A review of qualitative research on the childhood cancer experience from the perspective of siblings: a need to give them a voice

"What about me?": lived experiences of siblings living with a brother or sister with a life-threatening or life-limiting condition

BACKGROUND

There is a lack of knowledge regarding siblings' experiences of being a brother or sister of a child with a life-threatening or life-limiting condition. Siblings' perspectives are often expressed through their parents and not by siblings themselves.

METHOD

This study has a qualitative design within hermeneutic phenomenology. Thirteen siblings (ages 3-29) of children with cancer or genetic conditions participated in semi-structured interviews. Analyses followed a thematic analysis guided by van Manen's lifeexistentials.

RESULTS

One overall theme, "What about me?", illustrates that siblings of children with LT/LL conditions are dealing with their own challenges and needs in the situation while also struggling to receive attention from their parents. The overall theme derives from three subthemes: living with heavy strains, feeling disregarded, and having needs of one's own.

CONCLUSION

The study revealed that siblings' own needs compete with the needs of the ill child, resulting in the risk of siblings taking a step back rather than expressing what they might actually need themselves. These findings can inform healthcare professionals on the importance of educating and supporting parents and the surrounding community close to the sibling, for example, by helping schoolteachers understand how to meet siblings' needs.

"Why Are we Giving up on my Brother?"-The Unmet Needs of the Adolescent Facing End-of-Life Care in a Sibling

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.

The impact of individuals with profound intellectual and multiple disabilities on peer relationships of typically developing siblings

INTRODUCTION/BACKGROUND

This study aims to determine the impact of a person with profound intellectual and multiple disabilities on peer relationships of their siblings.

METHODS

Information obtained from typically developing siblings of individuals with profound intellectual and multiple disabilities served as research material for this study. There were a total of 18 participants in the study. The analysis and interpretation were based on the procedures of grounded theory.

RESULTS AND CONCLUSION

The results of the study show that young adults with a brother or sister with profound intellectual and multiple disabilities have some difficulties in establishing relationships with their peers, especially those more intimate such as friendships or romantic endeavors. At the same time, research confirms that siblings of individuals with profound intellectual and multiple disabilities have high levels of empathy and understanding for others as well as sincere attachment to family.

Involvement of children and young people in the conduct of health research: A rapid umbrella review

BACKGROUND

Patient and public involvement and engagement (PPIE) have long been considered important to good research practice. There is growing, yet diverse, evidence in support of PPIE with children and young people (CYP). We must now understand the various approaches to involvement of CYP in research.

AIMS

This rapid umbrella review aimed to provide an overview of when, how and to what extent CYP are involved in the conduct of health research, as well as the reported benefits, challenges, and facilitators of involvement.

METHODS

We searched OVID Medline, Embase and PubMed. Published reviews were included if they reported meaningful involvement of CYP in the conduct of health research. Extracted data were synthesised using thematic analysis.

RESULTS

The 26 reviews included were predominately systematic and scoping reviews, published within the last decade, and originating from North America and the United Kingdom. CYPs were involved in all stages of research across the literature, most commonly during research design and data collection, and rarely during research funding or data sharing and access. Researchers mostly engaged CYP using focus groups, interviews, advisory panels, questionnaires, and to a lesser extent arts-based approaches such as photovoice and drawing. Visual and active creative methods were more commonly used with children ≤12 years. The evidence showed a shared understanding of the benefits, challenges, and facilitators for involvement of CYP, such as time and resource commitment and building partnership.

CONCLUSION

Overall, the review identified consistency in the range of methods and approaches used, and stages of research with which CYP are commonly involved. There is a need for more consistent reporting of PPIE in the literature, both in terminology and detail used. Furthermore, the impact of approaches to CYP involvement on research and community outcomes must be better evaluated.

PATIENT/PUBLIC CONTRIBUTION

This review forms part of broader research initiatives being led by the authors. Together, these projects aim to support embedding of child voices in research practice and to explore the desirability and suitability of Young Persons Advisory Groups within birth cohort studies. The findings from this review, alongside public and stakeholder consultation, will inform development of resources such as practice recommendations to guide future involvement of CYP in health research undertaken at the author's respective institutions.

What challenges do siblings of children with chronic disorders express to their parents? A thematic analysis of 73 sibling-parent dialogues

PURPOSE

The study explored challenges experienced by siblings of children with chronic disorders, as expressed by siblings in parent-child dialogues.

DESIGN AND METHODS

Seventy-three parent-child dialogues (M duration = 28.6 min) were analyzed using qualitative thematic analysis. The dialogues took place within the SIBS group intervention for siblings and parents of children with chronic disorders. The siblings (aged 8 to 14 years) had brothers and sisters with autism spectrum disorders, ADHD, rare disorders, cerebral palsy, or severe mental health disorders. The data are from session 5 in the SIBS intervention, in which the siblings are to express their wishes about family-related challenges (e.g., desired changes) to their parents. The parents are encouraged to listen, explore, and validate the child's perspective before discussing solutions.

RESULTS

Most of the family-oriented challenges the siblings expressed were related to the diagnosis of the brother or sister with a disorder. Four main themes were identified: (1) Family life (e.g., limitations in family activities); (2) The diagnosis (e.g., concerns about the future); (3) Violence; and (4) Important relationships.

CONCLUSION

The siblings experienced challenges and difficult emotions in interactional processes in which the diagnosis affected family life and relationships. The study adds a new dimension to the field by identifying siblings' expressed challenges based on parent-child dialogues.

PRACTICE IMPLICATIONS

Identified themes can guide how parents should meet and address siblings' needs, how health care providers inform and support parents in doing so, and emphasize the relevance of interventions targeting family-level risk and resilience factors.

Healthy siblings' perspectives about paediatric palliative care: A qualitative systematic review and meta-synthesis

BACKGROUND

Siblings of children requiring palliative care are often forgotten and overlooked, as the focus tends to be on the ill child and their parents. Limited knowledge of non-bereaved siblings' perspectives makes it challenging to provide appropriate support for them. A review of existing literature is thus needed to better understand the experiences of these siblings and to identify research gaps that may require further examination.

AIM

To consolidate the available qualitative evidence on the perspectives of non-bereaved healthy siblings regarding paediatric palliative care.

DESIGN

A qualitative systematic review using a meta-synthesis approach was conducted.

DATA SOURCES

Six electronic databases (PubMed, CINAHL, PsycINFO, Embase, Scopus and ProQuest Dissertations and Theses Global) were searched from each database's inception date until October 2022. The search included qualitative and mixed-method studies that reported the perceptions and associations of siblings of patients receiving paediatric palliative care. Data were synthesised using thematic analysis.

RESULTS

Eleven studies were included. The overarching theme of the review would be 'A walking shadow: Living in the darkness shaped by the dying sibling', and three key themes and nine subthemes were identified from the included articles: (1) Changing family dynamics; (2) Impact on school and socialisation and (3) Psychological impact and coping.

