Parental experiences of adult child death from cancer

Family Caregivers of Cancer Patients: Burdens and Support Preferences of Partner, Parent and Adult-Child Caregivers

OBJECTIVE

The aim of this study is to (1) identify similarities and differences in psychosocial burdens and support needs experienced by parent, partner and adult-child caregivers and (2) identify support needs of family caregivers regarding peer support programs.

METHODS

Semi-structured interviews (n = 30) were conducted with family caregivers of cancer patients. Interviews were transcribed and analyzed by inductive content analysis to identify themes.

RESULTS

Ten categories of burden were identified for all three groups of caregivers. Partners emphasized the time burden through caregiving, parents and adult-child caregivers accentuated the emotional burden. All caregivers wished for peer-to-peer exchange which will provide the feeling not to be alone, to share emotions and to prepare for what will come next. Preferences for matching with peers with similar prognosis for their sick relative and similar living conditions were found.

CONCLUSIONS

Partner, parent and adult-child caregivers describe similar burdens of caregiving. They wish for peer support programs that allow them to share their experiences with persons who understand their situation. Therefore, caregivers desire a good match with peers to enhance the positive outcome of peer exchange.

The death of an adult child and trajectories of parental depressive symptoms: A gender-based longitudinal analysis

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.

'She Can't Support Me Because She's so Old': A Mixed-Methods Study of Support Experiences and Needs in Adult Child-Parent Dyads at the End of Life

Little is known about support experiences and needs in the dyads of (1) terminally ill adult children and their parent caregivers and (2) terminally ill parents and their adult child caregivers. The current study aimed at investigating the experiences and needs of adult children and parents in end of life situations regarding their provision and receipt of support. The study employed a convergent parallel mixed-methods design, combining explorative qualitative interviews with the quantitative self-report Berlin Social Support Scales. Sixty-five patients (dyad 1: 19; dyad 2: 46) and 42 family caregivers (dyad 1: 13; dyad 2: 29) participated in the study (02/2018-11/2019). Results show that ill adult children felt less (well) supported than ill parents. Parent caregivers were often limited in the support they could provide, due to their age and health conditions. Hypotheses were deduced from patients' and family caregivers' notions to inform dyad-specific recommendations for support interventions.

Effects of E-Government Policy on the Management of Healthcare Systems

E-government began by addressing the challenges of new technologies by delivering e-services to its citizens and has since evolved to include a growing number of areas, such as citizen communication, macroeconomic projections, budget management, and e-healthcare services. E-government is known as the use of information technology to provide administrative services, communication transactions, information exchange, integration of various electronic systems, and autonomous services between the government and citizens, the government and business environment, and the government and government. This paper discusses the role of E-government policy in healthcare crises during COVID 19. Data collected from 435 employees in the tourism industry of Iraq was used to verify the abovementioned relationships via SPSS macro. The results indicate that E-government policy has a significant effect on healthcare crises; job insecurity negatively predicted healthcare crises. The results revealed that social support moderated the relationship between E-government policy and job insecurity. Results of the study contributed to the theory within this study by demonstrating that employees who enjoy a high level of social support show less job insecurity than those with a low level of social support.

Consensus-based recommendations for psychosocial support measures for parents and adult children at the end of life: results of a Delphi study in Germany

PURPOSE

The availability of psychosocial support measures has a significant impact on the quality of life of terminally ill and dying patients and the burden experienced by their relatives. To date, no intervention has specifically focused on promoting interaction within the dyads of the following: (1) terminally ill adult children and their parents and (2) terminally ill parents and their adult children. A national Delphi study was conducted to provide appropriate recommendations for dyadic psychosocial support measures.

METHODS

Recommendations were formulated from qualitative interview data on the experiences and wishes of patients and family caregivers within these two dyads. Experts from palliative and hospice care providers rated the relevance and feasibility of 21 recommendations on two 4-point Likert-type scales, respectively. Additional suggestions for improvement were captured via free text fields. Individual items were considered consented when ≥ 80% of participants scored 1 (strongly agree) or 2 (somewhat agree) regarding both relevance and feasibility.

RESULTS

A total of 27 experts (35% response rate) completed two Delphi rounds. Following the first round, 13 recommendations were adjusted according to participants' comments. After the second round, consensus was achieved for all 21 of the initially presented recommendations.

