Perceptions of the role of the school in providing information and support to adolescent children of women with breast cancer

Adolescents' needs for information and psychosocial support during their mother's breast cancer trajectory: A systematic review

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.

Children's understanding of maternal breast cancer: A qualitative study

PURPOSE

To explore how children understand their mother's diagnosis of and treatment for breast cancer.

METHOD

Interpretive description was adopted as the methodology in this study. Eight children aged 8-18 years old, whose mother has been diagnosed with non-terminal breast cancer, were interviewed individually and six of them drew a picture to express their understanding of maternal breast cancer.

RESULTS

Four themes were identified in this study: "the cancer word is scary" - children's understanding of cancer; "scars and tubes" - children's understanding of surgery; "hair loss" - children's understanding of chemotherapy, and "I can't explain it" - children's understanding of other treatments. Children's understanding of maternal breast cancer and its treatment was relatively realistic, although sometimes inaccurate.

CONCLUSIONS

Individual evaluation and appropriate explanation is significant to further children's understanding of their mother's illness. Future studies with larger sample size are needed to explore the understanding for children of different ages, in order to provide specific help for these children.

Contributing to making the school a safe place for the child: School nurses' perceptions of their assignment when caring for children having parents with serious physical illness

Aim

To explore how school nurses perceive their assignment when caring for children having parents with serious physical illness.

Design

An explorative inductive qualitative design.

Method

The study is based on interviews with 16 school nurses. The interviews were subjected to qualitative content analysis.

Results

The main category, “Contribute in making the school a safe place for the child”, reveals how the school nurses try to contribute to making the school a safe place for a child when his/her parent has a serious physical illness. They support children through individual support, as well as at an overall level in the school health team to make the school, as an organization, a safe place. Routines and collaboration to recognize the child when his/her parent has become ill is described as crucial to accomplishing this assignment.

The information needs of partners and family members of cancer patients: a systematic literature review

OBJECTIVE

This review examined the extent to which the information needs of partners and family members of cancer patients has been addressed in the literature.

METHODS

We conducted a systematic search of four databases for papers published between 1998 and 2008 which assessed the information needs of partners and/or family members of adult cancer patients.

RESULTS

Thirty-two papers were included in the review. Eleven categories of information need were identified. There was a predominant focus on breast or prostate cancer, leaving a knowledge gap in relation to other cancers. Few papers moved beyond the diagnosis and initial treatment phase, and most did not distinguish between met and unmet needs. Those that did, indicated that partners/family members are more likely to have unmet needs for information about supportive care than for medical information. The concept of 'information need' was generally poorly developed and theorised in the papers.

CONCLUSION

Establishing the information needs of partners and family members of cancer patients is an important, but as yet neglected, area of research. In order to develop our understanding of this area more empirical research, with sound conceptual and theoretical foundations is required.

Impact of maternal breast cancer on the peer interactions of children at school

Relatively little research has investigated the impact of parental cancer on developmental outcomes for school-aged children beyond the home. The current study was designed to examine the impact of maternal breast cancer on the social behavior, peer acceptance, and friendships of children and adolescents at school. It was hypothesized that children of women with breast cancer would have fewer friends and be viewed by peers, teachers, and themselves as more socially isolated than comparison classmates. A sample of 60 school-aged children (age 8-16) of women with breast cancer, 58 teachers, and 1138 classmates provided data in classroom settings. Comparisons were made between children in the maternal cancer sample and 60 classmates matched for gender, race, and age. No overall group differences were found on indicators of peer acceptance or friendships at school. Although marked behavioral similarities were found between groups, analyses indicated that sons, but not daughters, of mothers with breast cancer were seen by teachers and peers as more socially sensitive and isolated than comparison peers. Further research is warranted to confirm findings that sons of mothers with breast cancer may experience social isolation and to examine the stability and consequences of this behavioral pattern.

Adolescents’ views of helping professionals: A review of the literature

This paper reviews 54 papers exploring adolescents' own views of their interactions with doctors, mental health workers and other 'helping professionals'. Twelve global themes emerge repeatedly in the qualitative literature, where adolescents are asked to talk about their preferences or their experiences of receiving help from such professionals. The twelve themes are reported and illustrated with results of related quantitative studies, and implications of these themes for professionals offering services to this age group are considered. Methodological limitations of the literature are discussed, along with suggestions for future research.

Information and Support Needs of Adolescent Children of Women With Breast Cancer

PURPOSE/OBJECTIVES

To elicit detailed descriptions of adolescents' information and support needs in response to their mothers' breast cancer.

DESIGN

Exploratory, qualitative.

SETTING

Four different outpatient and inpatient oncology settings in western Canada.

SAMPLE

31 adolescent children of women in five illness phases.

METHODS

27 semistructured interviews and two focus groups were conducted. Interviews were audiotaped, transcribed, and analyzed using constant comparison techniques. The Communication Subscale of the McMaster Family Assessment Device also was administered to assess family communication patterns.

FINDINGS

Information needs were sources of information, information content, degree of helpfulness, and information timing. Support needs were type, degree of helpfulness, form, and source.

