Web-based counseling for families with parental cancer: Baseline findings and lessons learned

Interventions for Children of Parents With Cancer From the Time of Cancer Diagnosis Through Bereavement: Two Systematic Reviews

OBJECTIVE

While there has been increasing attention on caring for children following a parent's cancer diagnosis or death, few studies include scalable evidence-based interventions to facilitate adjustment. The aim of this review was to summarize recent empirical studies that included interventions for minor children (0-18 years) with clear pre- and post-assessments of the child's psychological functioning from the time a parent is diagnosed with cancer through bereavement.

METHODS

Two separate systematic reviews were conducted for interventions during either a parent's illness or bereavement. We searched Ovid Medline, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Sociological Abstracts, and Social Services Abstracts for articles published in 2015 and beyond.

RESULTS

For the first review, 113 articles were reviewed at the full-text level. Of those, 11 met study inclusion criteria. All were published between 2015-2023 and the sample size ranged from 16-176, including 534 children in total, aged 4-18 years. Thirteen validated measures were used. For the second review, 49 articles were reviewed at the full text level, and only one met criteria. This study, published in 2023, included 20 children aged 7-12 years. Two validated measures were used. Quality assessment indicated a generally low risk of bias and high methodological quality for both reviews.

CONCLUSIONS

Evidence-based interventions for minor children whose parents have been diagnosed with cancer or who are bereaved during childhood are limited. To standardize and move the field forward, we propose a model to guide the development of interventions for children whose parents have been diagnosed with cancer through bereavement.

Communication Interventions for Families with Parental Cancer With Dependents: Findings from a Scoping Review

BACKGROUND

Since 2019, invasive cancer diagnoses in people younger than 50 years old have increased by 12.8%, which impacts people of childbearing age. Currently, family interventions for parents with cancer primarily focus on the impacted parent communicating the initial cancer diagnosis or at end-of-life messages with their dependents through in-person interventions. Limited web-based interventions have been developed to increase communication across all family members (e.g., parents with cancer with co-parents or children with their parents) about communicating the impact of cancer on the individual's and family's well-being across the cancer trajectory, a key gap to improved outcomes in this population.

AIM

This scoping review aimed to comprehensively summarize family communication interventions designed for a parent with cancer who has dependents and to identify and analyze any knowledge gaps regarding family communication interventions in this population.

METHODS

A comprehensive informationist-assisted search was completed in seven databases. Two reviewers independently performed title/abstract reviews and full-text reviews within the Rayyan software system. Two reviewers performed data extraction.

RESULTS

Thirty-five articles were included, and 24 different interventions were investigated. Most articles were published by European teams (45%). Fourteen articles (40%) evaluated interventions that included the entire family, seven (20%) reported family theories, and three (9%) used a web-based delivery. Most articles focused on the outcomes of the parent with cancer and the outcomes of their dependents (31%). Most interventions aimed to increase parent communication with dependents at end-of-life (43%) or at early diagnosis (32%) in the breast cancer population.

LINKING EVIDENCE TO ACTION

In-person communication interventions have been developed to communicate with dependents about an early or terminal cancer diagnosis. The impact of the intervention on parents with cancer and their children's outcomes were also investigated. No web-based interventions have been published that focus on the entire family, include family-level outcomes, or completed dyadic analysis across the family on the family-level outcomes to determine relationships. Web-based interventions are needed to address communication challenges for all family members affected by a cancer diagnosis, and equitable access to such interventions should be supported.

"Share the Fear": Communication Concerns of Parents With Cancer With Dependents and Coparents: A Qualitative Needs Assessment Study

BACKGROUND

The estimated 1.6 million adults in the United States with cancer who also have dependents face unique challenges given the profound impact of cancer on their families, such as increased psychological distress, decreased quality of life, and altered family functioning. Unfortunately, little is known about the mutual cancer-related communication concerns from the perspectives of the parents with cancer or the coparents. Coparents care for the patient and dependents until they reach adulthood (eg, unmarried, divorced, stepparent, and/or same-sex partnerships).

