Understanding grief in children who have lost a parent with cancer: How do they give meaning to this experience? Results of an interpretative phenomenological analysis

Parental terminal cancer and dependent children: a systematic review

BACKGROUND

When a parent has terminal cancer, their children are part of that experience. Parents often want to protect their children from their disease and prognosis. Knowledge of dependent children's experience will help ensure they receive appropriate support. To date, there is lack of synthesis of this evidence examining children's perspectives.

OBJECTIVES

To systematically search and synthesise the qualitative literature exploring the experiences of dependent children when their parent has terminal cancer.

METHODS

Databases of MEDLINE, Embase, PsycINFO, CINAHL, Assia and the Cochrane library were searched systematically from inception to July 2020 to determine eligible studies. Included studies were appraised for quality and thematically synthesised using Thomas and Harden's thematic synthesis framework.

RESULTS

Fourteen studies were included, which interviewed children about their experiences (n=654 children aged 4-18 years at the time of parental death), from six countries. Five descriptive themes were identified, further categorised into two broad themes: (1) finding out about parental cancer and its impact on the family and (2) coping with life with parental cancer, death and beyond.

CONCLUSION

Children want to be involved in their parent's cancer experience and to help support the family. Healthcare professionals are ideally placed to support and encourage parents to include their children. They should reassure parents that children can cope well and that maintaining normality will help, and explain the benefits of honest and open communication and how they can include dependent children from diagnosis and beyond.

"I Don't Know What to Say": Teachers' Perspectives on Supporting Bereaved Students After the Death of a Parent

This qualitative study examined teachers' experiences dealing with bereaved students following the death of a parent. The researchers conducted in-depth, semi-structured, face-to-face interviews with 25 teachers in Israeli schools who had counseled one of their students after the death of a parent. The interviews were recorded and transcribed and underwent content analysis. Analysis of the findings revealed that the teachers felt helpless, confused, overloaded emotionally and anxious when counseling students who had lost a parent. In addition, the teachers discussed the complex nature of their relationship with the remaining parent, ranging from a desire to support the family through avoidance for fear of hurting the parent to fears of being overwhelmed by the child's problems. Many teachers mentioned their need for support from school officials.

Posttraumatic Growth Experiences of Adolescents With Parental Loss: A Phenomenological Study

This study examines the post-traumatic growth of adolescents who have lost their parents about their experiences. Eight adolescents whose parents had died participated in the study conducted in the phenomenological design. The data were collected with three-step semi-structured interviews and analyzed using the phenomenological analysis technique performed in five stages. The findings were grouped into three main themes as "reactions to loss," "readjustment," and "post-traumatic growth," and nine subthemes under each, and these sub-themes were categorized into forty-five codes.

Acute and long-term grief reactions and experiences in parentally cancer-bereaved teenagers

Background

Previous research shows that many cancer-bereaved youths report unresolved grief several years after the death of a parent. Grief work hypothesis suggests that, in order to heal, the bereaved needs to process the pain of grief in some way. This study explored acute grief experiences and reactions in the first 6 months post-loss among cancer-bereaved teenagers. We further explored long-term grief resolution and potential predictors of having had “an okay way to grieve” in the first months post-loss.

Methods

We used a population-based nationwide, study-specific survey to investigate acute and long-term grief experiences in 622 (73% response rate) bereaved young adults (age > 18) who, 6–9 years earlier, at ages 13–16 years, had lost a parent to cancer. Associations were assessed using bivariable and multivariable logistic regression.

Results

Fifty-seven per cent of the participants reported that they did not have a way to grieve that felt okay during the first 6 months after the death of their parent. This was associated with increased risk for long-term unresolved grief (odds ratio (OR): 4.32, 95% confidence interval (CI): 2.99–6.28). An association with long-term unresolved grief was also found for those who reported to have been numbing and postponing (42%, OR: 1.73, 95% CI: 1.22–2.47), overwhelmed by grief (24%, OR: 2.02, 95% CI: 1.35–3.04) and discouraged from grieving (15%, OR: 2.68, 95% CI: 1.62–4.56) or to have concealed their grief to protect the other parent (24%, OR: 1.83, 95% CI: 1.23–2.73). Predictors of having had an okay way to grieve included being male, having had good family cohesion, and having talked about what was important with the dying parent.

