The lived experience of childhood cancer: one sibling's perspective

Self-reported experiences of siblings of children with life-threatening conditions: A scoping review

Sibling relationships are one of the most long-lasting and influential relationships in a human's life. Living with a child who has a life-threatening condition changes healthy siblings' experience. This scoping review summarized and mapped research examining healthy siblings' experience of living with a child with a life-threatening condition to identify knowledge gaps and provide direction for future research. Studies were identified through five electronic databases. Of the 34 included studies, 17 used qualitative methods, four gathered data longitudinally and 24 focused on children with cancer. Four broad themes of sibling experience were identified across studies: family functioning, psychological well-being, social well-being, and coping. Siblings experienced challenges and difficulties over the course of the child's illness. Future research should incorporate longitudinal designs to better understand the trajectory of siblings' experiences and focus on a wider variety of life-threatening conditions.

Parents and Their Children in the Face of Cancer: Parents' Expectations, Changes in Family Functioning in the Opinion of Caregivers of Children with Neoplastic Diseases-Further Studies

(1) Background: The onset and duration of the child’s illness is a difficult test for the entire family. The stress, in which the family lives from this moment, influences the relationships within it, as well as external relations with the environment. The child’s cancer fundamentally changes the way the family functions, the quality of interactions within the family, and life plans. (2) Patients and Approach: A population survey was run between 2015 and 2020. A cross-sectional study was conducted involving 800 family caregivers of children with cancer during active treatment. The aim of the study was to assess changes in the family functioning in the opinion of parents of a child with cancer. (3) Results: Parents experience chronic anxiety (67%), nervousness (60%), and worry (64%). For 50% of parents, the illness of their child entirely changed their plans. As many as 75% of parents feel guilty for exposing their child to carcinogens. According to the parents, the child’s illness is a psychological (89%), somatic (49%) and financial (77%) burden for them. Only 7% of children cause behavioural problems and 16% have trouble learning due to their sibling’s illness. (4) Conclusions: Cancer is a great difficulty for all members of a family system. The disease disturbs the balance within the family and relations in the family, as well as more distant psychological, social, and material consequences.

Adaption strategies used by siblings to childhood cancer patients

OBJECTIVE

Siblings of childhood cancer patients experience social challenges. The results presented in this article are part of a larger qualitative study aiming to generate empirical knowledge about social consequences of childhood cancer from the family's perspective.

METHODS

Data were collected through interviews, observational studies, and questionnaires. The study included 68 childhood cancer patients, 39 siblings, and 39 parents from a total of 78 families. Grounded theory informed the data analysis.

RESULTS

Major life changes caused by childhood cancer entail an emotional hierarchy regarding the accommodation of each family member's need for help. This study identified a dynamic three-variable, four-adaption model for adaption strategies among siblings towards their parents, based on the sibling's perspective: (1) receives help without asking; (2) receives help after asking; (3) receives no help despite asking; and (4) receives no help and does not ask. Three variables are elaborative to understand the dynamic in adaption strategies: the patient's prognosis, the course of the disease, and the current situation of the diagnosed child. Even though the adaptions are reported by siblings, both patients and parents are aware of and concerned about the siblings' challenges.

CONCLUSIONS

These results have implications for practice and have the potential to improve social and health care professionals' awareness and ability to offer support and information needed by the families and the siblings. The knowledge presented in this article should be considered basic health care information in line with other information such as treatment protocols.

Striving to Survive: Families’ Lived Experiences When a Child Is Diagnosed With Cancer

When a child is ill with cancer, this affects the whole family for long periods. The aim of this study was to elucidate the family’s lived experience when a child in the family was diagnosed with cancer. A descriptive inductive design with a hermeneutic phenomenological approach including interviews with 17 families (parents, children, and siblings) was chosen. The families’ lived experience was described as a 2-fold essential theme comprising “a broken life world” and an immediate “striving to survive.” The families’ secure everyday life disappeared and was replaced by fear, chaos, and loneliness. When striving to make the child and the family survive, family members strove to feel hope and have a positive focus, to gain control, and to feel close to other people. Phenomenological human science research can deepen the understanding of the meaning of being a family with a child who is ill with cancer and can help pediatric oncology staff become increasingly thoughtful, and thus better prepared to take action to diminish the chaos occurring in the family.

