Qualitative analysis of the role of culture in coping themes of Latina and European American mothers of children with cancer

The Experience of Informal Newcomer Cancer Caregivers with Limited Language Proficiency: A Scoping Review

This scoping review explored what is known about the experiences of informal cancer caregivers (CGs) who are newcomers with limited language proficiency. A literature search was performed in seven databases and the search yielded 11,289 articles. After duplicate removal and title and abstract screening, 216 articles underwent full text review and 57 articles and were synthesized. Most studies (n = 41, 72%) were qualitative and were published in North America (n = 35, 61%). Most CG participants were female (69%) and only 19 studies explicitly identified the CG country of origin. Of those that did, 26% originated from Asia, with most migrating from East Asia. Significant challenges were experienced by newcomer CGs and chief among these were related to communication challenges with HCPs that were exacerbated by a lack of availability of medical interpreters and the complexity of oncology health information. Efforts are needed to better integrate newcomer CGs into cancer care.

The journey of embracing life: Mothers' perspectives of living with their children with retinoblastoma

PURPOSE

This study aimed to explore the experience and views of mothers with children who have been diagnosed with retinoblastoma.

DESIGN AND METHODS

A descriptive qualitative study was conducted in the period of 2019-2021. Interviews were conducted with 21 mothers of children diagnosed with retinoblastoma in Indonesia. Data were collected by semi-structured interviews and examined by content analysis.

RESULTS

Mothers evolved from a sense of unacceptability to accepting challenges and gaining inner strength. Three themes were identified: 1) physical and psychological suffering, 2) awareness of changes and demands, and 3) keep moving forward. Mothers developed positive adaptive mechanisms for coping with the problems associated with having a child with retinoblastoma. Psychological adjustment and religious beliefs were key elements in their journeys toward embracing life in the moment.

CONCLUSION

Findings illuminated psychological adaptation and coping strategies of mothers with seriously ill children and highlighted how difficulties and cultural norms shaped the adaptative process. Religion and health beliefs played varied and important roles in helping mothers to manage their stress and enhance their coping strategies.

PRACTICE IMPLICATIONS

Our findings revealed that it is important to routinely assess social support, traditional health beliefs, and spirituality on mothers, facilitate mentoring to help mothers find their inner strengths, and develop intervention programs designed to promote psychological adjustment without delaying treatment.

Existential Meaning-Making Coping in Iran: A Qualitative Study among Patients with Cancer

This article is written on the basis of a study on meaning-making coping in Iran. The study is a part of an international project in 10 countries with different religious and cultural backgrounds. This article aims to discuss the secular existential meaning-making coping methods employed by Iranian cancer patients. Interviews were conducted with 27 participants with various kinds of cancer. Nine secular existential meaning-making coping strategies emerged from the analyses of the qualitative interviews. These coping methods are as follows: Ignoring the illness, Distraction, Altruism, Encounter with others, Nature, Discourse of the self, Visualization, Positive solitude, and Positive thinking and transformational orientation. It seems that, using these strategies, our sample of Iranian cancer patients/survivors have been denying/ignoring their illness, and/or empowering themselves. We discuss the results, considering the potential influence of cultural elements, including Iranian Islam, Persian mysticism, and Persian literature, on the selection of the coping strategies. The study contributes to our understanding of coping via elucidating how seriously ill individuals in Iran try to manage the challenges caused by a health crisis.

Progressive Muscle Relaxation and guided imagery as techniques to enhance the way of coping of parents of children with malignancies: Findings from a randomized controlled trial

PURPOSE

The aim of this study was to test the effectiveness of relaxation techniques in altering the coping strategies that were employed by the parents of children with malignancy on active treatment.

METHODS

It was a randomized non-blinded controlled trial, including pre - and post assessments, comparing a 3-week relaxation intervention with the standard psychological care. Participants were recruited consecutively from two Public Pediatric Oncology - Hematology Departments in Cyprus and Greece. Fifty four parents of children hospitalized with a malignancy, were randomly assigned either to the intervention group (n = 29), receiving the Progressive Muscle Relaxation (PMR) and Guided Imagery (GI) Relaxation Techniques or to the control group (n = 25) receiving only the Standard Psychological Care by nurses and psychologists. Data were collected with the Questionnaire of 'Ways of Coping Checklist' (WofCC).

