The Effect of Perceived Parental Rearing Behaviors on Health-Related Quality of Life in Adolescents with Leukemia

The impact of parental overprotection on the emotions and behaviors of pediatric hematologic cancer patients: a multicenter cross-sectional study

Background

Parental overprotection may have an impact on children's emotional and behavioral problems (EBPs). As pediatric hematologic cancer patients have compromised immune systems, parents of such children often worry excessively, interfering with their daily lives. Therefore, avoiding overprotection is crucial for the overall physical and mental health of pediatric hematologic cancer patients.

Aims

The aim of this study was to examine the current status of EBPs in pediatric hematologic cancer patients and analyze their associated risk factors.

Design

This work was a multicenter cross-sectional observational and correlational study. We collected data anonymously through parental questionnaires from three pediatric hematologic oncology hospitals in China. The Strengths and Difficulties Questionnaire, the Parental Overprotection Measure (POM) scale, and a general information survey designed by the research team were employed to assess children's EBPs, the degree of parental overprotection, as well as basic demographic and disease-related information. Chi-square tests and generalized linear mixed-effects regression analysis were used to analyze the factors influencing EBPs among the pediatric hematologic cancer patients.

Setting and participants

Using a convenience sampling method, a total of 202 participants' parents were selected. All participants were invited to complete the questionnaire through one-on-one guidance.

Results

Emotional symptoms accounted for the highest proportion of abnormal EBPs in children (27.72%), followed by peer problems (26.24%), prosocial behavior (25.74%), behavioral problems (14.36%), and total difficulties (13.86%). A minority of children had abnormal hyperactivity scores (4.95%). The results of a generalized linear mixed regression analysis showed that age, duration of illness, and parental overprotection were significant factors influencing abnormal EBPs in children (p < 0.05). A POM score threshold of 37 exhibited good sensitivity (74%) and specificity (90%) in predicting abnormal EBPs in children.

Conclusion

Pediatric hematologic cancer patients under excessive parental protection are more prone to experiencing EBPs. Healthcare professionals should guide parents to reduce this excessive protection, thus mitigating the occurrence of EBPs in children.

Comparison of perceived parental empathy between adolescents with leukemia and healthy adolescents: A comparative descriptive study

Purpose

The purpose of this study was to investigate and compare perceived parental empathy between adolescents with and without leukemia.

Methods

This study used a cross-sectional, descriptive design. Thirty-eight adolescents with leukemia and 205 without, completed a self-reported questionnaire regarding their perceptions of parental empathy and general characteristics. For this comparative study, adolescents were selected through matched sampling, and 38 adolescents per group were used for analysis. Data were examined using independent t-tests.

Results

In terms of parental empathy, excessive emotional reactions and cold emotional reactions were perceived more frequently by adolescents with leukemia than healthy adolescents. Differences between the two groups were statistically significant.

Conclusion

Since parents caring for children with leukemia have an extra burden in caring for their children, these parents are continuously anxious about prognoses, and tend to feel guilty for their child's disease. Thus, healthcare providers need to develop a program for improving the ability of parents of cancer patients to demonstrate empathy, focusing on how to recognize and manage what may be perceived by their children as excessive or cold emotional reactions, and must take a role in communicating to parents how adolescents with leukemia perceive parental rearing behaviors and the impacts of these behaviors on their well-being.

Health-related quality of life and well-being in parents of infants and toddlers with cancer

Background

The unique psychosocial needs of parents and caregivers of young children with cancer are poorly understood. The aims of the present study were to examine health-related quality of life (hrqol), stress, and psychological distress in parents of young children (0-4 years) diagnosed with cancer; and the associations between parent psychosocial functioning and child treatment characteristics.

Methods

Parents (n = 35) with a child (n = 19 male, 54.3%) 0-48 months of age (median: 31.06 months) on active cancer therapy were recruited. Parents completed questionnaires related to demographics, parent hrqol, parenting stress, posttraumatic stress symptoms, and parent psychological distress.