The Experience of Japanese Adolescents and Young Adults After Losing Siblings to Childhood Cancer

The aim of this study was to describe Japanese adolescents’ and young adults’ experiences after losing siblings to childhood cancer. A conceptual framework of the transition and analysis based on narrative method were adopted from qualitative data from 6 Japanese adolescents and young adults who had lost their siblings to childhood cancer. It was revealed that the participants’ psychological experience after the sibling’s death was directed by their perceptions of their mothers’ responses to bereavement. We also found that the psychological distance between participants and their mothers could be an important factor in enabling transition into mourning and in orienting the lost sibling in their mind. The stories obtained from these 6 participants were categorized into the following 3 types of narratives: “Mother in another world and the sibling who became a god,” “Return of the loving mother and the sibling as savior,” and “The poor mother and the sibling who needs my help to carry on her legacy.” This typology will serve as a framework for grief care and future research.

The impact of participation in genetic research for families with cleft lip with and without cleft palate: a qualitative study

Despite being the most common congenital facial anomaly, little is understood about the genetic contribution to isolated clefts of the lip with or without cleft palate (CL/P). 'OzCleft', a family-based genotype/phenotype study, is investigating this further. Participation for families involves various clinical investigations of the child with the cleft, and their unaffected sibling(s) and parents. Informal feedback from individuals involved in OzCleft suggested that participation in this research programme had benefits for families. Taking a qualitative approach, this study sought to investigate this hypothesis further. Semi-structured in-depth interviews were conducted with nine parents who had participated in OzCleft. All parents described participation as a positive experience for themselves and their families. Perceived benefits included a greater appreciation of the cleft treatment experience by unaffected family members. Being involved in a genetic study raised issues for parents regarding the cause of clefting in their child. While some parents found the possibility of a genetic component reassuring, it also raised questions about the potential implications for future generations. Parents were largely unsure about how to communicate this information to their children and the predictive value of this information. This study suggests a lack of genetic understanding and/or perceived value of genetic information by parents of children with CL/P that, in turn, highlights the need for increased support from genetic health professionals in this area.

Siblings of children with cancer - their experiences of participating in a person-centered support intervention combining education, learning and reflection: pre- and post-intervention interviews

PURPOSE

To evaluate a person-centered intervention, directed to siblings with a brother or sister newly diagnosed with cancer that combines education, learning and reflection about cancer.

METHOD

Qualitative methods with pre- and post-intervention semi-structured interviews were conducted. Fourteen siblings aged 9-22 years participated. A qualitative content analysis was carried out.

RESULTS

The result comprises of five themes: 'grasping for knowledge about cancer, 'thinking for hours and having nightmares', 'experiencing physical pain', 'being emotional in several ways', 'waiting for a normal, good life despite the uncertain future". Pre-intervention; a low level of knowledge of cancer treatments and its side effects was revealed; siblings slept poorly, lay awake thinking and had nightmares about cancer; they felt pain in different parts of their body; they felt emotional and angry and were anxious as cancer is life-threatening; in the future the sick child will finished treatment and recovered. Post-intervention; siblings described having specific knowledge, felt more informed, and that it was easier to understand the sick child's situation; they slept better, but still had a lot on their minds regarding the sick child; most siblings said they no longer experienced pain, felt better and were happier but could still get sad; in the future the sick child would be healthy, not exactly as before, but almost.

CONCLUSION

Person-centered intervention helps siblings to be more knowledgeable about the sick child's cancer, leading to a more realistic view about treatments and consequences. Further studies of person-centered interventions for siblings are important.

Psychosocial adjustment of siblings of children with cancer: a systematic review

OBJECTIVES

To promote a broader understanding of the psychosocial impact of childhood cancer on siblings, a systematic review was undertaken. Directions for future research are proposed and clinical strategies are suggested for addressing the needs of these children.

METHODS

Searches of Medline, PsycINFO and CINAHL revealed 65 relevant qualitative, quantitative, or mixed methods' papers published between 1997 and 2008. These papers were rated for scientific merit and findings were extracted for summary.

