Maternal and Paternal Influences on Children's Coping with Cancer-Related Stress

Paternal Contributions to Biopsychosocial Outcomes of Children With Cancer: A Scoping Review

Though children with cancer experience better outcomes with supportive caregivers and family environments, these findings are predominantly informed by maternal perspectives. Given fathers' increasing involvement, this scoping review examined paternal contributions to the biopsychosocial outcomes of their children with cancer. English, full-text publications from any time before October 4, 2022 including at least one search term from these three groups were included: pediatric oncology diagnosis ≤18 years old, fathers/parents, child biopsychosocial outcomes. Title and abstract screening, full-text reviews, data extraction, and quality assessments were completed by at least two reviewers. Results are presented using Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review guidelines. Of 10,116 studies screened, 29 were included. Most studies were poor (38%) or fair (45%) quality. Seventy-six percent presented significant associations between father contributions and child biopsychosocial outcomes, including child mental state, coping, behavioral adjustment, relationship quality in adulthood, and adherence. Fathers' contributions were ambiguously related to children's quality of life and physical wellbeing. Limited findings suggest fathers contribute in significant, positive ways to their child with cancer's biopsychosocial outcomes. Findings underscore research gaps and suggest greater efforts should be made to include fathers in pediatric oncology research, interventions, and clinical practice.

The mediating role of caregiver hope in relations among caregivers' coping and emotional socialization beliefs in pediatric oncology

The purpose of this study is to identify links between caregiver hope, caregiver coping behaviors, and caregivers' coaching versus dismissing emotion socialization (ES) beliefs in a pediatric cancer sample.

Self-report measures.

Caregivers (N = 183, 80.20% mothers; 58.5% white; 32.2% Hispanic) of youth undergoing cancer treatment (51.10% hematological malignancy, 15.30% brain or spinal [CNS] tumor, and 25.14% non-CNS solid tumor) for at least six weeks.

We used a series of mediation models to examine links between caregivers' coping behaviors, hope, and ES beliefs.

Caregivers' hope significantly mediated a positive relation between caregivers' coping and their emotion coaching beliefs, as well as an inverse relation between caregivers' maladaptive coping and their emotion dismissing beliefs.

Enhancing caregivers' hope or adaptive coping may support caregivers' beliefs during the pediatric cancer experience.

Our findings support future research to evaluate whether enhancing caregivers' hope or adaptive coping may help support evidence-based interventions that target ES beliefs and behaviors.

Measure of perceived social support from family, friends, and healthcare providers for Korean adolescents and young adults with cancer

Objective

Assessing the perceived social support (PSS) that adolescents and young adults (AYAs) with cancer receive from family, friends, and healthcare providers is critical to promoting their adjustment. This study developed a reliable and comprehensive self-report PSS assessment tool that measures various aspects of social support by translating existing measurements into Korean.

Methods

The translation was completed in accordance with international guidelines. To focus on cultural adaptation, the main ideas associated with items were translated to reflect the differences between Western and Eastern culture. In total, 144 Korean AYAs with cancer (mean age: 17 years; 46% female) completed the translated version. A separate principal component analysis (PCA) with an orthogonal quartimax rotation, a minimum eigenvalue of 1.0, and minimum factor loadings of 0.50 was used for each subscale. Cronbach's alpha coefficients were calculated for each PCA-derived subscale.

Results

Four subscales with 46 items were identified. Two subscales represented perceived emotional support within the family (PSS-ESF, 14 items) and the AYA's perceived helpfulness within the family (PSS-HWF, 3 items). The third scale represented the perceived support of friends (PSS-Friends, 14 items). The final scale represented the perceived support of healthcare providers (PSS-HCPs, 15 items). Excellent reliability per subscale was demonstrated (Cronbach's alpha: 0.93 for PSS-ESF, 0.73 for PSS-HWF, and 0.92 each for PSS-Friends and PSS-HCPs).