Results

Parents reported clinically elevated parenting stress (5.9%), posttraumatic stress symptoms (18.2%), and psychological distress (21.9%). Compared with population norms, parents reported lower hrqol in the vitality (t = 5.37, p < 0.001), mental health (t = 4.02, p < 0.001), role limitation-emotional (t = 3.52, p < 0.001), and general health perceptions (t = 2.25, p = 0.025) domains. Social functioning (β = 0.33, p = 0.041) predicted general health perceptions; vitality (β = 0.30, p = 0.134) and parent mental health (β = 0.24, p = 0.285) did not [F _(3,29) = 12.64, p < 0.001, R ² = 0.57].

Conclusions

A subset of parents of young children on active cancer treatment experience clinically elevated psychosocial symptoms. Having poor social connections put parents at risk of perceiving their health more poorly in general. Supports that focus on preventing the emergence of clinically significant distress should focus on parents of young children with cancer who are most at risk of poor outcomes.

What's past is prologue: Recalled parenting styles are associated with childhood cancer survivors' mental health outcomes more than 25 years after diagnosis

BACKGROUND

With the increased survival rates of childhood cancer, long-term survivors' well-being over the life span has come into focus. A better understanding of the determinants of childhood cancer survivors' (CCS) mental health outcomes contributes to the identification of vulnerable individuals as well as to the development of evidence-based prevention and intervention efforts. It has been noted that psychosocial factors such as parental rearing behavior shape individual differences in mental health. There is also evidence that parents show altered parenting behavior in the face of childhood cancer, e. g. that they express more emotional support, but also more worries. However, little is known about the relevance of different parenting styles for CCS' mental health decades after diagnosis and treatment.

METHODS

We examined the associations of recalled parenting styles and disease-related factors with lifetime diagnoses of depression and anxiety disorders in a German, registry-based sample of adult CCS (N = 948, 44.50% women) with survival times >25 years. We conducted logistic regression analyses of lifetime diagnoses of depression and anxiety disorders, respectively, on dimensions of recalled parental rearing behavior (measured with a validated German short version of the EMBU) controlling for relevant adjustment variables such as the presence of physical illnesses.

RESULTS

Recalled parenting styles of both parents had statistically relevant associations with CCS' lifetime depression and anxiety diagnoses. Maternal emotional warmth was related to fewer lifetime diagnoses of depression and fewer lifetime diagnoses of anxiety. Memories of paternal control and overprotection were positively associated with lifetime diagnoses of anxiety.

CONCLUSION

The results indicate that mental representations of one's caregivers are associated with psychological long-term outcomes. Thus, medical professionals should involve the parents and support them in accompanying their child through the difficult times of treatment and survivorship. Interventions aimed at fostering survivors' quality of life should consider the sustained relevance of early relationships.

Parenting in the face of serious illness: Childhood cancer survivors remember different rearing behavior than the general population

OBJECTIVE

A child's cancer diagnosis and treatment affect the whole family. While it has been recognized that parents are an important resource for their children, little is known about the specifics of parenting in the face of serious illness.

METHODS

We used the Recalled Parental Rearing Behavior Questionnaire in a register-based cohort of adult childhood cancer survivors (CCS) (N = 951) and a representative population sample of the same age range (N = 2042). The questionnaire assesses behavior of mothers and fathers with three scales (emotional warmth, rejection/punishment, and control/overprotection) by querying the (former) child. We compared the two groups using general linear models. With a hierarchical linear regression analysis, we tested associations of recalled rearing behavior with disease- and treatment-related factors.

RESULTS

Compared with the general population, CCS remembered both parents as emotionally warmer, more overprotective, and less punishing/rejecting and less ambitious. The regression analysis showed that having received radiotherapy (β = 0.092; P = .009) and chemotherapy (β = 0.077; P = .027) was positively related to memories of maternal emotional warmth.

CONCLUSIONS

CCS remembered parenting styles which are generally deemed more positive. The extent of recalled control and overprotection deviated from the population in different directions, suggesting that parenting in childhood cancer entails more complex adaptations than being affectionate and giving comfort. The results suggest an adaptation of parental behavior to particularly challenging treatments. They highlight potential vulnerability and resilience factors, some of which were sex-dependent.

Family Management Style as a Mediator between Parenting Stress and Quality of Life of Children with Epilepsy

PURPOSE

To examine the possible relationship between parenting stress and quality of life of children with epilepsy together with the mediating effects of family management styles on this relationship.