OBJECTIVE

To understand the mutual cancer-related communication concerns from the perspectives of parents with cancer and the coparents and intervention delivery preferences.

METHODS

Fifteen parents with cancer and 15 coparents were recruited to participate in semistructured interviews between October 2022 and September 2023 within an academic medical center in Midwestern states. Interviews were conducted via Zoom. The data were analyzed through Charmaz's inductive grounded theory approach.

RESULTS

Parents with cancer and the coparents desire communication assistance with each other about discussing the cancer diagnosis with dependents, end-of-life planning, managing finances, and addressing mental health concerns and emotions. The majority of participants reported interest in a virtually delivered intervention.

CONCLUSIONS

Findings from this study provide a mutual understanding of cancer-related communication concerns from the perspectives of parents with cancer and the coparents.

IMPLICATIONS FOR PRACTICE

These findings provide awareness for providers and the foundation to inform a web-based communication intervention about cancer-related concerns to promote family resiliency in this population, which provides a resource for providers to utilize.

Interventions to improve illness-related communication between cancer patients and their minor children: A systematic review

BACKGROUND

Parental cancer conditions significantly impact the physical, social, and emotional well-being of minor children. Effective illness-related communication is crucial for both parents and their children to mitigate these effects.

OBJECTIVE

To systematically summarize the characteristics and effectiveness of interventions aimed at improving illness-related communication between parents with cancer and their minor children.

DESIGN

A systematic review.

DATA SOURCES

Six databases (CINAHL, Web of Science, PubMed, Embase, the Cochrane Library, and PsycINFO) were searched for articles published in English between 2000 and 2023.

METHODS

A three-step review process was employed to select articles. Two reviewers independently screened titles and abstracts, reviewed full texts to include studies aimed at facilitating illness-related communication between parents with cancer and their minor children under the age of 18, and assessed study quality using the Joanna Briggs Institute critical appraisal checklist.

RESULTS

The search yielded 9409 articles, of which 21 met the inclusion criteria, 4 were randomized controlled trials and 17 were quasi-experimental studies. These studies involved 213 families, 149 parents, and 192 minor children. The interventions were categorized as family-centered, parent-centered, or children-centered and emphasized disease knowledge, communication skills, emotional management, and future planning in illness-related communication. The synthesized results indicate that family-centered interventions show unique advantages in improving family life; parent-centered interventions bring benefits in enhancing parenting quality, parents' self-efficacy in coping with cancer, and children's social behavior; and children-centered interventions exhibit a significant impact on the psychological well-being of children.

CONCLUSION

Parent-centered interventions demonstrated significant potential in promoting illness-related communication, particularly by emphasizing the patient's parental role, enhancing intrinsic motivation to sustain communication, and recognizing that patients themselves may be more suitable targets for clinical oncology practice. High-quality research is recommended to enrich the content of parent-centered interventions and encourage the measurement of intervention effects on communication as well as the mechanism of action.

REGISTRATION NUMBER

The review protocol was registered in PROSPERO under the number CRD42023478107.

Psychosocial interventions targeting parenting distress among parents with cancer - A systematic review and narrative synthesis of available interventions

BACKGROUND

Balancing having cancer and parenting a major stressor, and may result in parenting distress, negatively affecting the whole family. To provide adequate support, knowledge of existing psychosocial interventions are crucial to guide future interventions. This study aimed to describe available psychosocial interventions for parents with cancer and dependent children (<18 years).

METHOD

We conducted a systematic review, and four databases were searched from January 2000 to March 2023.

RESULTS

Thirty studies were included, reporting on 22 psychosocial interventions for parents with cancer. They aimed to improve different aspects of parenting distress, and included psychoeducation and communication strategies. Interventions were beneficial to and acceptable among parents, but only a few had been evaluated. The study quality was, overall, assessed as moderate.

CONCLUSIONS

The results of this review highlight the diversity of available psychosocial interventions for parents with cancer and the outcomes on parenting distress, as well as methodological challenges.

