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Petermann-Meyer A, Panse JP, Bremen R, Dohmen M, Drueke B, Geiser F, Haastert B, Heier L, Heuser C, Holsteg S, Icks A, Karger A, Nakata H, Viehmann A, Brümmendorf TH, Ernstmann N. Effectiveness of a comprehensive support program for families with parental cancer (Family-SCOUT): results of a multicenter non-randomized controlled trial. ESMO Open 2024; 9:103493. [PMID: 38848662 DOI: 10.1016/j.esmoop.2024.103493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 03/21/2024] [Accepted: 05/06/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Cancer patients with minor children but also their families suffer from significant psychological distress and comorbidity. Protective factors predicting successful coping are well known. Corresponding systematic interventions are rare and limited by access barriers. We developed a comprehensive family-centered intervention for cancer patients with at least one dependent minor. PATIENTS AND METHODS Family-SCOUT represents a multicentric, prospective, interventional, and controlled study for families with parental cancer and their minor children. In the intervention group (IG), all family members were addressed using a care and case management approach for nine months. Families in the control group (CG) received standard of care. Participating parents were asked to complete the Hospital-Anxiety-Depression-Scale (HADS) questionnaire at enrolment (T0) and after 9 months (T2). The primary outcome was a clinically relevant reduction of distress in at least one parent per family, measured as minimal important difference (MID) of ≥1.6 in the HADS total score. The percentage of families achieving MID is compared between the IG and CG by exact Fisher's test, followed by multivariate confounder analyses. RESULTS T0-questionnaire of at least one parent was available for 424 of 472 participating families, T2-questionnaire after 9 months was available for 331 families (IG n = 175, CG n = 156). At baseline, both parents showed high levels of distress (HADS total: sick parents IG: 18.7 ± 8.1; CG: 16.0 ± 7.2; healthy partners: IG: 19.1 ± 7.9; CG: 15.2 ± 7.7). The intervention was associated with a significant reduction in parental distress in the IG (MID 70.4% in at least one parent) compared with the CG (MID 55.8%; P = 0.008). Adjustment for group differences from specific confounders retained significance (P = 0.047). Bias from other confounders cannot be excluded. CONCLUSIONS Parental cancer leads to a high psychosocial burden in affected families. Significant distress reduction can be achieved through an optimized and structured care approach directed at the family level such as family-SCOUT.
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Affiliation(s)
- A Petermann-Meyer
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Aachen; Center for Integrated Oncology, Aachen Bonn Cologne Duesseldorf (CIO(ABCD)).
| | - J P Panse
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Aachen; Center for Integrated Oncology, Aachen Bonn Cologne Duesseldorf (CIO(ABCD))
| | - R Bremen
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Aachen; Center for Integrated Oncology, Aachen Bonn Cologne Duesseldorf (CIO(ABCD))
| | - M Dohmen
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Aachen; Center for Integrated Oncology, Aachen Bonn Cologne Duesseldorf (CIO(ABCD))
| | - B Drueke
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Aachen; Center for Integrated Oncology, Aachen Bonn Cologne Duesseldorf (CIO(ABCD))
| | - F Geiser
- Center for Integrated Oncology, Aachen Bonn Cologne Duesseldorf (CIO(ABCD)); Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn
| | - B Haastert
- mediStatistica, Wuppertal; Institute for Health Services Research and Health Economics, Center for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Duesseldorf
| | - L Heier
- Center for Integrated Oncology, Aachen Bonn Cologne Duesseldorf (CIO(ABCD)); Center for Health Communication and Health Services Research, Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn; Chair for Health Services Research, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne
| | - C Heuser
- Center for Integrated Oncology, Aachen Bonn Cologne Duesseldorf (CIO(ABCD)); Center for Health Communication and Health Services Research, Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn; Chair for Health Services Research, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne
| | - S Holsteg
- Center for Integrated Oncology, Aachen Bonn Cologne Duesseldorf (CIO(ABCD)); Clinical Institute of Psychosomatic Medicine and Psychotherapy, University Hospital Düsseldorf, Faculty of Medicine, Heinrich Heine University Düsseldorf, Duesseldorf
| | - A Icks
- Institute for Health Services Research and Health Economics, Center for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Duesseldorf; Institute for Health Services Research and Health Economics, German Diabetes Center, Duesseldorf, Germany
| | - A Karger
- Center for Integrated Oncology, Aachen Bonn Cologne Duesseldorf (CIO(ABCD)); Clinical Institute of Psychosomatic Medicine and Psychotherapy, University Hospital Düsseldorf, Faculty of Medicine, Heinrich Heine University Düsseldorf, Duesseldorf
| | - H Nakata
- Center for Integrated Oncology, Aachen Bonn Cologne Duesseldorf (CIO(ABCD)); Center for Health Communication and Health Services Research, Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn
| | - A Viehmann
- Institute for Health Services Research and Health Economics, Center for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Duesseldorf
| | - T H Brümmendorf
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Aachen; Center for Integrated Oncology, Aachen Bonn Cologne Duesseldorf (CIO(ABCD))
| | - N Ernstmann
- Center for Integrated Oncology, Aachen Bonn Cologne Duesseldorf (CIO(ABCD)); Center for Health Communication and Health Services Research, Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn; Chair for Health Services Research, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne
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Dawes K, Simpson G, Lines L, van den Berg M. Interventions to support children after a parental acquired brain injury: a scoping review. Brain Inj 2024:1-14. [PMID: 38687294 DOI: 10.1080/02699052.2024.2347555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 04/22/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVE This scoping review aimed to identify manualised programs and practice suggestions to support children's health literacy, behaviors and emotions after a parental acquired brain injury. METHODS A systematic search of five scientific databases (PsychINFO, MEDLINE, ProQuest, Scopus, Cochrane) and gray literature occurred. Inclusion criteria included: studies and gray literature published 1989 to 2023, in English, child populations with relationship to parental acquired brain injury, identifying manualised programs or practice suggestions via content analysis approach. ETHICAL CONSIDERATIONS No data were collected from human participants. All included studies, where relevant, demonstrated consent and/or ethical processes. RESULTS Sixteen relevant studies and three gray literature resources (n = 19) were identified, including two studies that detailed manualised programs, and fifteen studies and two resource packs that included practice suggestions. Five common domains within practice suggestions were identified: systemic commitment (n = 17); family-centered approaches (n = 16); child-centered practices (n = 15); structured programs (n = 9); and peer support (n = 8). CONCLUSIONS More rigorous evaluation is required to test the potential benefits of manualised programs and practice suggestions. A systemic commitment at clinical and organizational levels to provide child and family-centered practices, structured programs, and access to peer support, early and throughout adult-health care settings, may help to meet the support needs of children.
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Affiliation(s)
- Kate Dawes
- South Australian Brain Injury Rehabilitation Service, SA Health, Adelaide, Australia
- Caring Futures Institute, Flinders University of South Australia, Adelaide, Australia
| | - Grahame Simpson
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, Sydney, Australia
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Sydney, Australia
| | - Lauren Lines
- Caring Futures Institute, Flinders University of South Australia, Adelaide, Australia
| | - Maayken van den Berg
- Caring Futures Institute, Flinders University of South Australia, Adelaide, Australia
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Ohan JL, Jackson HM, Bett R, Farmer GM, Martini A. Experiences and needs of children and adolescents affected by a parent's acquired brain injury: a systematic review and thematic synthesis. Disabil Rehabil 2024; 46:1034-1044. [PMID: 36861777 DOI: 10.1080/09638288.2023.2179673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 12/21/2022] [Accepted: 02/06/2023] [Indexed: 03/03/2023]
Abstract
PURPOSE To identify the experiences and needs of dependent children who have a parent with an acquired brain injury (ABI) using a systematic review and thematic synthesis. MATERIALS AND METHODS A systematic search of Medline, Embase, PsycINFO, CINAHL Plus, and Web of Science was conducted. The search included variants of: "children," "parents," "acquired brain injury," and "experiences" or "needs." Eligible articles reported on the experiences/needs of dependent children who have a parent with an ABI, from the child's perspective. Thematic analysis was used to identify themes. RESULTS A total of 4895 unique titles were assessed, and 9 studies met inclusion. Four themes were identified: (1) Sustained Emotional Toll (subthemes: (i) Initial Shock and Distress; (ii) Ongoing Loss and Grief; (iii) Present-Day Stress and Emotions), (2) Responsibilities Change and Children Help Out, (3) Using Coping Strategies (subtheme: Talking Can Help), and (4) Wanting Information about the Injury. CONCLUSION Themes highlighted significant disruption and challenges to children's wellbeing across development, with ongoing and considerable impacts many years after the parent's injury. The nature of the experiences shifted with time since the parent's injury. These children need ongoing support starting shortly after their parent's injury that is grounded in their particular experiences.IMPLICATIONS FOR REHABILITATIONWhen a parent has an acquired brain injury (ABI), dependent children and adolescents face emotional upheaval, significant stressors, increased responsibilities, and lack of information about their parent's injury that persist even many years after injury.The nature of these experiences and therefore their needs change based on the acute versus later stages of the parent's injury.Children often do not ask questions or tell others how they feel, which means that they need support that asks about, and listens and responds to their needs.Support for children needs to start soon after the parent's injury, be grounded in the lived experiences of this group, consider their parent's recovery stage, and be embedded as part of service provision rather than rely on children or families to make service contact.
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Affiliation(s)
- Jeneva L Ohan
- School of Psychological Science, The University of Western Australia, Crawley, Western Australia
| | - Hayley M Jackson
- School of Psychological Science, The University of Western Australia, Crawley, Western Australia
- Brightwater Research Centre, Brightwater Care Group, Perth, Western Australia
| | - Robyn Bett
- Brightwater Research Centre, Brightwater Care Group, Perth, Western Australia
| | - Glenda M Farmer
- School of Psychological Science, The University of Western Australia, Crawley, Western Australia
| | - Angelita Martini
- Brightwater Research Centre, Brightwater Care Group, Perth, Western Australia
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Taneja S, Vanstone M, Lysecki DL, McKean H, Bainbridge D, Sussman J, Molinaro M. "There's So Much More Support We Could Have Provided": Child Life Specialists' Stories of the Challenges Working in Adult Oncology. QUALITATIVE HEALTH RESEARCH 2023:10497323231215950. [PMID: 38035631 DOI: 10.1177/10497323231215950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
A cancer diagnosis in patients who are parents of minor children is uniquely stressful for both parents and children. Children need developmentally appropriate information and support to help reduce their fears and worries. Child life specialists (CLSs) are health professionals who work in pediatric environments to support children and families with the stress and uncertainty of illnesses. Increasingly, CLSs have been called upon to support children of patients in adult clinical environments. Our objective was to elucidate CLS caregiving narratives related to working with children of adult cancer patients. We used narrative inquiry to interview four CLSs working in adult oncology. Canadian CLSs who have experience providing care for children and families affected by parental cancer were recruited via convenience sampling. We used narrative analysis methods that included multiple close reads of the data, generating narrative themes, and noting conflicts or tensions in the data. CLSs' caregiving stories often highlighted the complexities of working in an adult oncology environment. Their narratives included challenges in providing optimal care to the children, including family-level barriers (such as parental wishes to withhold information from their children) and systemic barriers (such as late referrals and limited options for bereavement support). CLS participants identified several challenges of working with families in adult oncology. The CLSs highlighted a desire for additional institutional support for children of adult oncology patients and for themselves working in these environments in order to achieve what they believed to be optimal care.
