Background Posttraumatic growth (PTG), a positive change in values and major life goals experienced as a result of the struggle with a highly challenging life circumstance, has been shown to be related to the construct of hope, the belief that goals can be met. To date, no studies have examined the relationship between PTG and hope in parents of children with cancer. Procedure Participants were parents (N=85) of children and adolescents (ages 2–18 years, M = 7.72 years) receiving treatment for cancer. Parents completed a demographic questionnaire, the Posttraumatic Growth Inventory (PTGI), and Hope Scale (HS). Results Hope was found to be related to PTG in parents of children with cancer, with higher levels of hope associated with greater PTG. Exploratory analyses on the subscales of the PTGI revealed that hope was also related to higher scores on the Relating to Others, New Possibilities, Personal Strength, and Appreciation of Life subscales. Spiritual Change was not related to hope in parents. Conclusions Findings suggest that experiencing hope during the pediatric cancer experience may facilitate posttraumatic growth in parents. The construct of hope may be an important target of intervention for promoting positive adjustment in this population.

Ambiguity experienced by parents may be salient in the development of PTSS. Future research should examine these relationships longitudinally in larger samples to better understand adjustment in parents of children with cancer.

Psychosocial distress is a salient construct experienced by families of children with newly diagnosed cancer, but little is known about parental appraisal of the child's illness and the subsequent impact this may have on child and parent functioning. The goal of the present study was to examine the interrelationships among multiple parent illness appraisals, parent adjustment outcomes, and parent-reported child quality of life in parents of children diagnosed with cancer. Parents completed measures of illness appraisal (illness uncertainty and attitude toward illness), parent adjustment (general distress, posttraumatic stress, parenting stress), and child quality of life (general and cancer-related). Path analysis revealed direct effects for parent illness uncertainty and illness attitudes on all 3 measures of parent adjustment. Illness uncertainty, but not illness attitudes, demonstrated a direct effect on parent-reported child general quality of life; parenting stress had direct effects on general and cancer-related quality of life. Exploratory analyses indicated that parent illness uncertainty and illness attitudes conferred indirect effects on parent-reported general and cancer-related quality of life through parenting stress. Negative parent illness appraisals appear to have adverse impacts on parents' psychosocial functioning and have implications for the well-being of their child with cancer.

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Objective: The current study evaluated perceived barriers to care for parents of children with cancer and the mediating effect of illness uncertainty (IU; uncertainty from the ambiguity or unpredictability of the illness) on the relationship between barriers and parental psychological distress. We hypothesized that greater barriers to care would be related to higher levels of IU and, in turn, higher anxiety, depression, and posttraumatic stress symptom (PTSS) ratings.Methods: As part of an ongoing study of family adjustment to pediatric cancer, 145 caregivers of children diagnosed with cancer completed questionnaires assessing barriers to care, parent IU, and anxious symptoms, depressive symptoms, and PTSS. Time since cancer diagnosis ranged from 1 to 12 months.Results: Three mediation models assessed IU as a mediator between barriers to care and anxious symptoms, depressive symptoms, and PTSS, controlling for annual income. IU significantly mediated the relationship between barriers to care and depressive symptoms (B = -.03, SE = .02; 95% CI [-.08, -.01]) and to PTSS (B = -.15, SE = .10; 95% CI [-.38, -.03]). The mediation model was not significant for anxious symptoms.Conclusion: Experiencing barriers to obtaining treatment for their child with cancer is a significant risk factor for symptoms of depression and PTSS among parents.Specifically, greater barriers to care is significantly associated with IU, a wellestablished precursor to distress in this population. Interventions targeting IU may help ameliorate distress within the context of unmodifiable barriers to care.