RESULTS

Siblings of children with cancer do not experience elevated mean rates of psychiatric disorders, but a significant subset experiences post-traumatic stress symptoms, negative emotional reactions (e.g. shock, fear, worry, sadness, helplessness, anger, and guilt), and poor quality of life in emotional, family, and social domains. In general, distress is greater closer to time of diagnosis. School difficulties are also evident within 2 years of diagnosis. Qualitative studies reveal family-level themes such as loss of attention and status as well as positive outcomes including increased sibling maturity and empathy.

CONCLUSIONS

Research regarding siblings of children with cancer continues to be methodologically limited. The conclusions of qualitative and quantitative studies differ considerably. We propose a research agenda to propel this field forward including greater attention to alterations in normative development (as opposed to psychiatric conditions), development of more appropriate quantitative measures, examination of potential moderators of adaptation, and use of prospective longitudinal designs. Siblings of children with cancer are a psychosocially at-risk group and should be provided with appropriate supportive services.

The development of an instrument to assess the unmet needs of young people who have a sibling with cancer: piloting the Sibling Cancer Needs Instrument (SCNI)

The psychosocial needs of young people (aged 12-24) who have a sibling with cancer are still comparatively underresearched and largely underserviced. Steps taken in the development of a needs-based measure, the Sibling Cancer Needs Instrument (SCNI), are presented, involving a qualitative exploration of needs (focus group with 4 young people, telephone interviews with 7 young people, and a staff survey) and a quantitative piloting of the resulting first version of the SCNI on 71 young people. Results are explored in relation to the 10 identified domains of need (information, peer support [friends], peer support [similar experience], sibling relationship/support, expressing/coping with feelings, access to support services, respite/recreation, acknowledgement/attention for self, instrumental support, and involvement in the cancer experience). The survey data showed that 75% of young people endorsed 10 or more needs, whereas 50% endorsed more than half of all 80 needs, and on average, participants reported 10 unmet needs. Correlations between needs and psychological distress scores are also explored. Initial reliability, and face and content validity for the SCNI encourage further development of the instrument to assist in better monitoring and to meet the various needs of this underserviced population.

The influence of living donor liver transplantation on families with or without siblings

With child living donor liver transplantation (LDLT), two people from one family, a child patient and one parent and one parent are forced to be hospitalized, so the family faces very servere problems. This is especially severe in cases when pediatric patients have siblings. Our research investigated the influence of LDLT upon families with siblings as compared to those without, especially the impact of surgery and hospitalization on family relationships. Families with siblings had more stress about child care and they tended to be more anxious about child development. The siblings had a lot of stress and mental problems. Therefore, the families of LDLT are seen to need special supports, especially those who had siblings.

Experience of siblings of children treated for cancer

The aim was to obtain an understanding of the experience in everyday life of being a sibling when a brother or sister is receiving treatment for a cancer disease or has completed treatment. In order to illuminate the experience of the siblings themselves a phenomenological-hermeneutic method was used. Ten siblings were asked, in the form of a broad-based, open question, to tell about their experience of being the sibling of a brother or sister in this situation. There was an awareness of sibling-ship as a special relation since the brother or sister had got cancer. This feeling was very strong and close, and when needed the sibling admitted a protective and advocacy role. The siblings felt difficulties to always be loyal with the brother or sister needs and demands from other interests. They lived a new life and periods of ups and down following the condition of the brother or sister. Everyday life varied from joy to a life filled with worries and anxiety. Siblings experienced feelings of an existential nature, such as quality of life and death.

Experiences of siblings of patients with Fanconi anemia

BACKGROUND

Clinical management of families with autosomal recessive genetic disorders focuses almost exclusively on the affected family members. However, clinically unaffected members of such families may also be severely troubled by the serious illness in a family member. The purpose of this study was to explore the experiences of healthy siblings of patients with a chronic genetic disease, Fanconi Anemia (FA).

PROCEDURE

We used a qualitative, descriptive design, which consisted of in-depth, semi-structured interviews. A convenience sample of nine siblings of patients with FA was recruited from a National Cancer Institute clinical research protocol, which targets families with inherited bone marrow failure syndromes. NVivo 2.0 software facilitated qualitative content analysis of the data.

RESULTS

Siblings' rich descriptions provided novel insights into the intricate hardships of living within a family in which a rare, life-threatening, chronic genetic illness in one member is the focus of daily life. Four major themes of the sibling experience emerged from the interview data: (1) containment, (2) invisibility, (3) worry, and (4) despair.