RESULTS

The results showed that the intervention did not have an impact on the coping strategies that parents employed as these are reflected on the WofCC' factors. The results showed that parents in both intervention and control group prefer using positive ways of coping in stressful situations: positive approach, positive re-evaluation and prayer/daydreaming.

CONCLUSIONS

The findings did not support the utilization of PMR and GI as coping strategies altering interventions in this clinical context. However, these findings should be interpreted in light of the short duration of the intervention that under these specific circumstances might have required a more lengthy approach for coping strategies to be altered. Furthermore, the stress relieving properties of these interventions could fortify (although not altering) existing coping strategies.

Caregiver Stress, Coping Strategies, and Support Needs of Mothers Caring for their Children Who Are Undergoing Active Cancer Treatments

The diagnosis of childhood cancer not only affects the life of the child but also impacts the lives of the caregivers as well. This study aims to explore the caregiving stress, coping strategies, and support needs of mothers caring for children/adolescents with cancer during the active treatment phase. Individual semi-structured interviews were conducted, and two authors independently and thematically analyzed data. Caregiving mothers went through a process of emotional changes and a change in lifestyles when their children were diagnosed with cancer and undergoing treatments. It is important to ensure that caregiving mothers of children/adolescents with cancer are well supported by family, friends, and healthcare professionals. Healthcare professionals can develop informational booklets on cancer treatment protocols and work together with mothers. Parent support groups and plans for psychoeducational and spiritual care programs for mothers as forms of informational and emotional support may also be established.

Adding a Parent to the Brain Tumor Team: Evaluating a Peer Support Intervention for Parents of Children With Brain Tumors

Childhood brain tumors often present profound challenges to patients and families. To address these challenges, the California Chapter of the Pediatric Brain Tumor Foundation provides hospital-based support services to parents of children with brain tumors from a Veteran Parent (VP). This mixed-methods, cross-sectional study was designed to evaluate the effectiveness of the intervention using validated tools to compare parental resilience and impact of illness on the family between parents who met with the VP and those who did not. Two-tailed t tests assessed significant differences in scores on the PedsQL Family Impact module and Connor–Davidson Resilience Scale (CD-RISC-25). Additional qualitative data gleaned from focus groups with stakeholders (health care providers and parents) were analyzed using key constructs of social support theory with Atlas.ti. Although there were no significant differences in overall scores on the PedsQL Family Impact module or CD-RISC-25 between groups, parents in the intervention group scored better on items related to handling difficult decisions and painful feelings. Overarching themes emerged from focus groups around participants’ experiences with the program and included informational and emotional support, peer parent relatedness, changed outlook, and empowerment. Results reveal the impact of peer parent support and need for emotional and instrumental support.

Parents' Voice in Managing the Pain of Children with Cancer during Palliative Care

Context:

Pain experienced by children can adversely affect their growth and development. Pain is a major health problem for cancer patients and remains an unresolved problem.

Aim:

To know how the experiences of mothers managing their children's pain during palliative care following cancer diagnosis.

Background:

Pain experienced by children can adversely affect their growth and development.

Subject and Methods:

Using qualitative methods within a descriptive phenomenological approach, in-depth interviews were conducted with parents (mostly mothers) of eight children diagnosed with cancer. The data were collected using the snowball sampling method.

Results:

Participants experienced in managing the pain of children with cancer. Analysis of the results identified 8 themes: the dimensions of pain experienced by children undergoing palliative care; mothers' physical and psychological responses; mothers' emotional responses; barriers encountered by mothers when taking care of their child at home; mothers' interventions to reduce their child's pain; mothers' efforts to distract their child from pain; giving encouragement when the child is in pain; and mothers' efforts and prayers to make their child comfort.

Conclusion:

It can be concluded that the child's pain is the main cause of mothers' stress and pressure and also affects the daily lives of mothers and children. Along with the most effective intervention, nurses need to provide mothers and children with adequate information about cancer pain.