CONCLUSION

Siblings demonstrated negative psychological impacts and were affected by changing family structure and relationships. However, socialisation with society, and varied coping skills such as cognitive coping and using distraction techniques, were significant for siblings to go through this journey and even led to some positive outcomes for them.

Feasibility, acceptability and preliminary effectiveness of a mental health drop-in centre for the siblings of young people attending a paediatric hospital

Siblings of children with long-term conditions (LTCs) can have significantly elevated mental health needs, but these are often overlooked. A pragmatic single-arm feasibility pilot assessed feasibility, acceptability and preliminary effectiveness of a drop-in centre in a paediatric hospital addressing mental health needs of patients with LTCs, their carers and siblings. The drop-in centre accepted self-referral and supplemented existing provision offering a suite of interventions, including signposting, diagnostic assessments and/or guided self-help. This paper reports on feasibility, acceptability and preliminary outcomes of this centre for siblings. Eighteen siblings aged 2-17 used the centre. Sixteen of their parents completed the Strengths and Difficulties Questionnaires at baseline and 6 months post-baseline, and ten completed parent-reported PedsQL across two time points. Preliminary effectiveness results demonstrated a decrease in mental health symptoms with large effect size (score reduction of 3.44, 95% CI [1.25, 5.63], d = 0.84) and small effect on quality of life, with scores increasing from a median of 69.91, 95% CI [53.57, 91.67], to a median of 80.44, 95% CI [67.39, 89.13], r = 0.11 for these siblings. 88% of parents were satisfied with this provision for their sibling child. This study highlights the feasibility and value of assessing siblings for emotional and behavioural difficulties and providing them with an accessible, effective and acceptable intervention.

The experiences of siblings of children with chronic illness of health-related communication directed at them: a systematic review protocol and thematic synthesis of qualitative studies

The psychological, social and financial impact that chronic illness can have on a family and in particular the siblings of children with chronic illness (SCWCI) is well documented. Siblings are at risk of a variety of psychosocial and physical problems such as suffering from anxiety, experiencing headaches, appetite loss. However, the experiences with health-related communication of SCWCI is not well known. This may leave them with suboptimal information. The aim of this systematic review described in this protocol is to understand SCWCI experience of targeted health-related communication; detailing the communication strategies utilised, how helpful the information was and what they wish would be different. The Preferred Reporting Items for Systematic reviews and Meta-analysis for Protocols (PRISMA-P) checklist will be used to frame this protocol. Registration: PROSPERO (393998, 03 February 2023).

Self-reported experiences of siblings of children with life-threatening conditions: A scoping review

Sibling relationships are one of the most long-lasting and influential relationships in a human's life. Living with a child who has a life-threatening condition changes healthy siblings' experience. This scoping review summarized and mapped research examining healthy siblings' experience of living with a child with a life-threatening condition to identify knowledge gaps and provide direction for future research. Studies were identified through five electronic databases. Of the 34 included studies, 17 used qualitative methods, four gathered data longitudinally and 24 focused on children with cancer. Four broad themes of sibling experience were identified across studies: family functioning, psychological well-being, social well-being, and coping. Siblings experienced challenges and difficulties over the course of the child's illness. Future research should incorporate longitudinal designs to better understand the trajectory of siblings' experiences and focus on a wider variety of life-threatening conditions.

Siblings of young people with chronic illness: Caring responsibilities and psychosocial functioning

Siblings of young people with chronic illness commonly undertake caring responsibilities for their affected brother/sister, which may encourage maturation, yet may also be perceived as a burden. Our study determined (1) siblings' caring responsibilities, (2) siblings' current emotional distress and psychosocial functioning, and (3) how siblings' caring responsibilities and psychosocial functioning related to familial relationships and coping strategies. Siblings completed questionnaires which contained Sibling Inventory of Behavior, Sibling Inventory of Differential Experiences, PedsQL, emotion thermometers, Brief COPE, and a checklist of caregiving responsibilities. We analyzed the data with t-tests and multi-level models. Forty-five siblings (mean age = 15.40 years, SD = 3.31 years; 60.0% female) participated. Siblings who had caring responsibilities (n = 26, 57.8%) reported lower anxiety symptoms, lower need for help, greater use of problem-focused coping, and more companionship and teaching/directiveness with their affected brother/sister than siblings without caring responsibilities. Siblings reported lower psychosocial and physical functioning when they perceived their parents provided them with less affection than their affected brother/sister. Family-based psychosocial interventions may aim to improve the sibling-parent relationship (including expressing affection) and the sibling-sibling relationship. Future interventions may also focus on increasing siblings' use of problem-focused coping strategies.

Parents and Their Children in the Face of Cancer: Parents' Expectations, Changes in Family Functioning in the Opinion of Caregivers of Children with Neoplastic Diseases-Further Studies

(1) Background: The onset and duration of the child’s illness is a difficult test for the entire family. The stress, in which the family lives from this moment, influences the relationships within it, as well as external relations with the environment. The child’s cancer fundamentally changes the way the family functions, the quality of interactions within the family, and life plans. (2) Patients and Approach: A population survey was run between 2015 and 2020. A cross-sectional study was conducted involving 800 family caregivers of children with cancer during active treatment. The aim of the study was to assess changes in the family functioning in the opinion of parents of a child with cancer. (3) Results: Parents experience chronic anxiety (67%), nervousness (60%), and worry (64%). For 50% of parents, the illness of their child entirely changed their plans. As many as 75% of parents feel guilty for exposing their child to carcinogens. According to the parents, the child’s illness is a psychological (89%), somatic (49%) and financial (77%) burden for them. Only 7% of children cause behavioural problems and 16% have trouble learning due to their sibling’s illness. (4) Conclusions: Cancer is a great difficulty for all members of a family system. The disease disturbs the balance within the family and relations in the family, as well as more distant psychological, social, and material consequences.

The Lived Experience of Siblings of Children With Cancer Who Attended a Peer Support Camp in the United States

Childhood cancer has a profound and negative impact on siblings, yet there are limited studies exploring lived experiences from their perspective. This qualitative study examined the perceptions and experiences of siblings of children with cancer who attended a peer support camp. Semi-structured interviews were conducted three to six weeks after the weeklong peer support camp with a stratified random sample of 10 siblings (six non-bereaved and four bereaved) ages 8 to 16 years. The qualitative data were analyzed using conventional content analysis and an inductive data-driven approach. Four themes emerged: social connection (subthemes: support/feeling of belonging, mentorship, and expressing feelings), personal growth, identity, and freedom to have fun and relax. These findings add to the scant body of research by providing enhanced understanding of the siblings' experiences and new insights into their perceptions of meaning and outcomes associated with participation in a peer support camp. These findings have implications for peer support camp programs and the well-being of siblings of children with cancer.