CONCLUSIONS

Our data suggest that unrecognized psychosocial issues exist for the apparently healthy siblings of patients with FA. This study explores the psychosocial consequences of living in a family with FA and one of only a few studies to explore the sibling experience of chronic illness using a contemporaneous approach. These findings support the need for an increased awareness among health care providers; future hypothesis driven investigation, and improved assessment of problems with potential psychological morbidity.

Siblings' Experiences With Childhood Cancer

Childhood cancer and its treatment result in many challenges that impact the entire family. For siblings of children with cancer, the challenges can be particularly stressful as they often undergo tremendous change in their lives. Although there is a sound and growing body of knowledge on how siblings experience childhood cancer, there is still much to be learned. Part of a larger qualitative study aimed at detailing childhood cancer experience and its symptom trajectory from the perspective of parents, ill children, and siblings, this study aims to describe findings specific to 30 siblings who participated in the study. Siblings took part in individual interviews, focus group interviews, and participant observation. The constant comparative method of data analysis yielded the theoretical category of "ways of being in the world," which referred to the different ways that cancer impacted on the lives of children with cancer and their families. For the siblings, cancer was experienced as a different way of being within their family and involved siblings undergoing a loss of a family way of life and a loss of self within the family. Three themes related to a different way of being in the family were identified: committing to keeping my family together, being present, and enduring sadness. The findings reinforce that more needs to be done in helping healthy siblings through childhood cancer.

Transition: a conceptual analysis in the context of siblings of children with cancer

Transition has been described by many disciplines. However, the concept of transition has yet to be applied to the sibling experience of childhood cancer. Understanding the transitions that siblings encounter is important because it will offer nurses new possibilities for enhancing siblings' outcomes. Accordingly, the purpose of this article is to provide a conceptual framework that will assist nurses in their efforts to promote healthy transitions in siblings of children with cancer. The method of concept analysis developed by Walker and Avant [Walker, L., & Avant, K. (1995). Concept analysis. In Strategies for theory construction in nursing (3rd ed.) (pp. 37-54). Norwalk, CT: Appleton and Lane.] is employed. The result is a definition of transition that is relevant and useful for research and clinical practice in pediatric oncology.

A review of qualitative research on the childhood cancer experience from the perspective of siblings: a need to give them a voice

Researchers are increasingly adopting the qualitative research paradigm to study the world of siblings of children with cancer. The purpose of this review article is to identify the contributions of qualitative research in advancing the understanding of the childhood cancer experience from the perspective of siblings. Articles were selected for inclusion if (1) written in English; (2) published in a peer-reviewed journal between 1979 and present or, if a doctoral dissertation, easily accessible to the authors; (4) cited a specific qualitative research design or some type of qualitative research method of data collection and analysis; and (4) involved siblings of children with cancer as sole research participants or as research participants within the context of the family. Twenty-seven qualitative research studies were reviewed. Three themes emerged from an analysis of the primary findings: (1) changing lives, (2) intense feelings, and (3) unmet needs. Limitations in the conceptualization, research design, and research methods of the qualitative studies are discussed. Suggestions that will help researchers in conducting qualitative research with siblings are also presented.

Description and adequacy of parental coping behaviours in childhood leukaemia

This investigation explored how parents perceived the child's leukaemia and how well coped with it. Forty-one mothers and 30 fathers recruited from the largest Hellenic paediatric hospital were asked to answer closed and open-ended questions and to complete the Coping Health Inventory for Parents [CHIP]. Most of the participants perceived the child's disease as a serious and threatening situation. The strategies aimed at maintaining family strength and an optimistic outlook were ranked as being the most helpful. Using specific criteria, it became evident that, overall, the subjects coped well. Neither gender nor spousal differences were found in the variables examined. Implications for health-related research, theory and practitioners are addressed.

Being a Sibling

The purpose of this descriptive exploratory study was to explore the meaning of being a sibling using Parse’s human becoming perspective. Twelve children between 5 and 15 years of age with a younger sibling with a cleft lip and palate or Down Syndrome participated. Through semi-structured interviews and the use of art, children talked about their experiences. Major themes portrayed the complex and paradoxical nature of being a sibling. The themes also revealed that having a sibling with special circumstances includes some unique opportunities and challenges. The finding of this study is the descriptive statement, being a sibling is an arduous charge to champion close others amid restricting-enhancing commitments while new endeavors give rise to new possibilities. Implications for nursing are discussed in the context of understanding being a sibling.