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Affiliation(s)
- Shipra Taneja
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Meredith Vanstone
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - David L Lysecki
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Heather McKean
- Hamilton Health Sciences, McMaster Children's Hospital, Hamilton, ON, Canada
| | - Daryl Bainbridge
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Jonathan Sussman
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Monica Molinaro
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
- Institute of Health Sciences Education, McGill University, Montreal, QC, Canada
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Romare Strandh M, Hovén E, Sörensdotter R, Stålberg K, Enebrink P, Ljungman L, Wikman A. Psychosocial interventions targeting parenting distress among parents with cancer - A systematic review and narrative synthesis of available interventions. Crit Rev Oncol Hematol 2023; 191:104119. [PMID: 37683815 DOI: 10.1016/j.critrevonc.2023.104119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/30/2023] [Indexed: 09/10/2023] Open
Abstract
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.
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Affiliation(s)
- Maria Romare Strandh
- Department of Women's and Children's Health, Uppsala University, Akademiska sjukhuset, SE-751 85 Uppsala, Sweden; Centre for Women's Mental Health during the Reproductive Lifespan (WOMHER), Uppsala University, Akademiska sjukhuset, SE-751 85 Uppsala, Sweden.
| | - Emma Hovén
- Department of Women's and Children's Health, Uppsala University, Akademiska sjukhuset, SE-751 85 Uppsala, Sweden
| | - Renita Sörensdotter
- Centre for Gender Research, Uppsala University, Engelska parken, Humanistiskt centrum, Thunbergsvägen 3G, Box 527, SE-751 20 Uppsala, Sweden
| | - Karin Stålberg
- Department of Women's and Children's Health, Uppsala University, Akademiska sjukhuset, SE-751 85 Uppsala, Sweden
| | - Pia Enebrink
- Department of Clinical Neuroscience, Karolinska Institutet, Tomtebodavägen 18A 5th floor, SE-171 77 Stockholm, Sweden
| | - Lisa Ljungman
- Department of Women's and Children's Health, Uppsala University, Akademiska sjukhuset, SE-751 85 Uppsala, Sweden
| | - Anna Wikman
- Department of Women's and Children's Health, Uppsala University, Akademiska sjukhuset, SE-751 85 Uppsala, Sweden; Centre for Women's Mental Health during the Reproductive Lifespan (WOMHER), Uppsala University, Akademiska sjukhuset, SE-751 85 Uppsala, Sweden
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6
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Fernandes DCR, Nelson D, Siriwardena AN, Law G, Andreyev HJN. Understanding colorectal cancer patient follow-up: a qualitative interview study. Support Care Cancer 2023; 31:634. [PMID: 37843671 DOI: 10.1007/s00520-023-08108-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/06/2023] [Indexed: 10/17/2023]
Abstract
PURPOSE There are increasing numbers of patients who have been treated for colorectal cancer (CRC) who struggle with ongoing physical and psychological symptoms. 'Cancer survivor' is often used to describe these patients but this terminology remains controversial. This study sought to understand the follow-up experience of CRC patients in the UK and identify the terminology they prefer following diagnosis and treatment. METHODS Purposeful sampling of patients from specialist CRC follow-up clinics was performed until data saturation was achieved. Two 1:1 semi-structured qualitative interviews were performed for each participant. Data were analysed thematically. RESULTS Seventeen participants, median age = 62, 53% male were interviewed. Several themes were identified. Of note, fear of cancer recurrence dominates patients' agendas at follow-up appointments. There are also clinical and administrative barriers to discussing symptoms including being embarrassed, feeling that their symptoms were not relevant or not having enough time to discuss issues. However, there are several methods which may improve this, such as through the use of video consultations and questionnaires. In addition, patients identified inadequate holistic support despite significant psychological and social distress. Our data suggest that labelling a diverse group of patients as 'cancer survivors' can be problematic. CONCLUSION It is important that clinicians systematically screen patients for symptoms that are known to occur following treatment. Clinicians and patients should have routine access to pathways and programmes that can support patients in navigating their life after cancer therapy.
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Affiliation(s)
- Darren C R Fernandes
- The Department of Gastroenterology, United Lincolnshire NHS Trust, Lincoln County Hospital, Lincoln, UK.
- Community and Health Research Unit, University of Lincoln, Lincoln, UK.
| | - David Nelson
- Lincoln International Institute for Rural Health, University of Lincoln, Lincoln, UK
- Macmillan Cancer Support, London, UK
| | | | - Graham Law
- Lincoln Clinical Trials Unit, University of Lincoln, Lincoln, UK
- School of Health and Social Care, University of Lincoln, Lincoln, UK
| | - H Jervoise N Andreyev
- The Department of Gastroenterology, United Lincolnshire NHS Trust, Lincoln County Hospital, Lincoln, UK
- The Biomedical Research Centre, Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK
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Ward AL, McPherson L, Mc Glanaghy E. Discussion Surrounding Theory, Knowledge, and Practical Applications for Clinical Nurse Specialists to Aid Them in Caring for Parents with Cancer Who Have Young Children. Semin Oncol Nurs 2023; 39:151483. [PMID: 37567835 DOI: 10.1016/j.soncn.2023.151483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/10/2023] [Accepted: 07/10/2023] [Indexed: 08/13/2023]
Abstract
PURPOSE To identify the theory, knowledge, and practical applications that clinical nurse specialists should consider adding to their "toolkit" to support them in caring for people affected by cancer with young children. DATA SOURCES Expert opinion and relevant studies on the topic formed the basis of this article. CONCLUSION A conversation with experts identified five key areas of knowledge important to supporting clinical nurse specialists in caring for people affected by cancer with young children: family-centered and systemic practice, nursing responsibilities and competencies, trauma-informed practice, adult life stages, and stages of child development. Key areas identified have relevance to all healthcare professionals working in cancer care. IMPLICATIONS FOR NURSING PRACTICE This article provides a useful overview of psychological theories important to supporting healthcare professionals in caring for people affected by cancer. A discussion on the boundaries and competencies of the nursing role led to agreement about practical advice rooted in theory and knowledge that could benefit clinical practice. Concepts of emotional labor and the wounded healer were identified as important to inform reflection and supervision when caring for a parent affected by cancer who has a young family.
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Affiliation(s)
- Ashleigh Lauren Ward
- Consultant Nurse Cancer and Palliative Care, Directorate of Nursing, NHS Forth Valley, Stirling, UK; Honorary Clinical Senior Lecturer, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK.
| | - Lorraine McPherson
- Cancer and Palliative Care Facilitator, Directorate of Nursing, NHS Forth Valley, Stirling, UK
| | - Edel Mc Glanaghy
- Clinical Psychologist, Adult Psychological Therapies, NHS Forth Valley, Falkirk Community Hospital, Falkirk, UK
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Hertogh L, van Rosmalen M, Jager A, de Man-van Ginkel JM, Oldenmenger WH. Exploring the Psychosocial Needs of Adolescents Whose Parent Is Diagnosed With Breast Cancer. Semin Oncol Nurs 2023; 39:151475. [PMID: 37633761 DOI: 10.1016/j.soncn.2023.151475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/28/2023] [Accepted: 07/01/2023] [Indexed: 08/28/2023]
Abstract
PURPOSE Cancer has a major impact on the individual patient and their family, especially children. However, little is known about the needs of adolescents (10-19 years) whose parent is diagnosed with cancer, especially breast cancer. Insights into psychosocial needs are important to develop appropriate guidance and support for these adolescents. The aim of this study is to explore the psychosocial needs of adolescents whose parent is diagnosed with breast cancer to improve the support for these adolescents. DATA SOURCES This is an exploratory, qualitative study. In-depth interviews were conducted, and an interview guide was designed with the following topics: experiences, needs, and support. Participants were selected purposively and approached via the parent(s) after consultation. Interviews were audiotaped, transcribed, and thematically analyzed by using the software program NVivo. CONCLUSION Fourteen adolescents (12-19 years) were interviewed, which resulted in five themes: distraction, support, being able to talk about it, information, and continuing a normal life. Adolescents whose parent is diagnosed with breast cancer need the best possible preservation of their normal lives. It is important for them to be able to share their story and find support from someone close to them. IMPLICATION FOR NURSING PRACTICE The route to the adolescent is always through the parent. Healthcare professionals can discuss the well-being of the adolescent during regular consultation with the parent. If there are concerns, healthcare professionals can advise the parent about the possible needs of the adolescent and could coach the parent in supporting the adolescent to discuss their needs.
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Affiliation(s)
- Linda Hertogh
- Department of Internal Medicine, section Nursing Science, Erasmus University Medical Center (Erasmus MC), Rotterdam, The Netherlands; Department of Medical Oncology, Erasmus University Medical Center (Erasmus MC) Cancer Institute, Rotterdam, The Netherlands; Nursing Science, Program in Clinical Health Sciences, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Mandy van Rosmalen
- Department of Medical Oncology, Erasmus University Medical Center (Erasmus MC) Cancer Institute, Rotterdam, The Netherlands
| | - Agnes Jager
- Department of Medical Oncology, Erasmus University Medical Center (Erasmus MC) Cancer Institute, Rotterdam, The Netherlands
| | - Janneke M de Man-van Ginkel
- Nursing Science, Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands; Nursing Science, Program in Clinical Health Sciences, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Wendy H Oldenmenger
- Department of Medical Oncology, Erasmus University Medical Center (Erasmus MC) Cancer Institute, Rotterdam, The Netherlands
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Lammon M. The Ashes of Tragedy: Parental Death and Child Character Development in Bambi and The Lion King. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231202884. [PMID: 37713269 DOI: 10.1177/00302228231202884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
The Walt Disney company has been the topic of extensive research for decades; among the explored subjects and identified themes is Disney's fixation on death. Disney has capitalized on the incredibly traumatic childhood experience of the death of a parent by featuring parental death as a major narrative component. Speculation remains regarding the accuracy of not only death presentations in media, but death influence on characters. Using textual analysis, this paper explores the role of parental death on child character development within two Disney animated films. Analysis demonstrates an inaccurate depiction of parental death influence on children in a positive light - essentially overlooking the trauma associated with loss during childhood and the mediating factors of long-term bereavement outcomes. Conversations remain to be had regarding how these inaccurate depictions of death and dying in popular culture influence the children consuming them.
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Affiliation(s)
- Marissa Lammon
- Department of Media Studies, University of Colorado Boulder, Boulder, CO, USA
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Alexander ES, Halkett GKB, Lawrence BJ, O’Connor M. A Conceptual Model Depicting How Children Are Affected by Parental Cancer: A Constructivist Grounded Theory Approach. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1507. [PMID: 37761468 PMCID: PMC10530185 DOI: 10.3390/children10091507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/06/2023] [Accepted: 08/08/2023] [Indexed: 09/29/2023]
Abstract
Cancer patients' children are vulnerable to psychosocial and behavioural issues. The mechanisms underlying how children are affected by their parent's diagnosis are unknown, warranting further research. This study investigated how children are affected by their parent's cancer diagnosis and provides a theoretical model conceptualising this experience. Informed by methods of grounded theory, embedded within a social constructivist framework, 38 informants (15 health professionals (HPs); 11 parents; 12 children (5 to 17 years)) were interviewed using a semi-structured format. Three themes were identified: (i) children were worried and distressed because they felt alone, (ii) parents were unable to tend to children's needs because they were overwhelmed by practical factors, and (iii) HPs were not detecting children due to barriers that affected their visibility in clinical settings. The proposed Alexander's Children's Cancer Communication (ACCC) Model and clinical recommendations made can be used to guide the clinical practice and development of future intervention research.
