Justin M. Yopp

Parenting concerns, quality of life, and psychological distress in patients with advanced cancer

Parents with life‐limiting illness anticipate the loss of their parental role and the long‐term consequences of their illness on their children. The purpose of this study was to examine relationships between parenting concerns, quality of life (QOL), and symptoms of depression and anxiety in parents with advanced cancer who have dependent children.

Single fatherhood due to cancer.

Cancer is a leading cause of widowed fatherhood in the USA. Fathers whose spouses have died from cancer constitute a potentially vulnerable population as they adjust to their role as sole or primary caregiver while managing their own grief and that of their children. The importance of addressing the psychological needs of widowed fathers is underscored by data showing that fathers coping and emotional availability are closely tied to their bereaved childrens mental health. Surprisingly, scant attention has been given to the phenomenon of widowed fatherhood with virtually no clinical resources or research studies devoted to fathers who have lost their wives to cancer. This commentary highlights key challenges facing this underserved population of widowers and calls for development of research agendas and clinical interventions for single fathers due to cancer. Copyright

Parenting while living with advanced cancer: A qualitative study:

Background: Patients with advanced cancer who have dependent children are an important population with a life-limiting illness and high levels of psychological distress. Few studies have addressed the experience of being a parent with advanced cancer and their potential palliative needs. Aim: To describe the experience of living with advanced cancer as a parent, including illness experience, parental concerns, and treatment decision making and to explore whether these experiences differ by their functional status. Design: We conducted a cross-sectional, qualitative study using in-depth, semi-structured interviews. Data were analyzed using thematic content analysis. Setting and participants: A total of 42 participants with metastatic cancer and with at least one child under the age of 18 years were recruited from a comprehensive cancer center. 25 participants were rated as having high functional status (the Eastern Cooperative Oncology Group (ECOG) Performance Status Scale = 0–1) and 17 with low functional status (ECOG=2–4). Results: We identified four themes regarding the experience of being a parent with advanced cancer: (1) parental concerns about the impact of their illness and death on their children, (2) “missing out” and losses of parental role and responsibilities, (3) maintaining parental responsibilities despite life-limiting illness, and (4) parental identity influencing decision making about treatment. Parental functional status influenced not only physical responsibilities but also intensified parenting psychological concerns. Conclusion: Parents with metastatic cancer may have unique palliative care needs as they experience parenting concerns while managing the psychological and physical demands of advanced cancer.

Overlooked and underserved: Widowed fathers with dependent-age children

OBJECTIVE Widowed fathers and their children are at heightened risk for poor coping and maladaptive psychosocial outcomes. This exploratory study is the first to explicitly examine the psychological characteristics of this population of fathers. METHOD Some 259 fathers (mean age = 46.81; 90% Caucasian) with dependent-age children and whose wives had died from cancer within the previous five years completed a web-based survey that consisted of demographic questions, the Center for Epidemiologic Studies Depression Scale (CES-D), the Texas Inventory of Grief-Revised (TRIG-R), the Psychological Adaptation Scale (PAS), the Kansas Parental Satisfaction Scale (KPSS), and items assessing perceived parental efficacy. RESULTS Fathers were found to have elevated depressive (CES-D mean = 22.6) and grief (TRIG-R mean = 70.3) symptomatology, low adaptation (PAS mean = 3.2), and high levels of stress related to their parenting role. They reported being satisfied with their parenting (KPSS mean = 15.8) and having met their own parental expectations. Multivariate analyses revealed an association between fathers age and depression (p = <0.01), with younger fathers reporting greater depressive symptoms. Psychological adaptation was positively correlated with being in a romantic relationship (p = 0.02) and age of oldest child (p = 0.02). SIGNIFICANCE OF RESULTS The results of our exploratory study suggest that, while widowed fathers perceive themselves as meeting their parental responsibilities, it comes at a substantial psychological cost, with particularly high stress related to being a sole parent. These findings may help guide interventions for this neglected population and underscore the importance of developing targeted therapies and research protocols to address their needs.

