Stress and coping strategies among parents of children with cancer at Tikur Anbessa Specialized Hospital paediatric oncology unit, Ethiopia: a phenomenological study

Comparing the effectiveness of mandala art and value clarification on the anxiety and emotional state of parents of children with cancer: A randomized controlled trial

PURPOSE

The study aims to compare the effectiveness of mandala art and value clarification practices based on Watson's Theory of Human Caring on the anxiety and emotional state of parents of children with cancer.

METHODS

The study was conducted as a randomized controlled trial and included parents of children being treated for cancer at the Pediatric Hematology and Oncology Clinic of a university hospital. The sample of the study is three groups; it consisted of a total of 75 people as mandala group (n:25), value clarification group (n:25) and control group (n:25). The mandala group participated in 2 sessions of individual mandala art accompanied by music. Value clarification group participated in the value clarification activity in 2 sessions of individual writing accompanied by music. For the pre-test data, the Personal Information Form, State Anxiety Inventory (SAI), and Positive-Negative Affect Scale (PANAS) were administered to both groups before the first session. After the second session, the same two scales were used again for the post-test data. The analyses of data were carried out with the Statistical Package for the Social Sciences software (version 23.0, SPSS Inc.). Chi-squared tests, t-tests, and one-way ANOVA were used to analyze the differences in the mean scores between the groups.

RESULTS

The parents' average age was 36.2 years (SD = 7.40), with 92.0% being female. The SAI score and PANAS negative emotion score of the mandala and value clarification groups decreased significantly compared to the control group, and the PANAS positive emotion score increased significantly (p < 0.05). However, when comparing the mandala group with the value clarification group, no statistically significant differences were found in the mean SAI and PANAS scores (p > 0.05).

CONCLUSION

The individual mandala art and writing value clarification interventions based on Watson's Theory of Human Caring are effective in increasing positive emotions and reducing negative emotions and anxiety levels among parents of children with cancer.

Quality of Life and Associated Factors Among Family/Caregivers of Pediatric Patients Treated for Cancer at Tikur Anbessa Specialized Hospital: Institution-Based Cross-Sectional Study

BACKGROUND

Pediatric cancer significantly affects the quality of life (QOL) of patients and their families/caregivers particularly in low-income countries where there is scarcity of resources. Thus, the purpose of this study was to evaluate the QOL and associated factors among family/caregivers of pediatric patients treated for cancer at Tikur Anbassa Specialized Hospital (TASH), Addis Ababa, Ethiopia.

METHOD

An institution-based cross-sectional study design was used to collect information from family/caregivers who were present in the pediatric oncology unit at TASH from January 2, 2023 to May 30, 2023. The validated Amharic version of the caregiver oncology quality of life questionnaire (CarGOQOL) was used to collect the data. A random sampling technique was applied to select the study participants. The descriptive and regression analysis were conducted using statistical software SPSS version 27.0.

RESULTS

A total of 350 family/caregivers answered the questionnaire. The overall response rate was 82.7%, and about 55% of the respondents were women. Among the participants, under-35 age made up the majority (60.9%). About 81% of family/caregivers were parents, and 77.7% of family/caregivers were married. More than half of the participants have at least a secondary level education. In addition, about two-thirds of the participants (63%) live in rural areas. Furthermore, more than half of the participants generate less than $17.86 per month. Nearly fifty percent of family/caregivers of pediatric cancer patients had poor QOL. The finding showed that widowed family/caregivers (AOR:5.59, 95%CI: 1.12, 27.79, P-value: 0.03) had poor QOL as compared to married, and those with a monthly income of between $17.87- $89.29 were less likely to have poor QOL compared to those with an income below <$17.87 (P-value: 0.01).

CONCLUSION

In the current study, poor QOL was high among family/caregivers of pediatric cancer patients. Being widowed and lowest income were significantly associated with the QOL of the caregivers of pediatric patients with cancer.

