Psychological resilience and long-term distress in Swedish and Icelandic parents' adjustment to childhood cancer

The Complexity of Being a Parent in the Hospital and a Patient at Home: A Qualitative Study on Parenting Concerns and Challenges Among Parents With Cancer

BACKGROUND

Parents given a diagnosis of cancer must balance the demands of their illness and caregiving responsibilities. This can result in parental stress and have a negative impact on the well-being of the whole family. A greater understanding of the experiences of parents with cancer is necessary to provide adequate support.

OBJECTIVE

The aim of this study was to explore parenting concerns and challenges among parents with cancer who were caring for dependent children younger than 18 years.

METHODS

Semistructured interviews were carried out with 22 parents with cancer. Interviews were audio-recorded, transcribed, and analyzed using thematic analysis.

RESULTS

Parental concerns and challenges affected parents in their parental role and their everyday family life. Three overarching themes described the struggles in balancing life as a parent and as a patient: navigating dual roles as a parent with cancer, impact of cancer on parenting, and impact on family life. Parents' primary focus was on their children's well-being, and they struggled to manage their own expectations of parenting and the demands on their role in the family.

CONCLUSION

The results highlight the complexity of being a parent with cancer while caring for dependent children. To support parents during the cancer journey, it is important to understand the consequences of their illness on their parental role and the family.

IMPLICATIONS FOR PRACTICE

Supporting parents to feel secure in their parental role and providing support to them during their cancer journey should be integrated into routine cancer care, where parenting concerns and challenges are addressed.

Occurrence and correlates of anxiety and depression in carers of autistic children across three nations

Purpose

Caring for an autistic child is associated with elevated stress, anxiety and depression. Although some data suggest that 'child' or 'carer' factors may moderate the severity of carer distress, relatively few international comparisons have been made, limiting the generalizability of previous findings. This study aimed to address this issue.

Method

A survey-based comparison was made of carers from three nations (Australia, Denmark, Greece), and the effects of demographic, child, and carer variables upon carer anxiety and depression were investigated.

Results

Only limited cross-nation consistency was found for nation, child, or carer variables and their effects upon carer anxiety or depression.

Conclusion

The application of universal treatment models for carer anxiety and depression may be of differing value across nations.

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.

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.

Sense of Coherence in Parents of Children With Cancer and Its Relationship With Self-Construal in Southeastern Iran

This study aimed to determine sense of coherence and its relationship with self-construal in parents of children with cancer in southeastern Iran. In this descriptive correlational study, 127 parents of children with cancer were studied using sense of coherence scale (SOC) and self-construal scale (SCS) in Iran. The results of the study showed that total mean score of SOC was 51.4 ± 14.2 and the interdependent self-construal (INT) in parents was higher than independent self-construal (IND). Also, the relationship between SOC and SCS showed that IND had a positive and statistically significant relationship with SOC manageability subscale. The weak SOC in the studied parents can cause more stress and suffering in dealing with their child's disease. It is essential that health care providers provide a comprehensive program to enhance parents' SOC and it should be noted that people who have a more INT felt less able to manage challenging situations.

Social Support Received and Provided in the Adjustment of Parents of Children With Cancer

OBJECTIVE

The aim of the present study is to determine the relation between the satisfaction of parents of children with cancer with the social support received and provided from a multidimensional perspective (sources and types of support) and the disruptions that take place in different areas of their lives (partner, children, family, social relations, and economic and employment situation).

METHOD

One hundred twelve parents of children diagnosed with cancer who received treatment at the Mother and Child Hospital of Málaga (Spain) were recruited. Data were gathered through self-reporting measures. The instrument used includes a questionnaire about socio-demographic variables, a questionnaire about parents' adjustment to the situation and a questionnaire about social support received and provided based on the different sources and types of support.

RESULTS

There is a negative and significant relation between satisfaction with support received and provided and the magnitude of disruptions in parents' lives.

CONCLUSION

Satisfaction with emotional support received from the partner and family, and support provided to these sources, relate to lower disruption in different areas of parents' lives. These results can have significant practical implications for the psychosocial care provided to parents of children with cancer.