Conclusions

A culturally adapted and reliable Korean version questionnaire with four independent subscales was developed. Further assessment of the Korean PSS is required and will contribute to the development of culturally adapted and tailored interventions.

Development and effects of an internet-based family resilience-promoting program for parents of children with cancer: A randomized controlled trial

PURPOSE

The diagnosis of cancer in children can negatively impact their parents, owing to the complex treatment processes. Families with high levels of resilience can overcome these difficulties and thus perform higher family functions. We aimed to develop an internet-based family resilience-promoting program for parents of children with cancer and evaluate its effect on the levels of family resilience, depression, and family function.

METHODS

This prospective, parallel-group, randomized-controlled study that was conducted at Yonsei Cancer Center from June to October 2021 included 41 parents of children with cancer. In total, four sessions of the internet-based family resilience-promoting program, led by a nurse, were conducted individually for parents. Levels of family resilience, depression, and family function were measured before, immediately after, and 4 weeks after the program. The data were analyzed using the linear mixed-effect model, and program satisfaction was evaluated through an internet-based questionnaire and interview.

RESULTS

The experimental group (the family resilience-promoting program participants) differed more significantly from the control group in the level of change in family resilience (β = 13.214, p = 0.003, effect size = 0.374) and family function (β = 1.256, p = 0.018, effect size = 0.394). However, there was no significant difference between the groups in the level of depression (β = 2.133, p = 0.187, effect size = 0.416). All the program participants showed a high program satisfaction score of 4.75 out of 5.00 points overall.

CONCLUSIONS

The applicability of the internet-based family resilience-promoting program as an appropriate nursing intervention was verified. Its application can help the families of children with cancer adapt to the stressful situation of their children's cancer diagnosis and treatment.

Parental psychosocial factors predicting adolescents' psychological adjustment during the surging and remission periods of COVID-19 in China: A longitudinal study

BACKGROUND

Parents play a critical role in adolescents' psychological adjustment, especially in stress response. Few studies have investigated parental impact on adolescents' psychological adjustment in the pandemic. The longitudinal study examined how parental psychosocial factors at the surging period of the pandemic (T1) in China predicted adolescents' anxiety and depression concurrently and at the remission periods three (T2) and six months (T3) later.

METHODS

Middle and high school students and their parents from three schools in Shanghai, China, completed online surveys on March 10, 2020 (T1), June 16, 2020 (T2), and Sep 25, 2020 (T3). Adolescents' anxiety/depression levels were assessed by matching self- and parent-reports at T1, T2, T3, and parents reported their psychological state (emotion and psychopathology), pandemic response (appraisal and coping), and perceived social support (PSS) at T1.

RESULTS

Parental positive/negative emotions, anxiety, depression, control-appraisal, forward- and trauma-focus coping style and PSS were all significantly related to their children's anxiety/depression at T1. All factors, except coping style, predicted adolescents' anxiety/depression at T2 and T3, even after controlling for T1 adjustment levels. Parental positive emotion and depression had the strongest impact on adolescents' adjustment.

LIMITATIONS

Some participants didn't complete the surveys at later time points, and the participants were only recruited in Shanghai.

CONCLUSIONS

The study found that parents' psychosocial factors played a pivotal role on adolescents' psychological adjustment during COVID-19, highlighting the need to provide help to parents who were suffering from potential psychological distress.

Hematopoietic and Lymphoid Cell Neoplasms in Children as a Factor Inducing Negative Emotions and Toxic Stress in Parents

Parents whose children suffer from cancer experience chronic negative emotions, which may have a detrimental influence on their mental health. The aim of this study, conducted with a group of parents whose children were hospitalized for leukemia or lymphoma, was to assess stress, anxiety, depression, aggression and stress coping strategies as well as the correlations that take place between them. The study was conducted with a group of 101 parents of early school children (aged between 7 and 12) who were hospitalized for cancer in three medical centers in southern Poland. The HADS -M, PSS-10 and COPE questionnaires were used in the study. Mothers were found to experience higher levels of anxiety, depression and stress as compared to fathers. It was more common for men to resort to the strategy of substance use. Socio-demographic variables did not determine the examined emotions, the level of stress and the choice of stress coping strategies, with the exception of the strategy of suppression of competing activities. A positive relationship was found between the incidence of negative emotions and the selected strategies of coping with stress. Early diagnosis of disorders and assessment of parents' strategies of coping might help to counteract long-term consequences of trauma.