Association of Family-Centered Care With Psychological Distress Among Caregivers of Children With Cancer at a Tertiary-Level Hospital in Ethiopia: Cross-Sectional Study

BACKGROUND

Psychological distress (PD) is a common mental health problem faced by caregivers of children with cancer. The involvement of families in childcare was found to be associated with lower levels of distress.

OBJECTIVE

The study aims to determine the associations between family-centered care (FCC) and PD among caregivers of children with cancer receiving treatment at Tikur Anbessa Specialized Hospital (TASH), Ethiopia.

METHODS

An institution-based, cross-sectional study was conducted from June to December 2022. Caregivers of children with cancer aged 0-14 years receiving cancer treatment at the pediatric oncology unit completed a face-to-face, interviewer-administered, structured questionnaire during a routine inpatient or outpatient visit. The questionnaire included questions on the characteristics of the child and caregiver, PD (measured by the Kessler Psychological Distress Scale [K10]), FCC (measured by the Measure of Processes of Care [MPOC-20]), and social support (measured by the Oslo-3 Social Support Scale [OSS-3]). Data were collected using the Kobo toolbox and exported to SPSS (version 26; IBM Corp) for cleaning and analysis. A multivariable logistic regression model was used. An odds ratio with a 95% CI was calculated, and a P value less than .05 was considered statistically significant.

RESULTS

A total of 384 caregivers of children with cancer participated in the study. The total PD score ranged from 10 to 50, with a mean score of 17.30 (SD 8.96; 95% CI 16.84-18.60). The proportion of caregivers found to have mild, moderate, and severe levels of PD was 43 (11.2%), 35 (9.1%), and 51 (13.3%), respectively. The overall prevalence of mild to severe PD symptoms was 33.6% (95% CI 28.9%-38.3%). A statistically significant negative association was found between FCC and PD (adjusted odds ratio [AOR] 0.68, 95% CI 0.53-0.86). In addition, having no formal education (AOR 2.87, 95% CI 1.28-6.45), having a history of relapse (AOR 3.24, 95% CI 1.17-9.02), beginning cancer treatment at TASH (AOR 2.82, 95% CI 1.4-4.85), beginning treatment within the last 3 months (AOR 3.99, 95% CI 1.73-9.23), and beginning treatment within the last 4 to 18 months (AOR 2.68, 95% CI 1.25-5.76) were significantly associated with higher level of PD.

CONCLUSIONS

A total of 1 in 3 caregivers have reported PD. FCC was found to be protective of PD. The finding of this study suggests the need for FCC intervention to improve the mental health condition of caregivers. In addition, the intervention needs to consider the educational status of the caregivers, the time since the cancer diagnosis, and the history of relapse.

Prevalence of Anxiety and Depression among Parents of Children with Cancer-A Preliminary Study

BACKGROUND

A child's cancer is a highly stressful experience for the entire family. Childhood cancer disrupts family functioning and is one of the most stressful and challenging events parents face, often beyond their control. Parents play a crucial role in providing emotional support to children throughout their illness, and their ability to cope can help reduce the child's negative emotions. The aim of this study was to assess the prevalence of anxiety and depression among parents of children with cancer.

METHODS

This cross-sectional study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines and included parents of children undergoing cancer treatment. Convenience sampling was used. The Beck Depression Inventory and the Hospital Anxiety and Depression Scale were utilized to assess the parents.

RESULTS

This study included 270 participants (73% women, 27% men) with children at an average age of 8.75 ± 4.82 years. Diagnoses included leukemia (53%), lymphoma (29%), and other cancers. On the Beck Depression Inventory, 33% of parents were mildly depressed, 12% moderately depressed, and 32% severely depressed, with an average score of 20.63 ± 12.39 points. The HADS-M scale indicated anxiety at 48.43 ± 20.78%, depression at 45.01 ± 22.8%, and aggression at 54.72 ± 28.71%.