Resilience in children and their parents enduring pediatric medical traumatic stress

Due to the general lack of familiarity with the concept in the medical field, resilience is rarely considered in pediatric medical traumas. Resilience is an ability that enables recovery after adversities such as traumas, surgeries, serious health problems, or social issues. Stress from medical traumas encompasses both the psychological and physical responses of children and their families. Lack of resilience in children with medical traumatic stress may contribute to poor adjustment, slow recovery, disruptive behaviors, and psychiatric disorders. Furthermore, persistent parental distress increases the child's risk of low resilience. Consequently, these patients and their parents require early identification. This is achievable using a common stress measure such as the Perceived Stress Scale. Moreover, health care providers can screen patients' risks for low resilience, which include few social contacts, poor family functioning, and low cohesion among family members. Findings from the stress scale and screened risks could indicate the need for additional psychosocial support at the time of diagnosis of a serious illness, soon after injuries, and before and after operations. Such interventions can include decreasing distress, counseling children and their parents, and enabling strong connections to health care providers. Health care providers can help parents to minimize distress and adjust to their child's illness, thereby supporting the child's resilience, adjustment, and recovery.

Psychological Adjustment of Parents of Children Born with Atypical Genitalia 1 Year after Genitoplasty

PURPOSE

We examined the psychological adjustment of parents of children born with moderate to severe genital atypia 12 months after their child underwent genitoplasty.

MATERIALS AND METHODS

Parents were recruited longitudinally from a multicenter collaboration of 10 pediatric hospitals with specialty care for children with disorders/differences of sex development and/or congenital adrenal hyperplasia. Parents completed measures of depressive and anxious symptoms, illness uncertainty, quality of life, posttraumatic stress and decisional regret.

RESULTS

Compared to levels of distress at baseline (before genitoplasty) and 6 months after genitoplasty, data from 25 mothers and 20 fathers indicated significant improvements in all psychological distress variables. However, a subset of parents continued endorsing clinically relevant distress. Some level of decisional regret was endorsed by 28% of parents, although the specific decision that caused regret was not specified.

CONCLUSIONS

Overall the majority of parents were coping well 1 year after their child underwent genitoplasty. Level of decisional regret was related to having a bachelor's level of education, increased levels of illness uncertainty preoperatively and persistent illness uncertainty at 12 months after genitoplasty but was unrelated to postoperative complications.

A systematic review on factors and consequences of parental distress as related to childhood cancer

The literature including correlates of parental distress as related to childhood cancer is abundant. It is important to identify predictive factors and outcomes of this distress in parents. The objective of this review was to update previous syntheses on factors of distress and to identify outcomes of parents' distress in the recent literature (2007-2012). We performed a systematic review to identify all quantitative studies including measures of parental distress and associated factors during the study period. We found 56 eligible studies, of which 43 had a Low risk of bias (Cochrane guidelines). Forty-two reports included potential predictive factors. Significant relationships were found with clinical history of the child, sex of the parent, coping response and personal resources, pre-diagnosis family functioning, but not education/income or marital status. Twenty-five reports studied potential consequences of distress and focused on psychological adjustment in parents and children. Compared to past periods, a higher proportion of studies included fathers. Measures used to evaluate distress were also more homogeneous in certain domains of distress. This review underscores the need for appropriate methods for selecting participants and reporting results in future studies. Appropriate methods should be used to demonstrate causality between factors/consequences and distress.

Severe congenital malformations, family functioning and parents' separation/divorce: a longitudinal study

BACKGROUND

We aim to explore the association of a severe congenital malformation (SCM) with postnatal family functioning and parents' separation/divorce and to examine if this association might be moderated by birth order of the child and parental level of education. SCM refers to malformations that, without medical intervention, cause handicap or death.

METHODS

Using the Quebec Longitudinal Study of Child Development, an ongoing population-based birth cohort study initiated in 1998, we compared 1675 families of children with and without a SCM to identify if having a child with a SCM was associated with maternal perception of family functioning. We examined if an SCM was associated with parents' separation and examined parents' education level and birth order of the children to evaluate whether these factors had any moderating effect on the results.