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Affiliation(s)
- Elise S. Alexander
- Discipline of Psychology, School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, WA 6102, Australia; (E.S.A.); (B.J.L.)
| | - Georgia K. B. Halkett
- Curtin School of Nursing/Curtin Health Innovation Research Institute (CHIRI), Faculty of Health Sciences, Curtin University, Bentley, WA 6102, Australia
| | - Blake J. Lawrence
- Discipline of Psychology, School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, WA 6102, Australia; (E.S.A.); (B.J.L.)
| | - Moira O’Connor
- Discipline of Psychology, School of Population Health/Curtin Health Innovation Research Institute (CHIRI), Faculty of Health Sciences, Curtin University, Bentley, WA 6102, Australia;
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Søby AKH, Moos CM, Andersen AH, Ravn SL, Andersen CM, Roessler KK. Adolescents' needs for information and psychosocial support during their mother's breast cancer trajectory: A systematic review. Psychooncology 2023; 32:1163-1172. [PMID: 37271880 DOI: 10.1002/pon.6172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/28/2023] [Accepted: 05/12/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Breast cancer is the most common cancer diagnosis among women. The acute crisis and uncertainty that often follow diagnosis put the family at risk of exhaustion and dysfunction. Adolescents have been identified as a particularly vulnerable group of relatives. To investigate how to prevent distress in this group, we systematically reviewed research on adolescents' (11-21 years) needs for information and psycho-social support during their mothers' breast cancer trajectory. METHOD Systematic searches were conducted in five bibliometric databases. Peer-reviewed, original research of adolescents aged 11-21 with a mother diagnosed with breast cancer was included. Two researchers conducted screening, quality assessment, and data extraction independently. Thematic synthesis was applied to the included studies. RESULTS A total of 8066 studies were screened, and five quantitative and six qualitative studies were included. The results indicated that adolescents' information and psycho-social support needs were poorly met. Many were reluctant to share feelings with family and peers and experienced abandonment during the crisis. Adolescents who were not well informed experienced distress. Poor family functioning increased the level of adolescents' distress. CONCLUSIONS Despite limitations regarding heterogeneity among the studies, eligibility criteria, and quality assessment, this review provides clear clinical implications. Encounter groups may support adolescents during their mother's breast cancer trajectory. Furthermore, healthcare professionals could provide more indirect support to adolescents by providing support and clearer guidelines to parents. Finally, adolescents from poor-functioning families need extra attention.
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Affiliation(s)
| | - Caroline M Moos
- Department of Clinical Research, Hospital Sønderjylland, Aabenraa, Denmark
| | | | - Sophie Lykkegaard Ravn
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Specialized Hospital for Polio and Accident Victims, Rødovre, Denmark
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12
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Fugmann D, Richter P, Karger A, Ernstmann N, Hönig K, Bergelt C, Faller H, Maatouk I, Hornemann B, Stein B, Teufel M, Goerling U, Erim Y, Geiser F, Albus C, Senf B, Wickert M, Weis J. Caring for dependent children impacts practical and emotional problems and need for support, but not perceived distress among cancer patients. Psychooncology 2023; 32:1231-1239. [PMID: 37277899 DOI: 10.1002/pon.6173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/26/2023] [Accepted: 05/14/2023] [Indexed: 06/07/2023]
Abstract
OBJECTIVE More than one in 10 cancer patients care for dependent children. It is unclear whether this status makes a difference in terms of the distress and associated problems they experience, or whether it is linked to differences in the need for or utilization of psychosocial support. METHODS Secondary analysis of a cross-sectional German study in National Comprehensive Cancer Centers using self-report standardized questionnaires administered to inpatients. Patients living with dependent children (n = 161) were matched by age and sex with a subsample of 161 cancer patients not living with dependent children. The resulting sample was tested for between-group differences in Distress Thermometer (DT) scores and the corresponding DT Problem List. Additionally, between-group differences in measures of the need for and utilization of psychosocial support were examined. RESULTS More than 50% of all patients suffered from clinically relevant distress. Patients living with dependent children reported significantly more practical (p < 0.001, η2 p = 0.04), family (p < 0.001, η2 p = 0.03), and emotional problems (p < 0.001, η2 p = 0.01). Although reporting a greater need for psychological support, parents with cancer were not found to more frequently utilize any type of psychosocial support. CONCLUSIONS The specific problems and needs of parents with cancer who care for dependent children are currently not sufficiently addressed in the clinical care pathways. All families should be helped to establish open and honest communication as well as understand the available support systems and what they can provide. Tailored interventions should be implemented for highly distressed families.
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Affiliation(s)
- Dominik Fugmann
- Medical Faculty, Institute of Psychosomatic Medicine and Psychotherapy, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Peter Richter
- Medical Faculty, Institute of Psychosomatic Medicine and Psychotherapy, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - André Karger
- Medical Faculty, Institute of Psychosomatic Medicine and Psychotherapy, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Nicole Ernstmann
- Department of Psychosomatic Medicine and Psychotherapy, Center for Health Communication and Health Services Research (CHSR), University Hospital Bonn, Bonn, Germany
| | - Klaus Hönig
- Ulm University Clinic Department of Psychosomatic Medicine and Psychotherapy, Comprehensive Cancer Center Ulm (CCCU), Ulm, Germany
| | - Corinna Bergelt
- Department of Medical Psychology, Greifswald Medical School, Greifswald, Germany
| | - Hermann Faller
- Department of Medical Psychology and Psychotherapy, Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany
| | - Imad Maatouk
- Department of Medical Psychology and Psychotherapy, Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany
| | - Beate Hornemann
- Comprehensive Cancer Center, University Clinic Center Dresden, Dresden, Germany
| | - Barbara Stein
- Department of Psychosomatic Medicine and Psychotherapy, Paracelsus Medical University, General Hospital Nuremberg, Nuremberg, Germany
| | - Martin Teufel
- Department of Psychosomatic Medicine and Psychotherapy, Comprehensive Cancer Center Essen (WTZ) and LVR Hospital, University of Duisburg-Essen, Essen, Germany
| | - Ute Goerling
- Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität and Berlin Institute of Health, Berlin, Germany
| | - Yesim Erim
- Department of Psychosomatic Medicine, University Clinic Center Erlangen, Erlangen, Germany
| | - Franziska Geiser
- Department of Psychosomatic Medicine, University Clinic Center Bonn, Bonn, Germany
| | - Christian Albus
- Department of Psychosomatic Medicine & Center Psychooncology (CePO), University Clinic Center Cologne, Cologne, Germany
| | - Bianca Senf
- University Clinic Center Frankfurt University Cancer Center, Frankfurt, Germany
| | - Martin Wickert
- Comprehensive Cancer Center, University Clinic Center Tübingen, Tübingen, Germany
| | - Joachim Weis
- Department of Self-Help Research, Faculty of Medicine and Medical Center, Comprehensive Cancer Center, University of Freiburg, Freiburg, Germany
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13
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Allison KR, Patterson P, McDonald FE, Bibby K, Ciarrochi J, Tracey D, Hayes LL, Wright A, Konings S, Davis E, Hulbert-Williams NJ, Wakefield CE, White K. Truce: Feasibility and acceptability of an Acceptance and Commitment Therapy-based intervention for adolescents and young adults impacted by parental cancer. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2023. [DOI: 10.1016/j.jcbs.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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14
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Alexander ES, O’Connor M, Halkett GKB. The Psychosocial Effect of Parental Cancer: Qualitative Interviews with Patients' Dependent Children. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10010171. [PMID: 36670721 PMCID: PMC9857104 DOI: 10.3390/children10010171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/05/2022] [Accepted: 12/16/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Children living with parental cancer are at an increased risk for various psychosocial, emotional, and behavioural problems. However, research regarding how children are affected by their parent's diagnosis is still developing and patients' children are typically invisible in clinical practice. This study aimed to investigate how children are affected by their parent's cancer diagnosis, from children's perspectives. METHODS Informed by methods of grounded theory and embedded within a social constructivist framework, twelve children (ranging from 5 to 17 years) living with a parent with cancer were interviewed using a semi-structured format assisted by a novel approach derived from play- and art-based developmental literature. RESULTS Findings indicate that patients' children are constantly worried and distressed, and there are barriers that can be overcome to mitigate this. Four overarching themes were identified: (I) Feeling worried and distressed; (II) Comprehending their parent's cancer diagnosis; (III) Being disconnected from their supports; and (IV) Needing someone to talk to. CONCLUSIONS Children experience considerable levels of ongoing worry and distress when a parent is diagnosed with cancer and have difficulties comprehending and articulating this. They also feel a level of disconnection from their usual support systems (e.g., parents) and are limited regarding who they can seek out and talk to. Mitigating children's ongoing worries and distress by promoting the availability and accessibility of parents and other supports to children, and reducing communication barriers between children and adults, should be a primary focus of psycho-oncology research and practice.
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Affiliation(s)
- Elise S. Alexander
- Discipline of Psychology, School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, WA 6102, Australia
| | - Moira O’Connor
- Discipline of Psychology, School of Population Health/Curtin Health Innovation Research Institute (CHIRI), enABLE Institute, Faculty of Health Sciences, Curtin University, Bentley, WA 6102, Australia
| | - Georgia K. B. Halkett
- Curtin School of Nursing/Curtin Health Innovation Research Institute (CHIRI), Faculty of Health Sciences, Curtin University, Bentley, WA 6102, Australia
- Correspondence: ; Tel.: +61-8-9266-1762
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15
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Fu C, Glasdam S, Stjernswärd S, Xu H. A Qualitative Systematic Review About Children's Everyday Lives when a Parent Is Seriously Ill with the Prospect of Imminent Death - Perspectives of Children and Parents. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228221149767. [PMID: 36628967 DOI: 10.1177/00302228221149767] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Parental dying is a life changing experience for children. This study explores children's strategies and (inter)actions in their everyday life when facing critically ill parents and imminent death, from the children's and parents' perspectives. A qualitative systematic review was carried out, registered in PROSPERO (CRD42022306862). A literature search and screening in six databases resulted in eighteen articles. Thematic analysis showed that children were capable of developing various strategies to cope in everyday life, even in vulnerable situations. From parents' and children's perspectives, inclusion, openness, and communication about parents' situations, taking children's age and needs into consideration, were important to face and cope with the situation. Children were life-capable, also in vulnerable and difficult situations. This calls for the necessity of developing children-led support, by acknowledging, and taking the children's experiences, and resources, as starting points to tailor adequate support for children of critically ill parents.
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Affiliation(s)
- Cong Fu
- Integrative Health Research, Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Stinne Glasdam
- Integrative Health Research, Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Sigrid Stjernswärd
- Health-promoting Complex Interventions, Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Hongxuan Xu
- Integrative Health Research, Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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16
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Glasdam S, Karidar H, Lundqvist P, Stjernswärd S. Unity strengthens and inhibits development: A focus group interview with volunteer adults in support programs for bereaved children and their family. DEATH STUDIES 2023:1-11. [PMID: 36601887 DOI: 10.1080/07481187.2022.2160521] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
This article illuminates (inter)actions and group dynamics of adult volunteers in programs for bereaved children and parents. A focus group interview with seven volunteers in Swedish was conducted. A latent, thematic analysis was conducted, inspired by Braun and Clarke, and Goffman. Two themes were constructed: Personal despair as a motivation for establishing and consolidating voluntary involvement and The volunteers acted as an extended family. Group dynamics within the group contributed to uphold volunteers' adherence to formal and informal guidance related to the program. Strong engagement among volunteers and internal recruitment strategies contributed to uphold and consolidate the program's implementation.
