Annemieke Visser

Psychosocial consequences for children of a parent with cancer: A pilot study

When cancer is diagnosed in a parent, this may also have consequences for the children. The purpose of this pilot study was to gain more insight into the psychosocial consequences for children of a parent with cancer, from the perspective of both the children and their parents. For this study, 14 families participated in semistructured interviews and completed standardized questionnaires. Interviews were tape-recorded, transcribed, and analyzed using content analysis techniques. No significant difference was found in behavioral and emotional problems between the children in these families and the normative sample. However, parents reported problems on a borderline and clinically elevated level in one third of the children, and three of seven children self-reported problems on these levels. The interview results showed that parents reported (temporary) behavioral problems in most children during the acute stage of their parents’ illness. Other problems, such as anxiety, sleeping disorders, and compulsive behavior, persisted for longer. Parents reported that their children had more problems than the children themselves reported. This finding was not supported by the quantitative analysis. The results from the Child Behavior Checklist and the Dutch version of the Family Adaptability and Cohesion Evaluation Scales showed that children of families with poor family functioning were more vulnerable. In particular, extremely high adaptation (chaotic) and extremely low family cohesion (disengaged) seemed related to the prevalence of emotional and behavioral problems in these children. Absence of home healthcare was an additional burden for adolescent children.

Parental cancer - Characteristics of parents as predictors for child functioning

The vulnerability of children when a parent is diagnosed with cancer may depend on a variety of variables. The current study examined the impact of characteristics of 180 parents diagnosed with cancer, along with 145 spouses, on the prevalence of emotional and behavioral problems in children.

Emotional and behavioral problems in children of parents recently diagnosed with cancer: A longitudinal study

This study examines the prevalence of problems in children within four months after a parents cancer diagnosis (T1) and six (T2) and twelve months (T3) afterwards. Sixty-nine ill parents and 57 spouses completed the Child Behavior Checklist for 57 primary school (aged 4–11 years) and 66 adolescent children (aged 12–18 years). Adolescents completed the self-report version. Childrens functioning was compared to that of the norm group and a sample of families that were confronted with parental cancer between one to five years before study participation (retrospective study). Most children were reported as having a similar level as or fewer problems than was reported in the norm and retrospective studies. Reported problems decreased with time, but children who initially had more problems remained vulnerable during the year. Fathers and mothers highly agree in their perception of childrens behavior, with the exception of adolescent daughters’ behavior. Agreement between mothers and adolescent daughters was high, whereas agreement between fathers and adolescent sons and daughters, and mothers and adolescent sons was low to moderate. The outcomes suggest that most children do not experience problems shortly after the parents diagnosis and were functioning over time on a level equal to or better than that of their peers. Differences in informants perceptions appear and remain of interest.

Psychological impact of having a parent with cancer.

The diagnosis of cancer has a great impact on many aspects of the patient’s and other family members’ lives. It may cause substantial distress in the whole family system and especially in minor children as they are dependent on the care and custody of their parents. Children may experience a sequence of stress periods, beginning from the initial diagnosis of cancer and continuing throughout medical treatment to recovery. Many children face the continuous threat of the death of their parent. As cancer becomes more and more a chronic issue, parental cancer may have long-term negative consequences for children [1]. A confrontation with cancer in a parent may thus lead to temporary and long-lasting changes in their lives, and children have to adapt to these changes. A recent population-based study in the USA estimated that 2.85 million children younger than 18 years live with a parent diagnosed with cancer. Furthermore, more than half a million children has a parent who is about to start cancer treatment or in recovery [2]. These high numbers of children confronted with parental cancer constitute a reason for gaining evidence on the psychosocial consequences of such a stressful event and to identify which children are more vulnerable. This evidence can be used to develop guidance for parents and/or healthcare providers in order to minimise the distress. Since 2000 the amount of studies published on the impact of parental cancer on children and their families has increased markedly. This paper will provide a narrative overview of the most important findings of systematic reviews and other key papers published during the last decade with regard to the psychosocial impact of parental cancer on school-aged children and adolescents, and the factors that mediate or moderate this impact. Intervention studies and studies focussing on the bereavement of the children of cancer patients are outside the scope of this overview. The theoretical model of children’s adjustment to parental cancer from Su and Ryan-Wenger [3] will serve as a basis for the presentation of the results. Their stress-coping model is based on a synthesis of the literature, and specifies the relationships between the stressor of having a parent with cancer, moderator and mediator variables, and child functioning. Outcomes may serve as a guideline for the support of families in this situation and future research. This paper will first address the psychosocial impact of parental cancer on schoolaged children and adolescents. Second, significant moderating and mediating variables related to child functioning in this situation will be described. Third, overall conclusions and implications for healthcare providers will be discussed.

