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da Silva EF, Matsubara MDGS, Soares MADL, Mazzaia MC, De Domenico EBL. Communication between parents diagnosed with cancer and their children: study with data triangulation. Rev Esc Enferm USP 2024; 57:e20230079. [PMID: 38373186 PMCID: PMC10876183 DOI: 10.1590/1980-220x-reeusp-2023-0079en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 12/14/2023] [Indexed: 02/21/2024] Open
Abstract
OBJECTIVE To characterize the perceptions and feelings of parents diagnosed with cancer in relation to communication with their children between 3 and 12 years old. METHOD A cross-sectional, multicenter, with data triangulation, through structured and semi-structured interviews, with a question with a Semantic Differential Scale, carried out with the father or mother with cancer undergoing outpatient treatment in two hospital institutions in the city of São Paulo, São Paulo, Brazil. Data were analyzed using descriptive statistics, content analysis, using the ATLAS.ti 8.0R software and the Social Representation Theory. RESULTS Forty-three respondents participated, 37 (86.0%) were female, 23 (53.5%) aged between 31 and 50 years old, 29 (67.5%) with only children between 7 and 12 years old. The experience was considered painful (73.1%), stressful (53.6%), clear (53.7%) and safe (51.2%). The feelings experienced generated two categories: Trial by fire; and Grateful rewards. Children's reactions from parents' perspective generated the categories: Sadness and suffering; Trust and support; Change of behavior; and Denial or insensitivity. CONCLUSION Communication was assessed as negative and conflicting, positive and welcoming, and causing changes in children's behaviors.
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Chong YY, Temesgen WA, Chan H, Wong CL, Cheng HY. Psychosocial interventions for improving mental health and family functioning in families with parental cancer: A systematic review. Eur J Oncol Nurs 2024; 68:102505. [PMID: 38309255 DOI: 10.1016/j.ejon.2024.102505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 01/05/2024] [Indexed: 02/05/2024]
Abstract
PURPOSE Parental cancer significantly impacts both parents and children, necessitating psychosocial interventions to enhance family well-being. This systematic review aimed to assess the effectiveness of psychosocial interventions targeting parents with cancer on their mental health, quality of life, their children's well-being, and family functioning. METHODS A comprehensive search was conducted in Ovid MEDLINE, PubMed, PsycINFO, and Cochrane Central Register of Controlled Trials databases for relevant articles published from 2006 to 2023. The methodological aspects of eleven studies from diverse countries were critically evaluated. RESULTS The review included 496 parents, primarily female breast cancer patients, and their children. Narrative synthesis highlighted interventions that aimed to strengthen parent-child connection (Enhancing Connection (EC)), enhance family communication, improve psychological well-being of parents (Struggle for Life Intervention), and address children's mental health (Wonders and Worries (W&W)). Additionally, interventions like Cancer PEPSONE Program (CPP) aimed to expand social networks and support systems. These interventions demonstrated success in reducing depressive and anxiety symptoms, parenting stress, and mitigating children's externalizing and internalizing problems. However, they were not exempt from methodological limitations such as participant selection bias, lack of blinding, and low follow-up rates. CONCLUSIONS Based on the review, psychological support for parents with cancer is an emerging field, predominantly explored in Western countries with a significant emphasis on maternal experiences. The early stage of this field and inherent methodological limitations warrant cautious interpretation of these findings and further research for comprehensive understanding and application.
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Affiliation(s)
- Yuen Yu Chong
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region of China.
| | - Worku Animaw Temesgen
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Hailey Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Cho Lee Wong
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Ho Yu Cheng
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region of China
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Asiedu C, McKinney NS, Willis AI, Lewis FM, Virtue S, Davey A. Cancer and the family: Variations by sex and race/ethnicity. Cancer Med 2024; 13:e6969. [PMID: 38379329 PMCID: PMC10831911 DOI: 10.1002/cam4.6969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 01/08/2024] [Accepted: 01/16/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Cancer affects patients and their families, but few data are available on factors associated with diversity of family structures among patients with cancer. Family is a source of both support and responsibility that must be understood to support patients and their families. METHODS Pooled data (2004-2015) from the National Health Interview Study were used to compare characteristics of cancer survivors with and without minor children and differences by sex and race/ethnicity among survivors with minor children. RESULTS 13.9% of cancer survivors have minor children in the household, and this experience is more likely for women and people who identify as other than non-Hispanic White. CONCLUSION There are considerable differences by sex and race/ethnicity in the characteristics of cancer survivors with minor children. Clinicians should make consideration of family circumstances a routine part of their history. Doing so will help to identify potential sources of support and responsibility that may affect adherence.