Development of a Culturally Competent Service to Improve Academic Functioning for Latino Survivors of Acute Lymphoblastic Leukemia: Methodological Considerations

Many survivors of childhood acute lymphoblastic leukemia (ALL) develop neurocognitive deficits that compromise academic functioning, especially in the presence of sociodemographic risk factors. The extent to which these risk factors coexist for Latino ALL survivors is not well described, but with shifts in U.S. demographics and improved survival in ALL, culturally competent interventions are needed. The Achieving Best Cognitive Successes after Cancer service was designed and implemented by a team representing nursing, medicine, psychology, and social work. Service components include neurocognitve assessment and individualized intervention for treatment-related risks and improving academic success for school-aged ALL survivors. Interventions are child-focused and parent-directed, recognizing that parents are major sources of support and advocates for their children within school systems. The service was designed to be culturally appropriate for the predominantly Latino patient population at our center, based on (1) linguistic competency of children and parents; (2) multicultural and ecological considerations for urban, low socioeconomic status, and migrant populations; (3) literacy barriers; and (4) contextual factors. This report describes methodological considerations and practice implications relevant to the design and implementation of similar culturally competent services for Latino pediatric cancer survivors.

Spirituality to build resilience in primary caregiver parents of children with autism spectrum disorders: a cross-country experiment

Objectives: To examine the effect of spirituality and spiritual training on resilience in primary caregiver parents of children with autism spectrum disorders (ASD). Methods: A cross-country pre- and post-test-based experimental design has been used. The sample of this one-year-long study comprised 1687 parents of children with ASD in 15 countries. A six-day customized spiritual lessons package was administered to the study participants. Three scales have been used: Resilience Scale (RS), Sense of Coherence Scale (29-items) (SOC-29), and Parenting and Family Adjustment Scale (PAFAS-30). Results: Results of the paired t-test showed that post-test RS and SOC-29 scores of the participants were higher indicating greater resilience and sense of coherence post treatment. Post-test PAFAS-30 scores were lower indicating lower dysfunction and better adjustment. Logistic regression and structural equation models showed that parents from European countries including the UK, US, Canada, and Australia, Christians, those who did three-four rounds of the spiritual lessons through the study period and those who self-practiced, had higher post-test scores. Further mothers and middle-class parents were likely to have higher post-test resilience scores. Hierarchical regression analysis showed that self-practice was the most significant predictor of participants' post-test scores. Conclusion: The study findings re-inforce the resilience-promoting potential of spirituality/spiritually sensitive interventions for parents of children with ASD, contingent on variations due to domicile country, religion, rounds of spiritual lessons, and self-practice as critical predictors, and sex and economic class as secondary predictors.

Prevalence and predictors of anxiety and depression after completion of chemotherapy for childhood acute lymphoblastic leukemia: A prospective longitudinal study

BACKGROUND

The months immediately after the completion of treatment for childhood acute lymphoblastic leukemia (ALL) are often regarded as a stressful time for children and families. In this prospective, longitudinal study, the prevalence and predictors of anxiety and depressive symptoms after the completion of treatment were examined.

METHODS

Participants included 160 children aged 2 to 9 years with standard-risk ALL who were enrolled on Children's Oncology Group protocol AALL0331. Parents completed standardized rating scales of their children's emotional-behavioral functioning and measures of coping and family functioning at approximately 1 month, 6 months, and 12 months after diagnosis and again 3 months after the completion of chemotherapy.

RESULTS

At 3 months off therapy, approximately 24% of survivors had at-risk/clinically elevated anxiety scores and 28% had elevated depression scores, which are significantly higher than the expected 15% in the general population (P = .028 and .001, respectively). Patients with elevated anxiety 1 month after diagnosis were at greater risk of off-therapy anxiety (odds ratio, 4.1; 95% confidence interval, 1.31-12.73 [P = .022]) and those with elevated depressive symptoms 6 months after diagnosis were at greater risk of off-therapy depression (odds ratio, 7.88; 95% confidence interval, 2.61-23.81 [P = .0002]). In adjusted longitudinal analyses, unhealthy family functioning (P = .008) and less reliance on social support coping (P = .009) were found to be associated with risk of emotional distress. Children from Spanish-speaking families (P = .05) also were found to be at a greater risk of distress.

CONCLUSIONS

A significant percentage of children experience emotional distress during and after therapy for ALL. These data provide a compelling rationale for targeted early screening and psychosocial interventions to support family functioning and coping skills. Cancer 2016;122:1608-17. © 2015 American Cancer Society.