CONCLUSION

The Delphi-consented recommendations for parents and adult children at the end of life provide the first guidance for hands-on dyadic psychosocial support measures for parent-adult child relationships, specifically. The next step could involve the structured implementation of the recommendations, accompanied by scientific research. This study was registered on October 27, 2017, with the German Clinical Trials Register (DRKS00013206).

Communication in dyads of adult children at the end of life with their parents and parents at the end of life with their adult children: Findings from a mixed-methods study

OBJECTIVE

Patient-family member communication plays a decisive role in coping with an end-of-life situation and is strongly influenced by the dyadic relationship. There is a lack of research exploring and comparing the specifics of communication between (1) terminally ill adult children and their parents and (2) terminally ill parents and their adult children. The present study aimed at describing and comparing communication specifics within these two dyads.

METHODS

As part of the research project Dy@EoL on parent-adult child interactions, this mixed-methods study combined qualitative interviews and the Berlin Social Support Scales self-report questionnaire. Participants in both dyads were recruited via 12 inpatient and ambulatory palliative/hospice care providers between February 2018 and September 2019.

RESULTS

Participants included 65 patients (dyad 1: 19; dyad 2: 46) and 42 family members (dyad 1: 13; dyad 2: 29). Qualitative interviews revealed communication changes in the terminal illness situation and provided insight into each dyad partner's perception of openness and avoidance in the dyadic communication. The quantitative results showed that patients in both dyads provided significantly less informational support relative to family members. A strong similarity present in both dyads was the central motivation for limiting information sharing.

CONCLUSIONS

Individual preferences for information sharing suggest that the divergent needs of dyad partners must be carefully negotiated to ensure that patients are able to address important topics without putting too great an emotional burden on their family members. Tailored psychosocial support measures are needed to achieve this goal. The study was registered prospectively in the German Clinical Trials Register (registration N° DRKS00013206).

'Mums are sacred, and mums don't die': A mixed-methods study of adult child-parent dyadic relationships at the end of life

OBJECTIVES

The aim of the present study was to report the specific challenges pertaining to the experiences and needs of (1) terminally ill adult children and their parents and (2) terminally ill parents and their adult children, regarding their relationship and relationship roles. The study sought to identify similar and differing relationship patterns between the two dyadic types.

DESIGN

This prospective observational study used an exploratory mixed-methods approach.

PARTICIPANTS

Patients and caregivers were recruited (Feb. 2018 - Nov. 2019) via general and specialist palliative care providers in Germany.

METHODS

The study combined semi-structured interviews with quantitative questionnaires covering socio-demographic details, attachment style and emotional intimacy.

FINDINGS

A total of 65 patients and 42 family caregivers participated in the study. Interview data indicate that illness situation and dependencies were perceived in both dyads to represent a relationship role reversal contrary to the 'natural order'. With respect to dyad 1, adult children stressed their need for autonomy, whereas caregiving parents strived for greater intimacy in the relationship. Within dyad 2, terminally ill parents and adult children experienced a new relationship intensity. Questionnaire data showed that emotional intimacy was perceived by patients in both dyads and adult child caregivers as significantly higher in the current illness situation compared to the pre-illness situation.

CONCLUSIONS

This was the first study to contribute to an understanding of the different needs of terminally ill adult children/parents and their parent/adult child caregivers, thus contributing to an understanding of the different needs of these parties, both within and between the dyadic forms. The results suggest that the dyads share similar themes, which should be integrated into general support interventions; however, some themes appear more relevant for one dyad, only.

IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS

For both dyads, we recommend psychological counseling to support open communication and understanding between parties.

Perceived efficacy of COVID-19 restrictions, reactions and their impact on mental health during the early phase of the outbreak in six countries

The COVID-19 pandemic forced millions of people to drastically change their social life habits as governments employed harsh restrictions to reduce the spread of the virus. Although beneficial to physical health, the perception of physical distancing and related restrictions could impact mental health. In a pre-registered online survey, we assessed how effective a range of restrictions were perceived, how severely they affected daily life, general distress and paranoia during the early phase of the outbreak in Brazil, Colombia, Germany, Israel, Norway and USA. Most of our over 2000 respondents rated the restrictions as effective. School closings were perceived as having the strongest effect on daily life. Participants who believed their country reacted too mildly perceived the risk of contracting SARS-CoV-2 to be higher, were more worried and expressed reduced beliefs in the ability to control the outbreak. Relatedly, dissatisfaction with governmental reactions corresponded with increased distress levels. Together, we found that satisfaction with one's governmental reactions and fear appraisal play an important role in assessing the efficacy of restrictions during the pandemic and their related psychological outcomes. These findings inform policy-makers on the psychological factors that strengthen resilience and foster the well-being of citizens in times of global crisis.