The Experience of Children With Neuroblastoma and Their Parents During Single-Room Isolation for 131I-Metaiodobenzylguanidine Therapy: A Qualitative Descriptive Study

Background: Administration of ¹³¹I-metaiodobenzylguanidine (¹³¹I-MIBG) for neuroblastoma requires hospitalization in single-room isolation and limits caregiver physical contact due to the child's radioactive burden. Though used for decades, there is a dearth of research on the experiences of children and their parents while isolated. Methods: This qualitative descriptive study evaluated the experience of children with neuroblastoma undergoing single-room isolation for ¹³¹I-MIBG therapy and their parents. Ten nurses, nine parents, and five children were interviewed; transcripts were analyzed applying a conventional content analysis approach. Results: Child themes included overall experiences ranging from positive to negative; emotional stress was common; symptoms were common but mostly managed; the children were adequately prepared for isolation; and audiovisual technology and entertainment helped. The indwelling urinary catheter was a source of emotional stress and/or pain for several children. Parent themes included I thought it was going to be a lot worse; it gets better with time; feeling concerned and overwhelmed; prepared as much as you can be; and you feel like you're not alone. Discussion: Findings suggest that children and parents would benefit from additional coping support interventions to address emotional distress. Efforts should be made to identify other sources of technology or room designs that can maximize the child's sense of connection with parents and healthcare professionals. Additional research is needed to examine the impact of this isolation experience on the long-term psychological outcomes of children and parents.

Parental experiences of adolescent cancer-related distress: A qualitative study

OBJECTIVE

Adolescents' cancer-related distress is more complex, severe, and long-lasting than that of children and adults. Parents adopt an active role in supporting their adolescent, reporting that adolescent cancer-related distress is the most problematic symptom parents experience. Research has predominantly focused on exploring adolescents' experiences of cancer-related distress, with little attention to how their parents experience their adolescent's cancer-related distress. Therefore, we aimed to explore parents' experiences of distress within the context of parenting an adolescent with cancer-related distress during or immediately subsequent to active treatment.

METHODS

A total of 21 semi-structured interviews were conducted face-to-face or via telephone, with parents of adolescents aged 12-18 years from south-west England. Inductive reflexive thematic analysis was used to analyse the data.

RESULTS

Three themes were generated: "The contagion of distress", "Navigating breaking point" and "Developmental disruption". Parental distress transcended from adolescent cancer-related distress, eliciting uncertainty and challenging parenting limits. Parental distress was perpetuated by feelings that their adolescent had missed out on "normal" adolescence during and just after active treatment.

CONCLUSION

Parental distress reflected the multi-faceted nature of their adolescent's cancer-related distress. Findings advocate the importance of providing a parental voice within adolescent oncology populations. Developing tailored interventions to address parental distress are suggested.

The psychological impact on family caregivers of children and adolescents with sickle cell anemia

Abstract Sickle cell anemia represents an aversive context, placing the family in a situation of vulnerability. This study investigated the psychological impact of sickle cell anemia on family caregivers of children and adolescents with this disease. A research with a quantitative approach followed by a survey was carried out, with a non-probabilistic sample of 100 caregivers who answered the instruments for measuring family functioning, disease-related stress, coping, anxiety, and depression. Clinical and sociodemographic characteristics were obtained from medical records and specific protocols. Caregivers of children with late diagnosis presented high disengaged coping scores, and minimum depression; early diagnosis was associated with mild depression. Family functioning domain scores were lower in families with younger children. Regression analyses showed that primary control coping indicates lower depression scores, and involuntaryengagement is a predictor of depression/anxiety. This study contributes to the understanding of the relationship between psychological, clinical, and sociodemographic variables in the context of sickle cell anemia.