Ethnographic Research on Adjustment of Mothers Caring for their Cancer Children in Korea

PURPOSE

The purpose of this study is to provide the basic data to develop the effective nursing intervention for the parent who have children with cancer by acquiring the deeper understanding of the mothers' adjustment of caring for their children with cancer.

METHODS

The ethnographic research method was used to find out the pattern of caring adjustment in Korean cultural context. Informants consisted of 12 mothers who were caring for their children with cancer. The data were collected using in-depth interviews, participant observation, and telephone interviews by maximum variation purposive sampling. The data were analyzed following Spradley's methodology.

RESULTS

The mothers' caring adjustment were organized into one cultural theme, four categories, and twelve properties. The cultural theme was 'standing alone as a mother with sin'. The four categories were 'blaming for falling illness', 'overcoming with motherhood', 'desperate struggling with side effects', and 'establishing new network as a dependent'.

CONCLUSION

For the mothers who are caring children with cancer, the supportive nursing intervention based on the deeper understanding of mothers' pattern of caring adjustment for their children and centered on facilitating effective adjustment in each cultural context especially from the very early stage of caring in the hospital ward is extremely required.

Participation in pediatric oncology research protocols: Racial/ethnic, language and age-based disparities

BACKGROUND

Survival rates in pediatric oncology have improved dramatically, in part due to high patient participation in clinical trials. Although racial/ethnic inequalities in clinical trial participation have been reported in adults, pediatric data and studies comparing participation rates by socio-demographic characteristics are scarce. The goal of this study was to assess differences in research protocol participation for childhood cancer by age, sex, race/ethnicity, parental language, cancer type, and insurance status.

PROCEDURE

Data on enrollment in any protocol, biospecimen, or therapeutic protocols were collected and analyzed for newly diagnosed pediatric patients with cancer from 2008-2012 at Rady Children's Hospital.

RESULTS

Among the 353 patients included in the analysis, 304 (86.1%) were enrolled in any protocol. Enrollment in biospecimen and therapeutic protocols was 84.2% (261/310) and 81.1% (206/254), respectively. Logistic regression analyzes revealed significant enrollment underrepresentation in any protocol for Hispanics compared to Non-Hispanic whites (81% vs. 91%; Odds Ratio [OR], 0.43; 95% Confidence Interval [CI], 0.21-0.90; P = 0.021) and among children of Spanish-speaking vs. English-speaking parents (78% vs. 89%; OR, 0.45; 95%CI, 0.23-0.87; P = 0.016). Compared to patients aged 0-4 years, significant underrepresentation was also found among patients 15-21 years old (92% vs.72%; OR, 0.21; 95% CI, 0.09-0.48; P < 0.001). Similar trends were observed when analyzing enrollment in biospecimen and therapeutic protocols separately.

CONCLUSIONS

There was significant underrepresentation in protocol participation for Hispanics, children of Spanish-speaking parents, and patients ages 15-21. Research is needed to understand barriers to research participation among these groups underrepresented in pediatric oncology clinical trials.

Cultural Influences in Pediatric Cancer

Objective: To review the literature on cultural factors influencing clinical care and family management of pediatric cancer. Methods: A literature review including 72 articles related to cultural issues in pediatric cancer was conducted. Information was organized around several clinically driven themes. Results: Cultural factors influenced many aspects of the cancer experience including illness representations, reaction to diagnosis, illness disclosure patterns, complementary and alternative medicine use, management of medical procedures, coping strategies, and end of life issues. Conclusion: Increased awareness of cultural factors is needed to improve clinical care and reduce health disparities. Specific strategies to approach cultural differences are provided to enhance patient and family care from diagnosis to cure/end of life.

The Impact of a Web-Based Educational and Support Intervention on Parents’ Perception of Their Children’s Cancer Quality of Life

The purpose of this exploratory study was to (1) describe the development of an evidence-based web educational and support intervention for families of children with cancer and (2) assess the favorability of the website, and whether there was any impact on the cancer communication aspect of the quality of life instrument. In the study, 38 persons participated—15 mothers, 12 fathers, and 11 children. The favorability score of the website was found to be very high. The mothers rated the website most favorable, followed closely by the fathers. Furthermore, even though it was not significant, an increase was found in the mothers’ evaluation of cancer communication based on the Pediatric Quality of Life Questionnaire (PedsQL) after the intervention as compared with before. The findings suggest that the use of an evidence-based website is feasible, appears to enhance cancer knowledge and might, in that way, contribute to better management of the cancer situation for the families.

