Parental awareness of sibling adjustment: Perspectives of parents and siblings of children with cancer.

Abstract

Childhood cancer is a significant psychosocial stressor, and sibling adjustment ranges from resilience to clinically significant psychopathology. Siblings and parents often describe siblings' psychosocial functioning differently, which may reflect parental unawareness of siblings' adjustment to cancer and increase the risk for negative sibling outcomes. The present study characterizes siblings' and parents' perceptions of parents' awareness of siblings' psychosocial functioning and describes how family functioning influences parental awareness. Parents (N ϭ 13) and siblings (N ϭ 17, ages 8 -17) from 13 families completed in-depth qualitative interviews regarding siblings' psychosocial adjustment to cancer. Interviews were coded for dimensions of family functioning based on the McMaster Model and analyzed using applied thematic analysis. Families were stratified based on higher or lower levels of parental awareness (i.e., knowledge of the presence, severity, or content of siblings' cancer-related feelings). Themes related to communication, affective involvement, roles, problem-solving, and affective responsiveness influenced parental awareness. Parental awareness was hindered by siblings' reluctance to communicate their feelings to parents due to the messages they received about cancer (e.g., be positive/helpful), siblings' hesitancy to rely on parents for emotional support, and parents not consistently asking about siblings' emotions. Additionally, parents' cancer-related stress and family disruptions reduced parental focus on siblings and decreased parents' tolerance of siblings' negative emotions. Higher parental awareness was facilitated by closer relationships prediagnosis, consistent communication, and affective problem-solving in response to cancer-related changes. Findings provide a more comprehensive understanding of the family processes underlying parental awareness and inform best practices for sibling assessment and support.

Social support and siblings of children with cancer: A scoping review

“…Both found that when siblings perceive that parents are overwhelmed, they are less likely to ask for the support they need and put other family members' needs before their own. Higher parental awareness was found to be related to closer parent and sibling relationships prediagnosis, and parents' ability to problem solve to provide instrumental support, address sibling needs, and offer emotional support 37 …”

“…For example, when a child is diagnosed with cancer, the family turns their attention toward that child, resulting in less attention and support for siblings. Similarly, another study 37 used McMaster's model of family functioning, which assumes that individuals do not react in isolation but according to the organization and behavioral actions of those within their family. This study examined the ways in which stress among parents led to difficulties recognizing the support needs of siblings, and how siblings who sensed parental stress did not seek their support.…”

“…36 The family environment, specifically perceived low-levels of attention from parents, has been associated with higher rates of unmet support needs among siblings. 51 Two studies 37,57 found that a lack of awareness from parents regarding sibling needs impacted siblings' ability to have their needs met. Both found that when siblings perceive that parents are overwhelmed, they are less likely to ask for the support they need and put other family members' needs before their own.…”

“…Higher parental awareness was found to be related to closer parent and sibling relationships prediagnosis, and parents' ability to problem solve to provide instrumental support, address sibling needs, and offer emotional support. 37 One study looked at how the family members themselves support each other, 72 identifying that families flex their roles providing different types of support than they had previously in order to create a sense of strength and family cohesion. Some families reported difficulties discussing sensitive issues such as death or relapse causing reduced emotional support; however, companionship with family members seemed to alleviate this distress.…”

Are there young carers in oncology? A systematic review

“…Many studies in this review explored the emotional experience of living with a parent or a sibling with cancer, 8,9 including its impact on the family or on the children's lives. Cancer, like other illnesses, causes family upheaval and reorganization 71 . Indeed, one third of the included studies reported changes in the family, role shifts, and increased responsibilities for the children because of the cancer.…”