Disrupted biographies and balancing identities: A qualitative study of cancer patients’ communication with healthcare professionals about dependent children

Abstract

Objective About 14% of cancer patients live with dependent children. Healthcare professionals are well placed to help patients support their children as part of a patient‐centred practice. Children tend to appreciate open communication during the course of illness, but patients often find this difficult. However, research is unclear about patients’ preferences and their willingness to talk with healthcare professionals about their dependent children. Methods We conducted 15 in‐depth interviews with patients from haematological (N = 11) and gynaecological oncology (N = 4). The interviews and subsequent analysis focused on patients’ communicative preferences, taking the theoretical framework of “biographical disruption” as a starting point and using Jenkins’ concept of identity as a social, relational and dynamic process. Results We identified two overall identities at stake for seriously ill patients with parental responsibility: “patient identity” and “parent identity.” As “patients,” patients were ambivalent about relating to their children, but as “parents” they wanted healthcare professionals to talk about their children. Conclusion In order to be patient‐centred, clinicians should, we suggest, acknowledge that patients have these conflicting perspectives and identities, which surface at various times and situations throughout their illness trajectories. Research is needed to further explore these findings in different illness groups and cultures.

The perceived effect of parental cancer on children still living at home: According to oncology health professionals

“…We also found it was common for HPs to have limited knowledge and experience with children and this was likely to affect their confidence to approach patients' children or have conversations with patients about their children. This supports earlier studies that found staff are encumbered by their lack of knowledge and expertise regarding children (Dencker et al, 2019;Grant, Sangha, Lister, & Wiseman, 2016;Turner et al, 2009) and require more education and experience to improve their confidence in supporting patients'…”

“…Patients wait for their oncologist or other team member to instigate discussion (Dencker et al, 2019), and children do not recognise hospitals as a place to seek emotional support (Finch & Gibson, 2009).…”

“…Health professionals (HPs) within clinical settings are well positioned to identify and provide psychosocial support to patients’ children (Dencker et al., 2019). However, HPs often avoid initiating discussion with patients regarding children, preferring their patient to raise the subject (Dencker et al., 2019; Turner et al., 2009).…”

“…Health professionals (HPs) within clinical settings are well positioned to identify and provide psychosocial support to patients’ children (Dencker et al., 2019). However, HPs often avoid initiating discussion with patients regarding children, preferring their patient to raise the subject (Dencker et al., 2019; Turner et al., 2009). Reported reasons include HPs not having the skills to support children and fears of making the situation worse (Arber & Odelius, 2018; Franklin, Arber, Reed, & Ream, 2019; Niemelä, Väisänen, Marshall, Hakko, & Räsänen, 2010).…”

“…Reported reasons include HPs not having the skills to support children and fears of making the situation worse (Arber & Odelius, 2018; Franklin, Arber, Reed, & Ream, 2019; Niemelä, Väisänen, Marshall, Hakko, & Räsänen, 2010). Patients wait for their oncologist or other team member to instigate discussion (Dencker et al., 2019), and children do not recognise hospitals as a place to seek emotional support (Finch & Gibson, 2009).…”