Attachment theory and adjustment difficulties in siblings of children with cancer

Impact of growing up with a sibling with a neurodevelopmental disorder on the quality of life of an unaffected sibling: a scoping review

PURPOSE

Growing up with a sibling with a neurodevelopmental disorder can have positive and negative effects on personal, social and emotional well-being; however, little is known about the impacts on unaffected siblings' quality of life. The purpose of this review was to synthesize evidence from studies evaluating the quality of life of unaffected siblings of children with neurodevelopmental disorders.

METHOD

A systematic search was conducted on four databases to identify studies reporting the quality of life of unaffected siblings of children with neurodevelopmental disorders.

RESULTS

Seven studies met the inclusion criteria. Four studies reported impaired quality of life in unaffected siblings of children with neurodevelopmental disorder while three studies reported not the impaired quality of life. Parents reported the lower quality of life for children with or without neurodevelopmental disorders compared to children's self-reports.

CONCLUSIONS

This review provides the mixed evidence on the quality of life in unaffected siblings of children with neurodevelopmental disorders, and identifies the substantial gap in the research regarding the impacts of children's neurodevelopmental disorders on the quality of life of their unaffected siblings. Assessment of unaffected siblings' quality of life is necessary to identify those who may be at risk and to provide support programs for physical and emotional well-being. Future research examining the quality of life of unaffected siblings across a variety of NDD is needed.Implications for rehabilitationGrowing up with a sibling with a neurodevelopmental disorder influences the personal and social development of the unaffected child.Measuring quality of life can have a meaningful impact on the lives of unaffected siblings of children with neurodevelopmental disorders and their families. Evidence generated from such studies can be used by healthcare providers such as physicians, nurses, psychologists, and social workers to recommend appropriate supports to the family and siblings.

Evaluation of quality of life of healthy siblings of children with chronic disease

The quality of life determination of children with chronic disease is closely related to treatment success. Quality of life assessment studies revealed that it was not limited to the individual, the quality of life of the family members also had to be assessed. Along with the child being diagnosed with chronic illness, some changes occur in the family structure, and in family roles. Quality of life assessment studies in healthy siblings generally indicate a global influence. These children live in different senses such as closure, aggression, depression, anxiety, guilt, and isolation. Psychosocial impact (short or long-term) of healthy siblings have been associated with disease type, severity, disease duration, age, sex, and ability to cope. Further comprehensive studies among healthy siblings of children with chronic disease about quality of life are needed. Building support groups (especially family support groups) to express feelings and thoughts freely for healthy siblings can positively affect the well-being and self-esteem of the child.

Desire to have other children in families with a chronically disabled child and its effect on the relationship of the parents

AIM

The aim of this study was to examine the desire of the parents who had a chronically disabled child to have other children and to investigate the effect of having a disabled child on the relationship of the parents.

MATERIAL AND METHODS

The families of 145 chronically disabled children were included in the study. After the sociodemographic information belonging to the child and family were obtained, the prepared questionnaire form was used to interrogate if the parents lived together, the number of children in the family, if they wished to have other children and the relation of the disabled child with the household. Ethics committee approval was obtained from Dokuz Eylül University (date: 18.10.2012, decision number, 2012/34-13). The data obtained in the study were expressed as figures and percentages.

RESULTS

While 91.7% of the parents continued their relationship, 2.8% were divorced and 1.4% were left by their spouses. The rate of the parents who did not wish to have (or did not have) other children after a disabled child was found to be 65.2%. The major reason for the families not to wish to have other children was found to be the fact that they thought they could not spare enough time for their disabled child. While 35.1% of the parents stated that clemped together more tightly, 35.2% stated that their concerns about the future increased further. Fifty eight percent of the parents stated that social relations and community involvements were not affected, whereas others stated that they were affected in different ways.

CONCLUSIONS

Although the relationship between the parents was not affected to a great extent in families who had chronically disabled children, it was found that parents intensively experienced concern for the future. It was found that this also affected the desire of the parents who had a chronically disabled child to have other children with the concern that the child will be disabled.

The perspective of siblings of children with chronic illness: a literature review

This review gives an overview about the existing research concerning siblings' perspective within the familial experiences of childhood chronic illness. Besides attaining a conception of their world, it was intended to identify the unacknowledged issues concerning siblings' experience. Four databases were systematically searched. The analysis was concentrated on nine literature reviews. As a result, we identified a map of dimensions of experiences-well-elaborated as well as fragmentary. Many of the studies were conducted by a proxy and not from the sole siblings' perspective. Further research should concentrate on the sole siblings' perspective, in order to make siblings' voices audible.