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Affiliation(s)
- Stinne Glasdam
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Hakima Karidar
- Department of Health Sciences, Lund University, Lund, Sweden
- Palliative and Advanced Homecare (ASIH) Lund, Lund, Sweden
| | - Pia Lundqvist
- Department of Health Sciences, Lund University, Lund, Sweden
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17
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Rodriguez L, Dolan P, Kerin M, Groarke A. "I know I didn't ask for it, but I've got it and I've let my kids down": A secondary data analysis of qualitative maternal perspectives of their and adolescent children's unmet needs through a cancer diagnosis. Eur J Oncol Nurs 2022; 63:102191. [PMID: 36893572 DOI: 10.1016/j.ejon.2022.102191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 12/26/2022]
Abstract
PURPOSE This article is a secondary data analysis which explores maternal unmet needs and their perception of the 'unmet needs' of adolescent children when they experienced maternal cancer. The analysis is underpinned by the theoretical framework of the Offspring Cancer Needs Instrument OCNI, (Patterson et al., 2013). METHOD A secondary data analysis was carried out with ten maternal interviews analyzed using a deductive Thematic Analysis. This was to identify maternal unmet needs as well as their perceptions of their adolescent children's unmet needs and determine whether the OCNI framework was suitable to identify unmet needs of mothers and adolescent children in an Irish context. RESULTS The study found cancer is a challenging emotional burden for both mothers and their adolescent children. Emotions related to cancer recurrence were particularly difficult to deal with. Mothers struggle to identify the unmet needs of adolescent children and recognize that they lack the skills to approach the children, which adds to the burden of their illness burden and feelings of guilt. CONCLUSIONS The study highlights the need to provide safe spaces for patients and adolescent children to deal with their emotions, strengthen relationships and improve communication associated with maternal cancer as these have a significant impact in their lives and may lead to tension and conflict within families.
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Affiliation(s)
| | - Pat Dolan
- National University of Ireland, Galway, Ireland
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18
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Kjoelaas S, Jensen TK, Feragen KB. Dilemmas when talking about Huntington's disease: A qualitative study of offspring and caregiver experiences in Norway. J Genet Couns 2022; 31:1349-1362. [PMID: 35903951 PMCID: PMC10087240 DOI: 10.1002/jgc4.1610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 05/31/2022] [Accepted: 06/12/2022] [Indexed: 12/14/2022]
Abstract
Research provides a compelling list of reasons why offspring should be included in honest conversations about disease when the disease affects their caregivers. Despite this, we lack in-depth knowledge about how families affected by the severe and complex genetic condition Huntington's disease (HD) experience talking about the many aspects of how this disease affects their lives. This study aimed to provide an in-depth exploration of how offspring with a caregiver with HD and caregivers with a partner with HD experienced talking about disease throughout childhood. Thematic analysis was conducted with semistructured interviews of both caregivers (n = 14) and offspring (n = 36) from families affected by HD, reflecting both current and past experiences. In addition to highlighting the many needs offspring have for knowledge and conversation about the disease with their caregivers, our findings also show that a variety of dilemmas can follow these conversations, including when to talk, what to say, how often HD should be talked about on a day-to-day basis, and whether to share disease-related information with others outside the family. The findings show the complexity of talking with offspring about HD. A difficult task for both offspring and caregivers seemed to be finding out how to balance the many dilemmas that arise in conversations and how to use dialogue to best help offspring adapt and cope with the many challenges that can come with HD. The findings can assist health care professionals, such as genetic counselors, prepare, and guide families affected by HD in the many and complex conversations that arise about the disease, in turn helping offspring adjust and cope with their current lives or future lives affected by HD.
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Affiliation(s)
- Siri Kjoelaas
- Centre for Rare Disorders, Oslo University Hospital HF Rikshospitalet, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
| | - Tine K Jensen
- Department of Psychology, University of Oslo, Oslo, Norway.,Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Kristin B Feragen
- Centre for Rare Disorders, Oslo University Hospital HF Rikshospitalet, Oslo, Norway
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19
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Dalton LJ, McNiven A, Hanna JR, Rapa E. Exploring healthcare professionals' beliefs, experiences and opinions of family-centred conversations when a parent has a serious illness: A qualitative study. PLoS One 2022; 17:e0278124. [PMID: 36441706 PMCID: PMC9704560 DOI: 10.1371/journal.pone.0278124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 11/09/2022] [Indexed: 11/29/2022] Open
Abstract
This study explored healthcare professionals' perceived role in talking to adult patients about sharing their diagnosis with children. Semi-structured interviews were conducted to explore healthcare professionals' beliefs about how families could and should be supported when a parent has a serious illness. Participants were 24 healthcare professionals working in primary, secondary and tertiary NHS services in the UK with adult patients diagnosed with a serious illness. Data were analysed thematically. Many healthcare professionals reported systems to identify patients' family relationships, but this information was rarely used to initiate conversations on what and how to talk to children. It was frequently assumed that someone else in the healthcare system was supporting patients with family communication. Others reported there were more urgent priorities for the consultation or considered that talking to children was a private family matter. However, several professionals did undertake these conversations, viewing this as a central part of their role. Some healthcare professionals felt they had inadequate skills or confidence to raise talking to children with their patients and indicated a need for specific training to address this. The results highlight the importance of systematically documenting patients' relationships with children so that this information can be used to inform ongoing discussions with the healthcare team about what children have been told. Patients consistently report wanting support about how to talk to children and the benefits of effective communication are well documented. Dissemination of this evidence could encourage professionals across all specialities to include family-centred communication in routine patient care. Training resources are needed so that staff feel empowered and equipped to raise these sensitive subjects with their patients.
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Affiliation(s)
- Louise J. Dalton
- Medical Sciences Division, Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- * E-mail:
| | - Abigail McNiven
- Medical Sciences Division, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Jeffrey R. Hanna
- Medical Sciences Division, Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, United Kingdom
| | - Elizabeth Rapa
- Medical Sciences Division, Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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20
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Bergersen E, Larsson M, Lövgren M, Olsson C. Adolescents' and young people's needs and preferences for support when living with a parent with life-threatening cancer: a grounded theory study. BMC Palliat Care 2022; 21:164. [PMID: 36138453 PMCID: PMC9502590 DOI: 10.1186/s12904-022-01055-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Living with a parent facing life-threatening illness and losing a mom or dad at a young age can cause both short- and long-term health problems. Without satisfactory support, adolescents' and young people are at risk of developing low self-esteem, behavioural difficulties (e.g., anger and aggression), long-term illness or premature death caused by severe mental illness, substance abuse, self-harm and suicide attempts. The aim of this study was to explore adolescents' and young people's needs and preferences for support as they live with a parent with life-threatening cancer. METHODS Qualitative interviews were conducted with 10 respondents (17-24 years) in Norway and Sweden. Data were analysed through grounded theory according to Charmaz. RESULTS Adolescents' and young peoples' needs and preferences for support were described through the main category 'To feel safe and secure and to be prepared' and further broken down into five subcategories 'Relationships in the immediate family-balancing support and protection'; 'The social network-support and normalcy in a carefully selected group'; 'Maintaining everyday life-challenges in school and working life'; 'The right support at the right time-competence, trust and continuity in meeting health care professionals'; and 'Support outside the home-an opportunity for full transparency'. CONCLUSION Adolescents' and young peoples' preferences for support when living with a parent facing life-threatening illness are individual and unique, but they share a common need to feel safe and secure and to be prepared. Adolescents and young people express that they primarily want support from parents and friends, but they also want support from health care professionals, especially in situations when the ill parent becomes worse. Therefore, it is of the utmost importance for health care professionals to identify the most vulnerable adolescents and young people by mapping their social networks and paying extra attention to their needs for support when there is deterioration in the parent's illness state. This study also highlights the importance for health care professionals to establish a good relationship with adolescents and young people to meet their needs and preferences for support. In addition, information and support are needed in a timely manner and adapted to the life-threatening ill parent's illness state and individual's needs and preferences to optimise preparedness.
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Affiliation(s)
- Emily Bergersen
- Karlstad University, Universitetsgatan 2, 651 88, Karlstad, Sweden. .,Inland Norway University of Applied Sciences, Strandvegen 3, 2206, Kongsvinger, Norway.
| | - Maria Larsson
- Karlstad University, Universitetsgatan 2, 651 88, Karlstad, Sweden
| | - Malin Lövgren
- Marie Cederschiöld University, Box 11189, 100 61, Stockholm, Sweden
| | - Cecilia Olsson
- Karlstad University, Universitetsgatan 2, 651 88, Karlstad, Sweden.,Lovisenberg Diaconal University College, Lovisenberggt. 15b, 0456, Oslo, Norway
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21
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Tavares R, Brandão T, Matos PM. Communication concerns in mothers with cancer: Development and psychometric properties of a new measure. Eur J Cancer Care (Engl) 2022; 31:e13701. [DOI: 10.1111/ecc.13701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 07/27/2022] [Accepted: 08/12/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Rita Tavares
- Hospital Center of Vila Nova de Gaia/Espinho, EPE Vila Nova de Gaia Portugal
- Faculty of Psychology and Education Sciences University of Porto Porto Portugal
| | - Tânia Brandão
- Center for Psychology at University of Porto Porto Portugal
- CIP, Departamento de Psicologia Universidade Autónoma de Lisboa Luís de Camões Lisboa Portugal
| | - Paula Mena Matos
- Faculty of Psychology and Education Sciences University of Porto Porto Portugal
- Center for Psychology at University of Porto Porto Portugal
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22
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Trauma-Focused CBT in the Context of Parental Chronic Medical Conditions: A Case Report. COGNITIVE AND BEHAVIORAL PRACTICE 2022. [DOI: 10.1016/j.cbpra.2021.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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23
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How to support parenting in patients with cancer and co-parents? From research to practice. Curr Opin Oncol 2022; 34:285-293. [PMID: 35703229 DOI: 10.1097/cco.0000000000000839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
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.
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24
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Fisher CL, Kastrinos A, Curley A, Canzona MR, Piemonte N, Wolf B, Pipe T. Helping Diagnosed Mothers and Their Adolescent-Young Adult Daughters Navigate Challenging Breast Cancer Conversations. CANCER CARE RESEARCH ONLINE 2022; 2:e025. [PMID: 38239410 PMCID: PMC10795856 DOI: 10.1097/cr9.0000000000000025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
Abstract
Background Mothers diagnosed with breast cancer describe daughters as a critical source of support. Talking about breast cancer is especially distressing and challenging for mothers and their adolescent-young adult (AYA) daughters. Objective The over-arching study aim was to generate findings to integrate into an intervention to enhance diagnosed mothers' and AYA daughters' communication skills by identifying approaches they find helpful when talking about cancer. Methods We recruited 27 women (12 dyads). Diagnosed mothers and their AYA daughters (aged 18-29) participated in individual, in-depth, semi-structured interviews. Transcripts were thematically analyzed. Mothers'/daughters' perspectives were compared/ triangulated. Results Both mothers and daughters identified 3 approaches that helped them navigate cancer communication: (mothers) initiate conversations, keep communication positive, and limit cancer conversations. Only mothers reported it was helpful to downplay the seriousness of cancer. Only daughters identified it was important for them to reframe their perspective of mothers' disclosures. Conclusions Findings provide clinicians like nurses and families with a "psychosocial map" of communication approaches and associated strategies mothers and AYA daughters can use to talk about breast cancer in ways that promote daughters' comfort and/or alleviate distress. Implications for Practice Findings capture communication skills to focus on when tailoring developmentally focused interventions targeting diagnosed mothers and AYA daughters. Nurses can translate findings into practice to help patients talk to AYA daughters about cancer, thereby promoting a family-centered cancer care approach. What Is Foundational: AYA daughters are especially distressed talking about cancer with their diagnosed mothers. They can both use communication strategies to enhance their communal coping.