RESULTS

There were no significant differences in family functioning between families with and without a SCM child at 5 and 17 months. At 5 months, family functioning was significantly better (P = 0.03) for families with a SCM firstborn child than for families with a SCM child that is not firstborn. For parental separation, no significant differences were observed at 5 and 29 months and 4 years. No significant moderating effects were observed for birth order and parental education on parental separation.

CONCLUSIONS

Families of children with a SCM do not appear to be at higher risk of family dysfunction within the first 17 months after birth nor of parental separation within the first 4 years after birth. Family functioning tends to be worst in families where the child with SCM is the second or subsequent child born.

Resilience factors play an important role in the mental health of parents when children survive acute lymphoblastic leukaemia

AIM

Childhood cancer is a tremendous stressor that requires parents to adapt to new challenges, and research has mainly focused on psychopathology and rarely on a resource-oriented perspective, such as resilience. This study assessed resilience factors among parents of children surviving acute lymphoblastic leukaemia and parents of healthy children. We also explored the association between parental resilience and mental health.

METHODS

The study compared 57 parents of 40 children from eight to 15 years of age in remission from acute lymphoblastic leukaemia and 63 parents of 42 healthy children. The Resilience Scale for Adults and the General Health Questionnaire were used to assess parental resilience and mental health.

RESULTS

Parents of children surviving acute lymphoblastic leukaemia showed significantly lower levels of resilience than parents of healthy children, but no significant difference was found for mental health. Certain resilience factors were positively associated with mental health, especially for mothers, such as family cohesion, good perception of self and being able to plan their future.

CONCLUSION

Resilience factors may help to protect parents' mental health, especially mothers, when their child has survived acute lymphoblastic leukaemia and should be considered in a clinical setting. Further research on resilience factors for fathers is needed.

Satisfaction with support versus size of network: differential effects of social support on psychological distress in parents of pediatric cancer patients

OBJECTIVE

This study examined the direct and buffering effects of social support on longer-term global psychological distress among parents coping with pediatric cancer. In both sets of analyses, we examined whether these effects depended on the dimension of social support provided (i.e., satisfaction with support versus size of support network).

METHOD

Participants were 102 parents of pediatric cancer patients. At study entry, parents reported their trait anxiety, depression, and two dimensions of their social support network (satisfaction with support and size of support network). Parents subsequently reported their psychological distress in 3- and 9-month follow-up assessments.

RESULTS

Parents' satisfaction with support had a direct effect on longer-term psychological distress; satisfaction was negatively associated with distress at both follow-ups. In contrast, size of support network buffered (moderated) the impact of trait anxiety and depression on later distress. Parents with smaller support networks and higher levels of trait anxiety and depression at baseline had higher levels of psychological distress at both follow-ups; for parents with larger support networks, there was no relationship.

CONCLUSION

Social support can attenuate psychological distress in parents coping with pediatric cancer; however, the nature of the effect depends on the dimension of support. Whereas interventions that focus on increasing satisfaction with social support may benefit all parents, at-risk parents will likely benefit from interventions that ensure they have an adequate number of support resources.

Psychological resilience moderates the impact of social support on loneliness of "left-behind" children

This study examined the moderator effect of psychological resilience on the relationship between social support and loneliness of the "left-behind" children. A total of 200 left-behind girls and 214 left-behind boys completed the measures of psychological resilience, social support, and loneliness. Hierarchical regression analysis showed that psychological resilience moderated the association between social support and loneliness. When left-behind children reported a low level of psychological resilience, those with high social support reported lower scores in loneliness than those with low social support. However, the impact of social support on loneliness was much smaller in the high psychological resilience group, compared with that in low psychological resilience group.

Promoting resilience among parents and caregivers of children with cancer

BACKGROUND

Promoting resilience is an aspect of psychosocial care that affects patient and whole-family well-being. There is little consensus about how to define or promote resilience during and after pediatric cancer.