CONCLUSIONS

Most parents of children with cancer have symptoms of depression and anxiety, which are influenced by the duration of the child's illness. A strong correlation was observed between the level of anxiety and the tendency for depression.

The Predictive Power of Religious Coping on Care Burden, Depression, Stress, and Anxiety of Parents of Pediatric Oncology Patients in Turkey

This study aimed to determine the predictive power of religious coping of parents of children with cancer on caregiver burden, depression, anxiety, and stress in Turkey. It was designed as a descriptive and cross-sectional study, utilizing correlational analysis and regression models to explore associations between variables. Data were collected from 164 parents in the pediatric hematology-oncology clinics of a university hospital between November 2023 and March 2024. There was a negative correlation between caregiver burden score and negative and positive religious coping scores. Caregiver burden scores were positively correlated with depression, anxiety, and stress scores. Results indicated that caregiver burden, education level, employment status, family structure, family income, and age at diagnosis significantly predicted positive religious coping. For negative religious coping, caregiver burden, education level, family structure, and family income were significant predictors. This suggests that religious coping may help reduce caregiver burden, underscoring the importance of promoting constructive coping strategies to support caregivers' well-being.

Family-centered care for child cancer treatment in Ethiopia-A qualitative descriptive study

BACKGROUND

Families are the primary source of support and strength in the care process of children with cancer. Family-centered care (FCC) is a healthcare delivery approach that considers parents as both partners and care recipients, characterized by providing care based on dignity and respect, information sharing, participation, and collaboration or partnership.

AIM

This study aimed to describe the delivery of care based on the family-centered care approach at the Tikur Anbessa Specialized Hospital pediatric cancer unit.

METHOD

An exploratory, descriptive qualitative study was conducted from March 2023 to August 2023. Eighteen participants (thirteen parents and five health care providers) were interviewed using a semi-structured interview guide. All interviews were audio-recorded, transcribed verbatim, and translated into English. The translated transcripts were used for inductive, data-driven thematic analysis. ATLAS.ti 9 software was used to assist the analysis process.

RESULT

Two themes have emerged during the analysis. These are (1) Information sharing, and (2) Enabling and partnership. Under the information sharing theme, we described parents' understanding of child cancer, parents' information-related expectations, the process of obtaining information, adequacy of information received, and factors inhibiting information sharing. Under the enabling and partnership theme, we presented family participation in childcare, discussion among parents, parents' communication with healthcare providers and psychosocial support.

CONCLUSION

Suboptimal implementation of family-centered care practice was identified at the pediatric oncology unit.

PRACTICE IMPLICATIONS

The findings from this study indicate the need to strengthen the provision of child cancer-related information, improve communication, and strengthen family participation in childcare.

Effectiveness of Family Coping Interventions in Improving Problem-Solving Skills in the Care of Children and Adolescent Cancer Survivors during and after Treatment: A Scoping Review

(1) Context: Cancer triggers significant changes in family dynamics. It is noteworthy that coping and problem-solving skills, particularly in situations involving cancer in children and adolescents, have not been adequately explored in the context of family adaptation. This study aims to analyze the effectiveness of family interventions in coping to improve problem-solving skills in parents and/or caregivers of children and adolescents during and after oncological treatment. (2) Methods: This is a scoping review following the recommendations of the Joanna Briggs Institute and the Systematic Reviews and Meta-Analyses Extension for Scoping Review (PRISMA-ScR), from 2014 to 2024, in the databases LILACS, CINAHL, SCOPUS, Web of Science, and PUBMED. (3) Results: Forty-five studies were eligible. Coping strategies were categorized as follows: (1) positive attitudes (including a sense of courage and hope, family support to enhance resilience, and future planning), (2) caregiver empowerment (involving acceptance of diagnosis, emotional distancing, and coping through religiosity), and (3) communication skills (encompassing professional communication, horizontal dialogue with healthcare teams, and sincere communication with friends and family). (4) Conclusions: Over time, families develop coping and problem-solving strategies that influence changes in family functioning patterns, aiding them in accepting, reinterpreting, and reframing ideas and feelings associated with neoplasia.