Temperament as a predictor of internalising and externalising problems in adolescent children of parents diagnosed with cancer.

ObjectiveThis study examined the relationship between temperament and internalising and externalising problems among children of parents diagnosed with cancer, beyond the effects of socio-demographics, illness-related variables and life events.Materials and methodsThree hundred and forty adolescent children and their 212 parents diagnosed with cancer participated. Children and parents completed the Youth Self Report and the Child Behaviour Checklist, respectively. Children completed also the Early Adolescent Temperament Questionnaire.Main resultsDaughters of parents with cancer were reported as having more internalising problems than their counterparts did. Prevalence of problems did not depend on children’s and parents’ age or educational level. Recurrent disease and number of life events experienced by children and parents affected the problems reported. The most important temperament dimensions in the prediction of internalising problems in children were shyness and fear/worry, to a lesser extent, frustration and perceptual sensitivity (children only) and lower scores on pleasure intensity (parents only). Externalising problems were associated with effortful control and in children’s reports with frustration. Temperament seemed to be a more important predictor of problems reported by children than parents.ConclusionFindings suggest that temperament is useful in determining the relative vulnerability of children of parents who have been diagnosed with cancer. Social workers may help parents to recognise individual differences between children and to support children by using techniques that are compatible with the temperament of children.

Exploration of the difference in incidence of renal replacement therapy between Flanders and the Netherlands--investigation of explanatory variables.

AIM This study investigates the difference in the incidence of renal replacement therapy (RRT) between Flanders and the Netherlands and possible explanations for this difference. METHODS End-stage renal disease incidence data were obtained from the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA). Additional sources were the National Institute of Statistics (NIS), the Central Bureau of Statistics (CBS), the Organisation for Economic Cooperation and Development (OECD) health data and the WHO Health For All database (WHO-HFA). RESULTS There is remarkable difference in incidence rate of RRT between Flanders and the Netherlands, with a higher rate in Flanders. This difference is already present in patients aged 45-64 years and increases with age, being >2-fold higher in subjects of ≥ 75 years. With respect to the renal diagnoses leading to need for RRT, a higher share of especially diabetes mellitus type 2 and renovascular disease was observed in Flanders. Remarkably, the difference in incidence rate of RRT is not associated with a difference in survival on RRT, not even in the elderly, arguing against a restricted access to RRT in the Netherlands. In the general population, the expected number of healthy life years at birth is lower in Belgium than in the Netherlands, and in Belgium, the hospital discharge rates for diabetes, acute myocardial infarction and cerebrovascular accident and the number of coronary bypass procedures and percutaneous coronary interventions per capitum is higher, as is the prevalence of obesity. CONCLUSION Our data do not support the assumption that the differences in RRT incidence in the elderly between Flanders and the Netherlands are due to a more restricted access to RRT in the Netherlands but may be due to differences in underlying comorbidity and life style between the two populations.

