Investigation of the Role of Cognitive Emotion Regulation Strategies on Depressive Symptoms in Mothers of Children Given A Diagnosis of Cancer

BACKGROUND

The role of cognitive emotion regulation on depressive symptoms in mothers of children given a diagnosis of cancer is not yet well understood.

OBJECTIVE

The aim of this study was to investigate the effect of cognitive emotion regulation strategies on depressive symptoms in mothers of children with cancer.

METHODS

This study was conducted with a cross-sectional correlational design. The study included 129 participants. Participants completed the sociodemographic characteristics form, Beck Depression Inventory, and Cognitive Emotion Regulation Questionnaire. Hierarchical regression analysis was performed to determine the effect of cognitive emotion regulation strategies on depressive symptoms.

RESULTS

Hierarchical multiple regression revealed that depressive symptoms were independently associated with self-blame (β = 0.279, P = .001) and catastrophizing (β = 0.244, P = .003) after controlling for sociodemographic characteristics of mothers. Emotion regulation strategies explained approximately 39.9% of the variance in depressive symptoms.

CONCLUSION

The results of the study indicate that more frequent engagement of self-blame and catastrophizing were associated with more depressive symptoms.

IMPLICATIONS FOR PRACTICE

Nurses should screen mothers of children with cancer for depressive symptoms and identify mothers of children with cancer who use maladaptive cognitive emotion regulation strategies, such as self-blame and catastrophizing, as a risk group. Furthermore, nurses need to be involved in developing psychosocial interventions including adaptive cognitive emotion regulation strategies to help mothers coping with adverse emotions during a childhood cancer journey.

Parents' and patients' perspectives, experiences, and preferences for germline genetic or genomic testing of children with cancer: A systematic review

PURPOSE

Germline testing in pediatric cancer presents opportunities and challenges. Understanding family perspectives, experiences, and preferences will optimize integration into routine care.

METHODS

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched 4 databases for studies exploring perspectives, experiences, and preferences of parents/caregivers and/or patients regarding germline testing of children with cancer. Qualitative and quantitative data were extracted, organized, and summarized by research question and themes.

RESULTS

We identified 2286 unique articles, of which 24 were included. Interest in and uptake of testing was high. Families were motivated by altruism and a desire for inheritance/causation information. Testing barriers included psychological concerns, timing of the testing approach if offered at diagnosis or in a high-risk cancer setting and privacy/discrimination. Testing experiences highlighted challenges yet also positive impacts, with results providing psychological relief and informing proactive decision making. Timing preferences varied; however, allowing time to adjust to a new diagnosis was a common theme. Most wanted to receive as many germline sequencing-related results as possible.

CONCLUSION

Findings underscore the importance of integrating germline analyses into pediatric cancer care with flexibility and support for families facing challenges. Where possible, consent should be provided at a time that suits each family's situation with access to information aligning with their needs and preferences.

PROSPERO

CRD42023444890.

'I cannot accept it' distressing experiences in parents of children diagnosed with cancer: A qualitative study

AIMS

To explore the distressing experiences of Chinese parents of children with cancer from the perspective of psychological inflexibility.

DESIGN

A qualitative study using a descriptive qualitative approach based on the model of psychological inflexibility was adopted.

METHODS

Individual semi-structured interviews through synchronized online video were conducted with 21 Chinese parents of children with cancer from October 2020 to May 2021. Data were analysed using content analysis.

RESULTS

Four themes and 11 subthemes were identified: (i) immersion in struggling and suffering, (ii) avoidance and suppression, (iii) blaming and complaint and (iv) helplessness and worthlessness. Parents were unwilling to accept the diagnosis and witness their children's suffering, trapped in uncontrollable negative emotions and thoughts. Avoiding emotions and socializing, blaming themselves or complaining of injustice were common. They felt helpless towards life and valueless without the child.

CONCLUSION

The research findings provide additional perspectives in understanding the distressing experiences in parents of children with cancer. Overall, the emotional and coping styles indicated the lack of psychological flexibility of parents when facing childhood cancer, which is profoundly influenced by Chinese culture.

IMPLICATIONS FOR THE PROFESSION

Healthcare professionals are recommended to provide culturally sensitive strategies or interventions for building psychological flexibility in addressing parental psychological distress.

IMPACT

The study provides insights into exploring distressing experiences and reveals the inflexible psychological and behavioural patterns in parents of children with cancer, which could benefit healthcare providers in managing parental psychological distress and helping these parents build flexible coping strategies.

REPORTING METHOD

The COREQ guideline was followed.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public involvement.

Financial Aid in Children, Adolescents and Young Adult's Cancer Care: A Scoping Review

Background: The financial burden resulting from cancers on families is higher when it arises in young people compared with older adults. Previous research has provided insight into the financial toxicities associated with childhood cancer, but less is known about the efficacy of financial aid systems in reducing the financial burden on families. We conducted a scoping review to identify the determinants of success and failure of financial aid. Methods: Five databases were searched for articles published between January 1, 2000 and December 1, 2022. Dual processes were used to screen and select studies. Through thematic content analysis, we identified barriers and enablers of financial aid, categorised by country income level. Results: From 17 articles, which were evenly split between high-income countries and upper middle- to low-income countries, four major themes emerged: (1) accessibility of support, (2) delivery of support, (3) administration, and (4) psychosocial factors. Within these themes, the enablers identified were (1) support navigators, (2) establishing a direct contact between donors and beneficiaries, (3) implementation of digital solutions to improve outreach, and (4) using cultural and community values to encourage donor engagement. Conclusions: This scoping review identified the determinants of success and failure of financial aid in supporting families in the context of childhood, adolescent, and young adult (CAYA) cancers. By understanding the barriers and enablers identified in this review, organizations could develop pragmatic evidence-based care models and policies to ensure access to assistance is equitable and appropriate for families experiencing CAYA cancers.

Hispanic/Latinos and non-Hispanic whites' childhood cancer survivors and parents: a dyadic analysis of coping resources and mental health

PURPOSE

While limited, dyadic research demonstrates the interdependent relationship between the health and adjustment after treatment between cancer survivors and caregivers. We examined interrelationships between coping resources and mental health among childhood cancer survivors (CCS)-parent dyads.

METHODS

One hundred sixty CCS-parent dyads from the Project Forward pilot study completed validated questions assessing social support, religiosity, spirituality, depressive symptoms, and perceived stress. Bidirectional associations were identified with path analysis utilizing the actor-partner interdependence model (APIM). We used a multigroup approach to test for the moderating effects by Hispanic ethnicity on these relationships.

RESULTS

Mean age of CCS was 20 years old, 51% female, 30% diagnosed with leukemia, and mean of 7 years from diagnosis. The mean age of parents was 49 years old and 89% were mothers. For both CCS and parents, perceived social support was inversely associated with their depressive symptoms and perceived stress (e.g., actor effects). Parents' social support was not significantly associated with CCS's depressive symptoms and stress. However, higher perceived social support by the CCS was inversely associated with parents' depressive symptoms (β =  - 0.202, p < 0.01) and perceived stress (β =  - 0.164, p < 0.05) (e.g., partner effects). Additional actor effects were observed between spirituality, religiosity, and depressive systems when we explored the moderating effects of Hispanic ethnicity.

CONCLUSION

Partner effects of social support among CCS-parent dyads may influence psychological distress.

IMPLICATION FOR CANCER SURVIVORS

Our findings on parent-child associations between social support and psychosocial well-being imply that survivorship care can be enhanced when the social support needs of both survivors and their parents are addressed together.

Meeting Parents' Needs for Education and Preparation following Congenital Heart Disease Diagnosis: Recommendations from a Crowdsourced Study

OBJECTIVE

This article characterizes the educational needs of parents following fetal or neonatal congenital heart disease (CHD) diagnosis and generates recommendations for meeting these needs.