Socialization of Coping in Pediatric Oncology Settings: Theoretical Consideration on Parent-Child Connections in Posttraumatic Growth

This theoretical article aims to summarize the results of studies relevant to parental influence on coping with childhood cancer and provide implications for future research focused on parent–child connections in posttraumatic growth (PTG) following childhood cancer. Parental influence on child coping described by the socialization of coping and socialization of emotions theories has already been studied in connection with posttraumatic stress, but the role of parents in the process of PTG in the child has not been clearly described yet. Several studies focused on PTG in childhood cancer survivors and their parents simultaneously, but only two studies explicitly included a parent–child connection in PTG in statistical analysis. Studies suggest that child PTG may be facilitated through parental coping advice supporting emotion expression and that parent–child connection in PTG may be mediated by the child’s subjective perception of the parents’ PTG. More research is needed to describe specific strategies proposed by parents and leading to child PTG and design tailored interventions for the use in the clinical care of childhood cancer survivors and their family.

Integrative Literature Review on Psychological Distress and Coping Strategies Among Survivors of Adolescent Cancer

PROBLEM IDENTIFICATION

Cancer survivors, particularly those diagnosed in adolescence, are faced with physical, mental, and emotional stressors associated with the disease and its treatment. These stressors add to the demand placed on survivors' already taxed coping skills. This article reviews the literature on psychological distress experienced by survivors diagnosed with cancer during adolescence and the coping strategies they employed.

LITERATURE SEARCH

Three electronic databases (CINAHL®, PsycINFO®, PubMed®) were searched, and 19 studies were selected. Garrard's matrix method guided this integrative review.

DATA EVALUATION

Gough's weight of evidence framework was used to evaluate each study.

SYNTHESIS

Analysis revealed important findings about the types of coping strategies used by adolescents during and after cancer treatment and the impact of each on levels of psychological distress.

IMPLICATIONS FOR PRACTICE

Healthcare providers, who regularly assess for negative thoughts and unmet needs among survivors, may identify symptoms of psychological distress, intervene early, and facilitate better outcomes for their patients. Patient-centered interventions aimed at coping with psychological distress are most helpful.

In-person vs. web-based administration of a problem-solving skills intervention for parents of children with cancer: Report of a randomized noninferiority trial

BACKGROUND

Bright IDEAS (BI) problem-solving skills training is an evidence-based intervention designed to help parents manage the demands of caring for a child with cancer. However, the resource intensiveness of this in-person intervention has limited its widespread delivery. We conducted a multicenter, randomized trial with a noninferiority design to evaluate whether a web-based version of BI requiring fewer resources is noninferior to in-person administration.

METHODS

621 caregivers of children with newly diagnosed cancer were randomly assigned to standard BI delivered face-to-face or a web-based version delivered via mobile device. The primary outcome was caregiver-reported problem-solving skills. The noninferiority margin was defined as 0.2 standard deviation units of the change from baseline to end of intervention. Secondary outcomes included caregiver-reported mood disturbance, depression, and posttraumatic stress symptoms. The study was registered with ClinicalTrials.gov Identifier: NCT01711944.

FINDINGS

The effect of the standard treatment was preserved; parents in the standard BI arm improved their problem-solving (effect size = 0.53, t = 8.88, p < .001). Parents in the web-based BI group also improved their problem-solving (effect size = 0.32, t = 5.32, p < .001). Although the web-based intervention preserved 60% of the standard treatment effect, the test of noninferiority was non-significant (effect size = -0.21, p = 0.55). Similarly, the web-based intervention preserved > 60% of the standard intervention effect on all secondary outcomes; however, tests of noninferiority were non-significant.