Implementation of e-Mental Health Interventions for Informal Caregivers of Adults With Chronic Diseases: Mixed Methods Systematic Review With a Qualitative Comparative Analysis and Thematic Synthesis

BACKGROUND

Informal caregivers commonly experience mental health difficulties related to their caregiving role. e-Mental health interventions provide mental health support in a format that may be more accessible to informal caregivers. However, e-mental health interventions are seldom implemented in real-world practice.

OBJECTIVE

This mixed methods systematic review aimed to examine factors associated with the effectiveness and implementation of e-mental health interventions for informal caregivers of adults with chronic diseases. To achieve this aim, two approaches were adopted: combinations of implementation and intervention characteristics sufficient for intervention effectiveness were explored using qualitative comparative analysis, and barriers to and facilitators of implementation of e-mental health interventions for informal caregivers were explored using thematic synthesis.

METHODS

We identified relevant studies published from January 1, 2007, to July 6, 2022, by systematically searching 6 electronic databases and various secondary search strategies. Included studies reported on the effectiveness or implementation of e-mental health interventions for informal caregivers of adults with cancer, chronic obstructive pulmonary disease, dementia, diabetes, heart disease, or stroke. Randomized controlled trials reporting on caregivers' mental health outcomes were included in a crisp-set qualitative comparative analysis. We assessed randomized controlled trials for bias using the Risk of Bias 2.0 tool, and we assessed how pragmatic or explanatory their trial design was using the Pragmatic Explanatory Continuum Indicator Summary 2 tool. Studies of any design reporting on implementation were included in a thematic synthesis using the Consolidated Framework for Implementation Research to identify barriers to and facilitators of implementation.

RESULTS

Overall, 53 reports, representing 29 interventions, were included in the review. Most interventions (27/29, 93%) focused on informal cancer or dementia caregivers. In total, 14 reports were included in the qualitative comparative analysis, exploring conditions including the presence of peer or professional support and key persuasive design features. Low consistency and coverage prevented the determination of condition sets sufficient for intervention effectiveness. Overall, 44 reports were included in the thematic synthesis, and 152 barriers and facilitators were identified, with the majority related to the intervention and individual characteristic domains of the Consolidated Framework for Implementation Research. Implementation barriers and facilitators in the inner setting (eg, organizational culture) and outer setting (eg, external policies and resources) domains were largely unexplored.

CONCLUSIONS

e-Mental health interventions for informal caregivers tend to be well-designed, with several barriers to and facilitators of implementation identified related to the intervention and individual user characteristics. Future work should focus on exploring the views of stakeholders involved in implementation to determine barriers to and facilitators of implementing e-mental health interventions for informal caregivers, focusing on inner and outer setting barriers and facilitators.

TRIAL REGISTRATION

PROSPERO (International Prospective Register of Systematic Reviews) CRD42020155727; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020155727.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1136/bmjopen-2019-035406.

How to support parenting in patients with cancer and co-parents? From research to practice

PURPOSE OF REVIEW

When a parent is diagnosed with cancer, the entire family is impacted. Patients with cancer and co-parents may no longer feel able to fulfill their parenting roles. The aims of this article are to describe interventions designed to support parenting in the oncological context and to make suggestions for the development and assessment of such interventions.

RECENT FINDINGS

Ten parenting support interventions published in the last 10 years in oncology were identified, among which four randomized controlled trials (RCTs). The therapeutic aims, techniques, and modalities of these interventions were heterogeneous. Five main therapeutic aims were addressed to: increase parents' knowledge, promote parents' emotion regulation, enhance parents' self-efficacy related to parenting, promote parents' support of their children's reactions and coping strategies, and promote open and appropriate parent-child communication. Few studies have combined informational resources with experiential techniques.

SUMMARY

Very few studies examining the efficacy of parenting support interventions have been published. There is still a need to develop, test, and compare interventions that meet the many needs of parents and their children. Suggestions are made about the contents and formats of parenting support interventions in oncology.

