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Wickramasinghe LM, Yeo ZZ, Chong PH, Johnston B. Communicating with young children who have a parent dying of a life-limiting illness: a qualitative systematic review of the experiences and impact on healthcare, social and spiritual care professionals. BMC Palliat Care 2022; 21:125. [PMID: 35820910 PMCID: PMC9277932 DOI: 10.1186/s12904-022-01007-1] [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: 11/16/2021] [Accepted: 06/20/2022] [Indexed: 12/03/2022] Open
Abstract
Background Healthcare professionals play a key role in interacting with children who have a parent with a life-limiting illness. While playing such a role can be challenging, not much is known about how such interactions impact these professionals and affect their ability to render support. Methods Four databases were searched with the intention to conduct a qualitative systematic review. Articles were selected based on pre-determined inclusion and exclusion criteria. Their quality was assessed using the tool "Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields”. Findings were analysed using thematic analysis techniques outlined by Thomas and Harden as well as Sandelowski and Barroso. Review was registered with the Review Registry database. Results Three themes emerged – healthcare professionals’ discomfort; their assumptions and actions; and potentiating workplace factors. The discomfort had several dimensions: fear of making a situation worse, concern of not being able to cope with emotionally charged situations, and internal conflict that arose when their values clashed with family dynamics. Conclusion Healthcare professionals’ sense of discomfort was very pronounced. This discomfort, together with their assumptions, could impact their ability to support children. The organisation played an important role, which was reflected in the work culture, workflow and ability to collaborate with other agencies involved in supporting children. The discomfort was mitigated by having more professional experience, workplace support systems and training on communicating with children. It was apparent that the individual professional did not work alone when supporting children but alongside others within an organisation. As such, issues raised in this review will benefit from multi-faceted solutions. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-01007-1.
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Affiliation(s)
- Lasitha M Wickramasinghe
- HCA Hospice, 705 Serangoon Road, #03-01 Block A @ Kwong Wai Shiu Hospital, Singapore, 328127, Singapore.
| | - Zhi Zheng Yeo
- HCA Hospice, 705 Serangoon Road, #03-01 Block A @ Kwong Wai Shiu Hospital, Singapore, 328127, Singapore
| | - Poh Heng Chong
- HCA Hospice, 705 Serangoon Road, #03-01 Block A @ Kwong Wai Shiu Hospital, Singapore, 328127, Singapore
| | - Bridget Johnston
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, G12 8QQ, UK
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Usui Y, Kosugi K, Nishiguchi Y, Miura T, Fujisawa D, Uehara Y, Kawaguchi T, Izumi K, Takehana J, Matsumoto Y. Parenting experiences of cancer patients with minor children and their conversations about the possibility of death: a cross-sectional web-based survey for an online cancer community. Support Care Cancer 2022; 30:7715-7720. [PMID: 35701632 DOI: 10.1007/s00520-022-07220-1] [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: 11/24/2021] [Accepted: 06/09/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Many cancer patients with minor children experience difficulty talking about their illness with their children. This study aimed to investigate the parenting experiences of cancer patients with minor children and their conversations about the possibility of death. METHODS A cross-sectional web-based survey was conducted between April and May 2019. Cancer patients with at least one child aged < 18 years were recruited from an online peer support group called "Cancer Parents." The participants were asked to complete a questionnaire about their experiences of talking about their illnesses with their children. The participants were classified into those who disclosed their cancer to their children ("disclosing group"), and those who did not disclose ("non-disclosing group"). The association between whether they talked with their children about their cancer, and whether it included conversations about the possibility of death, was examined. RESULTS A total of 370 parents participated (with 80.8% female parents, with a median age of 43.0 years). The disclosing group (n = 274, 74.1%) wanted to know what their child felt, more than the non-disclosing group did (p < 0.001). Members of the non-disclosing group had a greater tendency than those in the disclosing group to report that they did not want their children to see their suffering (p = 0.002) and did not know how to explain their disease status (p < 0.002). Some members of both the disclosing (42.1%) and non-disclosing (6.5%) groups told their children about the possibility of death. CONCLUSION This study showed that 74.1% of the patients with minor children disclosed their cancer to their children. The parents' feelings when thinking about interacting with their children differed significantly between the disclosing and non-disclosing groups. It is important for healthcare professionals treating patients with cancer to provide appropriate multidisciplinary support for discussing their diagnosis and prognosis with their children.