The linguistic and construct validity of the Malay version of the Coping Self-Efficacy Scale (CSES-My): Evidence from a sample of Malaysian parents of children with leukemia or lymphoma

Background

Parents of children with hematological cancers such as leukemia and lymphoma need to cope with stress related to their child's diagnosis. The Coping Self-Efficacy Scale is a widely used and validated tool to measure an individual's confidence in dealing with stressful situations. Appropriate translation and validation are needed to produce a localized language version suitable for Malaysian contexts.

Objective

The study aimed to examine the linguistic and construct validity of the Malay version of the Coping Self-Efficacy Scale (CSES-My) among parents of children with hematological cancer.

Methods

The CSES-My was created through a sequential series of steps, starting with the translation of the original English version, followed by cultural adaptation, and then cognitive interviewing. The 26-item CSES-My was self-administered in a sample of parents of children with leukemia and lymphoma from October 2021 until February 2022. They were recruited via online or face-to-face methods. Exploratory factor analysis was performed to examine the construct validity of the CSES-My.

Results

A total of 165 complete responses were analyzed. The scale has two factors, including Personal Coping and Social Coping, accounting for 58.3% of the variance. Personal Coping (19 items, Cronbach's alpha = 0.958) represented the respondents' self-efficacy for independently executing coping strategies, whether through solving problems or changing the way they think about the situation. Social Coping (6 items, Cronbach's alpha = 0.867) represented their confidence in executing coping strategies, which involved using social resources such as seeking external support, distraction, and avoiding loneliness.

Conclusions

The CSES-My had reliable and valid psychometric properties, providing evidence for its utility in evaluating coping self-efficacy among parents of children with leukemia or lymphoma in Malaysia. The CSES-My is a valuable tool for nurses and other healthcare professionals investigating coping self-efficacy in Malay-speaking populations, and it may also aid in the development of future coping interventions.

Experiences of Parents of Children with Cancer in the Diagnosis Process: A Qualitative Study

This study aimed to describe the experiences of parents of children with cancer in the diagnosis process. A descriptive qualitative research design and content analysis method were used. Eleven parents participated in the study. Three main themes emerged, each with related sub-themes: encountering a cancer diagnosis, changes in the lives of those affected by the diagnosis, and coping strategies. Upon their children's diagnosis, parents reported feelings of guilt, regret, helplessness, devastation, constant thoughts of death, and changes in their lives, with some siblings displaying negative reactions. Some children felt their freedom was restricted, and some refused treatment. Parents coped by distracting their attention, praying, receiving support from their family, relatives or health professionals, and maintaining hope for their children's recovery. The study concludes that parents of children diagnosed with cancer require support to manage and adapt to the diagnosis process and meet their needs effectively throughout this difficult journey.

The effect of trans-theoretical model interventions and motivational interviewing on stress, hope and psychological toughness in mothers of children with cancer

PURPOSE

The present study aimed to determine the effect of trans-theoretical model (TTM) interventions and motivational interviews on stress, hope, and psychological toughness in mothers of children with cancer.

DESIGN AND METHODS

In this interventional study, 70 mothers of children with cancer were randomly divided into control and intervention groups. In the intervention group, the mothers completed the questionnaires. Next, TTM-based intervention was implemented three times, once a week, each session lasting 20 min. Trained nurses performed face-to-face motivational interviewing on each mother three times, each session lasting 20 min. The parenting stress, hope, and toughness questionnaires were completed a month later for the intervention group. For the control group, questionnaires were completed at the beginning of the study and two months later. Data were analyzed using SPSS-23 software, Chi-square, Kruskal-Wallis, Fisher's exact test, and t-test.