VIVÊNCIA DO CANCRO PARENTAL: ESTUDO DE CASO COM APLICAÇÃO DO MODELO DE NEUMAN

RESUMO Objetivo compreender à luz do Modelo de Sistemas de Betty Neuman, a experiência de uma mulher-mãe a vivenciar uma situação de cancro; identificar as necessidades da mulher-mãe e prescrever intervenções de enfermagem em linguagem classificada. Método estudo de caso do tipo qualitativo, de uma mulher-mãe de um adolescente, a vivenciar cancro. Colheita de dados realizada em Coimbra, Portugal, em 2021, através de entrevista semiestruturada, apoiada por um guião fundamentado no Modelo de Betty Neuman. Tratamento de dados realizado com base na análise de conteúdo categorial. Resultados a análise do discurso da mãe possibilitou identificar categorias concordantes com as variáveis do modelo: fisiológicas, psicológicas, socioculturais, espirituais e desenvolvimentais. As dificuldades mais expressas pela mãe foram o medo, alterações provocadas pela doença e o desempenho do papel parental. Os diagnósticos de enfermagem foram definidos com base nos focos “aceitação do estado de saúde”, “medo”, “papel parental” e “coping familiar”, associando-os às respetivas intervenções de enfermagem. As intervenções focaram-se no apoio e na educação. Conclusão o modelo teórico contribuiu para compreender e identificar as necessidades da mãe a experienciar o cancro parental, facilitando a prescrição de intervenções de enfermagem em linguagem classificada. O modelo mostrou-se pertinente para futuras intervenções em pais a vivenciar situações semelhantes.

EXPERIENCING PARENTAL CANCER: A CASE STUDY WITH APPLICATION OF NEUMAN’S MODEL

ABSTRACT Objective to understand, in the light of Betty Neuman’s Systems Model, the experience of a woman-mother with cancer, and identify the woman-mother’s needs and prescribe nursing interventions in classified language. Method a qualitative case study of a woman-mother of a teenager experiencing cancer. Data collection carried out in Coimbra, Portugal, in 2021, through a semi-structured interview, supported by a script based on Betty Neuman’s Systems Model. Data processing performed based on categorical content analysis. Results the analysis of a mother’s speech made it possible to identify categories in agreement with the model variables: physiological, psychological, sociocultural, spiritual and developmental. The difficulties most expressed by the mother were fear, changes caused by the disease and parental role performance. The nursing diagnoses were defined based on the focuses “acceptance of health status”, “fear”, “parental role” and “family coping”, associating them with the respective nursing interventions. Interventions focused on support and education. Conclusion the theoretical model contributed to understanding and identifying the needs of a mother experiencing parental cancer, facilitating the prescription of nursing interventions in classified language. The model proved to be relevant for future interventions in parents experiencing similar situations.

Programas de intervenção para crianças, adolescentes e pais a vivenciar o cancro parental: scoping review

Resumo Objetivos mapear programas de intervenção para crianças, adolescentes e pais, ou díade (doentes oncológicos e filhos) a vivenciar o cancro parental. Método scoping review segundo a metodologia recomendada pelo Joanna Briggs Institute (JBI) e o Preferred Reporting Items for Systematic Reviews - Scoping Reviews (PRISMA-ScR). Resultados foram identificados 29 programas de intervenção: 13 dirigidos à díade, 11 a crianças e adolescentes e 5 dirigidos aos pais. Dos programas identificados, 10 não especificam a tipologia das intervenções propostas, 9 referenciam intervenções psicoeducacionais, 7 referenciam intervenções educacionais e 3 referenciam intervenções do tipo psicossocial. Conclusão e Implicações para a prática verificou-se que a maioria dos programas identificados se dirige à díade crianças/adolescentes e pais. As caraterísticas dos programas e das intervenções diferem entre estudos, no entanto as intervenções psicoeducacionais são as mais prevalentes. O mapeamento de programas de intervenção e promoção da adaptação ao cancro parental contribui para a síntese da evidência existente sobre esta temática, conhecimento sobre as intervenções desenvolvidas e resultados obtidos, consciencializando os profissionais de saúde, nomeadamente enfermeiros, e decisores da área da saúde para a relevância da sua implementação na prática clínica, tendo em vista a qualidade dos cuidados de enfermagem prestados a essas famílias.