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Purpose:

In-depth exploration of how the couple relationship is affected by parental cancer in couples with dependent children.

Methods:

Semi-structured interviews were carried out with a convenience sample of 17 parents with cancer who were in a couple relationship and had children aged 18 years or younger. Data were analysed using qualitative content analysis.

Results:

The content analysis resulted in three categories representing areas in the couple relationship that had changed following the cancer diagnosis: Altered communication; Adapting to new roles; and A change in sex life, intimacy and fertility. The results illustrate a significant increase in the need for constructive communication when couples face a range of emotionally-charged topics that were made difficult to talk about due to the children being present. The results also showed that the experience of cancer had forced couples to adapt to new roles in their relationship, and in the family, in order to manage the complex practical issues of simultaneously being parents and dealing with cancer. Lastly, both physical and psychological aspects of cancer had affected the couples' sex life, intimacy and fertility including decreased sexual engagement and changed conditions impacting family planning.

Conclusions:

Results highlight the specific areas that are challenging for couples facing cancer who are parents of dependent children. Couples may need support to cope with these challenges due to the complexity of parenthood when managing cancer as a couple.

Background: Breast cancer is the most common cancer diagnosis among women in Sweden, and 20% of cases are women younger than 50 years. For many of these women, the diagnosis occurs during a period of active parenting, when they are responsible for the emotional and practical care of young children. This dual burden, coping with a life-threatening illness while maintaining a caregiving role, can lead to increased emotional strain, altered family dynamics and challenges in communication and support. The aim of this qualitative study was to explore the parenting experiences of women with breast cancer who have minor children, focusing on challenges, needs and interactions with the healthcare services

Methods: A self-selected sample of 131 mothers, living in Sweden, aged 25-60 years, who were diagnosed within the past five years participated. Participants were recruited via social media, patient organizations and oncology clinics. An online questionnaire was used to collect data between January and May 2023, which consisted of, among other things, sociodemographic information and an open-ended question about parenthood. The responses to the open-ended question were analysed using conventional content analysis.

Results: The analysis resulted in five categories: a significant impact on mothering and an increased emotional burden; challenges in communication within the family; a broad range of experiences of healthcare support from significantly lacking to positive experiences; the need for emotional and practical support from family, partners, relatives and school and the emotional and social impact on the children.

Conclusion: The findings highlight that there is a clear need for more accessible and structured support from the healthcare services to address the unique needs of mothers with breast cancer and their children, ensuring better communication, psychosocial care and practical assistance throughout the illness trajectory.

Many adults diagnosed with cancer are parents of dependent children. Balancing the roles of a patient and a parent is a stressor, with parenting concerns linked to elevated psychological distress. Despite this, the psychosocial support needs of parents with cancer are oftentimes not met. Addressing these gaps in support is essential to promote the psychological well-being of both parents and their families.

The overall aim of this thesis was to explore parenting concerns, challenges, and psychological distress among parents with cancer, assess psychosocial support needs, and evaluate the feasibility of a psychological intervention for parents. First, a systematic review was conducted to identify existing psychosocial interventions for parents with cancer (study I). Then, parents’ experiences and challenges in relation to cancer was explored in interviews (study II), and a cross-sectional survey examined levels of psychological distress and associated factors, including parenting concerns, self-efficacy, and emotion regulation (study III). A psychometric evaluation assessed the Swedish version of the Parenting Concerns Questionnaire (PCQ, study IV), and finally, a pilot study of online affect-focused psychodynamic psychotherapy for parents explored its feasibility, acceptability, safety and preliminary effects (study V).

The findings show that parenting concerns are central in parents’ lives. Study I identified 22 psychosocial interventions, some of which were promising but most were not formally evaluated. Study II highlighted the difficulties being both a parent and a patient, and how cancer impacted parenting and roles in the family. Parenting could serve as a source of stress or resilience. In study III, one in three parents reported symptoms above cut-off for depression, anxiety, or stress, and 16% experienced all three. Higher parenting concerns, low self-efficacy, and maladaptive emotion regulation were associated with increased psychological distress. Study IV assessed the Parenting Concerns Questionnaire (PCQ) as valid and reliable overall. In study V, affect-focused psychodynamic psychotherapy (AFT) was experienced as feasible, relevant, and beneficial in reducing psychological distress.

This thesis underscores that parenting with cancer reflects a complex interplay of individual, relational, and structural factors, highlighting the need for holistic psychosocial support that acknowledges parents not only as patients but as part of a family.

Background Parents given a diagnosis of cancer must balance the demands of their illness and caregiving responsibilities. This can result in parental stress and have a negative impact on the well-being of the whole family. A greater understanding of the experiences of parents with cancer is necessary to provide adequate support.

Objective The aim of this study was to explore parenting concerns and challenges among parents with cancer who were caring for dependent children younger than 18 years.

Methods Semistructured interviews were carried out with 22 parents with cancer. Interviews were audio-recorded, transcribed, and analyzed using thematic analysis.

Results Parental concerns and challenges affected parents in their parental role and their everyday family life. Three overarching themes described the struggles in balancing life as a parent and as a patient: navigating dual roles as a parent with cancer, impact of cancer on parenting, and impact on family life. Parents’ primary focus was on their children’s well-being, and they struggled to manage their own expectations of parenting and the demands on their role in the family.

Conclusion The results highlight the complexity of being a parent with cancer while caring for dependent children. To support parents during the cancer journey, it is important to understand the consequences of their illness on their parental role and the family.

Implications for Practice Supporting parents to feel secure in their parental role and providing support to them during their cancer journey should be integrated into routine cancer care, where parenting concerns and challenges are addressed.