O câncer infantil na perspectiva dos irmãos das crianças doentes: revisão bibliográfica

O estudo tem como objetivo realizar uma revisão bibliográfica de pesquisas que abordam temáticas relacionadas aos irmãos de crianças com câncer, no período de 1998 até 2003, a fim de identificar os conhecimentos disponíveis na área e fornecer subsídios para o cuidado de enfermagem aos irmãos das crianças com câncer. Utilizamos as bases de dados MEDLINE, LILACS, CINAHL e PsycINFO, também, artigos disponibilizados on line, na íntegra, por meio da editora OVID, com as seguintes combinações de palavras-chave: cancer e siblings;cancer, child e siblings; cancer, adolescent e siblings. A análise das publicações permitiu a identificação de quatro temáticas: o impacto da doença nos irmãos saudáveis; o significado da doença para o irmão saudável; suporte social e necessidades de cuidado e intervenção. Os dados indicam que as pesquisas enfocando os irmãos das crianças com câncer vêem crescendo, em especial nas áreas de enfermagem e psicologia; revelam ainda, a preocupação em transformar a prática clínica a fim de intervir efetivamente no cuidado às necessidades psicossociais dos irmãos.

Genetic testing for hereditary colorectal cancer in children: long-term psychological effects

Children who carry a gene mutation for familial adenomatous polyposis are virtually certain to develop colorectal cancer without annual endoscopic screening and a colectomy when polyps appear. Predictive genetic testing can identify children who need regular surveillance. While the medical benefits of genetic testing are clear, the psychological effects have not been well studied. We evaluated the long-term psychological effects of genetic testing in 48 children and their parents. In each family, one parent was a known APC gene mutation carrier. Before genetic testing, and three times afterward, participants completed measures of psychological functioning, which, for children, included depression and anxiety symptoms, and behavior problems and competencies. Parents completed a measure of depression symptoms. Data were collected at 3-, 12-, and 23-55 months after disclosure. Twenty-two children tested positive; 26 children tested negative. Mean length of follow-up was 38 months. There were no clinically significant changes in mean psychological test scores in children or parents, regardless of the children's test results or the sex of the affected parent. However, the group of children who tested positive and had a mutation-positive sibling showed significant, but subclinical, increases in depression symptoms. Furthermore, several individual mutation-negative children with a positive sibling had clinical elevations in anxiety symptoms at one or more follow-up. Behavior problems declined for all groups, and behavior competence scores remained unchanged. We conclude that most children do not suffer clinically significant psychological distress after testing. However, because some children showed clinically significant anxiety symptoms, long-term psychological support should be available to those families with both mutation-positive and mutation-negative children, and with multiple mutation-positive children. Our findings should call for a multidisciplinary approach to genetic testing for children.

The emotional response of families to children with leukemia at the lower socio-economic level in central Mexico: a preliminary report

Little research has been done in developing countries on the emotional impact experienced by families who have a child diagnosed with leukemia. This preliminary study looked at parents in Mexico who had to cope with their child's leukemia in the face of meager financial and social resources. The 51 children in the study were under 15 years and being treated for leukemia in hospitals affiliated with the Mexican Social Security Institute (IMSS) where their parents were interviewed using a questionnaire to ascertain their emotional responses to the illness. The data are analyzed and reported in five domains: perceived illness; psychological impact; coping strategies; family relationships; socio-economic impact. A strengthening of family bonds was found the most common response (82.4%). The second most common responses were concern for the expenses incurred by the illness and the time dedicated to caring for the sick child (both 78.4%). It is especially important to assess families with meager social and financial resources as to their emotional responses to life-threatening illness because these limitations impose greater burdens and make coping more difficult. Psychosocial interventions are key to ensuring adequate treatment of the child in these circumstances.

