted: 09/03/2015] [Indexed: 11/15/2022]
Abstract
CONTEXT Families are referred to pediatric palliative care (PPC) programs when a child is diagnosed with a medical condition associated with less than a full life expectancy. When a child dies, PPC programs typically offer a range of bereavement interventions to these families, often focusing on parents. Currently, it is unclear which factors increase the likelihood that bereaved siblings will experience negative outcomes, limiting the development of empirically supported interventions that can be delivered in PPC programs. OBJECTIVES The present study explored the relationship between parents' and surviving sibling's mental health symptoms (i.e., post-traumatic stress disorder [PTSD], prolonged grief disorder (PGD), and depression symptoms) after a child's death. Additionally, the extent to which parent functioning indirectly impacted sibling functioning through parenting behaviors (i.e., positive parenting and parent involvement) was also examined, with a specific focus on differences based on parent gender. METHODS Sixty bereaved parents and siblings (aged 8-18) who enrolled in a PPC program from 2008 to 2013 completed measures of PTSD, PGD, and depression related to the loss of a child/sibling. Siblings also completed a measure of general parenting behaviors. RESULTS Maternal, but not paternal, symptoms of PTSD and PGD were directly associated with sibling outcomes. Paternal symptoms were associated with sibling symptoms indirectly, through parenting behaviors (i.e., via decreasing positive parenting). CONCLUSION These results underscore the importance of examining both maternal and paternal influences after the death of a child, demonstrate differential impact of maternal vs. paternal symptoms on siblings, and stress the importance of addressing postloss symptoms from a family systems perspective.
Collapse
Affiliation(s)
- Adam T Morris
- Division of Child and Adolescent Psychiatry, Johns Hopkins Medicine, Baltimore, Maryland, USA.
| | | | | | | | - Douglas L Delahanty
- Department of Psychology, Kent State University, Kent, Ohio, USA; Department of Psychology and Psychiatry, Northeastern Ohio Medical University (NEOMED), Rootstown, Ohio, USA
| |
Collapse
|
27
|
Gerhardt CA, Lehmann V, Long KA, Alderfer MA. Supporting Siblings as a Standard of Care in Pediatric Oncology. Pediatr Blood Cancer 2015; 62 Suppl 5:S750-804. [PMID: 26700924 DOI: 10.1002/pbc.25821] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 09/27/2015] [Indexed: 11/09/2022]
Abstract
In this study, evidence is provided for supporting siblings as a standard of care in pediatric oncology. Using Medline, PsycInfo, and CINAHL, a systematic search of articles published over the past two decades about siblings of children with cancer was conducted. A total of 125 articles, which were primarily descriptive studies, were evaluated by the four investigators using Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. There is moderate-quality evidence, as well as support from community stakeholders, to justify a strong recommendation that siblings of children with cancer should be provided with psychosocial services and that parents and professionals are advised about how to meet siblings' needs.
Collapse
Affiliation(s)
- Cynthia A Gerhardt
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio
| | - Vicky Lehmann
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio
| | - Kristin A Long
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
| | - Melissa A Alderfer
- Nemours Children's Health System, Wilmington DE and Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| |
Collapse
|
28
|
Supporting youth grieving the dying or death of a sibling or parent: considerations for parents, professionals, and communities. Curr Opin Support Palliat Care 2015; 9:58-63. [PMID: 25581448 DOI: 10.1097/spc.0000000000000115] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE OF REVIEW The aim of this article is to highlight considerations for parents, professionals, and communities regarding supporting children and adolescents who are grieving the dying or death of a parent or sibling. RECENT FINDINGS Current research is directly engaging the voices of youth who have experienced a parent or sibling's death. Although there continues to be much evidence about the distressing effect of such deaths on children and adolescents, there is a welcome emerging tendency to distinguish between adaptive and maladaptive grief. Although the literature strongly encourages parents to take an open and honest approach to supporting youth prior to a death, many barriers remain to them doing so. The literature identifies healthcare providers as being ideally positioned to provide guidance to families around best practice in the area of preparing youth for the death of a parent or sibling. Following a death, there is now encouraging evidence regarding the efficacy of certain interventions for bereaved youth, both in the short and long term, which is an important development in the field. SUMMARY Youth benefit from being involved in open and honest conversations about a family member's cancer diagnosis, treatment, prognosis, and end-of-life care. Although advances are being made with regard to understanding the grief experience of youth, there remains a wide gap between the current theoretical knowledge and the availability of practical well informed support for grieving youth.
Collapse
|
29
|
Haugen AE, Preszler JR, Cookman ML, King AR. Sibling Death and Adult Maladjustment Indices: A Brief Report. JOURNAL OF LOSS & TRAUMA 2015. [DOI: 10.1080/15325024.2015.1048152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
30
|
Lövgren M, Jalmsell L, Eilegård Wallin A, Steineck G, Kreicbergs U. Siblings' experiences of their brother's or sister's cancer death: a nationwide follow-up 2-9 years later. Psychooncology 2015; 25:435-40. [DOI: 10.1002/pon.3941] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 07/15/2015] [Accepted: 07/17/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Malin Lövgren
- Department of Women's and Children's Health; The Childhood Cancer Research Unit, Karolinska Institute; Stockholm Sweden
- School of Education, Health and Society; Dalarna University; Falun Sweden
| | - Li Jalmsell
- Centre for Research Ethics and Bioethics; Uppsala University; Uppsala Sweden
- Oncological Unit; Visby Lasarett; Visby Sweden
| | | | - Gunnar Steineck
- Department of Oncology-Pathology; Karolinska University Hospital; Stockholm Sweden
- Department of Oncology; The Sahlgrenska Academy; Gothenburg Sweden
| | - Ulrika Kreicbergs
- Department of Women's and Children's Health; The Childhood Cancer Research Unit, Karolinska Institute; Stockholm Sweden
- Ersta Sköndal University College; Palliative Research Centre; Stockholm Sweden
| |
Collapse
|