Maternal stress, well-being, and impaired sleep in mothers of children with developmental disabilities: a literature review

Having children with developmental disabilities (DDs) requires a high level of caregiving responsibilities, and existing studies support that mothers of children with DDs experience high levels of maternal stress as well as poor sleep and well-being. Given the fact that the number of children with DDs has increased, an up-to-date literature review is necessary to identify factors associated with maternal stress, sleep, and well-being. In addition, understanding these factors and their relationships may provide better strategies in designing effective interventions that can reduce the burden in mothers of children with DDs. This review summarized 28 scientific research papers that examined maternal stress, sleep, and well-being in mothers of children with DDs in past 12 years. The study findings indicate that mothers of children with DDs experience higher levels of stress than mothers of typically developing children, and it remains high over time. In addition, these mothers often encounter depressive symptoms as well as poor sleep quality. The study results also reveal that there is a bidirectional relationship between maternal stress and depressive symptoms as well as between poor sleep quality and depressive symptoms. For example, higher stress mothers experienced more depressive symptoms. Mothers of children with DDs with poor sleep quality are significantly associated with more depressive symptoms. Child behavior problems were significantly associated with both maternal stress and depressive symptoms, but cautious interpretation is warranted due to the shared variance between child behavior problems, maternal stress, and depressive symptoms. Methodological guidelines for future research involve the use of reliable and valid instruments for the measurement of child behavior problems, maternal stress, and sleep. Recommendations for future research are included.

Predictors of stress of parents of a child with cancer: a Jordanian perspective

BACKGROUND

Most paediatric oncology studies agree that being parents of a child with cancer is an emotionally stressful event. Although an increasing number of studies have investigated psychological stress of parents of a child with cancer, few of these studies have included both parents or investigated the predictors of high stress levels for the mothers and the fathers. Moreover, studies published over the last few decades were limited to Western countries and have shown inconsistent findings about parental perceived stress whose children have cancer. This study explored differences in predictors of perceived stress between Jordanian mothers and fathers of children with cancer.

METHODS

This study involved a survey of 300 couples parenting a child with cancer. Participants answered the Arabic version of the Perceived Stress Scale 10-items, demographic and characteristics check list questionnaires. The main aims were to measure perceived stress levels for mothers and fathers, explore the predictors associated with high perceived stress levels and make a comparison between them.

FINDINGS

Mothers reported significantly higher stress levels than fathers (p<0.001), with a large effect size (0.30). Some of the factors associated with mothers and fathers high stress levels affected both parents whereas employment status affected only fathers' stress levels.

CONCLUSIONS

These findings indicate the need to work with the mothers and the fathers with a child with cancer in Jordan to recognise their psychological needs at the time of diagnosis and followed by on-going psychological support for both parents.

Mental health disparities between Hispanic and non-Hispanic parents of childhood cancer survivors

BACKGROUND

Parents of childhood cancer survivors (CCS) experience considerable distress related to their child's cancer. However, little is known about cultural variation in this experience. We examine parental distress, specifically symptoms of post-traumatic stress (PTSS) and depression, comparing Hispanic and non-Hispanic parents of CCS.

PROCEDURE

Seventy-nine Hispanic and 60 non-Hispanic parents of CCS (currently aged 14-25, off treatment ≥2 years) completed questionnaires assessing demographics, depression, PTSS, perceived stress, and child's health status/quality of life (QOL). t-Tests and chi-square statistics were used to compare differences in demographic characteristics between Hispanic and non-Hispanic parents and multivariable regression was used to determine independent risk factors associated with parental PTSS and depression.

RESULTS

Hispanic parents were significantly younger, had less education, lower incomes and reported significantly more PTSS and depressive symptoms than non-Hispanic parents (all P-values < 0.0001). Among Hispanic parents, foreign birthplace predicted higher PTSS after controlling for other factors (P < 0.001). Hispanic parents, regardless of birthplace, reported more depressive symptoms than non-Hispanic parents (US-born, P < 0.05; foreign-born, P < 0.01). For PTSS and depression, there were positive relationships with parental stress and negative relationships with the child's psychosocial QOL. Hispanic and non-Hispanic CCS did not differ significantly on disease and treatment factors or health-related QOL.