Adult Child-Parent Dyadic Interactions at the End of Life: A Scoping Review

Background

Being terminally ill affects not only the life of patients but also that of their loved ones. Dyads of adult children and their parents at the end of life may face specific challenges with regard to their relationship and interactions that need to be further examined.

Aim

The aim was to identify, describe and summarise available evidence on adult child–parent interaction and psychosocial support needs at the end of life. Research gaps in the existing literature are disclosed and recommendations for future research are presented.

Design

A type 4 scoping review according to Arksey and O’Malley’s (2005) methodological framework was conducted. The review includes studies regardless of study design and provides a descriptive account of foci of available research.

Data sources

The PubMed, PsycINFO, CINAHL, Google Scholar and Web of Science databases were searched from inception to 16 August 2018. An additional hand search was conducted. A highly sensitive search strategy was employed to cover all potentially relevant results.

Results

The authors screened 1832 records by title and abstract, retrieved 216 full-text articles and included 15 studies from the database search. One study was identified by way of hand search. The review identified six major themes: (1) adult child–parent relationship, (2) adult child–parent communication, (3) involvement in caregiving, (4) benefit and burden of caregiving, (5) coping strategies and (6) support and information for caregivers.

Conclusions

The scoping review accentuates the paucity of studies that address both patients’ and their parent/adult child caregivers’ relationship, interaction and psychosocial support needs.

Exploring end-of-life interaction in dyads of parents and adult children: a protocol for a mixed-methods study

Background

A considerable number of terminally-ill adult children are outlived by at least one parent and receive palliative care prior to their death. At the same time, adult children continue to be confronted with their parents’ terminal illnesses and end-of-life situations. The current study explores the specifics of dyadic interaction at the end of life between a) adult children suffering from a life-threatening disease and their parents, and b) terminally ill parents and their adult children.

Methods

This prospective observational study aims at filling the existing gap on adult child-parent interaction specifics at the end of life using an exploratory mixed-methods framework. The mixed-methods framework combines a qualitative face-to face interview and quantitative self-report questionnaires to study the topic at hand. The qualitative interview will focus on experiences, expectations, and wishes with regard to dyadic communication, information about illness and prognosis, expressed and perceived burden and support as well as caregiving role at the end of life. The questionnaires will cover socio-demographics, loneliness, attachment style, social support, and emotional closeness.

Discussion

The research group is currently adjusting a semi-structured interview guide and questionnaire instructions based on the results of a multiprofessional scientific advisory board meeting (Jan. 2018). In a next step, and prior to qualitative and quantitative data collection, the questionnaires will be piloted on patients and their family members in a palliative care setting. The main expected results are i) a description of the specifics of the interaction within and between both dyads, ii) the development of hypotheses and a theoretical framework on the specifics, similarities, and differences for both study groups, and iii) clinical conclusions on specific psychosocial care needs of both groups.

Trial registration

The study was registered prospectively in the Health Services Research Germany register (Versorgungsforschung Deutschland – Datenbank) (Registration N° VfD_Dy@EoL_17_003897; date of registration: November 22, 2017) and in the German Clinical Trials Register (Deutsches Register Klinischer Studien) (Registration N° DRKS00013206; date of registration: October 27, 2017). The study is visible in the International Clinical Trials Registry Platform Search Portal of the World Health Organization under the German Clinical Trials Register number.

A Qualitative Study of the Experiences of Parents With an Adult Child Who Has a Severe Disease: Existential Questions Will Be Raised

A prominent existential concept is that elderly parents should naturally become severely ill or die before a younger person does. If the reverse should happen, it may influence the parent's existential view of life. The aim of this study was to investigate the existential issues during illness time. This was a qualitative study with in-depth interviews and was conducted in a University Hospital in western Sweden. Eleven parents agreed to participate in individual interviews at baseline and 1 year later. The total number of interviews completed was 19. The study identified 5 areas according to an existential perspective: life took the wrong path, the age of the child, difficult to see the child as sick, worrying about the child, and the relationship with the adult child. Existential questions are often present in those circumstances and can be raised in conversations with parents. Existential questions began to arise for the parent when the child was diagnosed with the severe illness. The situation of having a severely ill child caused both fear and anxiety that the worst-case scenario they could imagine, that the child will die, might happen. Further research is required on this rarely investigated subject of having an adult child with a severe disease.