Emotional Experience and Type of Communication in Oncological Children and Their Mothers: Hearing Their Testimonies Through Interviews

The emotional experience and the type of communication about cancer within the family are important factors for successful coping with pediatric oncology. The main purpose is to study mother’s and children’s emotional experiences concerning cancer, whether they communicate openly about the disease, and relationships between the type of communication and the different emotions expressed by the children. Fifty-two cancer patients aged 6–14 years and their mothers were interviewed in separate sessions about the two central themes of the study: emotional experiences and type of communication. Analyses of response categories were performed to subsequently compare the age-groups and the mother–child responses. According to the results, mothers expressed emotions such as fear, sadness, or anxiety, while children report sadness, pain, but also happiness. Significant positive correlations were observed between mothers’ sadness and older children’s sadness, mothers’ anxiety and children’s fear, and mothers’ anxiety and children’s happiness. Regarding communication type, mothers tend to hide information about the disease from younger children and to provide direct information to the older children. Children usually prefer to communicate their concerns to parents; however, children whose mothers convey anxiety are more likely to prefer to communicate with others. These results support the idea that parents should talk honestly with their children, explaining their illness in an age-appropriate way, and encouraging them to share their emotional experiences. Further studies are needed from a developmental perspective to understand the disease management of children and families.

The Influence of a Peer Support Camp on Mitigating Emotional Distress in Siblings of Children With Cancer

Background: Siblings of children with cancer often experience anxiety and posttraumatic stress symptoms (PTSS), which negatively impact their self-esteem due to emotionally upsetting circumstances. The purpose of this longitudinal quantitative study was to investigate changes in anxiety, PTSS, and self-esteem of youth who participated in a peer support camp for siblings of children with cancer. Methods: A longitudinal study examined changes over time. Data were collected from 32 sibling surveys pre-, post-, and three months after camp. Siblings completed assessments to measure anxiety, PTSS, and self-esteem. A repeated measures ANOVA or Friedman Test was conducted to identify changes across the three data points for each outcome measured. Post hoc comparisons using paired sample t-tests or Wilcoxon Signed-Rank tests were conducted. Results: Significant improvements in anxiety; T1 and T2 (p < .000); T1 and T3 (p < .000). Significant decrease in PTSS; T1 and T2 (p = .001); T1 and T3 (p = .011). Significant improvement in self-esteem scores for older participants (ages 10-16); T1 and T2 (p < .000). Significant improvement in self-esteem for younger participants (ages 7-9); T1 and T3 (p = .005). Discussion: The data generated in this study expand knowledge about the influence of peer support camps on reducing the emotional distress of siblings of children with cancer. The findings warrant further research on the long-term impact of such camps, the value of repeated participation, differences between bereaved and nonbereaved siblings, the phase of the cancer experience, and elements of the camp that have the most impact.

Multifaceted Support Interventions for Siblings of Children With Cancer: A Systematic Review

BACKGROUND

When a child is given a diagnosis of cancer, the impact reverberates through the family unit. Siblings, in particular, experience an accumulation of distress. Siblings of children with cancer can experience both short- and long-term difficulties in psychosocial and physical functioning, and professional bodies have called for interventions targeted at their needs.

OBJECTIVE

The aim of this study was to describe outcomes, core components, and general characteristics of effective interventions intended to support sibling well-being and psychosocial health in pediatric oncology.

METHODS

MEDLINE (Ovid), EMBASE, CINAHL, PsycINFO, and Cochrane CENTRAL databases were searched in September 2019 and July 2020. Studies were included if they focused on interventions for siblings or family in pediatric cancer, had quantitative data to describe the effect or impact of the intervention, and were published in English. Included studies underwent quality appraisal, data extraction, and data synthesis.

RESULTS

Twenty articles fit inclusion criteria. Most interventions focused on 6- to 18-year-old siblings within a group setting. Most were theory based. Group format with multiple sessions was the most common approach. The most frequently assessed outcomes were depression, anxiety, posttraumatic stress symptoms, and health-related quality of life.

CONCLUSIONS

Understanding outcomes, core components, and characteristics of effective interventions is important to translate sibling-support interventions into standard practice. Such considerations are important in delivering equitable family-centered care to siblings of children with cancer.

IMPLICATIONS FOR PRACTICE

As institutions create mechanisms to support siblings, it may be important to target high-risk siblings initially, partner with community resources, attend to underrecognized populations of siblings, and more fully incorporate family into sibling support.

Health-related and cancer risk concerns among siblings of childhood cancer survivors: a report from the Childhood Cancer Survivor Study (CCSS)

OBJECTIVE

To characterize the prevalence and predictors of concerns regarding future health and cancer risk among siblings of childhood cancer survivors.

METHODS

This study reports longitudinal data (baseline and follow-up) from 3969 adult siblings (median age = 29 [range 18-56] years) of long-term survivors of childhood cancer (median time since diagnosis 19.6 [9.6-33.8] years). Self-reported future health and cancer risk concerns (concerned vs not concerned) were assessed. Demographics and health data reported by both the siblings and their matched cancer survivors were examined as risk factors for health concerns using multivariable logistic regression.

RESULTS

Percentage of siblings reporting future health and cancer risk concerns, respectively, decreased across decade of survivors' diagnosis: 1970s (73.3%; 63.9%), 1980s (67.2%; 62.6%), and 1990s (45.7%; 52.3%). Risk factors associated with future health concerns included sibling chronic health conditions (grade 2 Odds Ratio [OR]=1.57, 95% CI: 1.12-2.20; grades 3-4 OR=1.86, 95% CI: 1.18-2.94; compared to less than grade 2). Risk factors associated with future cancer concerns included sibling chronic health conditions (grade 2 OR=1.43, 95% CI: 1.05-1.94; grades 3-4 OR=1.64, 95% CI: 1.09-2.47; compared to less than grade 2).

CONCLUSIONS

Sibling concerns regarding future health and cancer have diminished in recent decades. There are subgroups of siblings that are at-risk for future health and cancer risk concerns.

IMPLICATIONS FOR CANCER SURVIVORS

Routine screening of concerns in at-risk siblings of survivors of childhood cancer may benefit the siblings of cancer survivors. These individuals may benefit from early interventions during diagnosis and treatment of their siblings.

Psychosocial interventions for siblings of children with cancer: A mixed methods systematic review

OBJECTIVE

This review systematically (1) describes the characteristics of psychosocial interventions for siblings of children with cancer (SCC); (2) assesses the effect of the psychosocial interventions on SCCs' outcomes, and (3) describes SCCs' experiences and perceptions of these interventions.

METHODS

Seven databases were systematically searched for relevant literature. We included both quantitative and qualitative studies of psychological interventions designed to improve the adjustment of SCCs.

RESULTS

Our database searches yielded 19 publications. We found a range of psychosocial interventions being used among SCCs, with group interventions being the most common. The primary outcomes focused on the SCCs' depression, anxiety, and quality of life. Quantitative studies provided insufficient evidence to draw definitive conclusions about the interventions' effects, whereas the qualitative studies indicated that SCCs can derive benefits from these interventions, including an enhanced sense of belonging and bonding, improved family relationships, increased self-awareness and confidence, increased cancer knowledge, and decreased somatic symptoms.