STUDY DESIGN

Online crowdsourcing methods were used to collect qualitative data from 95 parents of children with CHD regarding their needs for education and preparation following fetal or neonatal diagnosis. Data were analyzed using qualitative methods and themes were organized around the substructure of met and unmet needs.

RESULTS

Two themes represented consistently met needs, whereas 10 themes represented needs that were either inconsistently met or consistently unmet. Parents reported needing more information about social, emotional, and financial supports, preparation for long-term care, and guidance toward reputable online resources. Parents also provided recommendations for meeting these needs.

CONCLUSION

Parents' needs for education and preparation following CHD diagnosis are much broader in scope than what they currently receive. Addressing these may support parental coping and active participation in medical decision-making.

KEY POINTS

· CHD counseling after diagnosis may provide opportunities to promote parents' mental health.. · Guidelines recommend that this counseling should include emotional and decision-making support, however, it is unclear what parents actually receive.. · This study found that parents' needs for education and preparation following CHD diagnosis are much broader in scope than what they currently receive..

Prediction of family-centered care on the unmet care needs of parents of pediatric oncology patients and their psychosocial problems

BACKGROUND/OBJECTIVES

It was aimed to determine the predictive power of family-centered care of parents of children with cancer on their unmet care needs and psychosocial problems (anxiety, depression, stress). This study was conducted as a descriptive, correlational, and cross-sectional study.

DESIGN/METHODS

The study was conducted on 136 parents at a university hospital between January and September 2023, involving parents of children receiving care at the pediatric oncology clinic. Data collection instruments included an Information Form, Family Inventory of Needs Pediatric II (FINPED-II), Family-Centered Care Scale (FCCS), and Depression Anxiety Stress Scale (DASS-21). Data were analyzed using IBM SPSS 28, employing Pearson correlation analysis and linear regression to assess the relationships between variables.

RESULTS

The study revealed significant positive correlations between Family-Centered Care and Met Needs (r = .676, p < .001) and significant negative correlations between Met Needs and Stress scores (r = -.256, p < .001). Additionally, there were positive correlations between Anxiety and Depression scores (r = .700, p < .001), Anxiety and Stress scores (r = .768, p < .001), and Depression and Stress scores (r = .835, p < .001). Family-centered care significantly predicted Met Needs (p < .001) and accounted for 47% of the variation in Anxiety, Depression, Stress, and Family Inventory of Needs scores.

CONCLUSION

The findings highlight that family-centered care significantly predicts Met Needs, emphasizing its pivotal role in supporting parents of children with cancer. These findings underscore the importance of family-centered care in pediatric oncology, but also point to the need for further studies to address identified limitations and provide a comprehensive understanding of this complex healthcare dynamic.

Development of a theory-based family resilience intervention program for parents of children with chronic diseases: A Delphi study

BACKGROUND

Long-term illness exposes children with chronic diseases to a high risk of deterioration of physical and mental health. Developing an effective family resilience intervention program is a critical concern.

OBJECTIVE

To develop a theory-based family resilience intervention program for parents of children with chronic diseases and provide a reference for clinical intervention.

METHODS

A two-phased research design, guided by the Walsh family resilience process model, was employed to develop the intervention program. In phase 1, a scoping literature review was conducted to identify the possible elements of family resilience interventions. In phase 2, a three-round Delphi survey was conducted with experts (n = 14) using an online electronic survey to obtain their consensus on the intervention content.

RESULTS

Three main components were identified: (1) strengthening family beliefs, (2) adjusting the family organization pattern, and (3) improving the family communication process. And 8 modules were developed: "introducing adversity and family resilience", "finding and strengthening positive family beliefs, and building confidence to live with the disease", "analyzing and adjusting family structure", "assisting families to increase and utilizing internal and external resources", "optimizing communication skills", "strengthening collaborative problem-solving capacity", "enhancing the family narrative ability", and "enhancing emotional expression". After 3-round Delphi, the findings indicated that the intervention program is applicable and feasible for parents of children with chronic diseases in China.

CONCLUSION

The principal merit of this study lies in the development of a family resilience intervention program for parents of children with chronic diseases. The intervention's usability and efficacy should be investigated in future studies.

IMPLICATIONS TO PRACTICE

Developing a family resilience intervention program is a critical first step toward providing effective care for parents of children with chronic diseases, and evaluating the program's feasibility and suitability in the target population is warranted.

Determining the factors affecting chemotherapy-induced nausea and vomiting in children with cancer

PURPOSE

We evaluated the factors affecting chemotherapy-induced nausea and vomiting (CINV) in children with cancer.

DESIGN AND METHODS

This cross-sectional study was conducted with 62 children aged 9 to 18 years old with a solid tumor who received chemotherapy for the first time, and their parents. Data were collected using a data collection form, the State-Trait Anxiety Inventory for Children, the Beck Anxiety Inventory, the Spielberger State-Trait Anxiety Inventory, and the Baxter Retching Faces Scale. Data were analyzed using Spearman's correlation and logistic regression analyses.

RESULTS

Risk factors related to the child, treatment, and parent were examined. Child-related factors were determined as diagnosis (odds ratio [OR] = 5.5), time since diagnosis (OR = 1.9, OR = 4.7), pretreatment anxiety of the child (r = 0.439, r = 0.422), and past experience of nausea and vomiting before treatment (OR = 1.2). Treatment-related factors involved anti-emetic prophylaxis (OR = 4.9, OR = 9.2). Parent-related factors included pretreatment anxiety of the parent (r = 0.271, r = 0.287), accommodation (OR = 5.5), not eating (OR = 1.2, OR = 1.3), and bad smell (OR = 1.2), which were described amongst parents' as factors that trigger CINV.

CONCLUSIONS

The occurrence of CINV is significantly affected by child-, treatment-, and parent-related risk factors.

PRACTICE IMPLICATIONS

Pediatric nurses should create an environment for children and their parents to reduce their anxiety and provide basic knowledge and skills about the management of CINV.

Care Needs of Parents of Children With Cancer in a Low-Middle-Income Country

Background: Mapping out actual supportive care needs assists nurses in providing holistic individualized care. This study aimed to explore the care needs of parents of children with cancer in the Philippines. Method: Guided by the Supportive Care Needs Framework (SCNF), this study used an embedded mixed-method design with the quantitative revised Cancer Patient Needs Questionnaire and qualitative semistructured interviews to describe parents' care needs and priorities. Results: Filipino parents (N = 156) of children with cancer have various care needs which could be classified along the SCNF categories-practical, informational, spiritual, physical, emotional, and physical needs as ranked from highest to lowest. A number of variables were significantly associated with care needs. Solid tumor diagnosis was associated with greater practical, emotional, and psychosocial care needs; having a child who had undergone surgery was associated with more practical and spiritual care needs; and being within one year of the child's diagnosis was associated with practical, psychosocial, and spiritual care needs. Parent priority needs included (a) addressing financial needs; (b) access to temporary housing to minimize treatment-related costs; (c) support groups among parents of children with cancer as a source of information; (d) financial and social support between members of family and partners of parents of children with cancer; and (e) using prayer to facilitate acceptance. Conclusions: Supportive care needs of parents of children with cancer are important components of care that should be given recognition to enhance holistic individualized care throughout the childhood cancer experience.