Honoring the voices of bereaved caregivers: a Metasummary of qualitative research

BACKGROUND

Family caregiving in the context of advanced disease in particular, can be physically and emotionally taxing. Caregivers can subsequently face bereavement exhausted with few supports, limited resources and a significant proportion will develop negative psychological and social outcomes. Although some research has attended to the bereavement experiences of family caregivers who had cared for a person requiring palliative care, a comprehensive qualitative understanding of the impact of caregiving on bereavement has not been articulated. The purpose of this study was to conduct a qualitative metasummary to explore the experiences of bereaved family caregivers of people who received palliative care services, regardless of their underlying disease.

METHODS

Sandelowski and Barroso's qualitative metasummary method was utilized: 1287 articles were identified through extensive database searches (i.e. - MEDLINE, PsychINFO, and CINAHL) and reviewed to determine if they fit the criteria. Those included in the review were assessed for study quality. Findings from each study were then thematically coded and a frequency of themes was calculated.

RESULTS

The sample consisted of 47 qualitative studies. A total of 15 themes emerged. In descending order of frequency, the 15 themes were: the individual emotions of serenity, sadness, guilt, uncertainty, trauma, escape, and anger; post-loss experiences that helped the caregiver in bereavement; post-loss experiences that hindered; practical life changes; caregiver role identity; pre-loss experiences that helped; pre-loss experiences that hindered; caregiver context; and a need for different kinds of supports. Three key findings emerged from the themes: (1) many different aspects of the caregiving experience impact the bereavement experience, (2) every bereavement experience is unique, and (3) a variety of supports must be developed and made available to caregivers to meet these unique needs.

CONCLUSIONS

Based on the metasummary findings, changes are needed in practice and policy to ensure the health and well-being of the family caregiver is maintained by offering support both during caregiving and bereavement.

Tightrope walkers suffering in silence: A qualitative study into the experiences of older parents who have an adult child with cancer

BACKGROUND

Given the worldwide ageing of the population and the changes in the structure of society and family, the likelihood increases that older parents face a serious illness in an adult child and will even outlive their child.

OBJECTIVES

To gain insight into older parents' experiences, concerns, and dilemmas regarding their position and role as a parent of an adult child with cancer.

DESIGN

Qualitative interview design.

SETTING

A geriatric ward and four oncology wards of a university hospital, several nursing homes, local health service agencies.

PARTICIPANTS

Twenty-five parents (age range 65-91 years) of 22 adult children with cancer (age range 33-66 years) of differing stages and types (with a preponderance of breast cancer).

METHODS

Using a qualitative research methodology underpinned by grounded theory, we conducted semi-structured interviews with a fairly open framework.

RESULTS

Suffering in silence emerged as the core category encapsulating three interrelated balancing acts: (1) shielding their child while being shielded by their child, (2) being involved while keeping an adequate distance, and (3) shifting attentional priorities between their child, themselves, and others. The emotional interconnectedness between older parents and their adult child with cancer becomes tangible in the transformational process of their parental role and position described in the three balancing acts.

CONCLUSIONS

Faced with their child's illness and possible death, older parents experience overwhelming feelings often underestimated by their (close) environment. Nurses need to be susceptible for the needs and experiences of these older parents. For care by nurses to make a difference, their attention must be directed to how older parents can be invigorated in their parenthood while respecting the child's autonomy.

Caring for the bereaved parent: Guidelines for practice

PURPOSE

The purpose of this research review was to create practical guidelines for the primary care practitioner in comforting, counseling, and educating bereaved parents and their significant supporters.

DATA SOURCES

The authors used an extensive review of the literature for original research reports of bereaved parents' self-identified needs for comfort from their friends, family, and healthcare practitioners. Insight gained from the authors' clinical work with bereaved parents added further understanding.

CONCLUSIONS

Parents express strong preferences and needs regarding support from both social relationships and healthcare personnel. Specific guidelines were created for use by both friends/family members and health professionals.

IMPLICATIONS FOR PRACTICE

Nurse practitioners have an important role in supporting bereaved parents, and educating their friends and family on the most helpful behaviors during this painful time.

Aged parents' experiences during a critical illness trajectory and after the death of an adult child: a review of the literature

BACKGROUND

Given the growing life expectancy, the likelihood increases that health-care providers are confronted with older people having an adult child with a life-limiting disease.