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Affiliation(s)
- Carla L. Fisher
- University of Florida, College of Journalism and Communications & College of Medicine, UF Health Cancer Center, Gainesville, Florida
| | | | - Alana Curley
- University of Florida, College of Journalism and Communications & College of Medicine, UF Health Cancer Center, Gainesville, Florida
| | - Mollie R. Canzona
- Wake Forest University, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Nicole Piemonte
- Creighton University, School of Medicine, Phoenix Regional Campus, Phoenix, Arizona
| | - Bianca Wolf
- University of Puget Sound, Tacoma, Washington
| | - Teri Pipe
- Arizona State University, Phoenix, Arizona
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25
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Wuensch A, Kirbach A, Meyerding L, Bengel J, Pietsch S. Interventions for children of parents with cancer: an overview. Curr Opin Oncol 2022; 34:294-303. [PMID: 35730494 PMCID: PMC9983748 DOI: 10.1097/cco.0000000000000841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The purpose of this overview is to analyze existing reviews on psychosocial interventions for children of parents with cancer and synthesize implications for further practice, interventions, and research in this field. The aim of this overview is therefore to generate systematic knowledge about what can be classed as evidence-based knowledge in this field. RECENT FINDINGS The literature search in MEDLINE, CINAHL, PsycINFO, PSYNDEX, and PsycARTICLES resulted in three systematic reviews, which were evaluated by the AMSTAR-2-tool for quality assessment and the PRISMA-checklist for reporting. Results were analyzed through narrative synthesis due to the heterogeneity of the studies. The three systematic reviews were evaluated by the AMSTAR-2-tool for quality assessment and the PRISMA-checklist for reporting. AMSTAR-2 revealed critically low quality for all three reviews but taking into account the study situation of this scientific context, a more optimistic quality assessment can be suggested. The PRISMA checklist revealed good results. Positive evidence was found for the effect of psychosocial interventions concerning depressive symptoms, children's behavior, communication within the family, and quality of life. A comparison of the interventions is not possible due to the high degree of heterogeneity of the studies. SUMMARY Following the principles of evidence-based medicine, this overview, together with clinical-practical expertise and the needs of those affected, could contribute to evidence-based care and stimulate future guidelines in this important field. The valuable engagement with questions around evidence-based practice invites professionals and researchers to enter into a common discourse to ultimately contribute to an improvement of the life situation of children of parents with cancer.
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Affiliation(s)
- Alexander Wuensch
- Department of Psychosomatic Medicine and Psychotherapy, Section Psychossocial Counselling and Tigerherz. . . when parents have cancer, Medical Center – University of Freiburg, Faculty of Medicine, Albert Ludwigs University, Freiburg, Germany
- Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Annette Kirbach
- Department of Psychosomatic Medicine and Psychotherapy, Section Psychossocial Counselling and Tigerherz. . . when parents have cancer, Medical Center – University of Freiburg, Faculty of Medicine, Albert Ludwigs University, Freiburg, Germany
- Department Rehabilitation-Psychology and Psychotherapy, Institute for Psychology, University of Freiburg, Freiburg, Germany
| | - Luca Meyerding
- Department of Psychosomatic Medicine and Psychotherapy, Section Psychossocial Counselling and Tigerherz. . . when parents have cancer, Medical Center – University of Freiburg, Faculty of Medicine, Albert Ludwigs University, Freiburg, Germany
| | - J.ü.rgen Bengel
- Department Rehabilitation-Psychology and Psychotherapy, Institute for Psychology, University of Freiburg, Freiburg, Germany
| | - Stefanie Pietsch
- Department of Psychosomatic Medicine and Psychotherapy, Section Psychossocial Counselling and Tigerherz. . . when parents have cancer, Medical Center – University of Freiburg, Faculty of Medicine, Albert Ludwigs University, Freiburg, Germany
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Egberts MR, Verkaik D, van Baar AL, Mooren TTM, Spuij M, de Paauw-Telman LGE, Boelen PA. Child Posttraumatic Stress after Parental Cancer: Associations with Individual and Family Factors. J Pediatr Psychol 2022; 47:1031-1043. [PMID: 35595308 PMCID: PMC9487652 DOI: 10.1093/jpepsy/jsac041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 04/12/2022] [Accepted: 04/15/2022] [Indexed: 12/01/2022] Open
Abstract
Objective This study aimed to examine the severity of posttraumatic stress disorder (PTSD) symptoms in children of parents with cancer and to identify individual and family factors associated with these symptoms. Methods The sample consisted of 175 children (52% girls, aged M = 11.98, SD = 3.20, range = 6–20 years) from 92 families, of which 90 parents with a current or past cancer diagnosis and 71 healthy co-parents also completed questionnaires. Children reported on PTSD symptoms, trauma-related cognitions, emotion regulation difficulties, general family functioning, and family communication. Both parents reported on their own PTSD symptoms. Associations were investigated using multilevel regression. Results Twenty-seven percentage of the children showed clinically relevant PTSD symptoms. Intraclass correlations indicated that children from the same family showed little overlap in these symptoms. Multilevel analyses showed that child trauma-related cognitions and emotion regulation difficulties were related to higher levels of PTSD symptoms at the individual level. General family functioning was only related to child PTSD symptoms at the family level. Child PTSD severity was unrelated to parental PTSD symptoms and family communication at the family level when taking into account the other factors. Conclusions The current study highlights the psychological impact of parental cancer on children. Individual factors contributed more strongly to child PTSD symptoms than family factors. Trauma-related cognitions and emotion regulation difficulties might be targeted through specific psychoeducation for children and parents, family-oriented support and interventions, and evidence-based treatments for child PTSD.
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Affiliation(s)
- Marthe R Egberts
- Department of Clinical Psychology, Utrecht University, The Netherlands.,Ingeborg Douwes Centrum, Centre for Psycho-oncology, The Netherlands
| | - Dineke Verkaik
- Department of Clinical Psychology, Utrecht University, The Netherlands.,Child and Adolescent Studies, Utrecht University, The Netherlands
| | | | - Trudy T M Mooren
- Department of Clinical Psychology, Utrecht University, The Netherlands.,ARQ National Psychotrauma Centre, The Netherlands
| | - Mariken Spuij
- Child and Adolescent Studies, Utrecht University, The Netherlands.,TOPP-zorg, The Netherlands
| | | | - Paul A Boelen
- Department of Clinical Psychology, Utrecht University, The Netherlands.,ARQ National Psychotrauma Centre, The Netherlands
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Phillips F, Prezio EA, Currin-McCulloch J, Jones BL. Wonders & Worries: A randomized clinical trial of a psychosocial intervention for children who have a parent with cancer. Psychooncology 2022; 31:1399-1411. [PMID: 35470518 DOI: 10.1002/pon.5943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The aim of this study was to test the effectiveness of Wonders & Worries, a psychosocial intervention for children who have a parent with cancer. Primary goals were to improve family quality of life, functioning and communication skills as reported by parent and child, enhance children's emotional/behavioral adjustment and parenting efficacy, while decreasing parenting concerns and ill parents' depression and anxiety. METHODS Sixty families were recruited from a community based non-profit agency. Parents diagnosed with Stage I-III cancer and their children ages 5-14 years were enrolled and randomized into intervention (n = 32) or wait-list control groups (n = 28). Families received 2 parent consults, six weekly 1-h individual child sessions, and 1 treatment center tour. The intervention was comprised of an age-appropriate understanding of cancer and expression of feelings, coping skills to ease feelings related to parent's cancer and enhanced ability to communicate about the disease. Controls received parent consult and access to W & W resources. Data were obtained from standardized measures at baseline; 6 and 10 weeks follow up. RESULTS Intervention group significantly improved on parenting concerns, parenting self-efficacy, and family quality of life. Children in the intervention group had significantly lower emotional and behavioral problems and worries related to cancer compared to controls. The intervention failed to significantly affect ill parent's anxiety, depressed mood, family functioning and child's anxiety. CONCLUSIONS The Wonders & Worries intervention promoted positive adaptation for ill parents and their children. This intervention is promising enough to warrant further refinement and testing with larger, more diverse samples.
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Melchiors L, Geertz W, Inhestern L. Parental Cancer: Acceptance and Usability of an Information Booklet for Affected Parents. Front Psychol 2022; 13:769298. [PMID: 35282192 PMCID: PMC8907886 DOI: 10.3389/fpsyg.2022.769298] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 01/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background Parents affected by cancer are confronted with challenges such as communicating with their children about the disease and dealing with changes in their parental role. Providing appropriate information could support affected parents and their children. Still, high-quality and information booklets are rare. Therefore, we developed an information booklet for affected families. The study aims are: (1) investigating the acceptability and usability of the information booklet, (2) determining parental information needs, and (3) collating suggestions for implementation. Finally, we adapted the booklet according to the findings. Methods We interviewed five experts in psychosocial care of parental cancer and nine affected parents using a semi-structured interview guideline. Participants received the developed booklet after giving the consent to participate. Interviews on acceptability and usability of the booklet and information needs were conducted about 1 week after receiving the booklet. The interviews were analyzed using structuring content analysis. Results (1) Experts and parents reported that the information booklet addresses the experiences of affected families and that the content combination makes it useful in an unprecedented way indicating both acceptance and usability. (2) Following dimensions were identified as information needs: (a) communication, (b) support offers, (c) children's disease understanding and needs, (d) organization of family life, (e) competence in parenting, and (f) sources of additional information material. (3) The booklet should be handed out personally by, e.g., healthcare professionals and might be accompanied by a personal counseling. Minor adaptations on language and content were conducted based on the findings. Conclusion Indicated acceptance and usability of the developed information booklet for parents with cancer suggest a low-threshold, basic support for affected families and health professionals. The diverse parental information needs are covered. The long-term effects of the booklet, e.g., on the use of psychosocial support offers, parental self-efficacy and psychological distress will be quantitatively investigated.
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Affiliation(s)
- Leslie Melchiors
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Clinical Psychology, Helmut-Schmidt-University/University of the Federal Armed Forces, Hamburg, Germany
| | - Wiebke Geertz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Laura Inhestern
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Reupert A, Straussner SL, Weimand B, Maybery D. It Takes a Village to Raise a Child: Understanding and Expanding the Concept of the “Village”. Front Public Health 2022; 10:756066. [PMID: 35372232 PMCID: PMC8964422 DOI: 10.3389/fpubh.2022.756066] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 02/11/2022] [Indexed: 11/16/2022] Open
Abstract
This perspective article defines and discusses the concept of the “village” when working with families who are experiencing multiple adversities. The article starts with a discussion on what is meant generally by a village approach, followed by a historical overview of how families living in adversity have been defined and positioned. The need to move past a siloed, professional centric approach when working with families is then presented. Using a model of social connections, based on Bronfenbrenner's ecological theory, we then identify who the “villagers” might be. Some potential principles for how the village might work with families living with adversity are presented, along with two case studies, to demonstrate how these principles might be enacted. This perspective article provides an overview and discussion of “the village” concept, rather than present a definitive set of guidelines or recommendations.