CONCLUSIONS

Hispanic parents of CCS may be at greater risk for poorer mental health outcomes. Ethnic-specific factors (e.g., acculturation, immigration status, and previous trauma) may influence parents' responses and adjustment to their child's cancer. Research is needed to determine how to meet the needs of the most vulnerable parents.

A Systematic Review of Qualitative Studies Exploring the Experience of Parents Whose Child Is Diagnosed and Treated for Cancer

A growing body of research has investigated the experiences of parents of children treated for cancer. Until recently, a qualitative review has not been possible because of the lack of qualitative studies in this area. However, this has changed in recent years. The purpose of this systematic review is to summarize the findings from qualitative studies on the experiences of mothers and fathers from different countries and cultures. Twenty-eight qualitative studies were found to meet the inclusion criteria for this review. Key findings included the parents’ desire to feel in control, the need to continuously adjust to the unpredictable nature of cancer treatment, the adoption of various coping styles, emotional and practical support being valued, and gender and cultural differences being reported. Clinical implications include the need for health care professionals to provide clear information and aid the sense of control, care to be individualized with gender and cultural backgrounds taken into account, and fathers’ needs to be acknowledged and met. Other implications for clinical practice and future research are discussed.

A prospective study to determine the costs incurred by families of children newly diagnosed with cancer in Ontario

OBJECTIVES

A diagnosis of cancer in childhood places a considerable economic burden on families, although costs are not well described. The objectives of this study were to identify and determine independent predictors of the direct and time costs incurred by such families.

METHODS

A prospective, cost-of-illness study was conducted in families of children newly diagnosed with cancer. Parents recorded the resources consumed and costs incurred during 1 week per month for three consecutive months beginning the fourth week following diagnosis and listed any additional costs incurred since then. Descriptive and multiple regression analyses were performed to describe families' costs (expressed in 2007 Canadian dollars) and to determine direct and time cost predictors.

RESULTS

In total, 28 fathers and 71 mothers participated. The median total direct and time costs in 3 months were $CAD3503 and $CAD23 130, respectively, per family. The largest component of direct costs was travel and of time costs was time allocated previously for unpaid activities. There were no statistically significant predictors of direct costs. Six per cent of the variance for time costs was explained by language spoken at home.

CONCLUSIONS

Families of children with cancer are confronted with a wide range of direct and time costs, the largest being travel and time allocated previously for unpaid activities.

My child has cancer: finding the silver lining in every mother's nightmare

Having a child with cancer is one of the most taxing experiences a family can endure. With that in mind, the primary objective of this research was to explore the lived experiences of mothers of children with pediatric cancer during diagnosis, treatment, and the period thereafter. The specific purpose of this article however, was to examine the benefits or positives that emerged from the experience. One-on-one and e-mail semi-structured interviews were completed with 9 mothers of children treated for pediatric cancer. Four of the children had passed away from their illnesses. The subthemes derived for the benefits of the mothers' experiences consisted of: (1) support: importance of family and friends; (2) when life gives you lemons; and (3) finding the silver lining. It is anticipated that the findings from this exploratory research will be used as a source of support for individuals in similar situations and for front-line health care professionals.

How Do I Cope? Factors Affecting Mothers’ Abilities to Cope With Pediatric Cancer

The overall objective of this exploratory research was to examine the lived experiences of female caregivers of children with cancer during diagnosis, treatment, and the period thereafter. Specifically, the authors examined factors that affected mothers’ abilities to cope with a diagnosis of cancer. The interviews were completed with 9 mothers of children who had been treated for pediatric cancer, in addition to 3 health care workers who provided care for families with children with cancer. From this process, a number of salient issues were identified, one of which was factors that assisted or hindered mothers’ abilities to cope. The subthemes of this theme consisted of: (1) support; (2) faith, positive thinking, and hope; (3) taking care of self; (4) being fearful and protective—keeping family close; and (5) living life— during and after the diagnosis. This research enabled caregivers of children with cancer to express their experiences about provision of care and factors that affected their ability to cope. Health care professionals, particularly pediatric oncology nurses and social workers, are perfectly aligned to help families reduce or manage the turmoil in families that must cope with a diagnosis of pediatric cancer.