Coping strategies used by parents of children with cancer in Shiraz, Southern Iran

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Article Information:


Group: 2007
Subgroup: Volume 9, Issue 3
Date: July 2007
Type: Original Article
Start Page: 124
End Page: 128

Authors:

  • F Hashemi
  • Instructor of Fatemeh College of Nursing and Midwifery,Shiraz University of Medical Sciences, Shiraz, Fars, Iran
  • Sh Razavi
  • Fatemeh College of Nursing and Midwifery, Shiraz, Fars, Iran
  • F Sharif
  • Fatemeh College of Nursing and Midwifery, Shiraz, Fars, Iran
  • MM Shahriari
  • Pediatric Oncology Department,Medical School,Shiraz University of Medical Sciences, Shiraz, Fars, Iran

      Correspondence:

      Affiliation: Instructor of Fatemeh College of Nursing and Midwifery,Shiraz University of Medical Sciences
      City, Province: Shiraz, Fars
      Country: Iran
      Tel: +9177142113, +98-711-6260598
      Fax: +98-711-6279134
      E-mail: hashemifa@hotmail.com

Abstract:


Background: The assessment of family coping patterns and resources will provide a further basis for helping family's adaptation. This study was undertaken to assess the coping strategies used by parents of children with cancer in Aliasghar Cancer Hospital affiliated to Shiraz University of Medical Sciences.

 

Methods: Data collection was conducted based upon Family Crisis Oriented Personal Evaluation Scale (F-COPES) including social and spiritual support, reframing, seeking help and passive appraisal. A total of 72 parents including 28 couples, 8 single mothers and 8 single fathers participated in this study.

 

Results: The spiritual support ranked the highest and the social help, the lowest strategies used by the parents. Seeking help, reframing and passive appraisal were the remaining strategies. Statistically significant differences were found between the age of participants and reframing and seeking help strategies. A significant difference was also observed between the level of parent’s education and reframing strategy but not between gender and coping strategies.

 

Conclusion: Familiarity with coping strategies and the method to use them could balance the emotional, psychological and social consequences of parents who have a child with cancer.

 

Keywords: Coping strategies; Parents; Children; Cancer; Iran

Manuscript Body:


Introduction

 

Cancer is still regarded as one of the most important diseases of man, although recent advances in the therapy of childhood cancer have increased the chances of long-term survival for many patients. Even with the hopeful prognosis that can be realistically given in most cases, the emotional impact of the diagnosis of cancer is extreme and long lasting.1 Childhood cancer is the second leading cause of death in children aged 1 to 14 years and the incidence of cancer in this age group was reported to be 129 per million children. The projected number of new cases and deaths in United States was estimated to be 8200 and 1600 per year respectively.2 Parents who have a child suffering from cancer face distress in regard to multiple hospitalizations, chemotherapy side effects (hair loss, nausea, vomiting and infections). They try to provide support for their child as he or she undergoes a variety of tests and procedures.3,4 Parents who have a child afflicted with cancer, would face distress and emotional problems, if they do not receive enough social and spiritual supports.5

Parent's views are thus helpful for planning services and highlighting areas of practice and administration in which improvement can be made.2 Coping is a vital concept in nursing and its strategies can influence the nature of adaptation of a family. A nurse can support the family by respecting them and serve as a support by making referrals, providing information about the illness or its management, allowing emotional expression by all family members, and by responding to the emotions when expressed. It is crucial for the nurse to take a long-term view of problems and not to expect all of them to be solved quickly.6 Kazak and Barakat (1997) reported that children and families, who were well adapted to diagnosis and treatment, would cope better with the stressors. Family coping strategies must be broad enough to include resources which are helpful in coping with not only diagnosis, but also concurrent stressors, over which family members may have little or no control, as well as chronic uncertainly. Therefore, interpretation of the action of a family using the knowledge of both coping and family development may provide clues for children's nurses about the level of disruption caused to individual families.7 In a study on 40 families, only 12% showed adaptation while at least one family member needed psychological support, indicating to the fact that early adaptation affects long term adaptation.8 In another study on 50 families, 98% of them believed they needed psychological support.9 Brett and Davis (1988) indicated to the need of psychological and spiritual support of parents who have a child suffering from cancer.10 To cope with these problems and to have a good nursing service, assessing of coping strategies in parents seems essential.11,12 This study was performed to assess the coping strategies used by parents of children with cancer in Shiraz Southern Iran.

 

 

Materials and Methods

 

From August 2001 to August 2003, 72 parents comprise 28 couples, 8 single mothers and 8 single fathers who had children suffering from leukemia or lymphoma, referred to Aliasghar Hospital, affiliated to Shiraz University of Medical Sciences, participated in present study. Data collection and scoring were carried out according to Bomar (1996).13 The study population was determined using available simple random sampling method with a confidence interval of 95%. The inclusion criteria were duration of diagnosis for at least 6 months, absence of any other diseases except leukemia and lymphoma with both parents being alive without any history of divorce, and the supervision of children under treatment by an oncologist. Data were recorded in a questionnaire divided into two parts. The first part covered demographic information including age, gender, birth order, residential area, family size, time of hospitalization, last hospitalization date, the level of education, occupation and income of parents. The second part consisted of the translated version of English Standard Questionnaire into Persian, prepared in the Department of Psychiatry of Shiraz Medical School, to assess coping strategies used by our units. The questionnaire of the Family Crisis Oriented Personal Evaluation Scale (F-Copes)13-17 was used to divide the coping patterns into five subdivisions of social support, spiritual help, reframing, seeking help and passive appraisal.