CONCLUSIONS

Although a growing number of psychosocial interventions have been developed to improve the adjustment of SCCs, research evidence of the effects of these interventions on SCCs' adjustment remains limited. Future research needs to rigorously evaluate the effects of these interventions.

Development of a Stress Scale for Siblings of Childhood Cancer Patients

Most siblings of childhood cancer patients (SCCP) report not only post-traumatic stress but also daily stresses due to changes in their daily lives. The purpose of this study was to develop a stress scale for SCCP and to examine the validity and reliability of the scale. Based on conceptual analysis, 40 preliminary items were selected. After its content validity was determined by six experts, 37 items were chosen. For the psychometric testing, 125 SCCPs, aged 11–16, were surveyed. Through item analysis and exploratory factor analysis for construct validity, 27 items explained 61.2% of the variance, and they were categorized into six factors. Criterion validity was confirmed by examining the overall correlation with standard instruments according to the age group. Reliability was evaluated using Cronbach’s alpha (0.91) and test-retest correlation (r = 0.597). This self-administered questionnaire with a 4-point Likert-type scale may be useful in clarifying and measuring stress levels in SCCPs.

The Effect of Theraplay on Prolonged Grief and Post-Traumatic Stress Disorder in Bereaved Siblings of Children with Cancer: A Preliminary Study

Background: Death of any of siblings is an overwhelming, severe, and prolonged challenge in children development process and is a major risk factor for psychiatric disorders in childhood and later. Interventions for bereaved families following a child’s death have been examined over the last several decades. However, no effective treatment for bereavement siblings prolonged grief disorder (PGD) and post-traumatic stress disorder (PTSD) has been found yet. Objectives: The study aimed at determining the effect of Theraplay on the symptoms of prolonged grief (PG) and post-traumatic stress disorder (PTSD) in siblings of a deceased child with cancer. Methods: In this preliminary study, a multiple baseline single-subject design with a follow-up period was used. The statistical population included siblings and mothers of children aged 6-10 years who had been under treatment at Mahak Child Cancer Hospital and died 1or 2 years ago. From this population, 4 mother-child pairs were selected as the study sample by convenience sampling. Each mother-child pair participated in 15 Theraplay sessions once a week (45-minute section). Assessments were performed using the inventory of prolonged grief for children (IPG-C) and the University of California at Los Angeles Posttraumatic Stress disorder reaction index for DSM-5 (UCLA PTSD-RI) at baseline, intervention sessions and follow-up stages. Visual analysis of graphic displays of level, reliable change index (RCI) and clinical significance were used to analyze the data. Data analysis and drawing graphs were performed in Microsoft Excel 2016. Results: Results of visual and quantitative analysis of data showed that PG symptoms decreased in all 4 participants during the treatment and follow-up. Also, according to the results, Theraplay intervention significantly reduced PTSD in all participants. Conclusions: Theraplay appears to be effective in reducing PG and PTSD in bereaved siblings. However, the reduction rate varied in different subjects. According to the findings, Theraplay helped subjects accept grief and loss and this method can be used to help the mental health of other bereaved children.

'We're touching the topic, but we're not opening the book:' A grounded theory study of sibling relationships in young people with perinatally acquired HIV

HIV-related stressors affecting young adults with perinatally acquired HIV (PHIV+) and their siblings include parental and sibling ill-health and death, own ill-health, HIV disclosure, and stigma. Young people with PHIV+ typically share their HIV status with family members. We explored sibling relationships in young people with PHIV+. Ten participants (six females, 17–23 years old) with PHIV+ took part in a semi-structured interview, analysed using Grounded Theory. The data were condensed into three theoretical codes: (1) HIV disclosure in sibling relationship; (2) Patterns of communication about HIV between siblings; and (3) Patterns of coping and support in sibling relationship.

I'm Here, Too: Being an Adolescent Sibling of a Pediatric Cancer Patient in Turkey

PURPOSE

This study aimed to determine experiences and needs of Turkish adolescent siblings of children with cancer (SCC) and to identify if there is a country/culture-specific risk factor for these siblings.

DESIGN AND METHOD

In this qualitative study hermeneutic phenomenological approach was used. Eighteen eligible siblings were selected purposively from two hospitals in Ankara, Turkey. Interviews were conducted with a semi-structured form. Content and thematic analyses were used to analyze the data.

RESULTS

The data revealed three levels of themes. The main theme was based on "I am here, too". From the first moment of diagnosis, siblings need to be visible and noticed by others. They seek ways to make sense of the disease as they experience dramatic changes in all aspects of their lives (high level themes - first encounter with the disease and changes in life). They expect their parents and relatives to support them (expectations) when they turn to various methods to cope with the changes (coping styles).

CONCLUSIONS

The lack of protective psychosocial care is a basic risk factor for adolescent SCC in Turkey. Despite its various limitations, the strongest aspect of this study is that it is the first publication that determines the experiences of Turkish SCC in their own words. In addition to supporting recent findings about siblings' experiences, obtaining some country-specific findings is a strength of the present study.

PRACTICE IMPLICATIONS

Providing psychosocial risk assessment of the siblings' immediately after diagnosis is necessary. It can be helpful to inform parents about the risks.

"It has been fun. Super-duper fantastic": Findings from a Danish respite programme to support young carers

Awareness of young carers' experiences and needs is low on governmental and societal levels in Denmark. This article presents findings from the first evaluation of a Danish respite programme, the Buddy Programme, which aims to provide support to young carers aged 5-15 years who experience serious, chronic or mental health problems and/or death of a parent or sibling. Over a four-six month period, volunteer students from University College Copenhagen offer young carers the opportunity of respite through participating in ordinary activities such as play and sports. In 2017-2018, based on a child-centred approach, we conducted a qualitative study with interviews focusing on how the Buddy programme affected the children. The interviews took place at programme start, halfway through, and after completion with 22 children and 21 parents, as well as single interviews with 20 Buddies assigned to families after completion. Three main themes were identified: (1) the Buddy programme as an activity, (2) how the Buddy Programme affected the children and (3) ending the Buddy programme and wanting to continue the friendship. Our findings emphasise the importance of fun and cosy activities that provide children with respite from the serious concerns that otherwise fill the lives of young carers. Being with a Buddy created a free space, allowing children to play undisturbed and to temporarily keep concerns and a guilty conscience at a distance. By offering friendship, Buddies provided opportunities for young carers to feel special, be seen, acknowledged and taken seriously as a child with valid and specific needs and interests. Our findings may help increase awareness of the needs and interests of young carers on governmental and societal levels.

Featured Article: Caregiver Perceptions of Stress and Sibling Conflict During Pediatric Cancer Treatment

Objective

The current study examined the effect of stress on sibling conflict during the first year of pediatric cancer treatment.