Fathers' Experiences of Childhood Cancer: A Phenomenological Qualitative Study

Research has shown differences in how fathers and mothers respond to a child's cancer diagnosis. Previous studies have highlighted that sociocultural norm shape fathers' experiences of their child's cancer diagnosis. Our phenomenological qualitative study aimed to examine the lived experiences of fathers whose children have been diagnosed with cancer and explore the impact of sociocultural gender roles. Fathers whose children were currently receiving treatment or had completed treatment in the previous 15 months were recruited from across Australia. Twenty-one fathers were interviewed. Five themes were identified: (a) Your world falls apart: Diagnosis and treatment; (b) Care for the child: Just the way it is; (c) Keeping strong: Finding ways to cope; (d) Employment: Practical and emotional support at work; and (e) Guilt, relief, and grief: Facing death. This study demonstrates the profound impact of a child's diagnosis on fathers and demonstrates that societal-cultural norms influence fathers' experience of childhood cancer.

What Was on the Parents' Minds? Changes Over Time in Topics of Person-Centred Information for Mothers and Fathers of Children with Cancer

Acquiring information about one's child's cancer diagnosis is a complex and ever-changing process, and parents' needs change over time. As yet, we know little about what information parents require at different stages of their child's illness. This paper is part of a larger randomized control trial studying the parent-centered information given to mothers and fathers. The aim of this paper was to describe the topics addressed in person-centered meetings between nurses and parents of children with cancer and how those changed over time. Using qualitative content analysis, we analyzed nurses' written summaries of 56 meetings with 16 parents and then computed for each topic the percentage of parents who brought it up at any time during the intervention. The main categories were Child's disease and treatment (addressed by 100% of parents), Consequences of treatment (88%), Emotional management for the child (75%), Emotional management for the parent (100%), Social life of the child (63%), and Social life of the parent (100%). Different topics were addressed at different points in time, and fathers raised more concerns about the child's emotional management and the consequences of treatment than mothers. This paper suggests that parental information demands change over time and differ between fathers and mothers, implying that information should be person-centered. Registered at Clinicaltrials.gov (NCT02332226).

Importance of Social Support of Parents of Children with Cancer: A Multicomponent Model Using Partial Least Squares-Path Modelling

The purpose of the present study is to build a model combining some variables that have been previously studied separately to improve our understanding on how they relate in parents of children with cancer. A total of 112 parents with an average age of 41 completed the self-assessment questionnaires containing the factors studied: social support received, social support provided, stress, adjustment of parents and life satisfaction. Two models were developed: one for social support received and one for social support provided. Structural equation models based on the variance estimated through partial least squares were used to analyze factors involved in quality of life based on an exploratory model of second order. The estimated model was robust in terms of quality of measurement (reliability and validity). According to results from the structural model, in the model of social support received, the impact of social support received on stress was considerable (β = -0.26; p = 0.02) and it explained 16% of the variance. The impact of social support received by parents on their adjustment (β = -0.56; p < 0.001) was also considerable, explaining 32% of the variance. Finally, adjustment of parents also showed an effect on life satisfaction (β = -0.33; p < 0.001) and it explained 26% of the variance. However, the relation between social support received (β = 0.15; p = 0.11) and life satisfaction, the relation between stress (β = -0.15; p = 0.08) and life satisfaction, and the relation between adjustment of parents (β = 0.20; p = 0.07) and stress were not significant. In the model of social support provided by parents, social support provided (β = 0.35; p < 0.001), and adjustment of parents (β = -0.31; p < 0.01) impacted life satisfaction, explaining 36% of the variance. Social support provided (β = -0.34; p < 0.01) impacted adjustment of parents and it explained 12% of the variance. Adjustment of parents (β = 0.28; p < 0.05) also impacted parents' perception of stress, explaining 14% of the variance. However, the relation between social support provided (β = -0.17; p = 0.06) and stress, and the relation between stress (β = -0.13; p = 0.08) and life satisfaction, were not significant. Social support received showed a strong connection with stress and parents' adjustment. Additionally, social support received showed a decrease in stress and parents' adjustment. Social support provided by parents and the adjustments they experience are linked to their life satisfaction. Additionally, social support provided showed a decrease in adjustment and an increase in parents' life satisfaction. The models can be used to improve parents' situations and it has strong practical implications.

Promoting positive physical activity behaviors for children and adolescents undergoing acute cancer treatment: Development of the CanMOVE intervention using the Behavior Change Wheel

Background

Increasing participation in physical activity has the potential to improve outcomes for children and adolescents with cancer during treatment and into survivorship. The aim of this study is to outline the theoretical process behind development of CanMOVE, a behavior change intervention designed to increase physical activity for children and adolescents with cancer.

Study design

This study followed a theoretical design process consistent with the Behavior Change Wheel to inform the design of a complex intervention.

Materials and methods

The three stages of the Behavior Change Wheel intervention design process include: (1) understanding physical activity behavior within the pediatric cancer setting, (2) identifying potential intervention functions, and (3) identifying appropriate behavior change and implementation strategies. Qualitative and behavior change literature relevant to the pediatric cancer treatment setting were used to inform each stage.

Results

An individualized and flexible approach to physical activity promotion that considers intrinsic factors specific to the child/adolescent and their environment is required. Fifteen behavioral change strategies were identified to form the intervention components of CanMOVE. Implementation strategies were identified to build motivation, opportunity and capacity toward increasing physical activity behaviors. Key intervention components of CanMOVE include standardized assessment and monitoring (physical activity, physical function, and health-related quality of life), provision of an activity monitor to both child/adolescent and parent, and one-on-one capacity building sessions with a healthcare professional. Capacity building sessions include education, goal setting, an active supervised physical activity session, barrier identification and problem solving, and action planning.

Conclusion

CanMOVE is a novel approach to physical activity promotion in the pediatric cancer treatment setting. The use of a theoretical intervention design process will aid evaluation and replication of CanMOVE when it is assessed for feasibility in a clinical setting. The design process utilized here can be used as a guide for future intervention development.

What’s in a Name? Parents’ and Healthcare Professionals’ Preferred Terminology for Pathogenic Variants in Childhood Cancer Predisposition Genes

Current literature/guidelines regarding the most appropriate term to communicate a cancer-related disease-causing germline variant in childhood cancer lack consensus. Guidelines also rarely address preferences of patients/families. We aimed to assess preferences of parents of children with cancer, genetics professionals, and pediatric oncologists towards terminology to describe a disease-causing germline variant in childhood cancer. Using semi-structured interviews we asked participants their most/least preferred terms from; ‘faulty gene,’ ‘altered gene,’ ‘gene change,’ and ‘genetic variant,’ analyzing responses with directed content analysis. Twenty-five parents, 6 genetics professionals, and 29 oncologists participated. An equal number of parents most preferred ‘gene change,’ ‘altered gene,’ or ‘genetic variant’ (n = 8/25). Parents least preferred ‘faulty gene’ (n = 18/25). Half the genetics professionals most preferred ‘faulty gene’ (n = 3/6); however this was least preferred by the remaining genetics professionals (n = 3/6). Many oncologists most preferred ‘genetic variant’ (n = 11/29) and least preferred ‘faulty gene’ (n = 19/29). Participants across all groups perceived ‘faulty gene’ as having negative connotations, potentially placing blame/guilt on parents/children. Health professionals described challenges selecting a term that was scientifically accurate, easily understood and not distressing to families. Lack of consensus highlights the need to be guided by families’ preferred terminology, while providing accurate explanations regarding implications of genetic findings.

Experience of childhood cancer: A narrative inquiry

PURPOSE

To more fully understand the possible impact of childhood cancer on a young person's life through their own story.

DESIGN AND METHODS

Using Connelly and Clandinin's narrative inquiry method, a participant named Noelle was engaged in a series of narrative interviews and a creative self-expression activity about her cancer experience when she was 12. Her story was examined through the three-dimensional space of experience (person, place, and time), and analyzed using Erikson's Psychosocial Stages of Development framework theoretical lens.