F-Copes measured family coping behavior. The subscales of the instrument integrated the perception of stressors within the system and use of resources, both internal and external to the family system. The instrument also measured coping that involved direct action and the more palliative modes of coping. The subscales of the instrument measured the perception of stressors, the use of family resources, and the coping behaviors used by families. The internal coping strategies included the confidence of the family in active problem-solving methods as well as more passive methods such as reframing the family perspective or passive appraisal. The external strategies used by families consisted of using resources such as church or religion; the support of the extended family, friends, and neighbors; and the use of resources available through community organizations. Scoring the instrument was done by summing-up the numbers circled for items in each subscale, except for items 17, 26 and 28, which were reversed. The subscales were social support (1,2,5,8,10,16,20,25,29); reframing (3,7,11,13,15,19,22,24), spiritual support (14,23,27,30), mobilizing the family to acquire and accept help (4,6,9,21) and passive appraisal (12,17,26, 28). Data were statistically analyzed using Mann-Whitney U and Kruskal-Wallis statistical tests to evaluate the coping strategies in relation to demographic information. A P value of less than 0.05 was considered significant.

 

 

Results

 

The demographic information of parents presented in Table 1 shows that most parents aged between 30 to 39 years (41.7%), and comprised those with primary to high school education (69.4%), and housewives (41.7%). Table 2 shows that, 77.3% of children were male, 63.6% aged more than 6 years, 43.2% were the third sibling or more in the birth order, 63.6% had first time hospitalization, and 54.5% experienced the disease for less than 2 years. The results, as demonstrated in Table 3, showed that spiritual support surpassed all other strategies (=4.23±0.35), followed by seeking help (=3.90±0.37), reframing (=3.88±0.40), passive appraisal (=2.93±0.51) and social support (=2.84±0.67). Table 4 shows the coping strategies in relation to the duration from disease diagnosis. There was no statistically significant between children with less and more than 1 year duration. The strategies of reframing and seeking help were used significantly by 20-29 years old age group. There was a statistically significant relationship between age and reframing (p=0.045) and seeking help strategies (p=0.019), which showed coping strategies were used less frequently by older age parents. This difference regarding social and spiritual support and passive appraisal was not significant (Table 5). There was also a significant relationship between the level of education and reframing strategy, which showed a more frequent use of reframing strategies by those with higher education (p=0.040). However, no significant relationship was observed between level of education and other coping strategies (Table 6). Reframing and spiritual coping strategies were used mostly by fathers, whereas social support, seeking help and passive appraisal were used more frequently by mothers, but the difference was not statistically significant (Table 7).

 

 

Table 1: Demographic information of the parents participated in the study

Variable

No

%

Age (years)

 

 

Education

 

 

 

Occupation

 

 

Type of referral

 

 

Pregnancy plan

 

 

Residence

 

 

No. of

children

20-29

30-39

³ 40

Illiterate

Primary and

middle school

High school

University

Government

Business

Housewife

Single

Sometimes couple

Always couple

Determined

Undetermined

 

Urban

Rural

 

1

2

³ 3

17

30

25

10

25

25

 

12

26

16

30

11

27

34

65

7

 

19

25

 

4

11

29

23.6

41.7

34.7

13.9

34.7

34.7

 

16.7

36.1

22.2

41.7

15.3

37.5

47.2

90.3

9.7

 

43.2

56.8

 

9.1

25

65.9





 

 

Table 2: Demographic information of the children participated in the study

Variable

No

%

Sex

Male

34

77.3

Female

10

22.7

Age (years)

£ 6

16

36.4

> 6

28

63.6

Birth order

1

17

38.6

2

8

18.2

³ 3

19

43.2

Duration of diagnosis

<1 year

13

29.5

1-2 years

11

25

> 2 years

20

45.5

Hospitalization times

1

28

63.6

2

9

20.5

³ 3

7

15.9

Last hospitalization

< 1 year

21

47.7

1-2 years

12

27.3

> 2 years

11

 

25

Previous history of disease

Positive

Negative

26

46

36.1

63.9

 

 

Table 3: Mean of coping strategies (±SD) in Shiraz, Southern Iran, 2003

Coping strategies

 ±SD

Min

Max

Social support

2.84 ±0.67

1.5

4.1

Reframing

3.88±0.40

2.5

4.3

Spiritual support

4.23±0.35

2.0

4.5

Seeking help

3.90±0.37

2.5

4.5

Passive appraisal

2.93±0.51

2.0

4.5

 

 

Table 4: Coping strategies of families in relation to the duration of diagnosis 2003 

Coping strategies

 

Diagnosis duration

No.

