A Conceptual Model Depicting How Children Are Affected by Parental Cancer: A Constructivist Grounded Theory Approach
Abstract
:1. Introduction
2. Materials and Methods
2.1. Ethics Approval
2.2. Participant Recruitment
2.3. Participants
2.4. Interviews
2.5. Children’s Activity
2.6. Data Collection
2.7. Data Analysis
3. Findings
3.1. Children
Worried, Distressed, and Alone
Interviewer: “You feel worried and frustrated a lot of time?”
Child: “Yes”.
Interviewer: “When do you feel happy?”
Child: “When Mummy’s okay and she’s doing stuff” (Batari; female: 8.5 years).
Child: “I spent more time with her before she got sick. She’s having another operation to take the bag away and then we’re going to have more time to be with her again”.
Interviewer: “Are you looking forward to that?”
Child: “I’ve been waiting for it for 1000 years” (Arianna, female: 6.5 years).
Interviewer: “Can you tell me what you know about mum’s cancer?”
Child: “Brain cancer, kills people” (notably, the parent did not have a brain cancer diagnosis).
Interviewer: “Did someone you know have brain cancer?”
Child: “It’s Granddad. He died” (Arianna; female: 6.5 years).
Interviewer: “Do you know what you would ask?”
Child: “I’m generally unsure of it, I just feel the need to know something”.
Interviewer: “Is it something you can ask Mum about?”
Child: “It might be, but I’m unsure of how to do this” (Lucas, male: 12 years).
3.2. Parents
Children’s Needs Are Unattended
“If you have to phone to change an appointment, you don’t go to a receptionist. You go to some third party who may or may not be able to change an appointment or answer a question, so it’s absolutely hopeless whatever that system is, so we don’t even bother” (Parent 1)
“There’s always something that comes up. We’ve tried to plan for the best but expect the worst”.
“While he’s neutropenic you can eat an apple, but you’ve got to wash your hands; wash your face before you kiss or hug dad; you’ve just got to be really conscious. Lots of extra handwashing. We have good hygiene, but I’m just seeing bugs everywhere. It’s cleaning constantly” (Parent 2).
“The children pick up on my stress. They certainly pick up on his stress. My five-year-old was wetting the bed and the more [patient] got sleep deprived because he was getting up in the middle of the night changing sheets, the less tolerant of it he became and that becomes like a negative cycle” (Parent 9),
the family had limited childcare support,
“The first time I brought her to the hospital, she saw a lot of patients in very bad conditions” (Parent 8),
or there was an emergency.
“He [patient] got very sick and ended up in the high intensity unit because they had to call a code blue, which was probably a bit of a shock seeing Dad so sick in hospital, and for [child]—that was probably the hardest week for him. It was stressful for all of us; me trying to still work, going into hospital every night” (Parent 4).
3.3. HPs
Children Are Invisible
“That’s [screening] something we initiate ourselves. We normally try to get as much information about their social life and their family life as we can and then if they tell us they do have kids, then we explore” (HP5).
“Sometimes they [children] will process it through play therapy, but not be able to articulate it verbally how they’re feeling. Then, once the diagnosis has got to a safer distance, they might be able to engage in some verbal dialogue, or as they’re getting a little bit older, they might be in a position to articulate and want to revisit what’s happened” (HP9).
“I’m not experienced in child psychology. I really am fearful that I would be doing an injustice opening up a conversation that I didn’t have the tools to complete” (HP3).
“I feel a lot of the time they shield the kids, so they don’t bring them in” (HP4).
“With the ones that are reluctant to talk, it is a lot more challenging, and I feel that even when I am trying to build more of a rapport with them and sneakily get some questions in here and there, it’s not always going to go well” (HP12).
3.4. Explanatory Model: How Children Are Affected by Their Parent’s Cancer Diagnosis
Compromised Social Interactions and Communication Breakdowns
4. Discussion
4.1. Clinical Recommendations
- Training and education aimed at developing HPs’ communication skills and developmental knowledge.
- The development of a communication tool to be used by HPs to effectively communicate with patients’ children. The new tool might also capture the benefits of technology and integrate the methods used in this study whereby children were encouraged to write and draw about their thoughts and feelings.