RESULTS

Two significant narrative patterns emerged: identity and relationships. Although the physical effects of the cancer were successfully treated, the impact of this disease impacted Noelle's own psychosocial development as she was trying to evolve her relationships with peers and family, while grappling with her new identity as a cancer patient.

PRACTICE IMPLICATIONS

Healthcare professionals need to intentionally increase their sensitivity to adolescent patients' lived experience of cancer. More specifically, there is a need for further education of healthcare professionals on the psychosocial impact of cancer in both the immediate and long-term trajectory of the cancer disease process.

Relation Between Social Support Received and Provided by Parents of Children, Adolescents and Young Adults With Cancer and Stress Levels and Life and Family Satisfaction

Introduction

The present study aims at analysing how social support received and provided by parents of children, adolescents and young adults (AYA) diagnosed with cancer, as well as their sociodemographic and clinical variables, affect those parents’ stress levels and life and family satisfaction.

Materials and Methods

A total of 112 parents of children and AYAs who had been diagnosed with cancer and who received treatment in Malaga participated in the study. In the study, participated all parents who voluntarily agreed to fulfil the questionnaire. The main inclusion criterion was that their child had cancer. Instruments used were Questionnaire on the Frequency of and Satisfaction with Social Support (QFSSS), Paediatric Inventory for Parents (PIP), Life Satisfaction Scale and Family Satisfaction Scale.

Results

In the mean difference analyses, male parents showed 3.38 (SD = 0.56) in social support received and female parents showed M = 3.08 (SD = 0.72). Conversely, in social support provided, female parents showed 3.22 and male parents showed M = 3.55 (p = 0.020). Significant differences were also found in family satisfaction, where female parents (M = 3.64) feel more satisfied than male parents (M = 3.06; p = 0.027). Parents of children aged between 0 and 14 years (M = 3.06) feel more stress than those parents of children aged 15–21 (M = 2.61; p = 0.021). The correlation analysis shows that there is a negative and significant relation between stress levels experienced by parents when facing different situations related to the child’s disease and both types of support, received r = −0.411, p < 0.001 and provided r = −0.282, p < 0.01. There is also a positive and significant relation between life satisfaction and social support received r = 0.292, p < 0.01, and social support provided r = 0.409, p < 0.001. There is a positive and significant relation between family satisfaction and social support received r = 0.330, p < 0.01, in the same way as with social support provided r = 0.222, p < 0.05. The regression analysis related to stress levels of parents indicates that social support received predicts levels of stress significantly p < 0.001, with the variable of number of children being the one that showed to be significant p < 0.05. Social support provided showed the most significant results p = 0.001, meaning that social support provided increased life satisfaction. Social support received explains family satisfaction (p = 0.50), as it increases the family satisfaction of parents of children with cancer.

Discussion

Analysing social support received and provided, as well as sociodemographic and clinical variables, allowed us to broaden the knowledge on the effect social support has on stress levels, life satisfaction and family satisfaction in parents of children and AYAs diagnosed with cancer. This may have relevant practical implications for the design of interventions that would improve parents’ lives.

Feeling like the sky is falling down: Experiences of parents of adolescents diagnosed with cancer in one-child families in China - A qualitative study

BACKGROUND

As a result of the one-child policy of 1979, today there are numerous one-child families with adolescents in Mainland China. Little is known about the experiences of parents of such adolescents diagnosed with cancer.

OBJECTIVES

This study explored the experiences of parents whose adolescent child was diagnosed with cancer in one-child families in China.

METHODS

A qualitative methodology based on hermeneutic phenomenology was employed. The participants were parents of adolescent cancer patients in one-child families. Data were collected using in-depth semi-structured interviews and analysed using van Manen's hermeneutic phenomenological approach. The COREQ checklist was used for this study.

RESULTS

Fourteen parents (eleven mothers, three fathers) participated in the study. One overarching theme emerged: feeling like the sky is falling down. In addition, there were five related themes: self-condemnation; 'white lies' - that is, difficulty in telling the truth; struggling with a sense of collapse; fear of losing the child and hopelessness. Almost all the participants experienced insomnia after learning about the diagnosis. In a few cases, hopelessness-induced suicidal ideation or even suicidal behaviour.

CONCLUSIONS

Parents of adolescents diagnosed with cancer in one-child families in China experienced extremely painful emotions. The truth about their child's condition not only caused immense psychological trauma but also induced pessimism about their own future.

IMPLICATIONS FOR CLINICAL PRACTICE

The experiences of parents in one-child families where an adolescent child has been diagnosed with cancer should be taken seriously. In addition, support should be provided to help parents maintain a normal life and feel hopeful for their future.

The experiences of mothers who have a child diagnosed with cancer

Objective: This qualitative study explored the experiences of mothers who had a child diagnosed with cancer.Design and Outcome Measure: Informed by Interpretative Phenomenological Analysis, semi-structured interviews were completed with 13 participants, transcribed verbatim with individual and cross-case analysis conducted.Results: One superordinate theme, Protecting My Child, Whatever the Cost, was identified with five related subordinate themes. Participants battled to protect the development of their ill child. They richly described the personal costs and losses experienced, including putting their life on hold, and lost time with their healthy children. Participants faced realities of cancer treatment that were incongruent with their goal of protecting their child. Self-care awareness was significant for well-being as they protected themselves from reminders of their child's mortality. Despite living in a crisis, participants reported changes suggestive of posttraumatic growth.Conclusion: Childhood cancer brings profound psychosocial and biographical disruption to the lives of mothers as they lose socially valued roles and have their identity as competent mothers challenged. Mothers protect their child, often at a cost to their health and well-being but also bringing positive consequences. The findings offer insights for psychologists in supporting mothers to reclaim their identity as competent mothers and renegotiate their mothering expectations.

The Association of Sources of Support, Types of Support and Satisfaction with Support Received on Perceived Stress and Quality of Life of Cancer Patients

INTRODUCTION

The aim of the present study is to carry out a multidimensional analysis of the relationship of social support with quality of life and the stress perceived by cancer patients.

METHODS

The participants were 200 patients with cancer. Data was gathered on sociodemographic characteristics, health, quality of life, social support and perceived stress.

RESULTS

Frequency of and satisfaction with different sources and types of support are related positively with improvement of quality of life and negatively with perceived stress. The emotional support from the partner and the emotional and informational support from the family are significant predictors of quality of life. Emotional support from the family reduces patients' perceived stress. Satisfaction with emotional support from the partner and with the informational support from friends and family increases quality of life. Satisfaction with emotional support from the family and with informational support from friends decreases patients' perceived stress. Instrumental support and support provided by health professionals are not good predictors of quality of life and perceived stress. Satisfaction with the support received is more significantly related with quality of life and stress than the frequency with which the sources provide support.

CONCLUSIONS

These results have important practical implications to improve cancer patients' quality of life and reduce their perceived stress through social support. Designing intervention strategies to improve satisfaction with the support provided to patients by their closest networks results in a global benefit for the patient's quality of life.

The parental experiences of caring for children with childhood cancers in Singapore: a pilot focus group study

Background:

Research on the parental experiences of caring for children diagnosed with cancer in Singapore are limited and not well understood.

Objectives:

We conducted a pilot focus group to understand the experiences of Singaporean parents whose child had survived cancer.

Methods:

Using convenience sampling, five parents were invited to participate in a focus group discussion regarding the psychosocial needs at the time of cancer diagnosis and into survivorship. The discussion was transcribed verbatim and analysed using Braun and Clarke’s 6-step approach to thematic analysis.

Results:

The analysis revealed three major themes of intrapersonal impact, interpersonal connectedness and financial implications.