Background and purpose: As many as one in four adults with cancer have children under 18 years. Balancing parenting and cancer is challenging and can be a source of psychological distress. This study aimed to examine psychological distress in parents with cancer and its associations with parenting concerns, self -efficacy, and emotion regulation.

Materials and methods: This was a cross-sectional questionnaire study of 406 parents (aged 25-60 years) diagnosed with cancer within the last 5 years, with at least one dependent child (<= 18 years). Parents completed questionnaires on psychological distress (DASS-21), parenting concerns (PCQ), self -efficacy (GSE), emotion regulation (ERQ), mental and physical health, and sociodemographics. Data were analysed using multiple logistic regressions on depression (yes/no), anxiety (yes/no), and stress (yes/no).

Results: Higher parenting concerns were associated with greater odds of depression (OR = 2.33, 95% CI: 1.64-3.31), anxiety (OR = 2.30, 95% CI: 1.64-3.20), and stress (OR = 3.21, 95% CI: 2.20-4.69) when adjusting for health and sociodemographic factors. Poorer self -efficacy was associated with increased odds of anxiety (OR = 0.94, 95% CI: 0.89-0.99, p < 0.05), whereas lower use of cognitive reappraisal and higher use of expressive suppression increased the odds of depression (OR = 0.76, 95% CI: 0.59-0.98 | OR = 1.46, 95% CI: 1.18-1.80).

Interpretation: The findings highlight the complexity of parental well-being in relation to parenthood and cancer, stressing the need for interventions that address relevant psychological factors to improve overall mental health in this population.

Background and purpose: Parenting concerns can be a major source of distress for patients with cancer who are parents of dependent children; however, these are often not addressed in health care. The Parenting Concerns Questionnaire (PCQ) is an instrument designed to assess parents' worries about the impact of cancer on their children and their ability to parent during this time. The Swedish version of the PCQ has, however, not been evaluated. This study therefore aimed to examine the psychometric properties of the PCQ in a sample of Swedish parents with cancer.

Material and methods: A sample of 336 patients with cancer having dependent children (<= 18 years) were included in a cross-sectional web-based survey. Participants completed questionnaires assessing parenting concerns, depression, anxiety, and stress symptoms (DASS); self-efficacy, family functioning (FAD-GF); and sociodemographic and clinical characteristics. Descriptive analyses, as well as reliability and validity analyses, were conducted followed by a confirmatory factor analysis of the factor structure proposed by the authors of the original version of the PCQ.

Results: The majority were mothers (94.9%) with breast cancer (66.4%) aged 40-50 years (59.5%). The results showed evidence for convergent, criterion, and known group's validity, but the original three-factor structure of the PCQ was not fully supported by confirmatory factor analysis.

Interpretation: Evaluating parenting concerns may be an important step towards identifying patients who could benefit from targeted psychosocial interventions. However, the PCQ may require some further refinement to fully capture the breadth of parenting concerns in parents with cancer in different settings.

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.

BACKGROUND: Mental illness in children and youths has become an increasing problem. School-based mental health services (SBMHS) are an attempt to increase accessibility to mental health services. The effects of these services seem positive, with some mixed results. To date, little is known about the implementation process of SBMHS. Therefore, this scoping review synthesizes the literature on factors that affect the implementation of SBMHS.

METHODS: A scoping review based on four stages: (a) identifying relevant studies; (b) study selection; (c) charting the data; and (d) collating, summarizing, and reporting the results was performed. From the searches (4414 citations), 360 were include in the full-text screen and 38 in the review.

RESULTS: Implementation-related factors were found in all five domains of the Consolidated Framework for Implementation Research. However, certain subfactors were mentioned more often (e.g., the adaptability of the programs, communication, or engagement of key stakeholders).

CONCLUSIONS: Even though SBMHS differed in their goals and way they were conducted, certain common implementation factors were highlighted more frequently. To minimize the challenges associated with these types of interventions, learning about the implementation of SBMHS and using this knowledge in practice when introducing SBMHS is essential to achieving the best possible effects with SMBHSs.

Background: Mothers diagnosed with cancer experience significant psychological distress, affecting both their own and their families’ well-being. Despite high support needs, easily accessed psychological support remains limited. Affect-focused psychodynamic psychotherapy (AFT) has been shown effective in improving psychological well-being but has not been studied in this population.

Purpose: To test the feasibility, acceptability, safety and preliminary effects of online delivered AFT among parents with cancer.

Methods: This feasibility study included qualitative interviews analysed with inductive content analysis to assess feasibility, acceptability and safety, and quantitative pre- and post-intervention assessments of changes in mental health outcomes using questionnaires. Primary outcomes were symptoms of depression and anxiety. Secondary outcomes were parenting concerns, emotion regulation, affect-phobia, self-efficacy, closeness in the family, and self-rated health.

Results: The qualitative findings highlighted key factors concerning the conditions of participation, the content of the intervention and the perceived effects. The quantitative results indicated improvements in depression, anxiety, as well as in all secondary outcomes but one subscale of emotion regulation.

Conclusions: Findings suggest that online delivered AFT is feasible, acceptable, and safe for mothers diagnosed with cancer, and promising in terms of improvement in several aspects of psychological function. 

Implications: Online delivered AFT may provide accessible and effective psychological support for mothers diagnosed with cancer, addressing an important gap in routine cancer care. To confirm efficacy and explore the long-term effects, randomised controlled trials with larger and more heterogeneous samples should be conducted. Further studies also need to explore factors related to optimising implementation in clinical settings.