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Low CE, Loke S, Rana S, Sim B, Ho CSH. Prevalence and incidence of suicide, suicidal ideation and self-harm in caregivers of cancer patients: A systematic review and meta-analysis. Gen Hosp Psychiatry 2024; 90:35-43. [PMID: 38936297 DOI: 10.1016/j.genhosppsych.2024.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 06/19/2024] [Accepted: 06/20/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVE Caregiving burden is set to increase with the rising incidence of cancer globally. The meta-analysis seeks to investigate the prevalence of suicide, suicidal ideation and self-harm among the caregivers of patients with cancer (CPCs). METHODS This PRISMA-adherent systematic review involved a systematic search of PubMed, Embase, Cochrane and PsycINFO for all studies that evaluated the prevalence of suicide, suicidal ideation and self-harm in CPCs. Random effects meta-analyses were used for primary analysis. RESULTS Eleven studies were included. Meta-analyses indicated that the prevalence of suicidal ideation in CPCs was 11% (95%CI:6-18), suicide prevalence was 6% (95%CI:3-12), and self-harm prevalence was 15% (95%CI:8-26). Subgroup analyses revealed that CPCs above the age of 50 experienced a greater prevalence of suicidal ideation (17%, 95%CI:10-28) as compared to CPCs below 50 (6%, 95%CI:3-12). Family caregivers particularly spouses were also found to have a higher prevalence of suicidal ideation (17%, 95%CI:13-23), as compared to children (5%, 95%CI:2-10) or mothers (3%, 95%CI:1-8). Systematic review found that having a pre-existing mental health condition and lower socioeconomic status increased likelihood of suicidality. CONCLUSION We highlight the need for more support of CPCs at risk of suicidality. Additional research is warranted to identify other risk and protective factors.
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Affiliation(s)
- Chen Ee Low
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Sean Loke
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Sounak Rana
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ben Sim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Cyrus Su Hui Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Psychological Medicine, National University Hospital, Singapore.
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Pholsena TN, Lewis FM, Phillips F, Loggers ET, Yockel MR, Zahlis EH, Shands ME. Advanced parental cancer and adolescents: Parenting issues and challenges. Palliat Support Care 2024:1-6. [PMID: 38736375 DOI: 10.1017/s1478951524000774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
BACKGROUND An estimated 609,820 child-rearing adults in 2023 died from advanced cancer, affecting 153,675 dependent children. Although children are known to suffer significant distress when a parent is diagnosed with cancer, few studies have described parents' views of their adolescent's behavioral response to their advanced cancer or what the parent did to interpret or manage that response. OBJECTIVES To describe patient-reported concerns about their adolescent and how they responded to their adolescent's behavior. METHODS Single occasion interviews were administered to 6 adolescent-rearing parents with Stage IV cancer. Interviews were analyzed using inductive content analysis by trained coders. Trustworthiness of results was protected through peer debriefing, coding to consensus, and maintaining an audit trail. RESULTS The core construct that explained study data was Being There without Taking Over, comprised of 4 domains: Struggling to Read My Child, Attempting to Talk with My Child about My Cancer, Trying to Maintain Optimism, and Understanding My Child. CONCLUSIONS Parents were deeply concerned about the impact of their advanced cancer on their adolescent but were unable to distinguish between cancer-related distress and adolescent angst. They feared initiating cancer-related discussions and struggled with their own feelings of guilt and parental inadequacy but did not turn to professionals for help. SIGNIFICANCE OF RESULTS Adolescent-rearing patients with advanced disease need to be triaged into services that offer a framework from which parents can interpret their child's behavior and learn ways to have adolescent-appropriate conversations about the cancer. Such services should also help parents gain skills to manage feelings of parental inadequacy and guilt. In the absence of services, parents struggle and do not know how to interpret and respond to their adolescent's cancer-related behavior.