Conclusions:

The identified themes indicated some universal and unique caregiving experiences among Singaporean parents and those reported in western and other Asian cultures. In particular, the findings provided an update on the parental experiences of caring for children with cancer in Singapore and highlighted the need for ongoing research and the development of early and holistic psychosocial support services for these parents.

Physical activity for children undergoing acute cancer treatment: A qualitative study of parental perspectives

BACKGROUND

Little is known about how to facilitate participation in physical activity among children receiving acute cancer treatment.

OBJECTIVE

To understand the parental perspectives on physical activity for children during acute cancer treatment and explore strategies to overcome physical inactivity.

METHODS

A qualitative study was completed. Data were collected via semistructured interviews with parents of children (aged 4-18 years) who were in their first nine months of cancer treatment. Data were analyzed thematically.

RESULTS

Twenty parents were interviewed. A childhood cancer diagnosis and subsequent treatment were described as setting in motion a spiral of physical inactivity. Parents identified movement restrictions as a result of commencing treatment and the hospital environment as factors initiating this decline. Parents described the subsequent impact of movement restrictions on their child over time including loss of independence, isolation, and low motivation. These three consequences further contributed to an inability and unwillingness to be physically active. Parents responded in a variety of ways to their child's inactivity, and many were motivated to overcome the barriers to physical activity yet exhibited a reduced capacity to do so. Suggested intervention strategies highlighted the need for comprehensive support from the organization providing treatment.

CONCLUSIONS

Reasons for reduced physical activity in children receiving acute treatment for cancer are complex and multifactorial. Inactivity cannot be addressed by children and parents alone but requires support from the oncology team through changes to the environment, services, and policies to promote physical activity. These findings may be used to inform targeted, effective, and feasible physical activity interventions.

'I can hardly breathe': Exploring the parental experience of having a child with a functional disorder

Functional disorders in children and adolescents are common. Still, little is known about parents' experience of having a child with a functional disorder. The aim of this qualitative interview study was to explore challenges encountered by parents caring for a child undergoing treatment for functional disorder. Sixteen parents to children with functional disorders were interviewed when their child was referred from a paediatric department for further specialized treatment with family therapy in child and adolescent mental health services. Analysis identified three themes, reflecting the parental experiences: parents in limbo, which described how limited knowledge about functional disorders among professionals in non-specialized settings influenced parental roles; a counterintuitive kind of caring, describing parental struggles with adhering to treatment recommendations for functional disorders; and challenges to parental identity, describing parental emotional challenges. These challenges may bar the acceptance of psychological treatment approaches in families with a child with functional disorders.

You are at rock bottom: A qualitative systematic review of the needs of bereaved parents as they journey through the death of their child to cancer

PROBLEM IDENTIFICATION

This systematic review will examine the social support needs of bereaved parents in the specific context of pediatric cancer by synthesizing the qualitative evidence. Social support encompasses emotional, practical, informational, and meaning-making support needs.

LITERATURE SEARCH

The Joanna Briggs Institute procedures for conducting qualitative systematic reviews guided every stage of this review. Four databases (PsychInfo, CINAHL, Pubmed, and ASSIA) were systematically searched, in addition to the gray literature and scoping review. Through a five-step critical appraisal process 11 out of 668 potential articles were identified as meeting the inclusion criteria.

DATA EVALUATION/SYNTHESIS

Relevant findings were synthesized with a thematic-synthesis approach. Findings, which follow the journey of bereaved parents integrated under the core-category "Needs." This encompasses of four higher-level categories: Last days: Parent needs when caring for their dying child Rest in peace: Parent needs during the child's death Feeling abandoned: Parent needs for contact after the child's death Searching for Meaning: Parents needs when making sense of loss.

CONCLUSION

Informational support needs is largely unexplored in academic literature. Staff in the treating-hospital are central in offering bereavement-support to parents, who may otherwise feel that they have lost their second home (hospital) and second family (staff).

Parent Perspectives of Receiving Early Information About Palliative and End-of-Life Care Options From Their Child's Pediatric Providers

BACKGROUND

Parents of children diagnosed with cancer may experience decision regret about cancer treatment decisions and dissatisfaction with the perceived clarity in information received from their child's providers.

OBJECTIVE

The aim of this study was to describe parental perspectives about receiving an early palliative care and end-of-life (PC/EOL) communication intervention titled "Communication Plan: Early through End of Life Intervention" (COMPLETE) from an interprofessional team of physician and registered nurse providers.

METHODS

Ten parents participated in semistructured interviews after receiving the COMPLETE intervention. The COMPLETE intervention included 3 sessions delivered shortly after diagnosis and at the next 2 cancer treatment evaluations. Sessions of COMPLETE focused on early PC/EOL care discussions at diagnosis and after tumor response evaluations with their child's providers.

RESULTS

Results included 2 theme categories: (1) COMPLETE nurtures realistic hope and meaningful dialogue by parents connecting with healthcare providers as a dyad, and (2) benefits of COMPLETE helped parents to make informed decisions. In addition, there were offered suggestions to improve COMPLETE.

CONCLUSION

The COMPLETE intervention provided a unique mechanism to foster early discussions about PC/EOL options between parents and an interprofessional team during the first 6 months of the child's cancer treatment. Future study is needed using a randomized clinical control-group design to evaluate COMPLETE with a large sample of parents.

IMPLICATIONS FOR PRACTICE

Findings provide promising evidence of parents' preference and receptivity to receive early information about PC/EOL care options for a child with a brain tumor with a poor prognosis. The COMPLETE intervention provided a mechanism to help encourage parental consideration of realistic hoped-for goals for their child's condition and care.

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.

Identifying and Prioritizing Family Education Needs at Pediatric Oncology Centers in Central America and Mexico

The educational needs of parents at the time of their child’s cancer diagnosis are often unclear, and research on this topic in low- and middle-income countries is limited. This study evaluated the educational needs of families at major pediatric oncology centers in Central America and Mexico.

Maternal Communication in Childhood Cancer: Factor Analysis and Relation to Maternal Distress

Objective

This study aimed to characterize mothers' communication with their children in a sample of families with a new or newly relapsed pediatric cancer diagnosis, first using factor analysis and second using structural equation modeling to examine relations between self-reported maternal distress (anxiety, depression, and posttraumatic stress) and maternal communication in prospective analyses. A hierarchical model of communication was proposed, based on a theoretical framework of warmth and control.

Methods

The sample included 115 children (age 5-17 years) with new or newly relapsed cancer (41% leukemia, 18% lymphoma, 6% brain tumor, and 35% other) and their mothers. Mothers reported distress (Beck Anxiety Inventory, Beck Depression Inventory-II, and Impact of Events Scale-Revised) 2 months after diagnosis (Time 1). Three months later (Time 2), mother-child dyads were video-recorded discussing cancer. Maternal communication was coded with the Iowa Family Interaction Ratings Scales.

Results

Confirmatory factor analysis demonstrated poor fit. Exploratory factor analysis suggested a six-factor model (root mean square error of approximation = .04) with one factor reflecting Positive Communication, four factors reflecting Negative Communication (Hostile/Intrusive, Lecturing, Withdrawn, and Inconsistent), and one factor reflecting Expression of Negative Affect. Maternal distress symptoms at Time 1 were all significantly, negatively related to Positive Communication and differentially related to Negative Communication factors at Time 2. Maternal posttraumatic stress and depressive symptoms each predicted Expression of Negative Affect.

Conclusions

Findings provide a nuanced understanding of maternal communication in pediatric cancer and identify prospective pathways of risk between maternal distress and communication that can be targeted in intervention.