Method

Families (N = 103) included a child with cancer (aged 2-17 years, Mage = 6.46, SD = 3.52) and at least one sibling aged <5 years of the child with cancer (Mage = 8.34, SD = 5.61). Primary caregivers completed monthly questionnaires throughout the first year of treatment assessing five sources of stress (i.e., general life, cancer-related, financial, perceived treatment intensity, and life threat) and level of sibling conflict. Using multilevel modeling, we explored the effects of these stressors on conflict both at the within- and between-family levels to examine if changes in stress resulted in concurrent changes in conflict within an individual family, and whether greater average stress affected the trajectory of conflict between families, respectively.

Results

At the between-family level, higher average levels of cancer-related stress, general life stress, and financial stress were associated with higher sibling conflict at the end of the first year of treatment. Perceived treatment intensity and life threat were not associated with conflict. No stressors were associated with conflict at the within-family level.

Conclusions

During pediatric cancer treatment, some stressors may spill over into family relationships and contribute to increases in sibling conflict.

Quality-of-life Evaluation of Healthy Siblings of Children with Chronic Illness

Background:

Chronic disease of children can cause changes in the health-related quality of life (HrQoL) of the family members.

Aims:

To evaluate the HrQoL of healthy siblings of children with chronic disease.

Study Design:

Cross-sectional study.

Methods:

The study included healthy sibling of children with chronic disease (cerebral palsy, epilepsy, diabetes, celiac disease, hematologic/oncologic disease, or asthma) and healthy sibling of healthy children to evaluate the quality of life. We used the Pediatric Quality of Life Inventory questionnaire; the physical health and psychosocial health scores were calculated using the responses of the sibling and parent. The primary endpoint was the comparison of HrQoL scores of healthy siblings of children with chronic disease and that of healthy siblings of healthy children.

Results:

This study included a respective healthy sibling of 191 children with chronic disease and healthy sibling of 100 healthy children. The physical health, psychosocial health, and total health scores of healthy siblings of children with chronic disease were significantly lower than that of healthy siblings of healthy children (p<0.001). Among the healthy siblings of children with chronic disease, the lowest psychosocial health score was found in the siblings of children with cerebral palsy, hematologic/oncologic disease, and asthma (p<0.001). The global impact on the quality of life for healthy siblings of children with chronic disease was significantly higher in the self-report of the children than that of the parents (30.4% versus 15.1%, p<0.05).

Conclusion:

Most healthy siblings of children with chronic disease are physically and psychosocially affected and there is low parental awareness of this condition. This can increase the risk of emotional neglect and abuse of these children. Therefore, special support programs are needed for the families of children with chronic diseases.

What young people need when a family member dies of cancer

PURPOSE

This study uses the newly developed Bereaved Cancer Needs Inventory to identify the unmet psychosocial needs of adolescents and young adults who have experienced the death of a parent or sibling to cancer, and to explore the relationship between unmet needs and psychological distress.

METHODS

In total, 278 bereaved offspring and 38 bereaved siblings (12-25 years) completed the 58-item Bereaved Cancer Needs Inventory (BCNI) and the Kessler psychological distress scale (K10).

RESULTS

Bereaved offspring reported 27 unmet needs on average (SD = 16.87, range: 0-58); 94% indicated at least one unmet need, with 80% indicating 10 or more needs. Bereaved siblings reported 23 unmet needs on average (SD = 17.30, range: 0-57); 97% indicated at least one unmet need, with 68% indicating 10 or more needs. For both bereaved offspring and siblings, the needs for "support from other young people" and "time out and recreation" were most frequently reported as unmet. Approximately half of all participants reported high to very high levels of psychological distress. There was a significant positive relationship between the number of unmet needs and the psychological distress score on the K10 for both groups.

CONCLUSIONS

Bereaved offspring and bereaved siblings report unmet psychosocial needs across many domains, which are associated with their levels of psychological distress. Findings suggest the BCNI may be used by healthcare professionals to identify unmet needs and direct clients to the appropriate services, resources, or support; with the intent to reduce their risk of mental illness and psychological distress.

Adaption strategies used by siblings to childhood cancer patients

OBJECTIVE

Siblings of childhood cancer patients experience social challenges. The results presented in this article are part of a larger qualitative study aiming to generate empirical knowledge about social consequences of childhood cancer from the family's perspective.

METHODS

Data were collected through interviews, observational studies, and questionnaires. The study included 68 childhood cancer patients, 39 siblings, and 39 parents from a total of 78 families. Grounded theory informed the data analysis.

RESULTS

Major life changes caused by childhood cancer entail an emotional hierarchy regarding the accommodation of each family member's need for help. This study identified a dynamic three-variable, four-adaption model for adaption strategies among siblings towards their parents, based on the sibling's perspective: (1) receives help without asking; (2) receives help after asking; (3) receives no help despite asking; and (4) receives no help and does not ask. Three variables are elaborative to understand the dynamic in adaption strategies: the patient's prognosis, the course of the disease, and the current situation of the diagnosed child. Even though the adaptions are reported by siblings, both patients and parents are aware of and concerned about the siblings' challenges.

CONCLUSIONS

These results have implications for practice and have the potential to improve social and health care professionals' awareness and ability to offer support and information needed by the families and the siblings. The knowledge presented in this article should be considered basic health care information in line with other information such as treatment protocols.

The family house-A safe haven: A qualitative study of families' experiences staying in a hospital family house during their children's hospitalisation

AIMS

To gain knowledge about families' experiences while staying in a hospital family house during their child's hospitalisation.

BACKGROUND

When a child is hospitalised with a chronic, serious or life-threatening disease, the entire family is stressed as normal everyday life is disrupted. In Denmark, accompanying the ill child to the paediatric wards is often possible only for one of the parents.

DESIGN

This qualitative study takes a phenomenological-hermeneutical approach, exploring the lived experience of families' everyday life in a hospital family house.

METHOD

The study comprised semi-structured interviews with 33 family members from 15 families who stayed in a hospital family house. The interviews were made in the summer of 2017. The Consolidated Criteria for Reporting Qualitative Research checklist was used as a guideline "see Appendix S1."

RESULTS

The families experienced the house as a home or a haven where they could stay together as a family. The house provided a quiet and peaceful environment with space for family life and playing. Overall, this gave the families a feeling of togetherness.

CONCLUSION

The families who stayed in the hospital family house experienced the house as a place to breathe freely, that is, as a safe haven. A place with peace and quietness, without "activity efficiency." In the house, the volunteers offered a very caring and supportive environment including all families in the house and embracing everyday activities. Providing accommodation for the whole family at the hospital family house afforded the family a place where they could stay together and maintain everyday life even though everything around them was, at times, chaotic.

RELEVANCE TO CLINICAL PRACTICE

Healthcare professionals should use knowledge about the healing environment to help create havens for families to a hospitalised child. Hospitalised children need safe places where no treatment takes place-therefore, family houses should stay treatment free.