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Affiliation(s)
- Thepthara N Pholsena
- UW Virology Research Clinic, Allergy and Infectious Disease Department, University of Washington, Seattle, WA, USA
| | - Frances Marcus Lewis
- School of Nursing, University of Washington, Seattle, WA, USA
- Affiliate, Public Health Sciences Division, Seattle, WA, USA
- Member, Clinical Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Farya Phillips
- Steve Hicks School of Social Work, Dell Medical School, Department of Health Social Work, University of Texas at Austin, Austin, TX, USA
| | - Elizabeth T Loggers
- Division of Oncology, School of Medicine, University of Washington, Seattle, WA, USA
- Clinical Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Mary Rose Yockel
- Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, Georgetown University, Washington, DC, USA
| | - Ellen H Zahlis
- School of Nursing, University of Washington, Seattle, WA, USA
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Tulpin M, Scherrens AL, Van Driessche A, Verhofstadt LL, Kreicbergs U, Goubert L, Beernaert K. "A sincere 'how are you?' is already a sign of acknowledgement that you're there too." - Interview study on the support needs of adolescents and young adults (AYAs) living with a parent with cancer. Eur J Oncol Nurs 2024; 70:102602. [PMID: 38810585 DOI: 10.1016/j.ejon.2024.102602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 04/04/2024] [Accepted: 04/26/2024] [Indexed: 05/31/2024]
Abstract
PURPOSE Parental cancer brings changes and challenges which affect the whole family. Evidence shows heightened psychosocial risk among the offspring. Research among adolescents and young adults (AYAs) facing parental cancer has mainly focused on these psychosocial problems. As a reaction, there has been an increase in research on the needs of this population, since this knowledge is crucial for developing appropriate support. Despite this increase, some AYAs are still underrepresented, namely those over eighteen years old and those who have a parent with incurable cancer. Moreover, the factors hampering or fostering access to and receipt of support addressing their needs are under-investigated. Increasing our understanding of these issues is crucial to developing more effective support interventions for these young people. Our aim was therefore to gain insight into the perceived support needs of AYAs who have a parent with cancer, including the mentioned underrepresented subgroups, and the perceived factors facilitating or hindering their use of support. METHODS We conducted semi-structured interviews with 17 AYAs who have a parent with cancer of any type and stage, which were analyzed using conventional Qualitative Content Analysis (QCA). RESULTS Six main categories emerged from the data, encompassing various subcategories: 1) Needs surrounding the time of disclosure, 2) Information needs, 3) Informal support needs, 4) Need for effective personal coping strategies, 5) Formal support needs, and 6) Contextual and medical factors affecting support needs. AYAs perceived family members, friends and teachers as important sources of informal support, but lacked contact with peers who also have a parent with cancer. They expressed a need for formal informational and emotional support from their parent's medical team, (onco)psychologists, and their general practitioner. AYAs faced barriers in accessing formal support. A proactive attitude from healthcare providers and information about available support would help them meet their needs. Furthermore, we shed new light on needs and issues in post-secondary education. CONCLUSIONS AYAs who are living with their parent with cancer experience informational, emotional, and practical needs in multiple contexts, such as the home, school, leisure and hospital environment. They identify their informal and formal network as important key figures in addressing these needs.
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Affiliation(s)
- Marthe Tulpin
- Ghent Health Psychology Lab, Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium; End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB), Brussels, Belgium & Ghent University, Ghent, Belgium.