Caregiver Stress, Coping Strategies, and Support Needs of Mothers Caring for their Children Who Are Undergoing Active Cancer Treatments

The diagnosis of childhood cancer not only affects the life of the child but also impacts the lives of the caregivers as well. This study aims to explore the caregiving stress, coping strategies, and support needs of mothers caring for children/adolescents with cancer during the active treatment phase. Individual semi-structured interviews were conducted, and two authors independently and thematically analyzed data. Caregiving mothers went through a process of emotional changes and a change in lifestyles when their children were diagnosed with cancer and undergoing treatments. It is important to ensure that caregiving mothers of children/adolescents with cancer are well supported by family, friends, and healthcare professionals. Healthcare professionals can develop informational booklets on cancer treatment protocols and work together with mothers. Parent support groups and plans for psychoeducational and spiritual care programs for mothers as forms of informational and emotional support may also be established.

Psychosocial Status of Turkish Families of Pediatric Cancer Patients

Introduction: In some countries, family members are not involved in routine pediatric cancer psychosocial care although it is essential. This integrative review aims to determine the extent of research on family members of pediatric cancer patients in Turkey. Method: Four main keywords were used: parent/sibling/family, child/pediatric, cancer and psychosocial outcomes to search articles on PubMed, EKUAL, ULAKBİM, WOS databases (limited to 1997-2017). Among first 317 hits, 284 records were excluded. Of 33 eligible articles, 14 were excluded due to sample characteristics. Results: Research on psychosocial effects of pediatric cancer on family members is mostly descriptive and offers moderate-quality evidence. The reported psychosocial effects are (1) depression, anxiety, hopelessness, acceptance; (2) burden of care, quality of life, posttraumatic stress disorder; and (3) need for social support, information. Discussion: This study will contribute to the literature and help for the planning of protective psychosocial interventions for family members of children with cancer in Turkey.

Experiences of Low Mood in Young People With Cancer: A Qualitative Study

Young people with cancer are at increased risk of psychological difficulty; yet there is little research on their experiences of low mood or depressive symptoms to help inform treatment interventions. This qualitative study explored experiences and opinions of low mood or depression in young people with cancer, how their mood related to developmental challenges, strategies used to cope, and how services could improve support. Nineteen young people diagnosed and treated for cancer completed semistructured interviews. Transcripts were thematically analyzed using the framework approach, and analysis produced eight themes, organized into three domains: “A Harder Time of Life,” “Interpersonal Impact of Cancer,” and “Learning to Understand and Describe Low Mood,” Participants interviewed experienced low mood during cancer and predominantly felt “low mood” was a helpful term to describe their emotions. There were similarities and variations in their reported mood compared with clinical depression. The developmental challenges of being a young person with cancer negatively affected their mood. Participants used a variety of different coping strategies to manage these challenges. Young people were clear that they would like others to help them understand negative emotions experienced through cancer are normal to feel and support for low mood to be accessible and available.

Impact of Age-appropriate Preparations for Children With Cancer Undergoing Radiotherapy on Parents and Family Functioning, Parents' Anxiety and Hospital Costs - A Feasibility Study

PURPOSE

The aim was to evaluate the impact of age-appropriate information and preparation procedures for children with cancer undergoing radiotherapy on 1) parents and family functioning, parents' anxiety and 2) hospital costs compared to traditional care.

DESIGN AND METHODS

An un-matched quasi-experimental controlled clinical trial was conducted consisting of a control group including 31 parents of 16 children receiving traditional care and an intervention group including 32 parents of 17 children receiving age-appropriate preparation including seven parts. Validated instruments measured parents and family functioning and parents' anxiety. Hospital costs were calculated.

RESULTS

Parents in the intervention group showed better communication throughout their child's radiotherapy (p = 0.01) and at their child's last fraction, parental social functioning improved (p = 0.02). Parents of children receiving general anesthesia, regardless of group, showed higher levels of anxiety (p = 0.04). In general, results regarding hospital costs lacked statistical significance. Development of the intervention was calculated to be USD 4.624.

CONCLUSION

Parents who receive age-appropriate information and preparation together with their child benefits in terms of improved communication and social functioning. When children avoid general anesthesia the parents experienced less anxiety and costs for the hospital was lowered.

PRACTICE IMPLICATION

Age-appropriate preparations consisting of basic, non-costly utilities and a structured approach are important. If more children are able to undergo radiotherapy without general anesthesia, it means for the individual child fewer risks and restrictions, and for the parents decreased anxiety. For the healthcare, it means lower costs, which enables the hospital to prioritize other areas of pediatric care.

"The child is our focus": On couple issues in child oncology treatment

OBJECTIVE

This study explored the perspectives of child oncology professionals and parents about the attention professionals should give to the parent couple relationship during treatment of the child.

METHODS

We employed a qualitative research design, framed within the approach of consensual qualitative research (CQR), gathering data from four focus groups with 20 professionals and from nine in-depth interviews with 16 parents. Thematic analysis of the focus group and interview data was done with MaxQda software, using two coders and member checks to strengthen confidence in the analysis.

FINDINGS

Both professionals and parents talked about an elevated tension in the partner relationship during oncology treatment of the child. However, explicit attention to the partner relationship in this context felt inappropriate to professionals and parents. All emphasized the importance of the professional helpers' openness to conversation and an attuned response to the parental couple relationship.

CONCLUSION

During treatment, the child is the primary focus for parents and professionals. The parents' focus on supporting their child makes talking about their own emotions or about issues in the partner relationship potentially disruptive and unhelpful. Therefore, it is crucial for professionals to support the parents in their parents' role, but with an openness to converse about issues in the partner relationship at the moments when these issues might threaten their focus on the child.

Through Their Eyes: Parental Perceptions on Hospital Admissions for Febrile Neutropenia in Children With Cancer

Febrile neutropenia requires prompt assessment and antibiotic administration and is the most common reason for unexpected hospital admission in pediatric oncology. Parents are expected to be vigilant and "drop everything" to take their child to their nearest hospital for assessment if fever occurs. Delays in antibiotic administration are associated with poorer outcomes; however, delays are common. Our aim was to understand and describe the lived experience of parents of children with cancer who received treatment for fever with confirmed/suspected neutropenia. We used descriptive phenomenological concepts to undertake and analyze interviews with parents, who were asked to describe their recent experience of hospitalization in Queensland, Australia. Nine participants were interviewed. Five children were treated in the tertiary treating center and four were treated in smaller regional towns. Three main categories were identified that shaped and characterized parents' experiences: being heard, confidence in capabilities of health care professionals, and living with anticipated distress and uncertainty. Parents' experiences were related to the level they needed to advocate for their child's care across all themes. Familiarity with health care professionals increased confidence and improved parents' experiences. Maintaining vigilance and managing the child and family's response to an unexpected admission had a substantial negative effect on parents. Understanding parents' experiences and perceptions of the management of febrile neutropenia adds to the current body of knowledge and offers potential new insights to improve clinical practice.

A força da informação sobre retinoblastoma para a família da criança

Resumo Objetivo: Compreender a necessidade de informação da família da criança com retinoblastoma. Métodos: Estudo qualitativo fundamentado no Modelo do Cuidado Centrado no Paciente e na Família. Participaram famílias de crianças em tratamento em uma instituição referência em oncologia pediátrica. A Análise Qualitativa de Conteúdo guiou a coleta e análise dos dados. Resultados: “A força da informação sobre retinoblastoma para a família da criança” revela o valor que a família atribui à informação sobre a doença da criança, em um tempo de intenso sofrimento; os caminhos que realiza para obter as informações; e os elementos que considera essenciais para se sentir atendida em seu direito. Conclusão: Torna-se primordial que a oferta de informações respeite o tempo da família, seja honesta, contemple as perspectivas de futuro para a criança, em um espaço dialógico. Dessa maneira, promove-se uma prática fundamentada no Modelo do Cuidado Centrado no Paciente e na Família.