INTERPRETATION

Noninferiority of web-based BI relative to standard face-to-face administration was not established. Further development of the web-based BI is needed before it can be recommended as a stand-alone intervention. However, the documented benefits of the web-based intervention as well as the advantages of low resource utilization and ease of delivery suggest that further development of web-based BI is indicated, and that it may play a valuable role in alleviating distress in caregivers of children with serious or chronic illness.

FUNDING

National Institutes of Health (U.S.), R01 CA159013 (P.I. Sahler).

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Experiences of Low Mood in Young People With Cancer: A Qualitative Study

Young people with cancer are at increased risk of psychological difficulty; yet there is little research on their experiences of low mood or depressive symptoms to help inform treatment interventions. This qualitative study explored experiences and opinions of low mood or depression in young people with cancer, how their mood related to developmental challenges, strategies used to cope, and how services could improve support. Nineteen young people diagnosed and treated for cancer completed semistructured interviews. Transcripts were thematically analyzed using the framework approach, and analysis produced eight themes, organized into three domains: “A Harder Time of Life,” “Interpersonal Impact of Cancer,” and “Learning to Understand and Describe Low Mood,” Participants interviewed experienced low mood during cancer and predominantly felt “low mood” was a helpful term to describe their emotions. There were similarities and variations in their reported mood compared with clinical depression. The developmental challenges of being a young person with cancer negatively affected their mood. Participants used a variety of different coping strategies to manage these challenges. Young people were clear that they would like others to help them understand negative emotions experienced through cancer are normal to feel and support for low mood to be accessible and available.

What do you need to learn in paediatric psycho-oncology?

Paediatric psycho-oncology is an evolving speciality and is increasingly being recognised as an essential component in children's cancer care. Modern paediatric oncology services aspire to integrate physical care with psycho-social care and build capacity within clinical teams to address the emotional needs of parents and children side by side with other aspects of medical care. This article discusses the unique challenges of paediatric psycho-oncology and common situations where psychological assessment and management of children and young people with cancer become especially important. The authors propose a tiered structure of training. Providing empathic evidence-based psycho-social care is 'everyone's business' in paediatric oncology and not merely that of mental health professionals. However, there are times when a more specialist intervention by a paediatric liaison psychiatrist and/or a clinical psychologist is needed for optimum outcome. Learning interviewing techniques suitable for children and adolescents should be a core part of the training in paediatric psycho-oncology. Professionals should be encouraged to reflect on their own emotional wellbeing, which in turn will provide a stable foundation of emotionally matured care to children, young people and their families.

Longitudinal associations among maternal depressive symptoms, child emotional caretaking, and anxious/depressed symptoms in pediatric cancer

Research has shown that children experience increased emotional distress when engaging in emotional caretaking of a parent. The current study is the first to examine this process in families in which the source of the stress is the child's illness. Prospective associations were tested among mothers' depressive symptoms near the time of their child's cancer diagnosis, mothers' expressed distress and their child's emotional caretaking during an interaction task, and child anxious/depressed symptoms at 1 year postdiagnosis. Families (N = 78) were recruited from two pediatric hospitals soon after their child's (Ages 5-18) new diagnosis or relapse of cancer. Mothers reported on their own depressive symptoms and their child's anxious/depressed symptoms near the time of diagnosis or recurrence (Time 1) and 1 year later (Time 3). At Time 2 (4 months after Time 1), mother-child dyads completed a video-recorded discussion of their experience with cancer that was coded for observed maternal expressed distress (anxiety, sadness) and observed child emotional caretaking. Maternal expressed distress during the interaction was significantly related to more emotional caretaking behaviors by both boys and girls. Results of a moderated mediation model showed that child emotional caretaking at Time 2 significantly mediated the relation between maternal depressive symptoms at Time 1 and child anxious/depressed symptoms at Time 3 for girls but not for boys. The findings suggest that children's emotional caretaking behaviors contribute to subsequent anxious/depressed symptoms for girls, but not for boys, with cancer. (PsycINFO Database Record (c) 2018 APA, all rights reserved).