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Communication with children about a parent’s advanced cancer and measures of parental anxiety and depression: a cross-sectional mixed-methods study

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Abstract

Purpose

Parents with advanced cancer are faced with difficult decision-making about communication about their illness with their children. The objectives of this study were to describe how parents communicated with their children about advanced cancer and to explore associations between communication and parental depression and anxiety.

Methods

This was a cross-sectional, mixed-methods study of 42 patients with stage IV solid tumor malignancies who had at least one child less than 18 years of age. Participants completed a semi-structured interview and the Hospital Anxiety and Depression Scale (HADS). We used multiple linear regression to evaluate the association between extent of communication and HADS Anxiety and Depression scores. Interview data were analyzed using standard qualitative content and thematic techniques and triangulated with survey data.

Results

Higher HADS Anxiety scores, but not HADS Depression scores, were cross-sectionally associated with greater extent of parental communication (p = 0.003), even when controlling for performance status and children’s ages. In qualitative analyses, parents who acknowledged the terminal nature of their illness or experienced higher symptom burden were more likely to report that they also communicated more extensively with children. A third of parents (n = 14, 33%) described difficulty with illness-related communication with their children.

Conclusions

In this pilot study, parents with advanced cancer who reported more illness-related communication with their children also reported more symptoms of general anxiety. Future interventions should address psychological distress relevant to parenting and further assess how parental communication may be linked to parental mood symptoms.

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Acknowledgements

The authors wish to gratefully acknowledge the patients who participated in this study and who gave their time to share their experiences. We also thank Sarah Frances Nemeroff, Alonso Saldana, and Marcia Alvarez for their assistance with subject recruitment and Paul Mihas, MA, for his assistance with interview guide development.

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Authors and Affiliations

  1. School of Medicine, University of North Carolina, Chapel Hill, NC, USA

    Claire E. Hailey

  2. Comer Children’s Hospital, University of Chicago Medicine, 5721 S. Maryland Avenue, MC 8000, Chicago, IL, 60637, USA

    Claire E. Hailey

  3. Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA

    Justin M. Yopp, Gili Grunfeld, Donald L. Rosenstein & Eliza M. Park

  4. Biostatistics Core Facility, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA

    Allison M. Deal

  5. School of Nursing, University of North Carolina, Chapel Hill, NC, USA

    Deborah K. Mayer

  6. Division of Geriatrics, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA

    Laura C. Hanson

  7. Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA

    Donald L. Rosenstein

Authors
  1. Claire E. Hailey
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  2. Justin M. Yopp
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  3. Allison M. Deal
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  4. Deborah K. Mayer
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  5. Laura C. Hanson
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  6. Gili Grunfeld
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  7. Donald L. Rosenstein
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  8. Eliza M. Park
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Corresponding author

Correspondence to Claire E. Hailey.

Ethics declarations

The UNC Institutional Review Board reviewed and approved the study.

Conflict of interest

The authors declare that there is no conflict of interest.

Funding

This work was supported by the North Carolina University Cancer Research Fund, the Doris Duke Charitable Foundation (Grant 2015213), the National Center for Advancing Translational Sciences (NCATS), and National Institutes of Health, through Grant Award Numbers 1UL1TR001111 and 1KL2TR001109 to Dr. Park.

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Hailey, C.E., Yopp, J.M., Deal, A.M. et al. Communication with children about a parent’s advanced cancer and measures of parental anxiety and depression: a cross-sectional mixed-methods study. Support Care Cancer 26, 287–295 (2018). https://doi.org/10.1007/s00520-017-3847-9

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  • DOI: https://doi.org/10.1007/s00520-017-3847-9

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