Care provided by the father to the child with cancer under the influence of masculinities: qualitative meta-synthesis

ABSTRACT Objective: To synthesize and interpret findings and conclusions of qualitative research addressing the experience of the father in the care of the child with cancer. Method: Meta-synthesis of 16 qualitative studies from six databases, analyzed through taxonomic analysis. Results: Child and adolescent cancer have several repercussions on the daily life of the father, especially related to the stigma around the disease, the fear of the unknown and the social and family role. Faced with the illness and the need to care for the child, the father seeks to recover normality in the family and transitions between hegemonic masculine behaviors and practices culturally recognized as female. Final Considerations: The complex experience of the father, influenced by masculinities, was evidenced. The limitations regard the restricted understanding of the contextual specificities of the experiences, due to the limited characteristics of the parents and children described in the studies. The knowledge produced is useful to promote involvement of fathers in the care of the child, as well as to strengthen and assist him in this task.

Parents' Voice in Managing the Pain of Children with Cancer during Palliative Care

Context:

Pain experienced by children can adversely affect their growth and development. Pain is a major health problem for cancer patients and remains an unresolved problem.

Aim:

To know how the experiences of mothers managing their children's pain during palliative care following cancer diagnosis.

Background:

Pain experienced by children can adversely affect their growth and development.

Subject and Methods:

Using qualitative methods within a descriptive phenomenological approach, in-depth interviews were conducted with parents (mostly mothers) of eight children diagnosed with cancer. The data were collected using the snowball sampling method.

Results:

Participants experienced in managing the pain of children with cancer. Analysis of the results identified 8 themes: the dimensions of pain experienced by children undergoing palliative care; mothers' physical and psychological responses; mothers' emotional responses; barriers encountered by mothers when taking care of their child at home; mothers' interventions to reduce their child's pain; mothers' efforts to distract their child from pain; giving encouragement when the child is in pain; and mothers' efforts and prayers to make their child comfort.

Conclusion:

It can be concluded that the child's pain is the main cause of mothers' stress and pressure and also affects the daily lives of mothers and children. Along with the most effective intervention, nurses need to provide mothers and children with adequate information about cancer pain.

Perceptions of support among Swedish parents of children after end of successful cancer treatment: a prospective, longitudinal study

INTRODUCTION

Most children survive childhood cancer, however parenting a child diagnosed with cancer is a major challenge. The main aim of the current study was to describe Swedish parents' need, opportunity and benefit of support from healthcare professionals and significant others after end of a child's successful cancer treatment.

MATERIAL AND METHODS

Data was collected from approximately one week after end of successful treatment/six months after transplantation (T4, n = 212) up to five years thereafter (T7, n = 137). Parents answered questions via telephone about need, opportunity and benefit of talking to psychologists, social workers, partners and friends.

RESULTS

The proportion reporting need of support from healthcare professionals varied between 73% (mothers' need of support from social workers, T4) and 7% (fathers' need of support from psychologists/social workers, T7). Need of support from significant others varied between 99% (mothers' and fathers' need of support from partners, T4) and 27% (fathers' need of support from friends, T7). The proportion reporting need of support decreased over time (p < .001), no decrease occurred from three months after end of treatment/nine months after transplantation (T5) to one year after end of treatment/18 months after transplantation (T6). More mothers than fathers reported need of support from friends at T5 (p < .001) and T7 (p < .05) and from psychologists at T7 (p < .05). Opportunities for support from healthcare professionals varied, most reported opportunity for support from significant others. Almost all reported benefit from received support.

CONCLUSION

A declining number reports a need of support over time, however subgroups report an unmet need and almost every parent perceive support from healthcare professionals as beneficial. More parents should get access to psychosocial support services after end of a child's cancer treatment/transplantation.

Health-related quality of life in parents of pediatric brain tumor survivors at the end of tumor-directed therapy

OBJECTIVE

This study examines theoretical covariates of health-related quality of life (HRQL) in parents of pediatric brain tumor survivors (PBTS) following completion of tumor-directed therapy.

METHODS

Fifty PBTS (ages 6-16) completed measures of neurocognitive functioning and their parents completed measures of family, survivor, and parent functioning.

RESULTS

Caregiving demand, caregiver competence, and coping/supportive factors were associated with parental physical and psychosocial HRQL, when controlling for significant background and child characteristics.

CONCLUSION

Study findings can inform interventions to strengthen caregiver competence and family functioning following the completion of treatment, which may improve both parent and survivor outcomes.

When trust is threatened: Qualitative study of parents' perspectives on problematic clinical relationships in child cancer care

OBJECTIVE

We explored parents' accounts of the parent-clinician relationship in childhood cancer to understand how parents who perceive threats to the relationship can be supported.

METHODS

Multicentre longitudinal qualitative study, with 67 UK parents of children (aged 1-12 years) receiving treatment for acute lymphoblastic leukaemia. Analyses drew on the wider sample but focussed on 50 semistructured interviews with 20 parents and were informed by constant comparison.

RESULTS

All 20 parents described problems with clinical care such as inadequate information or mistakes by staff but varied in how much the problems threatened their sense of relationship with clinicians. Some parents saw the problems as having no relevance to the parent-clinician relationship. Others saw the problems as threats to the clinical relationship but worked to "contain" the threat in ways that preserved a trusting relationship with at least one senior clinician. Parents' containment work protected the security they needed from the parent-clinician relationship, but containment was a tenuous process for some. A few parents were unable to contain the problems at all; lacking trust in clinicians, these parents suffered considerably.

CONCLUSIONS

Given the complexity of childhood cancer care, problems with clinical care are inevitable. By engaging in containment work, parents met their needs to feel secure in the face of these problems, but the extent to which parents should have to do this work is debatable. Parents could benefit from support to seek help when problems arise which threaten their trust in clinicians. Attachment theory can guide clinicians in giving this support.

Sick leave among parents of children with cancer - a national cohort study

BACKGROUND

Due to psychological distress and an increased care burden, parents of children diagnosed with cancer may face a higher risk of sickness absence from work. The objective of this study was to examine the association of childhood cancer with parents' sick leave.

MATERIAL AND METHODS

The sample comprised 3626 parents of 1899 children diagnosed with cancer in Sweden during 2004-2009, and a matched control group of parents (n = 34 874). Sick leave was measured as number of days with sickness benefit, retrieved from national registries. Logistic and negative binomial regression models were used to compare outcomes with parents from the control cohort.

RESULTS

The risk of sick leave was statistically significantly higher up to six years following a child's cancer diagnosis. The increase in number of days with sickness benefit was most pronounced the year after diagnosis. Although mothers' sick leave prevalence was higher, the increase in risk relative to control parents was similar for mothers and fathers. Bereavement was associated with a heightened risk of sick leave, especially on the year of the child's death.

CONCLUSIONS

Findings confirm that mothers and fathers of children diagnosed with cancer are at higher risk of sickness absence from work, with particularly pronounced risk among bereaved parents. Acquisition of further knowledge is warranted regarding possibilities and constraints of parents trying to combine their work life with caring for both their child and themselves.

Facilitating and hindering factors for coping with the experience of having a child with cancer: A Lebanese perspective

BACKGROUND

Families with a child with cancer face significant emotional and psychosocial stressors. The frequency of childhood cancer is increasing in Lebanon with more than 282 children diagnosed each year. This condition is reported to evoke a range of challenging emotions for parents, yet no studies have been conducted on the facilitating and hindering factors that affect Lebanese parents coping with a child with cancer.