End-of-life experiences of mothers with advanced cancer: perspectives of widowed fathers.

Objective Despite the importance of parenting-related responsibilities for adult patients with terminal illnesses who have dependent children, little is known about the psychological concerns of dying parents and their families at the end of life (EOL). The aim of this study was to elicit widowed fathers’ perspectives on how parental status may have influenced the EOL experiences of mothers with advanced cancer. Subjects 344 men identified themselves through an open-access educational website as widowed fathers who had lost a spouse to cancer and were raising dependent children. Methods Participants completed a web-based survey about their wifes EOL experience and cancer history, and their own depression (Center for Epidemiologic Studies Depression Scale, CES-D) and bereavement (Texas Revised Inventory of Grief, TRIG) symptoms. Descriptive statistics, Fishers exact tests, and linear regression modelling were used to evaluate relationships between variables. Results According to fathers, 38% of mothers had not said goodbye to their children before death and 26% were not at all ‘at peace with dying.’ Ninety per cent of widowed fathers reported that their spouse was worried about the strain on their children at the EOL. Fathers who reported clearer prognostic communication between wife and physician had lower CES-D and TRIG scores. Conclusions To improve EOL care for seriously ill patients and their families, we must understand the concerns of parents with dependent children. These data underscore the importance of parenting-related worries in this population and the need for additional clinical and research programmes devoted to addressing these issues.

An exploratory study of end-of-life prognostic communication needs as reported by widowed fathers due to cancer

Effective physician communication about prognosis is a critical aspect of quality care for families affected by terminal illness. This is particularly important for spousal caregivers of terminally ill parents of dependent children, who may have unique needs for communication about anticipated death. The objective of this study was to explore end‐of‐life prognostic communication experiences reported by bereaved fathers whose wives died from cancer.

Widowed parenting self-efficacy scale: A new measure

ABSTRACT The authors developed and tested a novel measure of parenting self-efficacy specifically for recently widowed parents of dependent-age children. They tested the scale among 244 recently widowed fathers via an open-access web survey. Exploratory factor analysis identified 3 factors: perception of meeting parenting expectations (α = .88), provision of effective discipline (α = .69), and sense of parental burden (α = .69). Scores on the new scale correlated positively with Kansas Parenting Satisfaction and Psychological Adaptation Scale scores, and negatively with CES-D (depression) and TRIG (grief) scale scores. The resulting 9-item Widowed Parenting Self Efficacy Scale is a promising measure for use in research and clinical settings.

How do parents with advanced cancer communicate with their children? A qualitative study.

241 Background: Parents with advanced or incurable cancer may struggle when communicating with their children about their illness. Most literature on family communication about cancer reflects the opinions of parents with early-stage cancer or the experiences of children. The life-limiting nature of incurable illness distinguishes the experiences of parents with advanced cancer. Therefore, the aim of this study was to describe how parents with advanced cancer communicated about their illness with their dependent children. METHODS We conducted semi-structured interviews with 46 patients with stage IV solid tumor malignancies who had at least one child under 18 years of age. Interviews addressed illness-related communication with children as well as other topics related to the experience of parenting with advanced cancer. Data were analyzed using thematic content analysis. RESULTS Parents usually sought to protect their children by limiting details about their illness or framing discussions in an optimistic manner. Age and developmental stage of children greatly influenced how parents communicated and what information was divulged. Disclosure about the life-limiting nature of their illness varied significantly. Parents identified several barriers to communication including childrens avoidance of discussion, personal difficulty accepting the terminal nature of their illness, uncertainty about prognosis, and concerns about how to communicate with their children. Despite these barriers, many parents had not received professional guidance to facilitate their communication. CONCLUSIONS Parents with advanced cancer reported a wide diversity in motivations and techniques in discussing their illness with their children. Despite the availability of child-focused communication resources, parents identified several barriers to illness-related communication with their children. Results from this study can provide guidance for clinicians to help patients overcome these challenges and to assist parents with the difficult task of communicating with children about their illness. Future research interventions to address communication barriers may lead to improved outcomes for patients and their families.