Comparison of continuing bonds reported by parents and siblings after a child's death from cancer

Encontrar sentido para continuar viviendo el reto al perder un hijo por cáncer infantil: revisión integrativa

La experiencia de perder un hijo por cáncer representa para los padres una carga emocional de alto impacto individual, familiar y social que no finaliza con la muerte. Esta revisión integrativa tuvo como objetivo identificar aspectos clave en la experiencia de perder un hijo como consecuencia del cáncer infantil. Los resultados mostraron un patrón (búsqueda de sentido) que rodea seis momentos del proceso de duelo, que pueden ser elementos de intervención para acompañar el proceso de afrontamiento de los padres. Se concluye que este patrón es un fenómeno importante para el desarrollo del área de cuidado paliativo al final de la vida y posterior.

Continuing Bonds and Bereavement Adjustment Among Bereaved Mainland Chinese

Given the important role of continuing bonds (CBs) in bereavement adjustment, the aim of this study was to examine the relationship between CBs and bereavement adjustment and identify influences on CB among bereaved mainland Chinese. The Continuing Bonds Scale, Prolonged Grief Questionnaire 13, and Posttraumatic Growth Inventory were administered to 273 bereaved participants. Findings in the current study suggest psychometric validity of the Continuing Bonds Scale in a mainland Chinese sample and confirm that externalized CB is positively associated with severity of grief symptoms, and internalized CB is positively associated with the respondent degree of posttraumatic growth and identifies influences on externalized CB and internalized CB. These findings clarify the complex influence of CB in grieving process and highlight the need of incorporating CB into grief counseling.

Parental Grief Following the Death of a Child from Cancer: The Ongoing Odyssey

BACKGROUND

The death of a child is a devastating event that results in profound grief and significant psychosocial and physical morbidities in parents. The parental grief journey is a complex phenomenon necessitating the utilization of newer models of bereavement with a focus on relationships and exploration of parents' perceived meanings of the experience.

OBJECTIVES

To further characterize the grief journey of parents whose child died from cancer in order to better identify parents who can benefit from additional bereavement support and design strategies to improve bereavement services for these parents.

DESIGN

We conducted focus group sessions with 11 bereaved parents. The parents were given two prompts to describe their grief journey before and after their child's death, and their responses in a narrative form were audio-recorded. The responses were coded and studied independently by semantic content analysis.

RESULTS

Collation and analysis of the coded responses to both prompts results in the emergence of four concepts from the parental narratives: (1) description of the grief trajectory and evolution of grief over time, (2) mechanisms of parental coping throughout the grief journey, (3) factors that exacerbate parental grief, and (4) sources of parental support throughout the grief journey.

CONCLUSIONS

The narratives highlighted that parents whose child died of cancer experience a unique and evolving form of grief and they wish to continue their bond with the deceased child. We recommend that healthcare providers and institutions incorporate support systems into a comprehensive bereavement program for families of children who die from cancer.

Fathers’ Experience After the Death of Their Child (Aged 1–17 Years)

The death of a child is traumatic for parents. The grief of bereaved fathers is inadequately understood since most studies on this subject have focused primarily on mothers. The goal of this phenomenological study was to understand fathers’ experiences following the death of their child. Interviews were conducted with 13 fathers whose child (aged 1–17 years) had died at least 1 and up to 6 years earlier, either from a life-limiting illness or unexpectedly in an intensive care unit in a pediatric hospital in Eastern Canada. The analysis indicates that fathers’ experience deep suffering after the death of their child and feel torn between the past and the future. Three major themes were identified: needing to push forward in order to avoid breakdown, keeping the child present in everyday life, and finding meaning in their experience of grief. Clinical implications for professionals working with this population are discussed.

Mourning 2.0--Continuing Bonds Between the Living and the Dead on Facebook

This study examines the burgeoning phenomenon of Facebook memorial pages and how this research about online social networking environments can contribute to the existing literature related to Klass, Silverman, and Nickman (1996) continuing bonds thesis. I argue that memorial pages constitute a new ritualized and public space for maintaining these continued bonds and that individuals exhibit several types of bonding interactions with the deceased. I conducted a content analysis on a purposively selected sample of 12 public Facebook "pages" where I coded 1,270 individual Wall postings. Analyses demonstrated that many individuals routinely used these Walls to continue their relationships with the deceased. Findings revealed several Wall posting categories, "guidance from beyond and reunion with the deceased," "messages and visitations from the deceased," and "conversations with the deceased," which I then combined under a central thematic heading of "paranormal copresence." There were 267 Wall postings coded under "guidance and reunion," 26 for "messages and visitations," and 340 for "conversations," with the total of 633 Wall postings under the central thematic heading of paranormal copresence. This research highlights how individuals have transcended the limitations of time and physical space in relation to traditional bereavement behavior and rituals and how data found on public websites, such as Facebook, can be used to further theorize bereavement and to demonstrate continue bonds between the living and the dead.