Distinct Trajectories of Positive and Negative Affect After Colorectal Cancer Diagnosis

Objective: Insight into trajectories of positive affect (PA) and negative affect (NA) across the cancer continuum may improve understanding of the nature of adjustment problems. The primary aim of this study was to identify subgroups of patients with distinct trajectories of PA and NA following diagnosis of colorectal cancer (CRC). Secondary to this aim, the co-occurrence between trajectories and their association with goal-related processes was explored. Method: CRC patients (n = 186) completed questionnaires within 1 month, 7 months, and 18 months after diagnosis. Multilevel models were used to study the trajectory of PA and NA, as measured with the Positive and Negative Affect Schedule (PANAS). Results: Four classes with distinct PA trajectories were identified: low (18.8%), increasing (6.7%), moderate (68.2%), and high (6.3%); 2 trajectories of NA emerged: low (36.3%) and moderate (63.7%). There was no significant association between PA and NA trajectory class probabilities. The average trajectory of PA covaried with levels of goal disturbance and goal reengagement over time, while the average NA trajectory covaried with goal disturbance and goal disengagement. Conclusions: Compared with the general population, our sample of cancer patients suffered from a lack of positive emotions, but not a high presence of negative emotions. About one fifth of patients reported low PA up to 18 months after diagnosis and may benefit from supportive care. Furthermore, the trajectory of PA was independent of that of NA and related with a distinct goal adjustment process (i.e., goal disengagement vs. goal reengagement). This finding indicates the need to tailor psychological care to the nature of the adjustment problem.

Impaired Mood in Headache Clinic Patients: Associations With the Perceived Hindrance and Attainability of Personal Goals

Headache disorders are often accompanied by impaired mood, especially in the headache clinic population. There is a large body of literature demonstrating that an illness or disability may affect the way in which patients perceive their personal goals and that the perception that the attainability of goals is hindered by the illness is a risk factor for impaired mood. However, empirical evidence regarding the extent to which goals are hindered or less attainable as a result of a headache disorder, and how that is related to mood, is currently lacking.

Living with chronic headache: a qualitative study exploring goal management in chronic headache

Abstract Objectives: Effective goal management may potentially prevent or reduce disability in chronic pain. The aim of this study was to gain insight into the nature of goal management in the context of chronic headache (CH). Methods: Interviews with 20 patients were conducted, coded, and analyzed using a combined data-driven and theory-driven approach. The dual process model (DPM) was used as a theoretical framework for this study. Results: Participants used a combination of strategies to regain and maintain a balance between personal goals and resources available for goal pursuit. Furthermore, their retrospective reports indicated a development in strategy use of time. Three goal management phases were identified: (1) a “persistence phase,” characterized by the use of “resource-depleting” assimilative strategies to remain engaged in goals, (2) a “reorientation phase” in accommodative strategies were used to regain balance, and (3) a “balancing phase” in which a combination of “resource-depleting” and “resource-replenishing” assimilative strategies was used to maintain balance. Conclusions: Goal management is a dynamic process that may contribute to the development of, and recovery from, headache-related disability. Rehabilitation services offered to individuals with CH should target this process to promote optimal functioning. Implications for Rehabilitation Individuals with chronic headache use assimilative and accommodative goal management strategies to be able to pursue personal goals despite the limitations of chronic headache. Before accommodating goals to the limitations of chronic headache, many patients go through a phase of persistence, characterized by the use of resource-depleting assimilative strategies. A reorientation phase, characterized by accommodation of goals to the limitations of chronic headache, allows patients to adopt a more balanced way of pursuing personal goals.

Studying learning in the healthcare setting: the potential of quantitative diary methods

Quantitative diary methods are longitudinal approaches that involve the repeated measurement of aspects of peoples’ experience of daily life. In this article, we outline the main characteristics and applications of quantitative diary methods and discuss how their use may further research in the field of medical education. Quantitative diary methods offer several methodological advantages, such as measuring aspects of learning with great detail, accuracy and authenticity. Moreover, they enable researchers to study how and under which conditions learning in the health care setting occurs and in which way learning can be promoted. Hence, quantitative diary methods may contribute to theory development and the optimization of teaching methods in medical education.