| | - Anne-Lore Scherrens
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB), Brussels, Belgium & Ghent University, Ghent, Belgium
| | - Anne Van Driessche
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB), Brussels, Belgium & Ghent University, Ghent, Belgium
| | - Lesley L Verhofstadt
- Family Lab, Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Ulrika Kreicbergs
- Population, Policy & Practice Department, University College London, London, United Kingdom
| | - Liesbet Goubert
- Ghent Health Psychology Lab, Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Kim Beernaert
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB), Brussels, Belgium & Ghent University, Ghent, Belgium
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Bergersen E, Larsson M, Lövgren M, Olsson C. Adolescents' and young people's needs and preferences for support when living with a parent with life-threatening cancer: a grounded theory study. BMC Palliat Care 2022; 21:164. [PMID: 36138453 PMCID: PMC9502590 DOI: 10.1186/s12904-022-01055-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Living with a parent facing life-threatening illness and losing a mom or dad at a young age can cause both short- and long-term health problems. Without satisfactory support, adolescents' and young people are at risk of developing low self-esteem, behavioural difficulties (e.g., anger and aggression), long-term illness or premature death caused by severe mental illness, substance abuse, self-harm and suicide attempts. The aim of this study was to explore adolescents' and young people's needs and preferences for support as they live with a parent with life-threatening cancer. METHODS Qualitative interviews were conducted with 10 respondents (17-24 years) in Norway and Sweden. Data were analysed through grounded theory according to Charmaz. RESULTS Adolescents' and young peoples' needs and preferences for support were described through the main category 'To feel safe and secure and to be prepared' and further broken down into five subcategories 'Relationships in the immediate family-balancing support and protection'; 'The social network-support and normalcy in a carefully selected group'; 'Maintaining everyday life-challenges in school and working life'; 'The right support at the right time-competence, trust and continuity in meeting health care professionals'; and 'Support outside the home-an opportunity for full transparency'. CONCLUSION Adolescents' and young peoples' preferences for support when living with a parent facing life-threatening illness are individual and unique, but they share a common need to feel safe and secure and to be prepared. Adolescents and young people express that they primarily want support from parents and friends, but they also want support from health care professionals, especially in situations when the ill parent becomes worse. Therefore, it is of the utmost importance for health care professionals to identify the most vulnerable adolescents and young people by mapping their social networks and paying extra attention to their needs for support when there is deterioration in the parent's illness state. This study also highlights the importance for health care professionals to establish a good relationship with adolescents and young people to meet their needs and preferences for support. In addition, information and support are needed in a timely manner and adapted to the life-threatening ill parent's illness state and individual's needs and preferences to optimise preparedness.
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Affiliation(s)
- Emily Bergersen
- Karlstad University, Universitetsgatan 2, 651 88, Karlstad, Sweden. .,Inland Norway University of Applied Sciences, Strandvegen 3, 2206, Kongsvinger, Norway.
| | - Maria Larsson
- Karlstad University, Universitetsgatan 2, 651 88, Karlstad, Sweden
| | - Malin Lövgren
- Marie Cederschiöld University, Box 11189, 100 61, Stockholm, Sweden
| | - Cecilia Olsson
- Karlstad University, Universitetsgatan 2, 651 88, Karlstad, Sweden.,Lovisenberg Diaconal University College, Lovisenberggt. 15b, 0456, Oslo, Norway
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Jessop M, Fischer A, Good P. Impact of expected parental death on the health of adolescent and young adult children: A systematic review of the literature. Palliat Med 2022; 36:928-937. [PMID: 35510358 DOI: 10.1177/02692163221092618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Few studies of health impacts of parental death focus on the developmental stage of adolescence and young adulthood and in particular, expected parental death from terminal illness. AIM To systematically review the health impact of expected parental death on adolescent and young adult children aged 15-25 years and provide a basis for further research and clinical practice. DESIGN Systematic review registered on PROSPERO (CRD42017080282). DATA SOURCES Pubmed, PsycINFO, CINAHL, MEDLINE and Cochrane databases were searched with no restrictions on publication date with the last search in March 2021. Eligible articles included studies of adolescent and young adult children (defined by age range of 15-25 years) exposed to parental death due to terminal illness, and with reported health outcomes (physical, psychological or social). Articles were reviewed using the QualSyst tool. RESULTS Ten articles met the inclusion criteria. Adolescent and young adult children reported poor family cohesion and communication with associated negative psychological outcomes. They reported distrust in the health care provided to their terminally ill parent, increased psychological distress and risk of unresolved grief, anxiety and self-harm. Some experience was positive with posttraumatic growth identified. CONCLUSIONS This review specifically analysed the health impact of expected parental death on adolescent and young adult children. It highlights their need for age-appropriate psychosocial support and clear information during parental illness, death and bereavement.
