The Experience of Therapeutic Support Groups by Siblings of Children with Cancer

Margaretha Nolbris, PhDc, MSc, RN; Jonas Abrahamsson, MD, PhD; Anna-Lena Hellström, PhD, RN; Lisa Olofsson, MSc, RN; Karin Enskär, PhD, RN

Disclosures

Pediatr Nurs. 2010;36(6):298-304.

Background

Participation in a sibling group has been shown to decrease anxiety, depression (Barrera, 2000; Barrera, Chung, Greenberg, & Fleming, 2002; Houtzager, Grootenhuis, & Last, 2001), behavioral suppression, and fear of cancer (Barrera, 2000; Barrera et al., 2002). Going to a camp with other children who had a sick sibling was also a positive experience, as was interaction with a group of people of different ages in a similar situation (Adams & Deveau, 1987; Freeman, O'Dell, & Meola, 2003; Havermans & Eiser, 1994; Mahon & Page, 1995; McKeever, 1983; Murray, 1998, 2001, 2002; Nabors et al., 2004; Nolbris & Hellström 2005; Sidhu, Passmore, & Baker, 2006; Sloper 2000).

Social support is very important for the siblings and helps them talk about and deal with their situation (Barrera et al., 2002; Murray, 2001). Creed, Rufflin, and Ward (2001) showed a sibling camp was helpful in dealing with the grief during and after the sick child's treatment, even in cases when the sick child eventually died. The siblings felt they were able to express their emotions by showing their sadness, anger, or happiness in a way they could not do before. It is beneficial for siblings to discuss their recurring and painful thoughts on jealousy and unfairness (Kübler-Ross, 1997). When they meet others in the same situation, the siblings realize they are not alone in their loss. Other benefits of groups could be the opportunity to ask questions in a safe environment in which participants do not have to worry about annoying or hurting anyone. In a study of focus groups for parents, Sidhu et al. (2006) found parents also realized a camp gave siblings time and space for self-reconciliation.

Experiences from sibling support groups need to be investigated further from the siblings' point of view. The aim of the study was to describe the siblings' experiences of their involvement in a therapeutic support group when the family has or has had a child with cancer.

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Table 1. Presentation of the Participants and the Sick/Deceased Children or Adolescents
Participant (Group Number)	Sibling's Gender and Age at Interview (Years)	Age of Sick Brother or Sister (Years)	Time from Diagnosis to Interview (Years)	Diagnosis	Time since Death (Years)
1 (1)	M 13	18	4.2	Colon cancer	1.2
2 (1)	M 18	13	3.4	Lymphoma	2.0
3 (1)	F 18	22	5.2	ALL, BMT	2.1
4 (1)	F 19	19	11.7	ALL	2.11
5 (1)	M 14	21	4.2	ALL	3.4
6 (1)	F 11	21	4.2	ALL	3.4
7 (2)	F 13	10	1.2	Ewings-sarcoma
8 (2)	M 12	14	1.6	PNET, medulloblastoma
9 (2)	F 19	15	0.5	Lymphoma
10 (3)	F 10	3	0.9	Neuroblastoma
11 (3)	M 8	3	0.9	Neuroblastoma
12 (4)	F 15	9	0.8	ALL, BMT
13 (4)	F 12	9	0.8	ALL, BMT
14 (4)	F 11	4	0.7	AML
15 (4)	F 9	4	0.7	AML

Note: ALL = acute lymphoblastic leukemia; BMT = bone marrow transplantation; AML = acute myeloid leukemia; PNET = primitive neuroectodermal tumors.

Table 2. Evaluation Questions
What has the group given you? What have you given the group? How did you feel about having a leader direct the group? Do you think the moderator conducted the meetings well? How did you feel about writing down your expectations? How did it feel to present another participant in the group? How did it feel to show a picture of your sibling? What was it like to choose a picture from more than a 100 to capture a feeling or an experience? How did you like painting with watercolors? How did you feel when you were asked if there was anything from the last meeting that you would like to talk more about? How did you like talking about your experiences after each group interview? Did you miss anything? Is there something you want to add? Do you have any questions?

Table 3. Categories and Subcategories
Category	Subcategory
Belonging to a group	Talking about your situation.
	It helped to hear what others were feeling.
	Recognizing yourself in what others were saying.
	Finding the inner strength to carry on.
Important as a member of the group	Getting to know each other.
	Allowed to talk or remain quiet.
	It was an advantage that the group members were of different ages.
Therapeutic support helped siblings recall and understand their memories
	The tools used gave a form to the feeling and brought back memories.
	It was good to end the meetings with closure.
	It was good to continue the discussions from the previous meeting.

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