Circumstances surrounding deaths from the perspective of bereaved Honduran families

PURPOSE

This qualitative study examined how bereaved individuals from Honduras responded to deaths of loved ones, particularly through exploring circumstances surrounding deaths and various coping strategies.

METHODS

With the help of a translator, bereaved family members in Honduras were interviewed using a semi-structured format. The interactions were audio-recorded and later translated and transcribed.

RESULTS

Some 60% of individuals spent time with other family members during their loved one's end of life and 22.5% of grieving individuals took solace in spirituality or religious practices and connecting with God. Some 40% wanted to speak with others through support groups. When individuals spoke about remembering the deceased, both comforting and discomforting effects were expressed.

CONCLUSIONS

Further research is needed to learn more about coping strategies in various cultures and support mechanisms that health professionals can use or suggest when working with bereaved individuals.

Bereavement Follow-Up After the Death of a Child as a Standard of Care in Pediatric Oncology

After a child's death to cancer, families commonly want continued connection with the healthcare team that cared for their child, yet bereavement follow-up is often sporadic. A comprehensive literature search found that many bereaved parents experience poor psychological outcomes during bereavement and that parents want follow-up and benefit from continued connection with their child's healthcare providers. Evidence suggests that the standard of care should consist of at least one meaningful contact between the healthcare team and bereaved parents to identify those at risk for negative psychosocial sequelae and to provide resources for bereavement support.

The central role of meaning in adjustment to the loss of a child to cancer: implications for the development of meaning-centered grief therapy

PURPOSE OF REVIEW

This review describes research on meaning and meaning-making in parents who have lost a child to cancer, suggesting the need for a meaning-centered therapeutic approach to improve their sense of meaning, purpose, and identity and help with management of prolonged grief symptoms.

RECENT FINDINGS

Several studies have demonstrated that parents bereaved by cancer experience unique meaning-related challenges associated with the caregiving and illness experience, including struggles with making sense of their loss, benefit-finding, their sense of identity and purpose, disconnection from sources of meaning, and sustaining a sense of meaning in their child's life. Meaning-centered grief therapy, adapted from meaning-centered psychotherapy, directly addresses these issues, highlighting the choices parents have in how they face their pain, how they honor their child and his/her living legacy, the story they create, and how they live their lives.

SUMMARY

Given the important role that meaning plays in adjustment to the loss of a child to cancer, a meaning-focused approach such as meaning-centered grief therapy may help improve parents' sense of meaning and grief symptoms. It seems particularly appropriate for parents who lost a child to cancer because it does not pathologize their struggles and directly targets issues they frequently face.

Long-term psychosocial outcomes among bereaved siblings of children with cancer

CONTEXT

The death of a child from cancer affects the entire family. Little is known about the long-term psychosocial outcomes of bereaved siblings.

OBJECTIVES

To describe 1) the prevalence of risky health behaviors, psychological distress, and social support among bereaved siblings and 2) potentially modifiable factors associated with poor outcomes.

METHODS

Bereaved siblings were eligible for this dual-center, cross-sectional, survey-based study if they were 16 years or older and their parents had enrolled in one of three prior studies about caring for children with cancer at the end of life. Linear regression models identified associations between personal perspectives before, during, and after the family's cancer experience and outcomes (health behaviors, psychological distress, and social support).

RESULTS

Fifty-eight siblings completed surveys (62% response rate). They were approximately 12 years bereaved, with a mean age of 26 years at the time of the survey (SD 7.8). Anxiety, depression, and illicit substance use increased during the year after their brother/sister's death but then returned to baseline. Siblings who reported dissatisfaction with communication, poor preparation for death, missed opportunities to say goodbye, and/or a perceived negative impact of the cancer experience on relationships tended to have higher distress and lower social support scores (P < 0.001-0.031). Almost all siblings reported that their loss still affected them; half stated that the experience impacted current educational and career goals.

CONCLUSION

How siblings experience the death of a child with cancer may impact their long-term psychosocial well-being. Sibling-directed communication and concurrent supportive care during the cancer experience and the year after the sibling death may mitigate poor long-term outcomes.

Bodies as means for continuing post-death relationships

Secondary analysis of data from 30 people in three interview studies shows that bereaved people use their own and the deceased’s body in their continuing efforts to maintain a relationship with the departed. Following the continuing bond perspective, the study reveals three body-associated strategies for maintaining post-death relationships: (a) the presence of the deceased in the bereaved’s body, (b) body-associated actions and activities, and (c) sensing and caring for the deceased’s body. The conceptual dimension of embodiment is used to interpret results. Attention is also given to the bereaved’s sense of disembodiment due to social rejection of these strategies for maintaining post-death relationships. Implications for health psychologists are offered.

