Abstract and Introduction
This integrative literature review examines the facilitators and barriers to open and clear parent-child communication in the context of childhood cancer (for this literature review, child refers to ages 0 to 19 years). The Resilience in Illness Model (Haase et al., 2017) was employed to organize the findings and link to resilience outcomes among children with cancer. In a search of three international databases (PubMed, CINAHL, and PsycINFO), 18 studies met inclusion criteria and were selected for review. The major barrier to open communication was the desire of parents and children to protect each other from the pain that shared knowledge and discussion of cancer treatment and risks may bring. In contrast, parents' desire to improve their relationship with their children worked as a facilitator. For children with cancer, the timing of communication, children's illness condition, and psychological status were critical factors in the decision to communicate. There was a noticeable absence of the child's voice, including adolescents, across the studies reviewed. To develop interventions to improve parent-child communication, an understanding of the perspectives of children is needed, along with perspectives from dyads of children and their parents. These studies will assist in the development of interventions focused on the positive results that come from engaging in open and clear parent-child communication in families of children with cancer.
Although childhood cancer encompasses a small portion of all annual cancer diagnoses in the United States (American Cancer Society, 2016), it is one of the leading life-threatening situations for children (Siegel, Miller, & Jemal, 2017), and the diagnosis of cancer may be a tragic experience for a family (Wiener, McConnell, Latella, & Ludi, 2013). Importantly, while the family is put in one of the most vulnerable positions when a child is diagnosed with cancer (Pai et al., 2007), the family is one of the most important coping resources for children undergoing life-threatening illnesses (Harris et al., 2009). In their studies on the development of the Resilience in Illness Model (RIM), Haase and colleagues (2017) found that the family environment has a profound impact on how children with cancer cope and develop resilience. The RIM highlights the many diverse factors in the family environment that support the communication between family members.
Family communication is defined as family members' ability to openly share their thoughts, feelings, and concerns (Haase, Kintner, Monahan, & Robb, 2014). Parent-child communication in the childhood cancer context is critical for sharing knowledge and perspectives regarding the cancer diagnosis, treatment decision-making, and prognosis, and to provide support by sharing their feelings and thoughts (Laursen, Coy, & Collins, 1998). Fostering open and clear communication among family members, especially between parents and children, is an integral part of quality pediatric cancer care (Jalmsell, Kontio, Stein, Henter, & Kreicbergs, 2015). Open and clear parent-child communication is also necessary to support a child's active involvement in decision-making and improve their quality of life throughout the cancer trajectory. When parents struggle to communicate with their children, those children may feel isolated, which can have a negative impact on their physiological and psychological well-being (Zebrack, Chesler, & Kaplan, 2010). If the child dies, parents may suffer from life-long regret over not talking openly about their thoughts and feelings, and encouraging their child to do so (Kreicbergs, Valdimarsdóttir, Onelöv, Henter, & Steineck, 2004).
However, aside from findings on the negative effects of failure to engage in family communication, little is known about how to support and encourage parent-child communication in the context of childhood cancer (Adduci et al., 2012). Therefore, the aim of this integrative review is to describe the state of knowledge on parent-child communication in the context of pediatric cancer and highlight gaps in knowledge. This integrative review focuses on the following questions: 1) What are the identified barriers to engaging in open and clear parent-child communication? and 2) What are the identified facilitators of engaging in open and clear parent-child communication? Given that the RIM (Haase et al., 2017) provides an empirically derived and tested model predicting the family environment as a protective resource to manage illness, we discuss the results of this review in the context of the key risk, protective, and outcome factors identified in the RIM: Illness-Related Distress, Defensive Coping, Spiritual Perspective, Social Integration, Family and Courageous Coping, and Hope-Derived Meaning (Leeman, Sandelowski, Havill, & Knafl, 2015).
Pediatr Nurs. 2019;45(3):129-141. © 2019 Jannetti Publications, Inc.