CONCLUSION

Most of the adolescents reported that their needs were poorly met.

IMPLICATIONS FOR NURSING

Women with breast cancer have a need for family-focused care. Further research is required to develop interventions that can assist nurses in providing care that meets the needs of adolescent children and other family members of women with breast cancer.

When a parent has cancer: a community based program for school personnel

Little information has been published on interventions designed to help school personnel respond to challenges faced by a family dealing with parental cancer. The current study describes the development and piloting of a program that educated school professionals about cancer's impact on families, and effective ways of supporting families facing parental cancer. The program was implemented at four sites; 244 participants completed self-report questionnaires before and after the program assessing knowledge and anxiety about helping families. t-tests indicated that after the program, participants rated themselves as significantly more knowledgeable and confident about helping families with parental cancer. These differences represented large effect sizes. Post hoc comparisons revealed that initial knowledge and knowledge change varied by profession, having had personal experience with cancer, and having worked with several families facing cancer. Participants reported learning about how to reach out and listen to families' needs. These results are extremely encouraging; plans for further program refinements and evaluation are discussed.

The impact of parental cancer on the adolescent: an analysis of the literature

Research has revealed the impact of the diagnosis of cancer on an individual, their spouse, and their family. One dimension that has received little attention is the impact of the cancer diagnosis on the patient's adolescent. This article offers an analysis of descriptive studies, intervention studies, and databased book chapters, published between 1966 and 2006, that examined the impact of parental cancer on the adolescent. The results of 45 studies and three databased book chapters are organized around four themes: adolescents' (1) emotions and behaviors (2) perceptions and knowledge of parental cancer (3) changes in roles and (4) ways of coping. These themes will assist the reader in understanding the application of the knowledge gained from the analysis of the literature to directions for future research.

Children's and family needs of young women with advanced breast cancer: a review

This article reviews literature about the impact of advanced breast cancer on children and families. It is clear that the adjustment of the family is influenced by disease stage and maternal adjustment, the needs of the particular child relating closely to their developmental stage. Interventions with children and families to promote adjustment when a parent has advanced cancer are also discussed, including implications for clinical practice.

Adolescents coping with mom's breast cancer: developing family intervention programs

The purpose of this pilot study was to gain a deeper understanding of how adolescents are affected by their mothers' breast cancer and to discover their opinions about how future intervention programs should be designed. Three focus groups were conducted with a total of 10 adolescents. Findings indicate that adolescents' lives had been complicated by their mothers' illness, as they often felt burdened with additional roles and responsibilities. Adolescents suggested that future intervention programs should have the following elements: Adolescent group comprised of boys and girls within 4 months of cancer diagnosis; psychoeducation; target coping skills sensitive to girls and boys of different ethnic and racial backgrounds; and after the adolescent groups, have multiple-family therapy groups that promote shared family understanding and open communication between parents and adolescents.

The impact of parental cancer on children and the family: a review of the literature

OBJECTIVE

Children of cancer patients may go through a distressing time. The aim of this review was to survey present knowledge on the impact of parental cancer on children and the family.

DESIGN

Studies published between January 1980 and March 2004 addressing emotional, social, behavioural, cognitive and physical functioning of children of a parent diagnosed with cancer, as well as the association with child, parental and familial variables were reviewed.

RESULTS

Fifty-two studies were found. Emotional problems in school-aged children (11 years) were reported in several qualitative studies, but in only one quantitative study. Quantitative and qualitative studies reported anxiety and depression in adolescents (12 years), in particular in adolescent daughters of ill mothers. Quantitative studies generally showed no behavioural and social problems in school-aged children and adolescents. One quantitative study found physical complaints in school-aged children. However, qualitative studies revealed behavioural problems in school-aged children and also described restrictions in cognitive and physical functioning in children of all ages. The most consistent variables related to child functioning appeared to be parental psychological functioning, marital satisfaction and family communication. Intervention studies directed to the needs of children and their families reported positive effects.

CONCLUSION

While quantitative studies reported especially disturbed emotional functioning, qualitative studies reported problems in all domains of child functioning. Well-designed studies are needed to gain more insight into the psychosocial functioning of children of cancer patients in order to develop tailored care.

Palliative care for families: remembering the hidden patients

Families of patients receiving palliative care are profoundly affected by the challenges of the illness. They observe care that the patient receives, provide care for the patient, and receive support from health professionals in the form of information, counselling, or practical assistance. As they witness and participate in the patient's care, they judge the quality of care that the patient receives. They often see themselves as the patient's care advocates and may harbour regret and guilt if they believe that the patient did not have the best possible care. The illness experience profoundly affects family members' psychological and physical health; recognition of this has coined the term "hidden patients." This article briefly synthesizes empirical work that suggests how to best support families in a palliative care context. We discuss how to define the family, emphasizing a systems approach to family care. We describe the impact of the illness on the family in terms of family members' health, family communication issues, psychological issues, needs for information, physical care demands, and family costs of caring.