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Affiliation(s)
- Yuko Usui
- Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa, Japan.,Department of Palliative Therapy, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kazuhiro Kosugi
- Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa, Japan.,Department of Psychiatry and Behavioral Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | | | - Tomofumi Miura
- Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa, Japan.
| | - Daisuke Fujisawa
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Yuko Uehara
- Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa, Japan.,Department of Palliative Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takashi Kawaguchi
- Department of Practical Pharmacy, Tokyo University of Pharmacy and Life Sciences, Hachioji, Japan
| | - Kayo Izumi
- Insight & Analytics Department, Medilead Inc, Tokyo, Japan
| | - Jun Takehana
- Insight & Analytics Department, Medilead Inc, Tokyo, Japan
| | - Yoshihisa Matsumoto
- Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa, Japan
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Wray A, Seymour J, Greenley S, Boland JW. Parental terminal cancer and dependent children: a systematic review. BMJ Support Palliat Care 2022:bmjspcare-2021-003094. [PMID: 35091436 DOI: 10.1136/bmjspcare-2021-003094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/28/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND When a parent has terminal cancer, their children are part of that experience. Parents often want to protect their children from their disease and prognosis. Knowledge of dependent children's experience will help ensure they receive appropriate support. To date, there is lack of synthesis of this evidence examining children's perspectives. OBJECTIVES To systematically search and synthesise the qualitative literature exploring the experiences of dependent children when their parent has terminal cancer. METHODS Databases of MEDLINE, Embase, PsycINFO, CINAHL, Assia and the Cochrane library were searched systematically from inception to July 2020 to determine eligible studies. Included studies were appraised for quality and thematically synthesised using Thomas and Harden's thematic synthesis framework. RESULTS Fourteen studies were included, which interviewed children about their experiences (n=654 children aged 4-18 years at the time of parental death), from six countries. Five descriptive themes were identified, further categorised into two broad themes: (1) finding out about parental cancer and its impact on the family and (2) coping with life with parental cancer, death and beyond. CONCLUSION Children want to be involved in their parent's cancer experience and to help support the family. Healthcare professionals are ideally placed to support and encourage parents to include their children. They should reassure parents that children can cope well and that maintaining normality will help, and explain the benefits of honest and open communication and how they can include dependent children from diagnosis and beyond.
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Affiliation(s)
- Alexandra Wray
- Wolfson Palliative Care Research Centre, Hull York Medical School, Univeristy of Hull, Hull, UK
| | - Julie Seymour
- Institiute of Clinical Applied Health Research, Hull York Medical School, Univeristy of Hull, Hull, UK
| | - Sarah Greenley
- Institute of Clinical and Applied Health Research, Hull York Medical School, University of Hull, Hull, UK
| | - Jason W Boland
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
- Palliative Medicine, Care Plus Group and St Andrew's Hospice, NE Lincolnshire, UK
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Accessing support before or after a parent dies from cancer and young people’s current wellbeing. Support Care Cancer 2017; 26:797-805. [DOI: 10.1007/s00520-017-3891-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 09/11/2017] [Indexed: 11/30/2022]
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Clipsham L, Islam Z, Faull C. Experiences of hospice inpatient nurses in supporting children before the death of a parent. Int J Palliat Nurs 2016; 21:453-9. [PMID: 26412276 DOI: 10.12968/ijpn.2015.21.9.453] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The need for pre-bereavement support for children facing the death of a parent is well recognised but how this is done by hospice ward nurses in practice is not well known. METHOD To explore the experiences of hospice ward nurses' identification of the support needs of children under 18 years old facing the death of a parent, and the impact on hospice nurses when involved in providing this support. DESIGN Semi-structured individual interviews with hospice nurses working on a single UK inpatient unit were audio-taped and analysed using thematic analysis to produce themes and subthemes. RESULTS Nurses were highly reflective, discussing their personal experiences, and identified potential enablers and barriers to providing support. Child and family factors were identified as influencing identification of support needs. CONCLUSION Multiple factors influencing provision of support emerged. Formal training and readily available resources would support hospice nurses working with children.