Siblings of Young People With Cancer in NZ: Experiences That Positively and Negatively Support Well-Being

Siblings of young people with cancer experience significant distress and these effects often exist long after their sibling's treatment has successfully been completed. In New Zealand, many families must travel several hours to receive treatment, with some having to live away from home for extended periods which can create additional strains. We interviewed 10 siblings of pediatric cancer survivors drawn from a larger quantitative study, to investigate what made siblings' experiences more difficult and to find out what was helpful in supporting their adjustment. The selected participants came from across New Zealand, represented a mix of gender and age, and had a range of depression scores. Our thematic analysis found that experiences that were associated with the most distress included concurrent stressors, and feeling left out, rejected, or isolated. Experiences that were most helpful to their well-being were feeling involved, knowing that they were still important and a priority for their parents, connecting with people through their experiences, and focusing on positive experiences. Our findings suggest that professionals working with these families could help siblings of a child with cancer by promoting hope, acknowledging positive growth, drawing attention to positive events to promote benefit finding, and providing opportunities to have fun. Increasing parental awareness of the impact of differential treatment and improving the public understanding of sibling issues might also be helpful.

Siblings’ Experiences of Everyday Life in a Family Where One Child Is Diagnosed With Blood Cancer: A Qualitative Study

Background: Childhood cancer not only presents challenges to the life of the child with cancer but also to the siblings’ daily family life. The aim of the current study was to gain a better understanding of siblings’ experiences of living in a family where one child has been diagnosed with blood cancer. Method: Ten siblings of children with leukemia or non-Hodgkin lymphoma completed a semistructured interview about their everyday family life experiences postdiagnosis. The verbatim transcripts of the interviews served as the data for an interpretative phenomenological analysis. Results: The results showed that overall the siblings experienced a continuity in many aspects of their family life: they still experienced their family as an important source of support and information/communication, as warm and loving and as a safe harbor where family members aim to protect each other. However, at the same time, the participating siblings also expressed that some things felt unmistakably different postdiagnosis: They felt that their family as a whole had been ripped apart, with a greater focus on the diagnosed child and changing responsibilities for each family member. Conclusion: This study informs parents and clinicians about the daily family life experiences from the siblings’ perspective, a perspective that is often overlooked. A focus on challenges as well as continuities within family life, the wish for connection expressed by the siblings, and the uniqueness of every sibling’s experiences is what can be taken away from this study by psychosocial workers in the field.

Evaluation of quality of life of healthy siblings of children with chronic disease

The quality of life determination of children with chronic disease is closely related to treatment success. Quality of life assessment studies revealed that it was not limited to the individual, the quality of life of the family members also had to be assessed. Along with the child being diagnosed with chronic illness, some changes occur in the family structure, and in family roles. Quality of life assessment studies in healthy siblings generally indicate a global influence. These children live in different senses such as closure, aggression, depression, anxiety, guilt, and isolation. Psychosocial impact (short or long-term) of healthy siblings have been associated with disease type, severity, disease duration, age, sex, and ability to cope. Further comprehensive studies among healthy siblings of children with chronic disease about quality of life are needed. Building support groups (especially family support groups) to express feelings and thoughts freely for healthy siblings can positively affect the well-being and self-esteem of the child.

Grief and growth in bereaved siblings: Interactions between different sources of social support

The objective was to characterize the relation between different sources of school-based social support (friends, peers, and teachers) and bereaved siblings' grief and grief-related growth and to examine whether nonparental sources of social support buffer the effects of low parent support on bereaved siblings. Families (N = 85) were recruited from cancer registries at 3 pediatric institutions 3-12 months after a child's death. Bereaved siblings were 8-18 years old (M = 12.39, SD = 2.65) and majority female (58%) and White (74%). During home visits, siblings reported their perceptions of social support from parental and nonparental sources using the Social Support Scale for Children, as well as grief and grief-related growth using the Hogan Sibling Inventory of Bereavement. Parent, friend, and teacher support were positively correlated with grief-related growth, whereas parent and peer support were negatively correlated with grief for adolescents. Teacher and friend support significantly moderated the association between parent support and grief such that teacher and friend support accentuated the positive effects of parent support. Friend and peer support moderated associations between parent support and grief/growth for adolescents but not children. School-based social support, namely from friends, peers, and teachers, appears to facilitate the adjustment of bereaved siblings. Findings suggest that bereaved siblings may benefit from enhanced support from teachers and friends regardless of age, with middle/high school students particularly benefitting from increased support from close friends and peers. (PsycINFO Database Record

Posttraumatic stress symptoms in young people with cancer and their siblings: results from a UK sample

PURPOSE

This study investigated levels of posttraumatic stress symptoms (PTSS) in children with cancer and their siblings from a British sample. It also examined aspects of the Ehlers and Clark ¹ model of posttraumatic stress disorder in the current population.

METHODS

Sixty participants (34 children with cancer and 26 siblings) aged between 8 and 18 years completed measures of PTSS, maladaptive appraisals, trauma-centered identity, perceived social support and family functioning.

RESULTS

Over a quarter of the sample scored above the clinical cutoff on the Impact of Events Scale-Revised. No differences were observed between patients and siblings with respect to levels of PTSS. Maladaptive appraisals and age were found to account for unique variance in levels of PTSS for the overall sample.

CONCLUSIONS

Rates of PTSS in the sample were relatively high. Support was found for aspects of the Ehlers and Clark ¹ model in explaining PTSS for the current population.

Trajectories of marital, parent-child, and sibling conflict during pediatric cancer treatment

OBJECTIVE

The stress of having a child with cancer can impact the quality of relationships within the family. The current study describes the longitudinal trajectory of marital, parent-child, and sibling conflict beginning around the time of diagnosis through the first year of treatment. We examined the average level of marital, parent-child, and sibling conflict at each monthly time point in the first year of treatment; the proportion of families that fall into the distressed range of marital, parent-child, and sibling conflict at each time point; the typical trajectory of conflict during the first year of treatment and whether there are differences in trajectories across families.

METHOD

A total of 160 families of children newly diagnosed with cancer (Mage = 5.6 years; range = 2-18 years) participated in a short-term prospective longitudinal study. Primary caregivers provided monthly reports of marital, parent-child, and sibling conflict.

RESULTS

Using multilevel modeling (MLM), most families showed stability in quality of family relationships, although considerable between-family variability was observed. For married couples, 25-36% of couples were in the distressed range at one time point over the first year of treatment. For married couples, more distress occurred at earlier months, particularly month 3. For parent-child and sibling dyads, the most difficult time periods were during later months.

CONCLUSION

Implications for development of interventions that target at-risk family relationships are discussed. Identifying processes that predict between-family variability in trajectories of family relationships is an important next step, particularly for the marital relationship. (PsycINFO Database Record

Siblings of Children With a Complex Chronic Health Condition: Maternal Posttraumatic Growth as a Predictor of Changes in Child Behavior Problems

Objective

The present study examined the role of maternal posttraumatic growth in changes in behavioral problems among the siblings of children with complex chronic health conditions.