When Grief Turns Into Love

A child’s death caused by cancer generates a deep impact on his/her parents, who can be affected by serious health problems due to an impairment of their lifestyle. Notwithstanding their suffering, some parents manage to overcome it and discover a new meaning for their lives. The goal of this phenomenological study is to understand the lived experiences that help parents to revive after the death of their child due to cancer. The participants were fathers and mothers who believe that they have elaborated their mourning. Their lived experiences were collected in interviews they had previously agreed to give. The question that steered the interview was: “What is the experience you went through that helped you to revive after your child died due to cancer?” Data were analyzed using Streubert’s method. Analyzing the interviews of the participants, 3 interweaved essences were detected: transition from surviving to reviving themselves; ascribing a sense and meaning to the life, agony, and death of a child; and helping other parents through one’s own experience.

The role of continuing bonds in coping with grief: overview and future directions

The existing empirical literature depicts a complex picture of the role that continuing bonds play in coping with bereavement, with contradictory findings emerging across studies. This article presents an overview of continuing bonds research and highlights several areas ripe for exploration. First, definitional issues are identified. Second, three paths for clarification are presented: the bereaved's perception of the bond as positive or negative, the quality of the predeath relationship, and the bereaved's afterlife beliefs. Through refining the definition and exploring these potential avenues of research, we hope to clarify the roles that continuing bonds may play in coping with bereavement.

Sorrow and solace: neglected areas in bereavement research

The author argues that in its focus on finding positive outcomes, bereavement research has neglected or denigrated central phenomena in intense and long-term grief sorrow and solace. Sorrow has two elements: yearning for the dead person and griefs depression. Consolation comes into sorrow in human relationships and from inner resources. The article notes that griefs depression can be, as William James said, the "openers of our eyes to the deepest levels of truth. "The author argues that our research would be more complete were we to include solace that comes into sorrow as one of the outcomes we can help foster.

Sudden Death, Sudden Friend

Challenging the dominant paradigm that relationships with the deceased must be terminated, our goal in this article is to exemplify how these relationships can be maintained. We demonstrate, in particular, how friends with a similar loss can help one another continue bonds with their deceased loved ones. Having both lost our mothers as young adults, we provide personal insight about this process and the ways in which our friendship has been influential in maintaining strong, posthumous connections with our mothers. By sharing our personal experiences, we illustrate that continuing bonds with the deceased is not a pathological choice, but rather a mechanism through which we can enrich our lives, open spaces for emotional growth, and understand ourselves as well as our deceased loved ones better.

Changes in siblings after the death of a child from cancer

BACKGROUND

Few studies have examined changes in siblings after the death of a brother or sister, particularly from mother, father, and sibling perspectives within the first year after death.

OBJECTIVE

This descriptive study identified and assessed the frequency of changes in siblings after a child's death from cancer.

METHODS

Participants were recruited from cancer registries at 3 hospitals in the United States and Canada 3 to 12 months after the child's death. Thirty-six mothers, 24 fathers, and 39 siblings from 40 families were included. Semistructured interviews using open-ended questions were conducted with each parent and sibling separately in the home. Content analysis identified emerging themes, and the McNemar tests compared frequencies between each paired set of reports (sibling vs mother, sibling vs father, mother vs father).

RESULTS

Sixty-nine percent of participants reported personal changes in siblings (eg, changes in personality, school work, goals/life perspective, activities/interests). Forty-seven percent noted changes in siblings' relationships with family members and peers. Only 21% of participants reported no changes attributed to the death. Comparisons of frequencies across informants were not significant.

CONCLUSIONS

Most siblings experienced changes in multiple areas of their lives after the death of a brother or sister to cancer. Some changes reflected siblings that were positively adapting to the death, whereas other changes reflected difficulties.

IMPLICATIONS FOR PRACTICE

Our findings offer guidance to improve aftercare for bereaved siblings and their families. Additional research is needed to further delineate the needs of bereaved siblings and to develop strategies to promote adaptation to loss.

National survey of children's hospitals on legacy-making activities

OBJECTIVE

Many hospitals offer legacy-building activities for children with serious illnesses or their family members, yet legacy-making has received little empirical attention. This descriptive cross-sectional study examined healthcare provider perceptions of legacy-making activities (e.g., memory books) currently offered by hospitals to pediatric patients and their families.

METHODS

Healthcare providers in seventy-seven (100%) teaching children's hospitals across the United States completed an electronic survey.

RESULTS

Nearly all providers surveyed reported offering legacy-making activities to ill children and their families, with patients and families usually completing the activity together. Most activities were offered before a patient died and when cure is no longer being sought. Perceived outcomes included benefit to bereaved families and a tangible memento of their deceased child.

CONCLUSION

Legacy-making may enhance life and decrease suffering for dying children and their families. Healthcare professionals can facilitate opportunities for children and their families to build legacies. Additional research is needed to examine activities across different age groups and conditions, the best time to offer such activities, and associations with positive and negative outcomes for ill children, their family members, and the bereaved.