Resilience model for parents of children with cancer in mainland China-An exploratory study

Highlights

• What is already known about the topic?

• Approximately 40000 Children (0–15 years) in China had been diagnosed with cancer in 2015.

• When a child is diagnosed, parents will experience considerable emotional distress.

• One of those potential personality factors which could help parents cope with the traumatic event is resilience.

• What this paper adds?

• Report an exploratory evaluation of the Resilience Model in Parents of Children with Cancer (RMP-CC).

• Served as a guideline for the clinical interventions designed specifically to promote parents' resilience in Chinese context.

Abstract

Purpose

Parents have psychosocial functions that are critical for the entire family. Therefore, when their child is diagnosed with cancer, it is important that they exhibit resilience, which is the ability to preserve their emotional and physical well-being in the face of stress. The Resilience Model for Parents of Children with Cancer (RMP-CC) was developed to increase our understanding of how resilience is positively and negatively affected by protective and risk factors, respectively, in Chinese parents with children diagnosed with cancer.

Methods

To evaluate the RMP-CC, the latent psychosocial variables and demographics of 229 parents were evaluated using exploratory structural equation modeling (SEM) and logistic regression.

Results

The majority of goodness-of-fit indices indicate that the SEM of RMP-CC was a good model with a high level of variance in resilience (58%). Logistic regression revealed that two demographics, educational level and clinical classification of cancer, accounted for 12% of this variance.

Conclusions

Our results indicate that RMP-CC is an effective structure by which to develop mainland Chinese parent-focused interventions that are grounded in the experiences of the parents as caregivers of children who have been diagnosed with cancer. RMP-CC allows for a better understanding of what these parents experience while their children undergo treatment. Further studies will be needed to confirm the efficiency of the current structure, and would assist in further refinement of its clinical applications.

Introduction

Although cancer occurs less frequently in children than in adults, there were still approximately 40,000 children aged 0–15 years in China diagnosed with cancer in 2015 (Chen et al., 2015). Advances in therapeutics have increased the survival rate for many childhood cancers, however, these diseases are still second to only accidents as the cause of death in children aged 5–14 years (Chen et al., 2015). When a child is diagnosed with cancer, the entire family is dramatically affected both physically and psychologically. There is a huge burden placed on the shoulders of the parents in terms of cancer treatment. In addition, the parents experience the constant fear of losing their child, as well as other negative emotions, such as disbelief, depression, anxiety, hope and shock (Jones, 2006). Identifying factors that are potentially protective in parents of children with cancer will aid in tailoring interventions to improve their psychological well-being (Costain et al., 1993). One such factor that may help with coping is psychological resilience (Jacobsen and Wagner, 2012), which is the capacity to resist negative psychological responses when encountering a potentially traumatic circumstance. In 2001, the Committee on Future Directions for Behavioral Health and Social Science Research at the National Institutes of Health urged for an increase in research on factors with health benefits. Specifically, the Committee recommended investigations to advance knowledge on resilience in the face of adversity (Singer and Ryff, 2001) with a particular emphasis on studies on resources that positively influence resilience and quality of life. Since 2001, the resulting increase in research in this area has enhanced our understanding of resilience. This research has been primarily been through a systems perspective, examined through multilevel analysis, and focused on understanding the dynamics of how individuals adapt and change (Masten, 2007, Cicchetti and Blender, 2006, McAllister and McKinnon, 2009). Although it was initially thought of as a solely psychological variable, resilience has recently been shown to be a biological response that relies upon plasticity in the reward and fear circuits in the brain (Bergstrom, 2007, Feder et al., 2009). Along these lines, 11 possible neurological mediators of resilience in response to extreme stress have been identified to date (Charney, 2004). Model evaluation is a stepwise process of testing and refining alternative exploratory models (Bollen, 1989, Haase, 2004), and then using data from a different sample set to analyze and confirm the best-fitting exploratory model. The purpose of this article is to report (1) an exploratory evaluation of the Resilience Model for Parents of Children with Cancer (RMP-CC), and (2) the level of resilience and other psychosocial outcomes among parents of children with cancer. The goal is for this article to serve as a guideline for the development of clinical interventions designed specifically to promote the resilience of Chinese parents, where medical staffs can make adjustments to the RMP-CC according to setting or specialty, if necessary.