Conclusion

More than half of the cancer-bereaved teenagers did not find a way to grieve that felt okay during the first 6 months after the death of their parent and the acute grief experiences and reaction were associated with their grief resolution long-term, i.e. 6–9 years post-loss. Facilitating a last conversation with their dying parent, good family cohesion, and providing teenagers with knowledge about common grief experiences may help to prevent long-term unresolved grief.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12904-021-00758-7

Validation of posttraumatic stress disorder (PTSD) and complex PTSD in Chinese children as per the ICD-11 proposals using the International trauma questionnaire

Background: Given that the validity of applying complex posttraumatic stress disorder (CPTSD) in nonclinical children remains unclear. Objectives: The current study aimed to explore the factor structure, discriminant validity, and risk factors of ICD-11 posttraumatic stress disorder (PTSD) and CPTSD using the International Trauma Questionnaire. Methods: A total of 3478 trauma-exposed Chinese children aged 9-12 years were included in this study. All participants were assessed for PTSD and CPTSD using the International Trauma Questionnaire (ITQ). Confirmatory factor analysis (CFA) was conducted to explore the factor structure of CPTSD in a sample of Chinese children. Latent class analysis (LCA) was employed to evaluate the discriminant validity of CPTSD symptoms. Multinomial logistic regression analyses determined associations between the different classes and traumatic events. Results: The CFA results showed that the first-order six-factor model was identified as the best-fitting model in Chinese children aged 9-12 years. Four different classes, CPTSD symptoms, PTSD symptoms, disturbances in self-organization (DSO) symptoms, and a low symptom class were found by LCA. Both prolonged interpersonal trauma and other types of trauma were risk factors for the CPTSD class and the PTSD class. Conclusions: The results of this study partially support the factorial validity and strongly support the discriminant validity of the ICD-11 proposals for PTSD and CPTSD in Chinese children, supporting the conceptualization of PTSD and CPTSD as sibling diagnoses based on the ICD-11. However, findings suggest the need for careful consideration of identified trauma types in the ICD-11 proposals.

A New Instrument to Assess Children's Understanding of Death: Psychometrical Properties of the EsCoMu Scale in a Sample of Spanish Children

The acquisition of the death concept in children may influence how these children cope with the losses that they will confront throughout their lives. At the present time, there is a lack of psychometric instruments in Spanish-speaking countries in order to evaluate the components of the death concept in children. The aim of this study was to create and validate a scale (EsCoMu-Escala sobre el Concepto de Muerte) in order to provide insight about the concept of death in children. The sample was formed by 358 children from ages 6 to 13 years. The final EsCoMu version has 27 items which serve to evaluate universality, irreversibility, non-functionality and causality. The results of the confirmatory factor analysis show an adequate fit index for the four dimensions model, reliability (α = 83) and validity evidence, specifically based on the children’s age. In conclusion, EsCoMu is an instrument that shows adequate reliability and validity indices in order to assess the concept of death and its four components among children. Due to its simplicity, this instrument can be very useful if applied to the field of neurodevelopmental disorders.

Operationalizing intersectionality as a framework in qualitative grief research

The field of thanatology emphasizes understanding grief as situated within social contexts. Yet, existing research largely examines individual experiences, neglecting to critically examine the role that sociocultural systems and forms of oppression play in how people grieve. In this manuscript, we use the social constructionist model of grief as an epistemological stepping stone to operationalize intersectionality as a framework to engage in this critical qualitative research. We provide an overview of the research process implementing an intersectional framework, including examples of research questions and procedures throughout, and discuss implications for helping praxis and education and future scholarship.

Regret and unfinished business in parents bereaved by cancer: A mixed methods study

BACKGROUND

Prior research has demonstrated that the presence of regret and unfinished business is associated with poorer adjustment in bereavement. Though there is a growing literature on these constructs among caregivers of adult patients, the literature on regret and unfinished business in bereaved parents has been limited.

AIM

The aim of this study was to examine regret and unfinished business in parents bereaved by cancer, as well as their associations with caregiving experiences and prolonged grief.

DESIGN

This was a cross-sectional mixed methods study that utilized self-report questionnaires with open-ended items.

SETTING/PARTICIPANTS

The multisite study took place at a tertiary cancer hospital and pediatric cancer clinical research institution. Participants were 118 parents (mothers = 82, fathers = 36) who lost a child aged 6 months to 25 years to cancer between 6 months and 6 years prior.

RESULTS

Results showed that 73% of the parents endorsed regret and 33% endorsed unfinished business, both of which were more common among mothers than fathers (p ⩽ 0.05). Parents were on average moderately distressed by their regrets and unfinished business, and both regret-related and unfinished business-related distress were associated with distress while caregiving and prolonged grief symptoms.

CONCLUSION

Findings have implications for how providers work with families, including increasing treatment decision-making support, supporting parents in speaking to their child about illness, and, in bereavement, validating choices made. Grief interventions that use cognitive-behavioral and meaning-centered approaches may be particularly beneficial.