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Affiliation(s)
- Melissa Jessop
- Department of Palliative Care, St Vincent's Private Hospital Brisbane, Main Street, Brisbane, QLD, Australia
| | - Amanda Fischer
- Department of Palliative Care, St Vincent's Private Hospital Brisbane, Main Street, Brisbane, QLD, Australia
| | - Phillip Good
- Department of Palliative Care, St Vincent's Private Hospital Brisbane, Main Street, Brisbane, QLD, Australia.,Department of Palliative and Supportive Care, Mater Health Services, Raymond Terrace, South Brisbane, QLD, Australia; Mater Research Institute-University of Queensland, Raymond Terrace, South Brisbane, QLD, Australia
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Oguro N, Suzuki R, Yajima N, Sakurai K, Wakita T, Hall MA, Kurita N. The impact that family members' health care experiences have on patients' trust in physicians. BMC Health Serv Res 2021; 21:1122. [PMID: 34666754 PMCID: PMC8527743 DOI: 10.1186/s12913-021-07172-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 10/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A family member's negative experiences with medical care have long-term effects on a patient's attitudes and emotions. However, the impact of family members' experiences on patients' trust in their own physicians and in physicians generally is poorly understood. This study aims to quantify these associations. METHODS A cross-sectional online survey involving adults with non-communicable diseases (cardiac disease, diabetes, cancer, depression, and rheumatic disease) was conducted in Japan during April 2020. The main exposure variable was dissatisfaction with the medical care that family members had received. The main outcomes were patients' (N = 661) own trust in their personal physicians and in physicians generally. The study adopted the Japanese version of the Abbreviated Wake Forest Physician Trust Scales. Both 5-item scales (general and individual physician trust) were translated and validated for the study. The total scores were transformed into a scale of 0-100 points. A series of linear mixed-effects models with consideration for clustering effect by prefectures were fit. RESULTS The results showed a lower rating for trust in physicians generally as compared to trust in the respondent's personal physician (mean 57.0 vs. 66.4 points; p < 0.001). Furthermore, dissatisfaction with a family member's medical care was associated with lower trust in physicians generally (mean difference - 9.58, 95 %CI -12.4 to -6.76). Interestingly, dissatisfaction with a family member's care was also associated with lower trust in the respondent's personal physician (mean difference - 3.19, 95 %CI -6.02 to -0.36), but the magnitude of this association was weaker. The lower trust in personal physicians may be mediated by reduced trust in physicians generally. CONCLUSIONS We suggest that physicians enquire about past patients' negative experiences, including dissatisfaction with family members' medical care, to repair hidden loss of trust, when they sense that patients doubt them or physicians generally.
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Affiliation(s)
- Nao Oguro
- Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Japan.,Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Ryo Suzuki
- Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Japan.,Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima, Japan.,Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Nobuyuki Yajima
- Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan.,Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima, Japan.,Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kosuke Sakurai
- Department of Pharmacy, Showa University Hospital, Tokyo, Japan
| | | | - Mark A Hall
- School of Law and School of Medicine, Wake Forest University, Winston-Salem, United States, North Carolina
| | - Noriaki Kurita
- Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Japan. .,Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima, Japan. .,Department of Innovative Research and Education for Clinicians and Trainees (DiRECT), Fukushima Medical University Hospital, Fukushima, Japan. .,Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Fukushima City, Japan.
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Upping my game as a parent: Attributed gains in participating in a cancer parenting program for child-rearing parents with advanced cancer. Palliat Support Care 2020; 18:339-345. [PMID: 32148212 DOI: 10.1017/s1478951520000103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The objective of this study was to describe in the words of child-rearing parents with incurable cancer, what they had gained or thought about as a result of participating in a five-session, scripted, telephone-delivered psycho-educational parenting intervention, the Enhancing Connections Program in Palliative Care. METHODS A total of 26 parents completed the program. Parents' responses were audio-recorded and transcribed verbatim and verified for accuracy. The analysis proceeded through four steps: unitizing, coding into categories, defining categories, and formation of a core construct that explained parents' attributed gains. Trustworthiness of study results was protected by coding to consensus, formal peer debriefing, and maintaining an audit trail. RESULTS Although 50% reached or exceeded clinical cutoff scores on anxiety and 42% reached or exceeded clinical cutoff scores on depressed mood, parents extensively elaborated what they gained. Results revealed six categories of competencies they attributed to their participation in the program: (1) being ready for a conversation about my cancer, (2) bringing things out in the open, (3) listening better to my child, (4) getting my child to open up, (5) not getting in my child's way, and (6) changing my parenting. CONCLUSIONS Despite an extensive symptom burden, parents with incurable cancer attributed major gains from a brief, fully scripted, cancer parenting communication intervention. A manualized telephone-delivered educational counseling program for symptomatic parents with incurable cancer has the potential to augment competencies for parents as they assist their children manage the cancer experience.