- The introduction of routine and standardised screening processes for HPs to detect patients’ children and efficiently refer them on to the appropriate supports and resources that are currently available. Oncology nurses may facilitate this approach while also being supported by the development of a new, or refinement of an existing, screening tool.
- The use of a multidimensional approach to support parents with the practical challenges of a cancer diagnosis. For example, a family support worker or social worker who can assist families from diagnosis onwards.
4.2. Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Population | Inclusion Criteria |
---|---|
HPs |
|
Parents |
|
Children |
|
Health Professionals | Number of Participants | n = 15 |
---|---|---|
Age | Range | 31–71 years |
Mean age (SD) | 51.21 (±10.14) years | |
Gender | Female Male | 80% 20% |
Role | Cancer Nurse Coordinator | n = 3 |
Psychosocial support worker or other allied health worker | n = 6 | |
Nurse practitioner | n = 1 | |
Clinical/oncological specialist | n = 3 | |
Clinical psychologist/psychiatrist | n = 2 | |
Years of relevant experience | ≤10 years | n = 5 |
≤20 years | n = 4 | |
≤30 years | n = 4 | |
>30 years | n = 2 | |
Interview method | Face to face | n = 8 |
Telephone | n = 7 | |
Parents | Number of Participants | n = 11 |
Age | Range Mean age (SD) | 28–52 years 39.7 (±7.44) years |
Gender | Female Male | 91% or n = 10 9% or n = 1 |
Health status | Patient | 5 |
Partner | 6 | |
Marital status | Married | 9 |
Separated/Divorced | 1 | |
Widowed | 1 | |
Number of children * | 1 child | 4 |
2 children | 4 | |
3 children | 2 | |
Age range of children * | 1 to 15 years | |
Cancer type (primary) * | Bowel cancer | 2 |
Brain | 1 | |
Breast | 1 | |
Burkitts lymphoma | 1 | |
Lymphoma | 1 | |
Melanoma | 1 | |
Non-Hodgkin’s Lymphoma B cell | 1 | |
Lung | 1 | |
Oral | 1 | |
Stage * (at time of interview) | II | 3 |
III | 1 | |
IV | 3 | |
Not reported/remission/deceased | 3 | |
Ethnicity | Australian | 82% or n = 9 |
Indonesian | 9% or n = 1 | |
Malaysian | 9% or n = 1 | |
Education | Postgraduate | 4 |
Tertiary | 5 | |
Other | 2 | |
Children | Number of Participants | n = 12 |
Age | Range Mean age (SD) | 5–17 years 9.46 (±3.43) years |
Gender | Female Male | 58% or n = 7 42% or n = 5 |
Cultural background | Australian | 75% or n = 9 |
Indonesian | 17% or n = 2 | |
Malaysian | 8% or n = 1 | |
Parent with cancer | Mother | 50% or n = 6 ** |
Father | 50% or n = 6 ** | |
Parent’s primary cancer diagnosis *** | Bowel cancer | 2 |
Brain | 1 | |
Breast | 1 | |
Burkitt’s lymphoma | 1 | |
Lymphoma | 1 | |
Melanoma | 1 | |
Non-Hodgkin’s Lymphoma B cell | 1 | |
Lung | 1 | |
Oral | 1 | |
Stage *** (at time of interview) | II | 3 |
III | 1 | |
IV | 3 | |
Not reported/remission/deceased **** | 3 |
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Alexander, E.S.; Halkett, G.K.B.; Lawrence, B.J.; O’Connor, M. A Conceptual Model Depicting How Children Are Affected by Parental Cancer: A Constructivist Grounded Theory Approach. Children 2023, 10, 1507. https://doi.org/10.3390/children10091507
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. 2023; 10(9):1507. https://doi.org/10.3390/children10091507
Chicago/Turabian StyleAlexander, Elise S., Georgia K. B. Halkett, Blake J. Lawrence, and Moira O’Connor. 2023. "A Conceptual Model Depicting How Children Are Affected by Parental Cancer: A Constructivist Grounded Theory Approach" Children 10, no. 9: 1507. https://doi.org/10.3390/children10091507