OBJECTIVES

The aims of this study were (1) to review the resilience literature in pediatric cancer settings; (2) to qualitatively ascertain caregiver-reported perceptions of resilience; and (3) to develop an integrative model of fixed and mutable factors of resilience among family members of children with cancer, with the goal of enabling better study and promotion of resilience among pediatric cancer families.

METHODS

The study entailed qualitative analysis of small group interviews with eighteen bereaved parents and family members of children with cancer treated at Seattle Children's Hospital. Small-group interviews were conducted with members of each bereaved family. Participant statements were coded for thematic analysis. An integrative, comprehensive framework was then developed.

RESULTS

Caregivers' personal appraisals of the cancer experience and their child's legacy shape their definitions of resilience. Described factors of resilience include baseline characteristics (i.e., inherent traits, prior expectations of cancer), processes that evolve over time (i.e., coping strategies, social support, provider interactions), and psychosocial outcomes (i.e., post-traumatic growth and lack of psychological distress). These elements were used to develop a testable model of resilience among family members of children with cancer.

CONCLUSIONS

Resilience is a complex construct that may be modifiable. Once validated, the proposed framework will not only serve as a model for clinicians, but may also facilitate the development of interventions aimed at promoting resilience in family members of children with cancer.

Impact of prior traumatic life events on parental early stage reactions following a child's cancer

BACKGROUND

In pediatric oncology, effective clinic-based management of acute and long-term distress in families calls for investigation of determinants of parents' psychological response to the child's cancer. We examined the relationship between parents' prior exposure to traumatic life events (TLE) and the occurrence of posttraumatic stress symptoms (PTSS) following their child's cancer diagnosis. Factors mediating the TLE-PTSS relationship were analyzed.

METHODOLOGY

The study comprised 169 parents (97 mothers, 72 fathers) of 103 cancer diagnosed children (median age: 5,9 years; range 0.1-19.7 years). Thirty five parents were of immigrant origin (20.7%). Prior TLE were collated using a standardized questionnaire, PTSS was assessed using the Impact of Events-Revised (IES-R) questionnaire covering intrusion, avoidance and hyperarousal symptoms. The predictive significance of prior TLE on PTSS was tested in adjusted regression models.

RESULTS

Mothers demonstrated more severe PTSS across all symptom dimensions. TLE were associated with significantly increased hyperarousal symptoms. Parents' gender, age and immigrant status did not significantly influence the TLE-PTSS relationship.

CONCLUSIONS

Prior traumatic life-events aggravate posttraumatic hyperarousal symptoms. In clinic-based psychological care of parents of high-risk pediatric patients, attention needs to be paid to life history, and to heightened vulnerability to PTSS associated with female gender.

Influencia del apoyo social sobre el estrés y la satisfacción vital en padres de niños con cáncer desde una perspectiva multidimensional

Objetivo: El presente estudio se plantea como objetivo principal analizar cómo la percepción de apoyo de los padres de niños diagnosticados con enfermedad oncológica influye en la percepción de estrés y la satisfacción vital. Método: Participaron 112 padres de niños con patología oncológica que recibían tratamiento en Málaga y pertenecían a una asociación de padres de niños afectados por esta enfermedad. Resultados: Respecto a las fuentes analizadas la percepción de apoyo familiar disminuye la frecuencia del estrés, el apoyo de los amigos y de las asociaciones disminuye el esfuerzo relacionado con el estrés y el apoyo de la pareja aumenta la satisfacción vital de los progenitores. Respecto a los tipos de apoyo, el apoyo instrumental es el que más reduce la frecuencia del estrés de los progenitores, el apoyo informacional reduce el estrés relacionado con el esfuerzo que los padres deben realizar y es la satisfacción con el apoyo emocional la variable que mejor predice la satisfacción vital. Conclusión: El análisis multidimensional del apoyo social ha permitido analizar con mayor profundidad la complejidad de las relaciones de apoyo social que acontecen durante la enfermedad oncológica de los hijos. Del estudio se derivan importantes implicaciones prácticas.