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Affiliation(s)
- Andrea Reupert
- Faculty of Education, Monash University, Clayton, VIC, Australia
- *Correspondence: Andrea Reupert
| | | | - Bente Weimand
- Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
| | - Darryl Maybery
- School of Rural Health, Monash University, Warragul, VIC, Australia
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30
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Bergersen EB, Larsson M, Olsson C. Children and adolescents’ preferences for support when living with a dying parent – An integrative review. Nurs Open 2022; 9:1536-1555. [PMID: 35156340 PMCID: PMC8994933 DOI: 10.1002/nop2.1187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 12/24/2021] [Accepted: 01/30/2022] [Indexed: 11/17/2022] Open
Abstract
Aim To identify and synthesize the evidence base regarding children and adolescents’ preferences for support when living with a dying parent. Design Integrative literature review study. Methods Searches were conducted in PubMed, CINAHL, PsycINFO, the Cochrane Library, Sociological Abstracts and Scopus, between 1 October 2019 and May 2021. Data were analysed and synthesized using integrative thematic analysis according to the analysis stages specified by Whittermore and Knafl. Results Twenty‐two articles were identified. Children and adolescents’ preferences for support were described through one overarching theme, Striving to achieve control and balance, together with six subthemes; “Involvement in the sick parent's care and treatment”; “Wanting to be with the sick parent but needing respite”; “Information must be continuous and individually adapted”; “emotional and communicative support from parents and family members”; “professional, compassionate and informative support”; and “support in friendships and opportunities to maintain normality.”
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Affiliation(s)
- Emily Beatrice Bergersen
- Department of Health Sciences Faculty of Health, Science and Technology Karlstad University Karlstad Sweden
- Section for Advanced Nursing Faculty of Social and Health Sciences Inland Norway University of Applied Sciences Elverum Norway
| | - Maria Larsson
- Department of Health Sciences Faculty of Health, Science and Technology Karlstad University Karlstad Sweden
| | - Cecilia Olsson
- Department of Bachelor Education Lovisenberg Diaconal University College Oslo Norway
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Liang N, Becker TD, Rice T. Preparing for the COVID-19 paediatric mental health crisis: A focus on youth reactions to caretaker death. Clin Child Psychol Psychiatry 2022; 27:228-237. [PMID: 34881673 PMCID: PMC8819560 DOI: 10.1177/13591045211061802] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
To promote clinician preparedness for working with children and adolescents who lost or will lose a parent or caretaker to COVID-19, findings from a review of the literature concerning youth reactions to parent and caretaker death and incapacitation were integrated with recent and emergent data concerning the COVID-19 pandemic. Children and adolescents who lose a parent or caretaker are at an increased risk of anxiety and depressive reactions and disorders, externalizing and health-risk behaviours, and substance use disorders. Particular aspects of the COVID-19 pandemic may influence these presentations and the risk of complicated grief. Youth with prior histories of adverse childhood experiences as well as boys and young men may require special considerations in formulation and planning. Tailored paediatric care based on the evidence advances accurate formulations and effective interventions for children and adolescents who suffer such a loss.
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Affiliation(s)
- Naomi Liang
- 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Timothy Rice
- 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Sousa AFD, Rodrigues JFC, Dias MJGSN, Santos DGSM, Ferreira MMDSRDS, Lomba MDLLDF. Programas de intervenção para crianças, adolescentes e pais a vivenciar o cancro parental: scoping review. ESCOLA ANNA NERY 2022. [DOI: 10.1590/2177-9465-ean-2021-0359] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
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.
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Hauskov Graungaard A, Hafting M, Davidsen AS, Lykke K. How is my child doing - parental understanding of their children when a parent has cancer. J Psychosoc Oncol 2021; 41:43-58. [PMID: 34961424 DOI: 10.1080/07347332.2021.2013386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
To explore the difficulties parents face when understanding their children's reactions to parental cancer and parents' reactions to their children's perceived needs. Qualitative interviews with cancer patients and their partners. Eleven patients and seven partners took part. Their children were aged 1-15 years. Eight patients were mothers and cancer was diagnosed median 28 (7-104) months ago. Inductive analysis with systematic text condensation. Parents were groping in the dark when understanding their children's reactions. They observed signs of distress in their children, but often avoided communication about emotional reactions. We suggest parental difficulties in containing own and children's emotions as an important cause for this situation. Parents lacked relevant support offers for the family as a unit. Identification of children's difficulties cannot be based on parental evaluation alone. We suggest family support as part of standard care for patients with minor children.
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Affiliation(s)
- Anette Hauskov Graungaard
- Section and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Denmark
| | | | - Annette Sofie Davidsen
- Section and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Denmark
| | - Kirsten Lykke
- Section and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Denmark
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Cockle-Hearne J, Aldiss S, Gibson F, Milne S, Todd J, Ream E. Support interventions provided during palliative care to families with dependent children when a parent has terminal illness: a scoping review protocol. JBI Evid Synth 2021; 19:3163-3173. [PMID: 34100829 DOI: 10.11124/jbies-20-00472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The objective of this scoping review is to identify and map support interventions provided during palliative care to families with dependent children when a parent has a terminal illness. INTRODUCTION For dependent children, losing a parent through terminal illness can be one of the most traumatic experiences they will face. Without age-appropriate information and support, parental death can lead to unresolved grief, post-traumatic stress, and longer-term negative social, emotional, educational, and behavioral consequences. Support from health care professionals is provided, but challenges within hospice and community palliative care mean the needs of dependent children may not be addressed. Greater emphasis is often placed on children's and families' bereavement needs as opposed to their pre-bereavement needs. The status of pre-bereavement support in palliative care for these families has not been documented. INCLUSION CRITERIA We will include studies of support interventions provided to families with dependent children when a parent has a terminal illness that are delivered during palliative care and in settings including, but not limited to, hospices, hospitals, and the community (including family and care homes). Empirical, peer-reviewed studies based on qualitative, quantitative, or mixed methods data, and gray literature, reporting any stage of intervention development will be included. METHODS This review will follow the JBI approach for scoping reviews. Multiple database searches will be conducted. Two authors will independently review full-text articles and extract data. Interventions will be mapped in terms of characteristics, evaluation methods, and implementation challenges. Data will be presented in tables, diagrammatic form, and narrative summary.
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Affiliation(s)
| | - Susie Aldiss
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Faith Gibson
- School of Health Sciences, University of Surrey, Guildford, UK.,Centre for Outcomes and Experience Research in Children's Health Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Shannon Milne
- Research Department, Princess Alice Hospice, Esher, UK
| | - Jennifer Todd
- Research Department, Princess Alice Hospice, Esher, UK
| | - Emma Ream
- School of Health Sciences, University of Surrey, Guildford, UK
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Breaking the silence about illness and death: Potential effects of a pilot study of the family talk intervention when a parent with dependent children receives specialized palliative home care. Palliat Support Care 2021; 20:512-518. [DOI: 10.1017/s1478951521001322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Objective
The entire family is affected when a parent is severely ill. Parents often need and appreciate professional support when talking to children about illness and death. The family talk intervention (FTI) is family-centered and intends to promote communication about the illness and its consequences, support parenting to enhance family coping and help family members share experiences with each other to create a shared family history. This study aimed to explore potential effects of FTI in specialized palliative home care, as reported by parents.
Method
This pre-post test intervention pilot was conducted in specialized palliative home care. A convergent mixed-method design was used to analyze interview and questionnaire data. Twenty families with dependent children were recruited from two specialized palliative home care units in Stockholm, Sweden.
Results
Parents reported that family communication improved after participation in FTI as family members learned communication strategies that facilitated open sharing of thoughts and feelings. Increased open communication helped family members gain a better understanding of each other's perspectives. Parents reported that relationships with their partner and children had improved as they now shared several strategies for maintaining family relationships. Parents were also less worried following participation in FTI. The ill parents stated that they gained a sense of security and were less worried about the future.
Significance of results
This study adds to the evidence that FTI may be a useful intervention for families with dependent children and an ill parent in a palliative care setting. This trial is registered at ClinicalTrials.gov Identifier NCT03119545.
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Illness unpredictability and psychosocial adjustment of adolescent and young adults impacted by parental cancer: the mediating role of unmet needs. Support Care Cancer 2021; 30:145-155. [PMID: 34241699 PMCID: PMC8636435 DOI: 10.1007/s00520-021-06379-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/19/2021] [Indexed: 11/14/2022]
Abstract
Purpose Given the large number of adolescents and young adults (AYAs) impacted by parental cancer and the potential for negative psychosocial outcomes in this vulnerable population, this study examined the mediating role of offspring unmet needs with regard to parental cancer and the relation between AYAs psychosocial adjustment and perceived illness unpredictability. Methods A total of 113 AYAs (aged 11–24 years) living with a parent diagnosed with cancer completed a questionnaire assessing illness unpredictability, offspring unmet needs, and psychosocial adjustment (i.e., health-related quality of life and internalizing problems). Results Higher offspring unmet needs were associated with lower health-related quality of life (r = –0.24**) and higher internalizing problems (r = 0.21*). Offspring unmet needs mediated the relation between illness unpredictability and health-related quality of life (standardized indirect effect = –0.100* [–0.183, –0.018]) but not internalizing problems (standardized indirect effect = 0.067 [–0.015, 0.148]). In particular, higher illness unpredictability was related to higher unmet needs (β = 0.351**) which, in turn, predicted lower health-related quality of life (β = –0.286**). Conclusion These findings identify offspring unmet needs and illness unpredictability as implicated in AYAs positive psychosocial adjustment to parental cancer. Given that AYAs are at greater risk of elevated psychosocial difficulties, interventions should target offspring unmet needs and perception of illness unpredictability to mitigate the adverse effects of parental cancer.
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Eklund R, Lövgren M, Alvariza A, Kreicbergs U, Udo C. Talking about death when a parent with dependent children dies of cancer: A pilot study of the Family Talk Intervention in palliative care. DEATH STUDIES 2021; 46:2384-2394. [PMID: 34214023 DOI: 10.1080/07481187.2021.1947415] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This study focused on families with dependent children who participated in the Family Talk Intervention (FTI) and lost a parent during the intervention or directly thereafter. The aim was to explore how they perceived information and communication about the imminent death during the illness trajectory and after the loss. Seven families from palliative homecare settings in Sweden participated. This study suggests that it is important to support family communication when a parent is dying, since communication in this situation is unlike everyday family communication, as they enter a complex and existentially unfamiliar area, hard to initiate on their own.
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Affiliation(s)
- Rakel Eklund
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Department of Neuroscience, National Centre for Disaster Psychiatry, Uppsala University, Uppsala, Sweden
| | - Malin Lövgren
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Department of Women's and Children's Health, Paediatric Oncology and Haematology, Childhood Cancer Research Unit, Karolinska Institute, Solna, Sweden
| | - Anette Alvariza
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Capio Palliative Care, Dalen Hospital, Enskededalen, Sweden
| | - Ulrika Kreicbergs
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Department of Women's and Children's Health, Paediatric Oncology and Haematology, Childhood Cancer Research Unit, Karolinska Institute, Solna, Sweden
| | - Camilla Udo
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
- Center for Clinical Research (CKF) Dalarna, Uppsala University, Sweden
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38
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McCaughan E, Semple CJ, Hanna JR. 'Don't forget the children': a qualitative study when a parent is at end of life from cancer. Support Care Cancer 2021; 29:7695-7702. [PMID: 34143326 PMCID: PMC8550711 DOI: 10.1007/s00520-021-06341-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/06/2021] [Indexed: 01/04/2023]
Abstract
Purpose Preparation for end of life is one of the greatest challenges faced by parents with cancer who have dependent children (< 18 years old), with requirement for support from professionals. The aim of this study is to explore how parents can be best supported in relation to their children, when a parent is at end of life from cancer. Methods This is an interpretive qualitative study, using 79 semi-structured interviews with parents at end of life (n3), bereaved parents (n21), health and social care professionals (HSCPs) (n32) and funeral directors (n23). Data were analysed thematically and triangulated. Results Parents are central to preparing their children for the death of a parent. Striving for everyday ordinariness, maximising social networks, maintaining hope and making preparations for the future are helpful for families when a parent is at end of life. Most HSCPs were unaware of the challenges faced by parents at end of life, and psychosocial support was often left outside the caring realm. As a result, funeral directors noted complexities faced by the families after the death. Results are discussed under four themes: (1) communication with the children as a process, (2) coping throughout the unfolding end of life experience, (3) tension and complexities at end of life and (4) preparing for the future. Conclusions Parents should be reassured that by involving the children early in the end of life experience when the ill-parent is ‘well enough’ to parent enables them to be actively involved in supporting their child through one of the greatest life changing event. A number of recommendations are discussed for professionals. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-021-06341-3.