Social

Support

 ±SD

Reframing

 

 ±SD

Spiritual

support

 ±SD

Seeking

help

 ±SD

Passive

appraisal

 ±SD

Less than 1 year

More than 1 year

Total

P.V

19

25

44

-

2.90±0.44

2.89±0.41

2.89±0.42

0.8

3.93±0.22

3.88±0.38

3.90±0.32

0.9

4.24±0.25

4.20±0.26

4.21±0.25

0.4

3.90±0.26

3.90±0.27

3.90±0.26

0.9

2.74±0.73

2.94±0.53

2.85±0.62

0.2

 

 

Table 5: Coping strategies in relation to age, 2003

Coping strategies

 

Age (year)

No.

Social support

 ±SD

Reframing

 

 ±SD

Spiritual
support

 ±SD

Seeking help

 ±SD

Passive
appraisal

 ±SD

20-29

30-39

40-49

17

30

25

3.02±0.62

2.86±0.73

2.70±0.63

4.07±0.15

3.83±0.39

3.82±0.49

4.25±0.27

4.21±0.41

4.21±0.33

4.08±0.18

3.82±0.47

3.87±0.29

2.85±0.60

2.99±0.55

2.92±0.38

Statistical test

d.f.=2

-

 

-

X2=2.422

P=0.297

X2=6.171

*P=0.045

X2=0.166

P=0.920

X2=7.907

*P=0.019

X2=1.340

P=0.511

 

 

Table 6: Coping strategies in relation to education, 2003

Coping strategies

 

Education

No.

Social
support

 ±SD

Reframing

 

 ±SD

Spiritual support

 ±SD

seeking help

 ±SD

Passive appraisal

 ±SD

Illiterate

Elementary and middle school

high school

University

10

25

25

12

3.23±0.66

2.76±0.75

2.68±0.60

3.05 ±0.52

3.68±0.53

3.90±0.39

3.86±0.40

4.07±0.16

4.20±0.23

4.15±0.49

4.30±0.22

4.21±0.28

3.65±0.67

3.93±0.32

3.94±0.23

3.98±0.33

2.95±0.61

2.99±0.48

2.85±0.44

2.98±0.62

Statistical test

d.f.=3

-

-

X2=5.696

P=0.127

X2=8.296

*P=0.040

X2=1.907

P=0.591

X2=4.23

P=0.237

X2=1.486

P=0.695

 

 

Table 7: Coping strategies in relation to gender, 2003

Coping strategies

Sex

No.

Social
support

 ±SD

Reframing

 

 ±SD

Spiritual support

 ±SD

Seeking help

 ±SD

Passive appraisal

 ±SD

Male

 

Female

 

 

36

 

36

2.78±0.63

 

2.82±0.72

 

3.91±0.39

 

3.85±0.40

 

 

4.22±0.41

 

4.21±0.27

 

 

3.88±0.28

 

3.92±0.44

 

 

2.93±0.40

 

2.94±0.60

 

 

Statistical test

 

-

 

-

Z=0.36

P=0.718

Z=1.145

P=0.252

Z=0.95

P=0.342

Z=1.040

P=0.298

Z=0.022

P=0.981

 

 

Discussion

 

Results of this study showed a higher spiritual support followed by seeking help, reframing, passive appraisal and social support. The religious conviction of Iranians is in accord with the results of present study. Yeh (2001) illustrated that expanding on the meaning of life and illness from perspective of spiritual belief, would help parents cope while caring for a child with cancer. Parents began to reconsider the meaning and the purpose of life through folk or religious beliefs.18 Barbarin (1985) showed that coping strategies are improved by seeking more information, concurrent with problem solving followed by efforts to restore emotional balance and religious beliefs19 (Table 3). Results of this study are similar to the findings of Fife et al. (1987), who showed that there was no significant difference between coping strategies and different and duration of diagnosis of the cancer.20

 

            In this study, reframing and seeking help, with respective P values of 0.045 and 0.019, were used more often in younger age parents, whereas reframing alone was followed more frequently by those with higher education (p=0.040). This demonstrated a more positive attitude in younger and more educated parents. Pradeep et al. (2004) showed that fathers mostly cope mostly through emotional withdrawal, whereas coping of mothers was facilitated by emotional release21 (Tables 5-7).

The chronic illness in children affected the psychological health of the parents whose coping strategies were variable.21 In another study it was demonstrate that parents used both emotion and problem-focused strategies for coping with their primary stressors.22 Thus, the foregoing coping strategies helped parents adapt themselves to the problems involved. Certain parents sought internal and external help and some others changed their attitudes and beliefs.23 Therefore, the adequate use of all strategies would help parents cope with their children's cancer more efficiently.

In conclusion, it is suggested that the parents of children afflicted with cancer should be encouraged to make use of and learn more about coping strategies. Necessary facilities should also be provided for implementation of these strategies.

 

 

Acknowledgement

 

The authors would like to thank the Office of Vice Chancellor for Research of Shiraz University of Medical Sciences for financial support of this study and Center for Development of Clinical Research of Nemazee Hospital for editorial and manuscript typing assistance.

 

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