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Affiliation(s)
- Charlotte Asiedu
- Department of Health Behavior and Nutrition SciencesUniversity of DelawareNewarkDelawareUSA
| | - Nicole S. McKinney
- Department of Counseling and Behavioral HealthThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Alliric I. Willis
- Department of Surgery, Surgical OncologyThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Frances M. Lewis
- Department of Child, Family, and Population Health NursingUniversity of WashingtonSeattleWashingtonUSA
| | - Shannon Virtue
- Helen F Graham Cancer Center and Research Institute, Christiana Care Health SystemNewarkDelawareUSA
| | - Adam Davey
- Department of Health Behavior and Nutrition SciencesUniversity of DelawareNewarkDelawareUSA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Alexander ES, O’Connor M, Halkett GKB. The Psychosocial Effect of Parental Cancer: Qualitative Interviews with Patients' Dependent Children. Children (Basel) 2023; 10:children10010171. [PMID: 36670721 PMCID: PMC9857104 DOI: 10.3390/children10010171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Park EM, Wang M, Bowers SM, Muriel AC, Rauch PK, Edwards T, Yi SM, Daniel B, Hanson LC, Song MK. Adaptation and Psychometric Evaluation of the Parenting Concerns Questionnaire-Advanced Disease. Am J Hosp Palliat Care 2022; 39:918-925. [PMID: 34619978 DOI: 10.1177/10499091211049801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE When patients with advanced cancer have minor children (age < 18), their health-related quality of life is closely linked to their concerns about the impact of progressive illness and death on their children. The Parenting Concerns Questionnaire (PCQ), a validated measure for parents with cancer, does not capture the full range of concerns in advanced cancer. The aim of this was study was to adapt and establish psychometrics for the PCQ for advanced disease (PCQ-AD). METHODS After generating an initial item-bank, we conducted concept elicitation interviews with clinicians (n = 8) and cognitive interviews with patients (n = 23) for face validity. New items addressed concerns about impact of parental death, making every moment count, communication, and financial impact of cancer on children. We administered 21 candidate items to 151 parents with advanced cancer. We conducted confirmatory factor analysis (CFA), calculated internal consistency, and assessed convergent and known-groups validity. RESULTS We removed 8 redundant items due to residual covariation between items. CFA of the 13-item PCQ-AD demonstrated satisfactory fit (CFI = 0.971, TLI = 0.966, RMSEA = 0.081) and high internal consistency (Cronbach's alpha = 0.94, composite reliability = 0.95). The PCQ-AD demonstrated convergent validity and known-groups validity; patients with poor functional status reported higher scores than patients with better functional status (Cohen's d = 0.56, p = 0.002). CONCLUSION Adaptation of the PCQ yielded the addition of constructs important in advanced cancer. The PCQ-AD appears to be a reliable and valid measure of parenting concerns in advanced cancer, but future studies are needed to examine measure performance in diverse populations and responsiveness of the PCQ-AD to interventions.
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Affiliation(s)
- Eliza M Park
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Mian Wang
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Savannah M Bowers
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Anna C Muriel
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA, USA
| | - Paula K Rauch
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Teresa Edwards
- H. W. Odum Institute for Research in Social Science, University of North Carolina, Chapel Hill, NC, USA
- RTI Health Solutions, Research Triangle, NC
| | - Samantha M Yi
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Brittany Daniel
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Laura C Hanson
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
- Division of Geriatric Medicine and Palliative Care Program, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Mi-Kyung Song
- Center for Nursing Excellence in Palliative Care, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
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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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Johannsen LM, Brandt M, Frerichs W, Inhestern L, Bergelt C. The Impact of Cancer on the Mental Health of Patients Parenting Minor Children: A Systematic Review of Quantitative Evidence. Psychooncology 2022; 31:869-878. [PMID: 35218110 DOI: 10.1002/pon.5912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/21/2022] [Accepted: 02/24/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To provide an overview of quantitative data on the impact of cancer on the mental health of patients parenting minor children. We focused on mental health outcomes, their levels and prevalence and applied measurement tools. METHODS MEDLINE, CINAHL, PsycInfo and Web of Science were searched up to March 2021. We included quantitative studies, published in a peer-reviewed journal and reporting outcomes on the mental health (e.g., depression, anxiety) of cancer patients parenting minor children (≤ 21 years). Study quality was assessed based on the NIH assessment tool for observational studies. This study is registered on PROSPERO (CRD42019141954). RESULTS A total of 54 articles based on 36 different studies were included in this systematic review. Studies differ markedly regarding study and sample characteristics (e.g., outcome measures, sample size, parental health status). Depression and anxiety levels range from normal to abnormal, according to applied measurement tools. 7%-83% of parents with cancer have depression scores indicating probable depression and 19%-88% have anxiety scores indicating anxiety disorder. CONCLUSIONS This review reveals the dimension of mental burden affecting cancer patients parenting minor children. To identify, address and timely treat potentially arising mental health problems and support needs, affected parents should be closely monitored by healthcare professionals and referred to specialized support offers, if necessary. In the context of a comprehensive patient- and family-oriented care, it is highly relevant to integrate mental health (including parental) issues routinely into oncological care by proactively asking for the patient's psychosocial situation and the family status. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Lene Marie Johannsen