AIM

This literature review aimed to (1) explore the experiences of aged parents with regard to their position and role as a parent of an adult child with a life-limiting illness, (2) detect gaps in the existing literature and (3) make recommendations for future research.

DESIGN

A literature search of English articles, including both quantitative and qualitative designs.

DATA SOURCES

Four electronic databases and the reference lists of included studies.

RESULTS

In total, 19 studies (7 quantitative and 12 qualitative) were included. Few studies describe the experiences of older people whose adult child has cancer or has died of cancer. Existing studies are merely descriptive and give no concrete recommendations for health-care providers in daily practice. The studies suggest that aged parents carry deep burdens from the prospect of losing their adult child. Aged parents want to stay involved but need to reconfigure their parent role. As soon as the cancer diagnosis is disclosed, parents are confronted with a re-awakening of parental nurturing, which clashes with the autonomy of the adult child. Even after the adult child is deceased, older parents retain the image of themselves as parents.

CONCLUSIONS

There is a need for more in-depth research to understand the lived experience of these parents and what health-care providers can do to assist them.

Bereaved Jewish mothers of children who died of cancer: the relationship between the mother and the deceased child and the mother's perceived functioning

BACKGROUND

Coping with grief after a child's death is a complex and dynamic process. The Two-Track Model of Bereavement, which served as the theoretical framework for this study, examines biopsychosocial reactions to bereavement (track I) and attachment to the deceased (track II).

OBJECTIVES

The objectives of this study were to identify differences in mothers' perceived functioning between bereaved mothers and mothers of children with cancer, describe mother-child relationships and relationship development over the course of illness and death, and describe the association between the 2 tracks.

METHODS

A quantitative cross-sectional study of 50 Jewish bereaved mothers and a matched comparison group of 50 Jewish mothers to children with cancer aged 6 to 18 years completed structured questionnaires.

RESULTS

No difference was found between the groups in overall maternal functioning. Bereaved mothers keep a relationship with their deceased child. Among mothers of currently ill children, there was a difference in the mean score of the mother-child relationship with the child before and after the cancer diagnosis. A negative correlation was found between the bereaved mother's relationship with the deceased child and her functioning; this was not found in the comparison group.

CONCLUSIONS

Mother-child relationships become closer following the cancer diagnosis and change further following the child's death. The relationship with the deceased child is an integral part of the bereaved mother's life and influences her functioning.

IMPLICATIONS FOR PRACTICE

Training programs for nurses need to be developed to help nurses be sensitive to maternal loss and grief and to incorporate the bereaved mother's relationship with her deceased child into interventions.

Evaluating a bereavement follow-up intervention for grieving fathers and their experiences of support after the death of a child--a pilot study

This article describes a study designed to evaluate the effectiveness of an intervention program for bereaved fathers and their experiences of it in a sample of intervention (n = 62) and control (n = 41) fathers. Data were collected by 3 scales: the Hogan Grief Reactions Checklist, a scale for measuring received social support, and a scale for measuring fathers' experiences of the intervention program. Assessment at 6 months after leaving the hospital showed that intervention fathers reported lower grief reaction scores and stronger personal growth. Intervention fathers reported the most emotional support from both health care personnel and peer supporters. The support received was perceived as helpful in coping, and fathers rated the intervention favorably. The findings support the continuation of the intervention.

Health care personnel's experiences of a bereavement follow-up intervention for grieving parents

The aim of this study is to investigate the experiences of health care personnel of a bereavement follow-up intervention for grieving parents and of the ways to develop it. The intervention included three components: a support package for grieving parents, peer supporters' and health care personnel's contact with parents. The sample included 29 health professionals. Data were collected via open-format questionnaires and telephone interviews from health care personnel. Content analysis was used as a means of data analysis. The support package for grieving parents was considered important and versatile. Health care personnel perceived the intervention and its viability as mostly good. Parents' willingness to receive support, health care personnel's good resources and organizational preconditions were important for the follow-up contact. The intervention clarified the policy related to supporting grieving parents. It was enabled by a good attitude, shift arrangements and co-worker support. However, the implementation was considered difficult because of scarce resources. Parental support engendered negative feelings in health care personnel and they desired systematic supervision to deal with these. Follow-up care of grieving parents is a demanding task. Continuous education about bereavement follow-up care and systematic supervision to health care personnel is needed. Family-focused care in supporting grieving families after leaving from hospital should be increased. Inter-organizational cooperation in supporting parents is important and feasible.