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Affiliation(s)
- Eilís McCaughan
- School of Nursing, Ulster University, Cromore Road, Coleraine, BT52 1SA, Co. L'Derry, UK
| | - Cherith J Semple
- School of Nursing, Ulster University, Shore Road, Newtownabbey, BT37 0QB, Co, Antrim, UK.,South Eastern Health and Social Care Trust, Cancer Services, Ulster Hospital, Upper Newtownards Road, Belfast, BT16 1RH, UK
| | - Jeffrey R Hanna
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, OX3 7JX, UK.
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Stafford L, Sinclair M, Rauch P, Turner J, Mann GB, Newman L, Wakefield CE, Gilham L, Mason K, Cannell J, Little R, Schofield P. Feasibility of Enhancing Parenting in Cancer, a psychoeducational intervention for communicating with children about parental cancer. Psychooncology 2021; 30:1172-1177. [PMID: 33599354 DOI: 10.1002/pon.5655] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 02/05/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Lesley Stafford
- Centre for Women's Mental Health, Royal Women's Hospital, Parkville, Victoria, Australia.,Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Michelle Sinclair
- Centre for Women's Mental Health, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Paula Rauch
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jane Turner
- Discipline of Psychiatry, Faculty of Medicine, University of Queensland, Herston, Queensland, Australia.,Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - G Bruce Mann
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia.,The Breast Service, The Royal Melbourne and Royal Women's Hospitals, Parkville, Victoria, Australia.,Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia
| | - Louise Newman
- Centre for Women's Mental Health, Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Claire E Wakefield
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Leslie Gilham
- Consumer Representative, Breast Cancer Network Australia, Melbourne, Victoria, Australia
| | - Kylie Mason
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and the Royal Melbourne Hospital, Parkville, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Julia Cannell
- Consumer Representative, Breast Cancer Network Australia, Melbourne, Victoria, Australia
| | - Ruth Little
- Centre for Women's Mental Health, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Penelope Schofield
- Department of Psychological Sciences, Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, Victoria, Australia.,Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
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Inhestern L, Bultmann JC, Johannsen LM, Beierlein V, Möller B, Romer G, Koch U, Bergelt C. Estimates of Prevalence Rates of Cancer Patients With Children and Well-Being in Affected Children: A Systematic Review on Population-Based Findings. Front Psychiatry 2021; 12:765314. [PMID: 34899425 PMCID: PMC8656299 DOI: 10.3389/fpsyt.2021.765314] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 10/20/2021] [Indexed: 11/25/2022] Open
Abstract
This review assessed population-based estimate rates of cancer patients with minor and young adult children (≤ 25 years), children and young adults having a parent with cancer as well as the psychosocial situation and well-being of children and young adults affected by parental cancer. Eighteen publications on population-based studies were included. Studies varied in the age ranges of both cancer patients and children. The prevalence rates of cancer patients having children ranged from 14 to 24.7% depending on the sample structure (e.g., age, gender). Studies reported that between 1.6 and 8.4% of children resp. young adult children have a parent with a history of cancer. Seven publications reported on the psychosocial situation or well-being in children and young adults affected by parental cancer. Estimate rates of psychosocial problems, psychiatric diagnoses or distress ranged between 2.5 and 34% of children depending on the method of measurement and outcome. The differences in the sample structure between the studies impeded the comparison of prevalence rates. However, the findings help to determine the need for specific support services and health care planning. The results emphazise the importance to routinely include issues on the parental role of patients and questions on the well-being and coping of children into psychooncological care. If necessary, support should be provided to families living with a cancer diagnosis.
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Affiliation(s)
- Laura Inhestern
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Lene Marie Johannsen
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Volker Beierlein
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Birgit Möller
- Department of Social Work, Münster University of Applied Sciences, Münster, Germany
| | - Georg Romer
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Münster, Münster, Germany
| | - Uwe Koch
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Corinna Bergelt
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Medical Psychology, University Medicine Greifswald, Greifswald, Germany
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Inhestern L, Johannsen LM, Bergelt C. Families Affected by Parental Cancer: Quality of Life, Impact on Children and Psychosocial Care Needs. Front Psychiatry 2021; 12:765327. [PMID: 34858234 PMCID: PMC8631390 DOI: 10.3389/fpsyt.2021.765327] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 10/12/2021] [Indexed: 11/18/2022] Open
Abstract
Parental cancer poses major challenges for families with minor children. Due to diagnosis and treatment family life is disrupted. To prevent long-term consequences in all family members and to design needs-oriented family-centered interventions, further understanding of the family's situation including the impact on the children, quality of life levels and the parental psychosocial needs is necessary. This study aims at investigating the impact of parental cancer on the minor children, family-specific psychosocial needs and quality of life levels of parents and children. Cancer patients parenting at least 1 minor child (<18 years) were eligible for study participation. In total, n=86 cancer patients under treatment participated in the study. After excluding participants without a minor child, 78 patients remained for analyses. We assessed children's quality of life using the parent proxy version of the KIDSCREEN-10 and parental quality of life using the EORTC QLQ C30 quality of life questionnaire. Additionally, the questionnaire comprised open questions about positive and negative changes parents perceived in their children as well as questions on specific family- and child-related psychosocial needs. The majority of participants were mothers (91%), mainly diagnosed with breast cancer (59%). The participating parents provided data on 117 minor children. Parents mentioned positive changes in 38% of the children (e.g., being more attentive and helpful). Negative changes were reported in 37% of the children (e.g., being more anxious and clingy). Parents reported family-specific psychosocial supportive care needs for themselves as a parent (e.g., support regarding parenting concerns), support needs for the partner or the children. Moreover, parents expressed family-related information needs and needs regarding practical aspects (e.g., childcare, household help). Global quality of life was M = 55.7 (SD = 23.4) for parents and M = 57.5 (SD = 15.5) for children. Pearson's correlation coefficient between parental and children's quality of life was 0.377 (p < 0.001). To identify parents with cancer and children in need for additional support, health care providers should proactively inquire about the impact of the disease on the children. In terms of a comprehensive cancer care, the direct assessment of family impact and family-specific support needs in cancer patients with minor children allows for needs-based allocation to support offers.
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Affiliation(s)
- Laura Inhestern
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lene Marie Johannsen
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Corinna Bergelt
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Medical Psychology, University Medicine Greifswald, Greifswald, Germany
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Just DT, O'Rourke HM, Berta WB, Variath C, Cranley LA. Expanding the Concept of End-of-life Care in Long-term Care: A Scoping Review Exploring the Role of Healthcare Assistants. Int J Older People Nurs 2020; 16:e12353. [PMID: 33124160 DOI: 10.1111/opn.12353] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 09/11/2020] [Accepted: 09/19/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND The context of care provided in long-term care homes is changing, as an increasing number of older adults are entering long-term care with advance stages of illness and higher care needs. Long-term care homes are quickly becoming the place of death for an increasing number of older adults, despite recent literature identifying inadequate and suboptimal levels of end-of-life care. Within long-term care, healthcare assistants represent 60%-70% of the unregulated workforce and provide 70%-90% of the direct care to residents. Research indicates that a high level of uncertainty exists surrounding the role of healthcare assistants in end-of-life care, with numerous studies reporting the role of healthcare assistants to be 'unclear' with varying levels of responsibilities and autonomy. OBJECTIVE The purpose of this scoping review was to explore healthcare assistants' experiences and perspectives of their role in end-of-life care in long-term care. METHODS We applied Arksey and O'Malley's methodological framework, with recommendations from Levac and colleagues' guiding principles. Electronic databases and the grey literature were searched for relevant articles. Search concepts included end-of-life care and healthcare assistants. Articles were included in this review if they explored healthcare assistants' experiences or perspectives of providing end-of-life care in long-term care. The peaceful end of life theory by Ruland and Moore (1998) was used to organise data extraction and analysis. RESULTS A total of n = 15 articles met the inclusion criteria. The most predominant role-required behaviours reported by healthcare assistants were as follows: psychosocial support to significant others, knows the resident's care wishes and physical care with respect and dignity. The most predominant extra-role behaviours reported by healthcare assistants were as follows: becoming emotionally involved, acting as extended family and ensuring residents do not die alone. CONCLUSIONS Findings from this review expanded the concept of end-of-life care by illustrating the role-required and extra-role behaviours healthcare assistants perform when providing end-of-life care in long-term care. IMPLICATIONS FOR PRACTICE Findings from this scoping review highlight the numerous behaviours healthcare assistants perform outside their role description in order to provide end-of-life care to dying residents in long-term care. These findings could inform policymakers and managers of long-term care homes.
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Affiliation(s)
- Danielle T Just
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | | | - Whitney B Berta
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Caroline Variath
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Lisa A Cranley
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
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Krall J, Helgeson VS, Tracy EL, Campbell MS, Korytkowski M, Berg CA. Perspectives of Parents With Type 1 Diabetes: Role of Children in Self-Management and Support. DIABETES EDUCATOR 2020; 46:552-558. [PMID: 33063626 DOI: 10.1177/0145721720964598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE The purpose of this study was to examine parents' perceptions of the role children play in their type 1 diabetes (T1DM) care. Family members are a resource to support T1DM self-management, but how children are involved in their parents' diabetes has not been well explored. METHODS Parents with T1DM (n = 85) and a subset of their romantic partners (n = 55) participated in interviews during which they described their children's knowledge of and involvement in diabetes care. Interviews were transcribed, responses coded/tallied, and themes identified. RESULTS All parents reported that children knew of their diabetes, which they learned about progressively from a young age. Most parents reported children to be accepting and understanding of the ways that diabetes affected their family experiences (eg, pause to treat low blood glucose). When asked about specific support, parents rated "making parent feel better about diabetes" as the most frequently occurring behavior. Some parents felt that children, particularly younger ones, occasionally detracted from T1DM management, but this was usually expected and considered transient. Regardless of child age, many parents did not want diabetes to burden children and limited their involvement. Both parents with T1DM and partners requested resources to enhance child awareness and preparedness to support diabetes. Respondents, particularly partners, were also interested in learning how to communicate better as a family and share perspectives on how diabetes affects individual family members. CONCLUSIONS Diabetes care and education specialists should consider developmentally and relationally appropriate ways to engage children of parents with T1DM in education and self-management.
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Affiliation(s)
- Jodi Krall
- University of Pittsburgh Diabetes Institute, Pittsburgh, Pennsylvania
| | - Vicki S Helgeson
- Psychology Department, Carnegie Mellon University, Pittsburgh, Pennsylvania
| | - Eunjin Lee Tracy
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Mary Korytkowski
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Cynthia A Berg
- Department of Psychology, University of Utah, Salt Lake City, Utah
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44
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Eklund R, Jalmsell L, Kreicbergs U, Alvariza A, Lövgren M. Children's experiences of the family talk intervention when a parent is cared for in palliative home care-A feasibility study. DEATH STUDIES 2020; 46:1655-1666. [PMID: 33054633 DOI: 10.1080/07481187.2020.1829747] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The aim of this study was to explore the feasibility of the family talk intervention (FTI) and its acceptability to dependent children when a parent is cared for in palliative home care. The main goal of FTI is to increase family communication about the illness. The present paper derives from a pilot study and is based on 25 children's reports, involving both questionnaires and interviews, after participation. A majority of the children appreciated the structure and content of FTI. They felt seen, heard, and acknowledged by the interventionists and recommended FTI to other children in similar situations.