Methods

Data were collected from a sample of 70 siblings from 58 families with at least one child diagnosed with a life-threatening genetic, metabolic, or neurological condition. Every 6 months for up to 4 years, sibling behavior problems were assessed through both parent-reports and youth self-reports. At each visit, mothers also completed self-reports of posttraumatic growth.

Results

Time-lagged multilevel regression analyses revealed that higher levels of maternal posttraumatic growth predicted subsequent declines in parent-reported internalizing, externalizing, and total behavior problems among healthy siblings. These findings were partially replicated using youth self-reports of their own behavior problems.

Conclusion

The findings suggest that the benefits of posttraumatic growth may extend beyond the self to other family members, particularly to children in the family.

Psychosocial interventions for rehabilitation and reintegration into daily life of pediatric cancer survivors and their families: A systematic review

Background

The survival rate of childhood cancer patients increased over the past decades. However, even after successful treatment the transition back to normalcy is often a major challenge for the whole family. Therefore, this study aims to provide an overview of psychosocial interventions for childhood cancer survivors and their families in the first years after the end of cancer treatment.

Methods

We conducted a systematic review following the PRISMA Checklist (Preferred Reporting Items for Systematic Reviews and Meta-Analyses; PROSPERO registration number: CRD42017059782). In November 2016 and September 2017, we searched the databases CINAHL, MEDLINE, PSYNDEX, and Web of Science. We included studies investigating psychosocial interventions for childhood cancer survivors diagnosed under the age of 21, their family members or the family as a whole. Further, we summarized the study characteristics and conducted a narrative synthesis of the results. Finally, we assessed the study quality with the Effective Public Health Practice Project Quality Assessment Tool.

Results

We identified a total of 8215 records based on our database searches and 17 additional records through hand searches. We included 33 articles in the qualitative synthesis. Most of the studies described interventions for the cancer survivor (n = 15). Nine studies investigated interventions for the whole family, and two studies interventions for siblings. The interventions mainly take place in an outpatient group setting (n = 15). Overall, most of the studies reported a significant psychosocial benefit of the interventions. However, the quality of the included studies was limited.

Conclusion

In summary, we identified a broad range of different interventions and thus could give a comprehensive overview of existing interventions for childhood cancer survivors and their families. However, there is a necessity for high quality studies. The results may help to optimize health care services that support families with the re-entry into daily life.

A possibility for strengthening family life and health: Family members' lived experience when a sick child receives home care in Sweden

Families often prefer home care to hospital care, and home-care services for ill children are increasing worldwide with limited knowledge of families' needs during curative and palliative home care. The aim of this study was to elucidate family members' lived experience when a sick child received home care from county-based primary healthcare services. A descriptive qualitative design was chosen and 12 families including sick children receiving home care and their mothers, fathers and siblings in the south of Sweden were interviewed between December 2015 and January 2017. The transcribed interviews were analysed using a hermeneutic phenomenological approach. The family members' lived experience was described in three essential themes: "Strengthening family life" relates to how home care induced freedom and luxury in a strained period of life and supported the families' everyday life. Usual social activities and relations were maintained as time and energy was saved when receiving home care. "Promoting health" relates to how the family members' burden of illness decreased as the child's signs of illness alleviated and the well-being of the whole family increased when the child received care in the home. This provided a peaceful respite for family members' psychosocial recovery. The third theme, "Creating alliances," relates to the importance of creating trustful alliances for communicating participation in care. If trustful alliances were not created, parents felt an overwhelming responsibility and family members became anxious. The findings suggest that care in the family's home is a useful complement to hospital care. Home care should be given with close attention to family members' needs and conditions, as positive effects of home care might be jeopardised when expectations and possibilities are not successfully shared.

Siblings' caring roles in families with a child with epilepsy

Despite large amounts of care for chronic conditions being provided within the family, information regarding the extent to which siblings contribute to informal care practices in families where a child has a chronic condition is limited. This article draws on multiple perspective data from 24 families that had a child with epilepsy. In doing so, the article illustrates siblings' significant contribution to caring for their brother or sister and further develops the alert assistant concept. Two additional distinct caring roles that the siblings took on are also outlined - the substitute parent and parenting assistant roles. The relationship between siblings' socio-demographic characteristics and their caring responsibilities is also explored. The paper's findings are that siblings who were older, female and those in families with a higher child to parent ratio took on more caring responsibilities. Consequently, this article contributes to the currently limited literature on siblings who care for a chronically ill brother or sister by increasing understandings of different caring roles and experiences of chronic illness in families.

Outcomes of an enhancement study with additional psychoeducational sessions for healthy siblings of a child with cancer during inpatient family-oriented rehabilitation

OBJECTIVE

Chronic illness of a child puts healthy children of the family at risk of distress. Previous studies have demonstrated that healthy children's psychological symptoms can be reduced when the child knows more about the disease. So far, there is limited evidence of the effectiveness of psychoeducational interventions for healthy children.

AIMS

To compare the effectiveness of an inpatient family-oriented rehabilitation program with vs without additional psychoeducational sessions for healthy children of families with children with cancer.

PATIENTS AND METHODS

We performed a controlled study in 4 German family-oriented rehabilitation clinics. The outcomes of n = 73 healthy children (mean age: M = 9.55; SD = 3.14; range: 4-18), who participated in 5 additional psychoeducational sessions, were compared with the outcomes of n = 111 healthy children (mean age: M = 8.85; SD = 3.28; range: 4-17), who underwent the usual inpatient rehabilitation program. Primary outcomes were the healthy children's cancer-specific knowledge and their emotional symptoms. Secondary outcomes were family satisfaction and quality of life.

RESULTS

Intention-to-treat analyses showed that both groups improved significantly from preintervention to postintervention. Improvements comprised knowledge about cancer (F(1,174) = 11.03, p < 0.001), self-reported emotional symptoms (F(1,135) = 31.68, p < 0.001), and parent-proxy-reported emotional symptoms (F(1,179) = 37.07, p < 0.001). The additional psycho-educational program did not significantly enhance the outcomes. The same pattern of significant improvement in both conditions emerged for all secondary outcomes. The immediate effects of the intervention persisted until 2 months after discharge from the rehabilitation program.

CONCLUSIONS

Inpatient family-oriented rehabilitation is effective in improving multiple psychosocial outcomes of healthy children in families which have a child with cancer. Additional psycho-educational sessions did not show any substantial additional improvement.

The Impact of a Childhood Cancer Diagnosis on the Children and Siblings’ School Attendance, Performance, and Activities: A Qualitative Descriptive Study

Families of children with cancer are confronted with unexpected out-of-pocket expenses and productivity costs associated with the diagnosis. One productivity cost that falls on children is the impact of cancer on children’s school attendance, performance, and activities (eg, play, friendships, and socialization). Nested within the Childhood Cancer Cost Study, this qualitative descriptive study used convenience sampling to recruit and interview parents of children newly diagnosed with cancer. Content analysis techniques were used to inductively descriptive the semistructured interview data. Sixty-six parents of 65 children with cancer and of 73 siblings participated. The most commonly reported productivity loss in children with cancer was school absenteeism mainly due to cancer treatment. Children fell behind their classmates academically and lost important social time with peers. A few siblings also fell behind their peers primarily due to limited parental attention. Parents adopted various strategies to lessen the impact of the diagnosis on their children’s school attendance, performance, and activities. Providing parents with additional resources and support may optimize their children’s academic and social reintegration into school.