RESULTS

The average stress score in the intervention group decreased by 30.62 points, while it increased by 4.45 points in the control group. The average score for hope in the intervention group increased by 4.45 points, but it increased by 2.54 points in the control group. Finally, the average toughness score of the intervention group increased by 24.68 points, while it decreased by 3.80 points in the control group.

CONCLUSION

TTM-based intervention and motivational interviewing reduced parental stress and increased hope and perseverance among mothers in the intervention group, which may contribute to improved quality of care for children with cancer.

PRACTICE IMPLICATIONS

According to this study, nurses and other treatment staff can use these interventions as effective methods to reduce stress and increase the hope and psychological toughness of mothers with children with cancer.

Level of Family centered care and associated factors among parents of children with cancer at tertiary level hospital, Ethiopia

OBJECTIVE

To determining level and factors affecting Family Centered Care (FCC) in pediatric oncology unit of Tikur Anbessa Specialized hospital (TASH), Ethiopia.

METHOD

A cross sectional study was conducted from June to December 2022. Three hundred ninety-three parents of children with cancer were consecutively interviewed using Measure of Processes of Care (MPOC-20). Multivariable linear regression was used to identify independent predictors of FCC.

RESULT

The total MPOC 20 means was 3.71(SD = 1.04). The mean score for respectful and supportive care, coordinated and comprehensive care, enabling and partnership, providing specific information and providing general information were found to be 4.8, 4.6, 3.7, 2.3 and 2.6, respectively. Family employment (-0.33(95% CI = -0.63, -0.03; P = .029)), low family education (-0.40 (95% CI = -0.70, -0.11; P = .008)), referral cases (-0.37(95% CI = -0.59, -0.14; P = .001)), shorter time spent in hospital (-0.49(95% CI = -0.85, -0.12; P = .010)) and psychological distress (-0.01(95% CI = -0.026, -0.001; P = .028)) were associated with lower mean score of FCC.

CONCLUSION

The total FCC mean score was found to be low. From the five FCC components providing general and specific information scored the lowest mean level.

PRACTICE IMPLICATIONS

Mechanism to improve information delivery that address parents from different background and referred from other health facility should be in place in order to improve FCC level. In addition, the FCC should be designed to address parents of children with different lengths of stay.

Clown care in the clinical nursing of children: a meta-analysis and systematic review

Background

Children treated in hospitals often experience high levels of anxiety and pain. The purpose of this meta-analysis was to analyze the effect of clown care in clinical nursing on children and to provide ideas for improving the clinical nursing care provided to children.

Methods

Two authors searched PubMed, Embase, Clinical trials, Cochrane Library, Web of Science, CINAHL, Scopus, China National Knowledge Infrastructure (CNKI), Weipu, and Wanfang databases to identify randomized controlled trials (RCTs) related to clown care for children until 15 September 2023. The quality assessment of the included RCTs and the data extraction were performed by two researchers, and meta-analysis was carried out using RevMan5.4.

Results

A total of 15 RCTs involving 2,252 children were finally included in this meta-analysis. The findings from this meta-analysis revealed that clown care was beneficial in reducing the pain [SMD = -0.96, 95% CI (-1.76, 0.16)], anxiety [SMD = -0.81, 95% CI (-1.16, -0.46)], and crying time [SMD = -1.09, 95% CI (-1.74, -0.44)] of children and the anxiety level of caregivers [SMD = -0.99, 95% CI (-1.95, -0.03)] (all P's < 0.05). No significant publication biases were detected in the synthesized outcomes (all P's > 0.05).

Conclusions

Clown care is helpful in reducing the pain, anxiety, and crying time of children and the anxiety level of caregivers. However, additional high-quality studies with larger sample sizes are warranted to further analyze the role of clown care in clinical practice.