DESIGN AND METHODS

We conducted a descriptive and exploratory study using data of participants were 93 parents with an epileptic child. Instruments were self-reported questionnaires including the Korean version of the Quality of Life (QOL) in Childhood Epilepsy Questionnaire (K-QOLCE), the Korean version of the Parenting Stress Index (PSI), and the Korean version of the Family Management Measure (FaMM). Six domains of FaMM were clustered into two domains: easy or difficult family management styles. Descriptive and Pearson correlation path analyses were used to analyze the data.

RESULTS

The direct effects of PSI on QOL were not significant (b = -0.21, t = -0.94, p = .349). Indirect effects of PSI through easy family management styles on QOL were significant (b = -0.33, 95% CI = [-0.77, -0.05]). Additionally, two other effects (i.e., indirect effects through difficult family management styles and direct effects) were non-significant. All effects of PSI on QOL were fully mediated through easy family management styles.

CONCLUSION

Easy family management styles are the most important factor in predicting QOL in childhood epilepsy patients.

PRACTICE IMPLICATIONS

Comprehensive intervention programs are recommended for parents and families of epileptic children to promote positive perceptions of the child's life and to increase parental management ability of the child's condition and parental mutuality.

The Minneapolis-Manchester Quality of Life Instrument: reliability and validity of the Adult Form in cancer survivors

PURPOSE

Childhood cancer survivors are at risk for deficits in health-related quality of life (HRQL) as they age. Youth (8-12 years) and adolescent (13-20 years) versions of the Minneapolis-Manchester Quality of Life Instrument (MMQL) have been developed to address survivor-specific issues and are currently in use; the MMQL-Adult Form has now been developed to assess HRQL in childhood cancer survivors aged 21-55 years.

METHODS

The MMQL-Adult Form was administered to 499 adults: 65 cancer patients on-therapy, 107 off-therapy, and 327 healthy controls. Forty-four percent of patients were under 30 years old at cancer diagnosis. Principal components analysis was performed. We evaluated internal consistency reliability, stability (re-administration of the MMQL-Adult Form 2 weeks later), construct validity (concurrent administration of the SF-36), and known-groups validity (score comparisons across the three groups).

RESULTS

Principal components analysis resulted in retention of 44 items across six scales: social functioning, physical functioning, cognitive functioning, outlook on life, body image, and psychological functioning. Internal consistency (Cronbach's α) was 0.80-0.90 for individual scales and 0.95 overall. Strong intraclass correlations (0.98 overall) indicated high stability. The MMQL-Adult Form distinguished between known groups; healthy controls scored better than patients on four of six scales. The MMQL-Adult Form scales correlated highly with similar SF-36 scales, demonstrating construct validity.

CONCLUSIONS

The MMQL-Adult Form is a reliable and valid self-report instrument for measuring multidimensional HRQL in cancer survivors. Development of this instrument ensures availability of a tool enabling cross-sectional and longitudinal assessment of HRQL in childhood cancer survivors as they age.

Evaluating the cancer related fatigue by children, mothers, and nurses in Turkish pediatric oncology patients

PURPOSE

The aims of this study were to evaluate cancer related fatigue by children', mothers', and nurses' perspectives in recently diagnosed pediatric oncology patients, to evaluate levels of agreement between the fatigue scales, and to evaluate the relationships between fatigue and sample characteristics.

METHOD

The sample of this cohort, descriptive, correlational study consisted of 26 recently cancer diagnosed children between the ages of 7 and 12, receiving inpatient treatment in pediatric oncology/hematology units, their mothers and their nurses. The data about children's fatigue were collected using the Child Fatigue Scale-24 h, Parent Fatigue Scale-24 h and Staff Fatigue Scale-24 h, for two consecutive days in the second and third weeks of the patient's first chemotherapy treatment cycle.

RESULTS

The mean scores of the Child Fatigue Scale-24 h showed the children's fatigue to be at a moderate level, a statistically significant difference was found between the CFS-24 h and PFS-24 h mean scores in the first and second measurement (p < 0.05). The Intraclass correlation showed a good agreement between scales and repeated measurements for these scales.

CONCLUSION

Fatigue in recently diagnosed cancer patients is an important symptom which is of particular concern to the children, their parents and nurses. The study showed that these three scales can be used alone an also used simultaneously, and also proved that these scales are reliable for repeated measurements.