The Impact of School Visits on Siblings of Children With Cancer

BACKGROUND

Childhood cancer affects the entire family. Siblings experience similar stress to that of the ill child, including anger, depression, jealousy, guilt, and social isolation. School reentry programs are shown to be positive interventions for patients, it is hypothesized that similar outcomes exist for siblings.

OBJECTIVE

To examine the feasibility of studying the impact of the Ontario Oncology Nurse School Visitation Program on the well-being and school adjustment of siblings of pediatric cancer patients.

METHODS

Fourteen sibling participants and parents completed a semistructured interview and the PedsQL^® questionnaire before and after a nurse school visit. School attendance was also compared and data were collected for logistics of study procedures.

RESULTS

The mode of data collection was agreeable and easy to plan and execute. School attendance showed a reduction of days missed; there was no significant impact on PedsQL results but the interviews yielded positive feedback.

CONCLUSIONS

The outlook for siblings improves with the support of family members and health care professionals. This pilot study provides hypotheses and design for future research.

Communication About Dying, Death, and Bereavement: A Systematic Review of Children's Literature

BACKGROUND

Children's books have the potential to facilitate communication about death for children living with a serious illness and for children coping with the death of a loved one.

OBJECTIVES

This study examines the content of children's literature relevant to the topic of dying and death and identifies books providers can share with children and their families.

DESIGN

A search of children's literature was conducted using four electronic databases and one additional search engine using the word "Death" or "Dying." Storybooks about dying, death, and bereavement published in English, French, or Spanish between 1995 and 2015 were included.

MEASUREMENTS

Each book underwent content analysis by at least two independent reviewers. Strict PRISMA standard was followed. Full protocol is available as PROSPERO #CRD42016042129.

RESULTS

Two hundred ten books met inclusion criteria. The dying subject was primarily a grandparent (n = 78) or pet (n = 44). Books on the experience of a child dying were scarce (n = 5). The word death or dying was used in 75% of the books (n = 158), while others utilized euphemisms. The majority of books featured animals (n = 40) or Caucasian subjects (n = 122) and included spiritual elements such as heaven (n = 122). Less than one-quarter of the books included tools for readers to address the topic of death.

CONCLUSIONS

Storybooks can be a helpful tool to introduce communication about dying and death with children. Gaps exist in current children's literature to effectively enable children to reflect on their own dying process. A general summary of available books is provided to assist those caring for children and families facing end-of-life issues.

Levels of unmet needs and distress amongst adolescents and young adults (AYAs) impacted by familial cancer

OBJECTIVE

To describe levels of, and relationships between, distress and psychosocial unmet needs in adolescents and young adults (AYAs) with a family member with cancer.

METHODS

Adolescents and young adults (12-24 years old) with a living sibling or parent with cancer participated. Participants completed demographics, the Kessler 10 (K10) distress scale and the Sibling or Offspring Cancer Needs Instruments. Descriptive statistics were obtained for all measures, item-level frequencies were examined to identify common unmet needs, and relationships between distress and unmet needs were explored.

RESULTS

Average sibling (N = 106) and offspring (N = 256) distress levels were in the high range (K10total = 22-30), with 29.6% and 31.6% in the very high range (K10total = 31-50), respectively. Siblings had mean = 19.7 unmet needs (range 0-45), 66% had ≥10 unmet needs, and 44% of the 45 needs were unmet on average. Offspring had mean = 22.4 unmet needs (range 0-47), 77% had ≥10 unmet needs, and 48% of the 47 needs were unmet on average. Strong positive correlations were found between K10 distress and the number of sibling/offspring unmet needs (r = 0.599 and r = 0.522, respectively, P = .00).

CONCLUSIONS

Australian AYA siblings and offspring impacted by familial cancer experience high levels and numbers of unmet needs and substantial distress. Strong associations were found between increased distress and more unmet needs. Distress levels were comparable to AYAs seeking treatment for mental health issues. Insights into the type and number of needs experienced by AYA siblings and offspring will facilitate development and delivery of targeted, age-appropriate interventions, and resources for these vulnerable and underserved young people.

Experiences of posttraumatic growth in siblings of children with cancer

As survival rates continue to improve for children diagnosed with cancer, strides in achieving better psychosocial outcomes for both children with cancer and their families have been accentuated. The current study aimed to explore the experiences of siblings of children diagnosed with cancer and attempted to overcome some of the limitations described in previous research. Primarily, the study considered the theoretical framework of posttraumatic growth (PTG) in the project design and analysis. Semi-structured interviews were completed with six siblings. Thematic analysis was employed to identify themes within the data set as a whole. The data revealed that siblings experienced a range of difficult emotions throughout the cancer trajectory as well as experiencing remarkable changes in their lives. This included both positive and negative changes. These changes included increased empathy and resilience, improved family relationships, disrupted routine, increased responsibility and perceived changes in the ill child. Siblings described factors which they found helpful and unhelpful in adjusting to these changes. The report ends with a discussion of the themes and their clinical and theoretical implications. The report also highlights the research limitations and areas for future investigation.

School Experiences of Siblings of Children with Chronic Illness: A Systematic Literature Review

PROBLEM

Siblings of children with chronic illness have unique experiences that can affect their school functioning, such that they may miss ongoing periods of school, experience difficulties with schoolwork or experience changes in their peer and teacher interactions. This review provides an overview of these siblings' school experiences.

ELIGIBILITY CRITERIA

Six databases (Medline, PsychINFO, CINAHL, ERIC, Embase and The Cochrane Library) were systematically searched for studies examining the school experiences and peer relationships of siblings of children with chronic illness, as well as school-based interventions for these siblings. Studies were included if they were published in or after 2000 and were published in English.

SAMPLE

We identified 2137 articles upon initial search. From these, we identified 28 eligible studies examining the school experiences of >1470 siblings of children with chronic illness.

RESULTS

Three key themes were identified throughout the reviewed articles. The literature described 1) the psychological impact on siblings at school; 2) decreases in school attendance and academic functioning, and; 3) changes or perceived differences in peer and teacher interactions. Siblings value teacher and peer support, and this support may contribute to better sibling school functioning.

CONCLUSIONS

Many siblings are socially resilient, yet overlooked, members of the family who may present with psychological, academic and peer related difficulties at school following diagnosis of a brother or sister with chronic illness.

IMPLICATIONS

Future research is needed to further delineate the sibling school experience to better facilitate the development of targeted sibling support interventions within the school environment.