The needs of siblings of children with cancer: a nursing perspective

Findings from research studies on the needs of siblings of children with cancer have highlighted the imperative that these siblings be supported and involved in the plan of care when a diagnosis of cancer is made. However, few studies have included the perspective of the nurse when evaluating sibling needs or identifying interventions used to meet the needs. This qualitative descriptive study used a combination of individual interviews and a focus group to capture perspectives from 13 pediatric oncology nurses employed at a leading Children's Hospital located in the northeast. Transcripts were analyzed for content and theme in relation to the 2 research questions. Needs identified included getting attention, wanting to know, having fears/worries, feeling at fault, wanting to help, and wanting a normal routine, whereas interventions identified included recognizing their needs, getting siblings involved, sharing appropriate information, being a resource, giving support, and bending the rules. Findings support previous studies that document the variety of needs experienced by siblings of children with cancer and offer examples of nursing interventions to meet these needs.

An integrative review of the literature about the transition of pediatric patients with intestinal failure from hospital to home

PURPOSE

Children with intestinal failure (IF) have complex needs that pose many challenges while in the hospital and upon transition to home. The purpose of this review was to identify factors associated with the complexity of transitional care in this population of children, as well as to explore frameworks for providing care for transition to home.

DESIGN AND METHOD

Eleven publications, including research and clinical practice articles, were identified for an integrative review.

RESULTS

Four themes emerged regarding IF and transition: complex healthcare needs, planning for and beginning transition, identification of family requirements, and frameworks for providing transitional care.

PRACTICE IMPLICATIONS

Nurses working with families of children with IF can facilitate successful transition into the home by planning in advance and using a framework that addresses the needs of the patient and family.

Psychosocial impacts of a camping experience for children with cancer and their siblings

BACKGROUND

We conducted a prospective two-group evaluation of pediatric cancer patients and their siblings regarding experiences and affective changes resulting from a 1-week summer camp experience.

METHODS

The patients and siblings were assessed prior to camp (Baseline), at the end of camp (Follow-up 1), and again 4-6 months later (Follow-up 2). Assessments included standardized tests for depressive affects, social competency, and a measure of pleasure and participation in camp activities.

RESULTS

Sixty-six children were assessed, including 31 (47%) patients and 35 (53%) siblings. Ages ranged from 7 to 17 years. Of the patient campers 19 (61%) had leukemia or lymphoma and 12 (39%) had solid tumors. Results showed marked changes in affective symptoms for patient campers over time (improvements), not shown by sibling campers. For patient campers these affective changes were not present immediately after camp, but were quite significant when measured 4-6 months later. Both patient and sibling campers reflected the same positive memories and pleasure in camp activities over time. For neither group did memories or pleasure fade over time. The camping experience did not have differential impacts on first time versus returning campers. Twelve campers (18% of sample) indicated suicidal ideation on the measure of depressive affects. They did well at camp and presented no special management issues.

CONCLUSION

Expectations appear substantially different for patient versus sibling campers. The camping experience appeared to impact these groups differently, with patient campers impacted in ways not experienced by sibling campers.

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.

Camping programs for children with cancer and their families

This paper presents an introduction to the role of camping programs for children with cancer and their families and a hypothesized theory of action. Nine previously published studies investigating recreation-based summer camps for children with cancer and their families are summarized. Overall, these programs appear to be effective; however, an overall conclusion is difficult to state due to variations in design, heterogeneity of subjects, and differences in the definition of camp programs. The lack of knowledge regarding the efficacy of these programs is identified as the largest deficiency in the current literature on this topic. Future research needs in this area are discussed.

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.

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.

The care of my child with cancer: a new instrument to measure caregiving demand in parents of children with cancer

The growing societal trend toward delivering more and more illness-related care in the home, driven both by family preferences and by mandates from third-party reimbursers, places additional responsibilities for increasingly complex caregiving on parents of children with serious illness. This article reports on the development and initial field test of The Care of My Child with Cancer, a caregiving demand instrument specific to the childhood cancer population. The instrument demonstrated strong internal consistency and test-retest reliability, and exploratory factor analysis provided initial evidence for the instrument's construct validity. The instrument will now be applied in a collaborative program of nursing research to further investigate caregiving demand and ultimately to develop nursing interventions to maximize medical and quality of life outcomes for children with cancer and their families.

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.