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Affiliation(s)
- Rakel Eklund
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Department of Neuroscience, National Centre for Disaster Psychiatry, Uppsala University, Uppsala, Sweden
| | - Li Jalmsell
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Department of Breast cancer, Endocrine Tumors and Sarcoma, Karolinska University Hospital, Stockholm, Sweden
| | - Ulrika Kreicbergs
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Department of Women's and Children's Health, Paediatric Oncology and Haematology, Childhood Cancer Research Unit, Karolinska Institute, Karolinska University Hospital, Astrid Lindgren Children's Hospital, Stockholm, Sweden
| | - Anette Alvariza
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Capio Palliative Care, Dalen Hospital, Stockholm, Sweden
| | - Malin Lövgren
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Department of Women's and Children's Health, Paediatric Oncology and Haematology, Childhood Cancer Research Unit, Karolinska Institute, Karolinska University Hospital, Astrid Lindgren Children's Hospital, Stockholm, Sweden
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45
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Alexander E, O'Connor M, Halkett GKB. The perceived effect of parental cancer on children still living at home: According to oncology health professionals. Eur J Cancer Care (Engl) 2020; 29:e13321. [PMID: 32902057 DOI: 10.1111/ecc.13321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/26/2020] [Accepted: 08/07/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE How children are affected by their parent's diagnosis is limited in the literature, and children are typically not considered in current clinical practice. Despite suggestion that the patient's oncology team are well placed to support their children, this is yet to be sufficiently explored. This study aimed to explore how oncology healthcare professionals (HPs) perceive children are affected by a parent's diagnosis of cancer. METHODS This qualitative study was informed by principles of grounded theory and embedded within a social constructivist framework. 15 health professionals working in oncology were interviewed using a semi-structured format. Data were analysed using methods of constant comparison. RESULTS From the perspective of HPs, when a parent is diagnosed with cancer, their dependent children are rendered invisible. Factors within the (a) clinical healthcare system and (b) the families' psychosocial context were identified, which contribute to the invisibility of children. CONCLUSION HPs are well-placed to facilitate an entry point into the healthcare system for patients' children; however, this is not occurring due to children's lack of visibility. Clinical and psychosocial barriers need to be addressed to ensure HPs are visibly aware of all children and thus able to appropriately support, intervene or refer on.
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Affiliation(s)
- Elise Alexander
- Western Australian Cancer Prevention Research Unit (WACPRU), School of Psychology, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Moira O'Connor
- Western Australian Cancer Prevention Research Unit (WACPRU), School of Psychology, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Georgia K B Halkett
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Perth, Australia
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46
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The Family Talk Intervention in palliative home care when a parent with dependent children has a life-threatening illness: A feasibility study from parents' perspectives. Palliat Support Care 2020; 19:154-160. [PMID: 32854809 DOI: 10.1017/s1478951520000735] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE One of the main goals of the Family Talk Intervention (FTI) is to increase communication within families with dependent children about illness-related consequences and to support parenting. FTI is family-centered and includes six manual-based meetings led by two interventionists. This study aims to evaluate the feasibility of the FTI in terms of acceptability from the perspective of parents in families with dependent children where one parent receives specialized palliative home care. METHOD A descriptive design employing mixed methods was used to evaluate the FTI in specialized palliative home care. In total, 29 parents participated in interviews and responded to a questionnaire following FTI. Qualitative content analysis and descriptive statistics were used for analyses. RESULTS FTI responded to both the ill parent's and the healthy co-parent's expectations, and they recommended FTI to other families. Parents found the design of FTI to be well-structured and flexible according to their families' needs. Many parents reported a wish for additional meetings and would have wanted FTI to start earlier in the disease trajectory. Parents also would have wished for a more thorough briefing with the interventionists to prepare before the start. The importance of the interventionists was acknowledged by the parents; their professional competence, engagement, and support were vital for finding ways to open communication within the family. The FTI meetings provided them with a setting to share thoughts and views. Parents clearly expressed that they would never have shared thoughts and feelings in a similar way without the meetings. SIGNIFICANCE OF RESULTS According to parents, FTI was found acceptable in a palliative home care context with the potential to add valuable support for families with minor children when a parent is suffering from a life-threatening illness.
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47
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Turner N. 'My life's properly beginning': young people with a terminally ill parent talk about the future. SOCIOLOGY OF HEALTH & ILLNESS 2020; 42:1171-1183. [PMID: 32242961 DOI: 10.1111/1467-9566.13086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This paper explores how young people who are living with a parent who is dying talk about the future. Drawing on a qualitative, interview study, I argue that young people are able to move imaginatively beyond the death of a parent, and in doing so, to maintain a sense of biographical continuity. While thinking about the future, most were able to generate an alternative to the 'harm story' typically associated with parental loss. Furthermore, the facility to engage with parental absence in the present enabled young people to make sense of living with dying, and gave meaning to their imagined futures. These findings suggest that young people's narratives of the future may act as a symbolic resource to draw on, albeit one requiring adequate material and social resources to construct. The paper extends the notion of continuing bonds derived from post-bereavement accounts to suggest that relational experiences of the dead begin prior to bereavement, and may facilitate everyday living in anticipation of significant loss. Enabling young people to imaginatively explore the future may support them in getting by when they are living in these difficult family circumstances.
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Affiliation(s)
- Nicola Turner
- School of Health Sciences, University of Nottingham, Nottingham, UK
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48
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Oja C, Edbom T, Nager A, Månsson J, Ekblad S. Informing children of their parent's illness: A systematic review of intervention programs with child outcomes in all health care settings globally from inception to 2019. PLoS One 2020; 15:e0233696. [PMID: 32453799 PMCID: PMC7250450 DOI: 10.1371/journal.pone.0233696] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 05/11/2020] [Indexed: 01/31/2023] Open
Abstract
Introduction Children are impacted when parents are ill. This systematic review gives an overview of the current state of research and extracts what children and parents found helpful in the interventions aimed at informing children of their parent’s illness. Methods This review was registered with PROSPERO and conducted in accordance with PRISMA guidelines. Five health and social science databases were searched from inception to November 2019 to identify original, peer-reviewed articles in English describing effective interventions. The authors selected and reviewed the studies independently, and any inconsistencies were resolved by discussion in face-to-face meetings and emails. A descriptive synthesis of evidence-based concepts from quantitative and qualitative studies was conducted. Results A total of 13 892 titles and 144 full-text articles were reviewed with 32 selected for final inclusion, 21 quantitative, 11 qualitative and no mixed-method studies published from 1993 to November 2019. Most of the research was conducted in mental health, including substance abuse (n = 22), but also in cancer care (n = 6) and HIV care (n = 4). Most studies using quantitative method showed a small to moderately positive statistically significant intervention effect on the child’s level of internalized symptoms. Content analysis of the results of studies employing qualitative methodology resulted in four concepts important to both children and parents in interventions (increased knowledge, more open communication, new coping strategies and changed feelings) and three additional concepts important to parents (observed changes in their children’s behavior, the parent’s increased understanding of their own child and the relief of respite). Conclusions In the literature there is evidence of mild to moderate positive effects on the child’s level of internalized symptoms as well as concepts important to children and parent’s worth noting when trying to bridge the still existing knowledge gaps. In further efforts the challenges of implementation as well as adaptation to differing clinical and personal situations appear key to address.
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Affiliation(s)
- Charlotte Oja
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Family Medicine and Primary Care, Karolinska Institutet, Stockholm, Sweden
| | - Tobias Edbom
- Department of Clinical Neuroscience (CNS), Center for Psychiatric Research, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Nager
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Family Medicine and Primary Care, Karolinska Institutet, Stockholm, Sweden
| | - Jörgen Månsson
- Department of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Solvig Ekblad
- Academic Primary Health Care Center, Region Stockholm, Stockholm, Sweden
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
- * E-mail:
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49
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Ohan JL, Jackson HM, Bay S, Morris JN, Martini A. How psychosocial interventions meet the needs of children of parents with cancer: A review and critical evaluation. Eur J Cancer Care (Engl) 2020; 29:e13237. [PMID: 32400938 DOI: 10.1111/ecc.13237] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 02/12/2020] [Accepted: 03/19/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate how psychosocial interventions for children aged 0-18 years of a parent with cancer meet their needs, using key needs as consumer-based "standards." METHODS A systematic literature review was conducted. Fifteen interventions met inclusion criteria and were assessed against six key needs identified by Ellis et al. (Eur. J. Cancer Care, 26, 2017, e12432): (1) provide children with age-appropriate information about their parent's cancer; (2) support family communication; (3) normalise and reduce feelings of isolation through peer support; (4) provide a space to share feelings; (5) individually tailor support; and (6), where appropriate, provide specialised bereavement support. RESULTS No intervention clearly met all six needs, but each partially addressed at least two needs, and three clearly met at least four needs. The most commonly addressed need was supporting family communication, and the least addressed need was bereavement support. CONCLUSION Interventions identified in this review addressed some needs of children impacted by a parent's cancer. This research provides a framework to inform the creation, modification and implementation of psychosocial support interventions that best meet the needs of these children, thereby mobilising consumer-focused service provision.
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Affiliation(s)
- Jeneva L Ohan
- School of Psychological Science, The University of Western Australia (M304), Crawley, WA, Australia
| | - Hayley M Jackson
- School of Psychological Science, The University of Western Australia (M304), Crawley, WA, Australia
| | - Samantha Bay
- School of Psychological Science, The University of Western Australia (M304), Crawley, WA, Australia
| | | | - Angelita Martini
- Brightwater Research Centre, Brightwater Care Group, Osborne Park, WA, Australia
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50
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Eklund R, Kreicbergs U, Alvariza A, Lövgren M. Children's Self-Reports About Illness-Related Information and Family Communication When a Parent Has a Life-Threatening Illness. JOURNAL OF FAMILY NURSING 2020; 26:102-110. [PMID: 31931660 DOI: 10.1177/1074840719898192] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Children's experiences of information and family communication when a parent has a life-threatening illness have been sparsely studied, though such information is important for the child's wellbeing. The aim of this study was to explore children's reports of illness-related information and family communication when living with a parent with a life-threatening illness. Forty-eight children, aged 7 to 19 years, were recruited from four specialized palliative home care units in Stockholm, Sweden. All but one child reported that someone had told them about the parent's life-threatening illness; however, two thirds wanted more information. A quarter of the teenagers reported that they had questions about the illness that they did not dare to ask. Half of the children, aged 8 to 12, reported that they felt partially or completely unable to talk about how they felt or show their feelings to someone in the family. Interventions are needed that promote greater family communication and family-professional communication.
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Affiliation(s)
- Rakel Eklund
- Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Ulrika Kreicbergs
- Ersta Sköndal Bräcke University College, Stockholm, Sweden
- The Department of Women's and Children's Health, Paediatric Oncology and Haematology, Karolinska Institute, Stockholm, Sweden
| | - Anette Alvariza
- Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Capio Palliative Care, Dalen Hospital, Stockholm, Sweden
| | - Malin Lövgren
- Ersta Sköndal Bräcke University College, Stockholm, Sweden
- The Department of Women's and Children's Health, Paediatric Oncology and Haematology, Karolinska Institute, Stockholm, Sweden
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