Experiences of caregivers of children with cancer in Malawi: A qualitative study

BACKGROUND

Studies have shown that caregivers of children with cancer experience challenges when caring for their children. To date, no studies have examined the experience of caregivers of children with cancer in Malawi, a low-income country in sub-Saharan Africa. Hence, this study aimed to explore the experiences of caregivers of Malawian children receiving cancer treatment.

METHODS

This explorative qualitative study used semi-structured interviews to collect data from 22 caregivers of children receiving cancer treatment. The data were analysed using qualitative content analysis.

RESULTS

Five themes emerged from the QCA. The caregivers perceived their children's cancer as a burden, a form of psychological torture and a disruptor of family routines and social lifestyles. They also reported self-isolation due to the stigma that they faced in the course of caring for their children and a need for informational, psychosocial, spiritual and financial support.

CONCLUSION

Caregivers of Malawian children with cancer experience physical and psychosocial challenges as they are caring for their children with cancer. Developing appropriate interventions would enable nurses to offer optimal support to these caregivers in dealing with these challenges and meeting their needs effectively.

Home experiences of parents of children undergoing hematopoietic stem cell transplantation: A qualitative study

PURPOSE

This study aimed to describe the home experiences of parents of children undergoing hematopoietic stem cell transplantation.

DESIGN AND METHODS

This study was conducted using a descriptive qualitative research design. The study sample consisted of 12 parents with a child treated with hematopoietic stem cell transplantation (HSCT) at a university hospital in Turkey. Semi-structured individual interviews and researcher observations were used for data collection. The interview transcripts of the study were analyzed using content analysis.

RESULTS

Five main themes were obtained, each of which had associated sub-themes: difficulties faced in home experiences, changes in family life, feelings about home experiences, parents' ways of coping with difficulties, and parents' suggestions.

CONCLUSIONS

Parents faced various difficulties in their own home experiences, and they felt fear, anxiety and stress during this period. Following the child's HSCT, there were changes in health, physical, psychological and social aspects of family life. Some parents used distraction techniques, and the support of their spouses and health professionals to cope with difficulties.

PRACTICE IMPLICATIONS

For pediatric nurses to comprehensively assess and support the home care needs of the child and parents, they should understand the difficulties parents face in home experiences, as well as their feelings, changes in their lives, suggestions regarding home experiences, and ways of coping. Regular health screening and psychosocial support can be provided for parents of children after HSCT, and regular training can be given for parents' management of care-related problems and increasing their self-efficacy for this management.

Family caregivers' experiences of caring for children diagnosed with haematological malignancies receiving chemotherapy in Ethiopia: A qualitative study

PURPOSE

Studies from different countries show that caregivers of children with haematological cancer receiving chemotherapy encounter substantial distress when witnessing their children's suffering from the illness and chemotherapy side effects, alongside experiencing psychosocial problems and financial difficulties. However, no studies for this are available from Ethiopia in its specific cultural background and health care system. Thus, this study aimed to explore and bring into light the experiences of Ethiopian family caregivers of children with haematological malignancies receiving chemotherapy.

METHODS

A qualitative descriptive study was conducted using a maximum variation purposive sampling method among 20 caregivers. Semi-structured in-depth face-to-face interviews were conducted until no new themes discovered. The data were analysed through qualitative thematic analysis.

RESULTS

Participants believed cancer comes from different reasons and chemotherapy is ineffective in curing cancer. They identified various chemotherapy-related side effects, and psychosocial problems. The lack of health insurance, loss of job or income, and high cost of treatments were the major financial challenges. Adhering to treatments, acceptance and reassurance, religious and spiritual therapies, traditional medicine, and a support system were the major coping strategies. They had needs for improved support in information and education, psychosocial support, and in the availability of medications.

CONCLUSIONS

Systematic health assessment, provision of targeted information and education, psychosocial support, nursing care respecting the caregivers' positive coping strategies, improvement in chemotherapy medication availability, and facilitating connections with supporting organisations would help improve child outcomes and address caregiver needs.