OBJECTIVES

The purpose of the study was to gain an in-depth understanding of factors facilitating and hindering coping methods of Lebanese parents with a child with cancer.

METHODS

The study followed purposeful sampling and saturation principles in which 12 parents (mother or father) of a child were interviewed. Data were analyzed following the Utrecht School of phenomenology.

RESULTS

Helpful and harmful experiences emerged through the coding process. The enabling factors were social/family support; talking about it; strong religious beliefs; and the communication style of health workers. On the other hand, the deterring factors were the waiting time and the hospital stay; changes in the couple's relationship; and sibling rivalry.

CONCLUSION

These results could be used as the basis for additional research aimed at developing a structured approach to care that endorses the coping processes of Lebanese parents with a child with cancer.

IMPLICATIONS FOR CLINICAL PRACTICE

Nursing and medical staff need to be conscious of parents' coping strategies and their impact on family dynamics and the relationship between the family and the health care team.

Experiences of Korean mothers of children with cancer: A Photovoice study

Using Photovoice, a participatory action research methodology, we investigated Korean mothers' lives postdiagnosis of their child with cancer. Photovoice was used to understand the mothers' perceptions of how they have adapted to their children's illnesses. Five mothers of children with cancer participated in five sessions of the Photovoice project, during which they took and shared photographs and narratives about their experiences and joined weekly group discussions on their selected themes. The following themes and subthemes emerged: "What I would like to do (taking a break, socializing with friends, spending time with other family members, developing my career)," "My child and food (whatever my child wants to eat, love of family)," "My days for my child (doing what my child wants to do, being a playmate, changing for my child)," and "Power sources for me (family, courage of children, mom is strong, hope)." Having a child with cancer greatly affects the mother's social and work lives as well as emotional well-being. Services and programs such as respite care, parenting education, and psychological support are recommended based on the study findings.

Short-term and long-term effects of childhood cancer on income from employment and employment status: A national cohort study in Sweden

BACKGROUND

There is insufficient knowledge regarding the economic impact of childhood cancer on parents. The objectives of the current study were to investigate the short-term and long-term effects of childhood cancer on mothers' and fathers' income from employment and employment status.

METHODS

The study sample consisted of the parents of children diagnosed with cancer from 2004 to 2009 in Sweden (3626 parents of 1899 children). Annual register data concerning income from employment and employment status (employed/not employed) were retrieved from the Longitudinal Integration Database for Health Insurance and Labor Market Studies. Using generalized linear models, the mean income from employment and employment status were compared with a matched control cohort of 34,874 parents sampled from the general population.

RESULTS

Parents' income was found to decrease significantly after the child's cancer diagnosis. The effect was most pronounced for mothers, whose income was reduced for 6 years after diagnosis, whereas fathers' income was similar to that of control fathers 3 years after the diagnosis. Mothers were more likely to stop working after a child's cancer diagnosis compared with controls. No association was found for fathers' employment status. Younger age of parents; lower level of education; and, among mothers, being born outside of Sweden were found to be associated with more adverse effects on income.

CONCLUSIONS

Parents' income from employment and employment status appear to be adversely affected by having a child with cancer. Socioeconomic consequences are not distributed equally: the income of fathers appears to catch up after a few years, whereas mothers tend to be disadvantaged in their professional life for several years after a child's cancer diagnosis. Cancer 2017;123:1238-1248. © 2016 American Cancer Society.

The Feasibility of Physical Activity Interventions During the Intense Treatment Phase for Children and Adolescents with Cancer: A Systematic Review

BACKGROUND

Physical activity may have benefits for children undergoing intense treatment for cancer, but such programmes are challenging to implement. This systematic review aimed to investigate the feasibly of physical activity interventions during intense cancer treatment for children and adolescents.

PROCEDURE

A systematic search of seven electronic databases (Cumulative Index to Nursing and Allied Health Literature, Medical Literature Analysis and Retrieval System Online, Public/Publisher MEDLINE, Psychological Information Database, Sportsdiscuss, Excerpta Medica Database, Allied and Complementary Medicine Database) from 2005 to August 2015 was completed. The risk of bias was assessed using the Downs and Black Checklist and The Critical Review Form-Qualitative Studies. Results were summarised descriptively across eight domains of feasibility: acceptability, demand, implementation, adaptation, practicality, integration, expansion and limited efficiency testing (including effectiveness).

RESULTS

Eleven quantitative studies and one qualitative study were identified for inclusion. Physical activity interventions were typically supervised, individualised programmes that prescribed a variety of activity types for hospital inpatients. There was evidence that physical activity interventions during the intense phase of cancer treatment were acceptable to parents and children, safe and successfully implemented. A trend of positive effects across all aspects of functioning was noted. Data were unavailable documenting feasibility for the domains of integration, adaptation and expansion.

CONCLUSION

There is preliminary evidence that physical activity interventions are feasible, in that they are acceptable, safe and potentially beneficial for children with cancer but more work needs to be done to understand the most effective ways to implement these types of programmes.

Parents' Lived Experiences During Their Children's Radiotherapy

BACKGROUND

The aim of radiotherapy is to provide a cure and/or symptomatic relief for children with cancer. Treatment is delivered on a daily basis, 5 days per week, over the course of 5 to 35 days. Many parents find that leaving their children alone during treatment and exposing them to radiation is a challenging experience. To gain an understanding of parents' lived experiences, 10 parents were asked to keep a diary while their children underwent radiotherapy.

METHODS

A descriptive inductive design with a hermeneutic-phenomenological approach was chosen to analyze the diaries. The parents were asked to write down their lived experiences while their children underwent radiotherapy. Daily notes, both short and long, were desirable.

FINDINGS

The parents described radiotherapy as a balancing act involving a constant attempt to maintain a balance between coercing and protecting their children in order to improve their children's chances of survival. Meanwhile, the parents themselves were struggling with their own despair and feelings of powerlessness. While protecting their children, they experienced a sense of hope and felt that they had gained control.

CONCLUSION

Parents' daily written reflections are important for clinical practice and provide vital knowledge. Parents need support when focusing on coercing and protecting their children and help with information and routines that enable them gain control.

Impressions That Last: Particularly Negative and Positive Experiences Reported by Parents Five Years after the End of a Child's Successful Cancer Treatment or Death

Objective

To describe the experience of parenting a child diagnosed with cancer by examining particularly negative and positive experiences reported by parents of childhood cancer survivors and parents of children lost to cancer.

Methods

168 parents (88 mothers, 80 fathers) participated. Data were collected five years after the end of successful treatment or the child’s death. The parents’ experiences were identified by open-ended semi-structured questions about particularly negative and positive experiences of the child’s cancer. An inductive approach was used in which the manifest verbal content of the answers was analysed using content analysis.

Results

The analysis revealed eight categories of negative experience (child late effects; distressing events; healthcare; impaired relationships; long-term psychological consequences; own reactions; surrounding institutions; the fact that the child got cancer) and seven categories of positive experience (healthcare; improved relationships; long-term consequences for the child; personal development; support systems; treatment outcome; unexpected joy). The categories were related to past events or to the present situation. The findings indicate variations in experiences between parents of survivors and bereaved parents, and between fathers and mothers, as some experiences were only reported by parents of survivors and some experiences were only reported by mothers.

Conclusions

The results highlight the importance of past and present events to parents, and accordingly the long-lasting impact of paediatric cancer on parents. The results also point to the wide range of negative as well as positive experiences involved in parenting a child diagnosed with cancer, and provide a comprehensive understanding of the overall experience for parents of children with cancer. Specifically, the findings give guidance to healthcare providers by illustrating the need to provide healthcare personnel with continuous training in communication skills, offering parents opportunities to meet other parents in the same situation and increasing the access to psychosocial supportive services and psychological care.