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Affiliation(s)
- Laura Clipsham
- Consultant in Palliative Medicine, University Hospitals of Leicester
| | | | - Christina Faull
- Consultant in Palliative Medicine, both at LOROS Hospice Care for Leicester, Leicestershire and Rutland
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Ellis S, Wakefield C, Antill G, Burns M, Patterson P. Supporting children facing a parent's cancer diagnosis: a systematic review of children's psychosocial needs and existing interventions. Eur J Cancer Care (Engl) 2016; 26. [DOI: 10.1111/ecc.12432] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2015] [Indexed: 11/29/2022]
Affiliation(s)
- S.J. Ellis
- Behavioural Sciences Unit, proudly supported by the Kids with Cancer Foundation; Kids Cancer Centre; Sydney Children's Hospital; Randwick NSW Australia
- Discipline of Paediatrics; School of Women's and Children's Health; UNSW Medicine; University of New South Wales; Sydney NSW Australia
| | - C.E. Wakefield
- Behavioural Sciences Unit, proudly supported by the Kids with Cancer Foundation; Kids Cancer Centre; Sydney Children's Hospital; Randwick NSW Australia
- Discipline of Paediatrics; School of Women's and Children's Health; UNSW Medicine; University of New South Wales; Sydney NSW Australia
- Cancer Institute of NSW; Alexandria NSW Australia
| | | | - M. Burns
- Behavioural Sciences Unit, proudly supported by the Kids with Cancer Foundation; Kids Cancer Centre; Sydney Children's Hospital; Randwick NSW Australia
- Discipline of Paediatrics; School of Women's and Children's Health; UNSW Medicine; University of New South Wales; Sydney NSW Australia
| | - P. Patterson
- Research, Evaluation and Social Policy; CanTeen Australia; Sydney NSW Australia
- Faculty of Nursing; Sydney Medical School; University of Sydney; Sydney NSW Australia
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Chen R, Regodón Wallin A, Sjölander A, Valdimarsdóttir U, Ye W, Tiemeier H, Fall K, Almqvist C, Czene K, Fang F. Childhood injury after a parental cancer diagnosis. eLife 2015; 4. [PMID: 26519735 PMCID: PMC4749389 DOI: 10.7554/elife.08500] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 10/27/2015] [Indexed: 12/22/2022] Open
Abstract
A parental cancer diagnosis is psychologically straining for the whole family. We investigated whether a parental cancer diagnosis is associated with a higher-than-expected risk of injury among children by using a Swedish nationwide register-based cohort study. Compared to children without parental cancer, children with parental cancer had a higher rate of hospital contact for injury during the first year after parental cancer diagnosis (hazard ratio [HR] = 1.27, 95% confidence interval [CI] = 1.22-1.33), especially when the parent had a comorbid psychiatric disorder after cancer diagnosis (HR = 1.41, 95% CI = 1.08-1.85). The rate increment declined during the second and third year after parental cancer diagnosis (HR = 1.10, 95% CI = 1.07-1.14) and became null afterwards (HR = 1.01, 95% CI = 0.99-1.03). Children with parental cancer also had a higher rate of repeated injuries than the other children (HR = 1.13, 95% CI = 1.12-1.15). Given the high rate of injury among children in the general population, our findings may have important public health implications. DOI:http://dx.doi.org/10.7554/eLife.08500.001 A diagnosis of cancer can be devastating for both a person and his or her family. Over the past 40 years, the number of individuals in Sweden diagnosed with cancer has more than doubled leaving growing numbers of families coping with the aftermath. Many individuals diagnosed with cancer have young children. Parents with cancer and their spouses often struggle to cope with disease and the demands of parenting simultaneously. In fact, previous research has shown children with a parent who has cancer have a greater risk of behavioral problems or distress than children with two healthy parents. Whether the stress of having a parent with cancer also affects the children’s physical wellbeing hasn’t been studied much. One concern in particular is whether these children may be at increased risk of injury. Injuries are the most common reason for a child to visit a hospital and in some cases lead to deaths. Children who are not well supervised or whose parents have poor mental health are at increased risk of injury. Coping with cancer and the mental anguish it causes may distract parents and possibly place their children at increased risk of injury. Based on data from nationwide population and health registers in Sweden, Chen, Regodón Wallin et al. now provide evidence that a child with a parent who has cancer is at a greater risk of injury than a child with two parents who are free of cancer. The analysis also revealed that the risk is particularly great if the parent with cancer also develops mental illness after the cancer diagnosis. The risk of injury is greatest in the first year after the parent’s diagnosis. Fortunately, the elevated risk of injury decreases overtime and is almost non-existing after the third year. The analyses suggest that providing extra support for parents with cancer might help to reduce the risk of injury in their children. DOI:http://dx.doi.org/10.7554/eLife.08500.002
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Affiliation(s)
- Ruoqing Chen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Amanda Regodón Wallin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Arvid Sjölander
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Unnur Valdimarsdóttir
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Weimin Ye
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henning Tiemeier
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Department of Child and Adolescent Psychiatry, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Katja Fall
- Clinical Epidemiology and Biostatistics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Lung and Allergy Unit, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Fang Fang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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