A qualitative exploration of psychosocial support for siblings of children with cancer

This qualitative study investigated what school-aged siblings of children with cancer perceive to be helpful in adjusting to having a sibling with cancer. The conceptual framework was guided by the work of House (1981) on social support. The sample comprised 50 school-aged siblings of children with cancer. Siblings were asked to "write about things they wish nurses or parents would do to help children who have a brother or sister with cancer" and "discuss things that nurses or their parents have done that have been helpful in adjusting to the childhood cancer experience." Content analysis revealed that the majority of siblings reported interventions aimed at meeting their needs for emotional and instrumental support, followed by informational and appraisal support, as being most helpful in adjusting to the childhood cancer experience. Social support interventions should be provided to siblings based on comprehensive assessments.

Social support for school-aged siblings of children with cancer: a comparison between parent and sibling perceptions

This descriptive, exploratory study investigated the social support interventions received by school-aged siblings of children with cancer and which of those interventions are perceived as being helpful. A comparison between the siblings' and parents' perceptions was made. The conceptual framework was guided by House's (1981) work on social support, which includes major categories of support variables including emotional, informational, instrumental, and appraisal support. A nonprobability purposive sample consisted of 50 school-aged siblings of children with cancer and their parents. Subjects completed either the sibling or parent version of the Nurse-Sibling Social Support Questionnaire (NSSSQ). Descriptive statistical analyses were performed to examine NSSSQ helpfulness and frequency scores for both siblings and parents. Paired t tests were used to test the difference between the responses given by siblings and by their parents on the NSSSQ helpfulness and frequency scales. Results demonstrated that siblings perceive interventions aimed at providing emotional and instrumental support as the most helpful. Parents perceived interventions aimed at meeting the siblings' need for emotional and informational support the most beneficial. Parents reported that siblings receive emotional, informational, and appraisal support more frequently than siblings did.

Development of two instruments measuring social support for siblings of children with cancer

The literature on childhood cancer provides a very limited understanding of healthy siblings' perceptions of supportive interventions during the childhood cancer experience. The purpose of this article is to discuss the development of the Nurse-Sibling Social Support Questionnaire (NSSSQ). Instrument methodology for the study involved item development, face and content validation, and internal consistency reliability as described by Hockenberry-Eaton, Manteuffel, and Bottomley (1997). Item development for the research instrument evolved from an extensive review of the literature and clinical experience of the principal investigator. Content validity of the instrument was accomplished by five experienced pediatric oncology nurses according to the methodology described by Lynn (1986). Using the content validity index, each nurse rated each item as either 4 or 5, indicating 100% agreement among experts that these items measured the concept of social support. Readability for the instrument was determined by using a computerized program. Results showed that readability was concordant with the grade school level for all items. Twenty-five school-age siblings of children with cancer and their mothers were asked to complete the questionnaire. Instrument completion was accomplished in less than 1 hour. The NSSSQ showed high internal consistencies (alpha coefficients >.90). Results indicated that siblings' perceptions of social support differed from those of their mothers. Siblings perceive emotional and instrumental support as greater in importance, whereas mothers perceive emotional and informational support as more beneficial to siblings. Support issues for siblings of children with cancer have been difficult to assess because of the lack of appropriate instruments. This study finding provides exploratory evidence to suggest that the new instrument can help measure siblings' perceptions of social support during the childhood cancer experience.

A concept analysis of social support as experienced by siblings of children with cancer

Social support is a complex phenomenon. The concept is variably defined by multiple disciplines. This article analyzes the concept of social support by using the methods outlined in the nursing literature. The concept analysis focuses on psychosocial support of siblings of children with cancer. Each step in the concept analysis is presented to show the relevance of the concept with siblings of children with cancer.

Attachment theory and adjustment difficulties in siblings of children with cancer

The demands of the childhood cancer experience on children and their parents has been investigated for a number of years. Despite this research, very little emphasis has been placed on well siblings. In the health care profession today, there is a growing perception that the psychosocial needs of the healthy siblings of children with cancer are less sufficiently met than those of other members of the family system. Previous research proposes that well siblings are especially susceptible to a number of adjustment difficulties (such as depression, anger, anxiety, feelings of guilt, and social isolation) (Murray, 1999). Given these findings, the question arises as to whether the adjustment difficulties seen in siblings are a result of the loss of, or separation from, the attachment figure--the mother who is busy caring for the child with cancer. The purpose of this article is to use attachment theory as a conceptual framework to try to understand the effects of the childhood cancer experience on siblings. Recent findings regarding siblings of children with cancer and some speculations regarding clinical implications are provided.