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Lewis FM, Loggers ET, Phillips F, Palacios R, Tercyak KP, Griffith KA, Shands ME, Zahlis EH, Alzawad Z, Almulla HA. Enhancing Connections-Palliative Care: A Quasi-Experimental Pilot Feasibility Study of a Cancer Parenting Program. J Palliat Med 2019; 23:211-219. [PMID: 31613703 DOI: 10.1089/jpm.2019.0163] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: In 2018, >75,000 children were newly affected by the diagnosis of advanced cancer in a parent. Unfortunately, few programs exist to help parents and their children manage the impact of advanced disease together as a family. The Enhancing Connections-Palliative Care (EC-PC) parenting program was developed in response to this gap. Objective: (1) Assess the feasibility of the EC-PC parenting program (recruitment, enrollment, and retention); (2) test the short-term impact of the program on changes in parent and child outcomes; and (3) explore the relationship between parents' physical and psychological symptoms with program outcomes. Design: Quasi-experimental two-group design employing both within- and between-subjects analyses to examine change over time and change relative to historical controls. Parents participated in five telephone-delivered and fully manualized behavioral intervention sessions at two-week intervals, delivered by trained nurses. Behavioral assessments were obtained at baseline and at three months on parents' depressed mood, anxiety, parenting skills, parenting self-efficacy, and symptom distress as well as children's behavioral-emotional adjustment (internalizing, externalizing, and anxiety/depression). Subjects: Parents diagnosed with advanced or metastatic cancer and receiving noncurative treatment were eligible for the trial provided they had one or more children aged 5-17 living at home, were able to read, write, and speak English, and were not enrolled in a hospice program. Results: Of those enrolled, 62% completed all intervention sessions and post-intervention assessments. Within-group analyses showed significant improvements in parents' self-efficacy in helping their children manage pressures from the parent's cancer; parents' skills to elicit children's cancer-related concerns; and parents' skills to help their children cope with the cancer. Between-group analyses revealed comparable improvements with historical controls on parents' anxiety, depressed mood, self-efficacy, parenting skills, and children's behavioral-emotional adjustment. Conclusion: The EC-PC parenting program shows promise in significantly improving parents' skills and confidence in supporting their child about the cancer. Further testing of the program is warranted.
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Affiliation(s)
- Frances Marcus Lewis
- University of Washington, Seattle, Washington.,Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | | | | | - Kenneth P Tercyak
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
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Hoffmann R, Kaiser J, Kersting A. Psychosocial outcomes in cancer-bereaved children and adolescents: A systematic review. Psychooncology 2018; 27:2327-2338. [PMID: 30120901 DOI: 10.1002/pon.4863] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 07/25/2018] [Accepted: 07/26/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Due to the unique importance of parental and sibling relationships and concurrently existing developmental challenges, the loss of a parent or sibling due to cancer is a highly stressful event for children and adolescents. This is the first systematic review that integrates findings on psychosocial outcomes after parental or sibling cancer bereavement. METHODS A systematic search of Web of Science, PubMed, PsycINFO, and PubPsych was conducted, last in December 2017. Quantitative studies on psychosocial outcomes of children and adolescents who lost a parent or sibling due to cancer were included. RESULTS Twenty-four studies (N = 10 parental and N = 14 sibling bereavement), based on 13 projects, were included. Ten projects had cross-sectional designs. Only 2 projects used large, population-based samples and nonbereaved comparison groups. Outcomes were partially measured by single-item questions. Bereaved children and adolescents showed similar levels of depression and anxiety compared with nonbereaved or norms. Severe behavioral problems were found rarely. However, in 2 large, population-based studies, about half of the bereaved individuals reported unresolved grief. Bereaved adolescents had a higher risk for self-injury compared with the general population in one large, population-based study. Communication with health-care professionals, family, and other people; social support; distress during illness; age; gender; and time because loss were associated with psychosocial bereavement outcomes. CONCLUSIONS Results indicate a high level of adjustment in cancer-bereaved children and adolescents. A modifiable risk factor for adverse psychosocial consequences is poor communication. Prospective designs, representative samples, and validated instruments, eg, for prolonged grief, are suggested for future research.
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Affiliation(s)
- Rahel Hoffmann
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Julia Kaiser
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Anette Kersting
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
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