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Germany
| | - Maja Brandt
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Germany
| | - Wiebke Frerichs
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Germany
| | - Laura Inhestern
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Germany
| | - Corinna Bergelt
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Germany.,Department of Medical Psychology, University Medicine Greifswald, Germany
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Abstract
Background: A 2012 systematic review by Oliver et al. of evidence-based research on telehospice included 26 research articles published between 2000 and 2010 on the use of telehospice connecting hospice professionals with caregivers and their care recipients. The present study replicated research by Oliver et al., extending the time frame from 2010 through 2020. The aim of this study was to answer the question-what is the current state of the evidence related to telehospice services? Materials and Methods: A systematic review was conducted for the time period 2010 to 2020 of the existing literature researching the topic of telehospice. Thirteen articles (five quantitative, six qualitative, and two mixed methods) were found that meet the inclusion criteria of the study. The Methodological Rigor Scoring Instrument was used to code the qualitative and quantitative articles separately to address methodological differences. Results: The most common findings were related to technology adaptation readiness for staff and caregivers. Studies assessed the use of telehospice that included incorporated technology, such as an electronic tablet, to provide synchronous communication between the provider and the patient/caregiver. Provider and caregiver attitudes regarding telehospice care were largely positive with studies reporting acceptance of telehospice as generally high. Conclusions: The past 10 years have yielded a small but significant body of research on telehospice. Published research on the topic reports a generally high level of patient and caregiver satisfaction about the experience, but limited findings have been published relating to patient outcomes. As adaptation of telehospice and technology has surged in the past year, it is expected that additional research on the impact of technology on clinical outcomes will emerge in the future.
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Affiliation(s)
| | - Kristen Munyan
- School of Nursing, Oakland University, Rochester, Michigan, USA
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Abstract
BACKGROUND Parents with advanced cancer struggle initiating conversations with their children about the cancer. When parents do not have the tools to talk with their children, they silently watch their children attempt to navigate their illness but can only wonder but not know what their children are thinking. The objective of the current study is to describe, from parents living with advanced cancer, the worries and concerns parents wonder their child holds, but has not spoken, about the parent's cancer. METHODS Twenty-seven parents with incurable cancer enrolled in a 5 session telephone intervention pilot study during which they were asked, "What questions do you have about what your child is thinking or feeling about the cancer?" Data were transcribed and inductively coded using content analysis methods adapted from grounded theory. RESULTS Analysis yielded 14 categories of parent concerns organized into 6 larger conceptual domains: Being Concerned and Scared about My Cancer; Worrying about Me; Changing How We Talk and Live Day-to-Day; Not Knowing What Will Happen; Having Unanswered Questions about My Cancer; and Understanding My Disease Is Terminal. CONCLUSIONS Study results add to our understanding of the magnitude of the emotional burden parents with advanced cancer carry as they struggle to balance their diagnosis and treatment and their life as parents.
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Zahlis EH, Shands ME, Lewis FM. Upping my game as a parent: Attributed gains in participating in a cancer parenting program for child-rearing parents with advanced cancer. Palliat Support Care 2020; 18:339-45. [PMID: 32148212 DOI: 10.1017/S1478951520000103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The objective of this study was to describe in the words of child-rearing parents with incurable cancer, what they had gained or thought about as a result of participating in a five-session, scripted, telephone-delivered psycho-educational parenting intervention, the Enhancing Connections Program in Palliative Care. METHODS A total of 26 parents completed the program. Parents' responses were audio-recorded and transcribed verbatim and verified for accuracy. The analysis proceeded through four steps: unitizing, coding into categories, defining categories, and formation of a core construct that explained parents' attributed gains. Trustworthiness of study results was protected by coding to consensus, formal peer debriefing, and maintaining an audit trail. RESULTS Although 50% reached or exceeded clinical cutoff scores on anxiety and 42% reached or exceeded clinical cutoff scores on depressed mood, parents extensively elaborated what they gained. Results revealed six categories of competencies they attributed to their participation in the program: (1) being ready for a conversation about my cancer, (2) bringing things out in the open, (3) listening better to my child, (4) getting my child to open up, (5) not getting in my child's way, and (6) changing my parenting. CONCLUSIONS Despite an extensive symptom burden, parents with incurable cancer attributed major gains from a brief, fully scripted, cancer parenting communication intervention. A manualized telephone-delivered educational counseling program for symptomatic parents with incurable cancer has the potential to augment competencies for parents as they assist their children manage the cancer experience.
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