This research suggests that the way parents perceive formal care, namely as being more or less family-centered, may influence the burden they experience as caregivers of a child with cancer and, indirectly, their adaptation. These findings highlight the relevance of gaining greater understanding of the interaction between the family and the health-care systems in the context of pediatric cancer.

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The purpose of this study was to examine the direct and indirect links between the perception of family-centered care (FCC) and psychological well-being via the perceived self-efficacy of parents of children with cancer. This study also sought to identify the potential moderators of these links (treatment status and patient age). This cross-sectional study was conducted at the pediatric oncology wards of two Portuguese public hospitals. The consecutive sample comprised 251 parents (87.6% mothers) of children/adolescents (8-20 years old) diagnosed with cancer. Participants completed self-report questionnaires measuring their perception of family-centered care (family-centered services and providing general information), perceived selfefficacy (regarding healthcare and parenting role) and psychological wellbeing. Results from the Structural Equation Modeling suggested that parents' perception of FCC was indirectly, but not directly, linked to psychological well-being via perceived self-efficacy. Multi-group analyses suggested that this mediation model was valid across treatment status (on vs. off-treatment) and patient age groups (children vs. adolescents). These findings highlighted that, through the implementation of FCC, healthcare professionals may promote parents' perceived self-efficacy and, consequently, their psychological well-being. Results also suggest that FCC may equally operate on parents' psychosocial functioning, regardless of treatment status or patient age. Overall, our findings reinforced the benefits of FCC practices in pediatric oncology wards.

This study aimed to examine the direct and indirect effects of hope on health-related quality of life (HRQoL) via anxiety of children/adolescents with cancer. We proposed to test if the mediation model was moderated by the child/adolescent's treatment status. The participants were 211 children/adolescents diagnosed with cancer, divided into two clinical groups according to treatment status: 97 patients on-treatment and 114 off-treatment. Self-reported questionnaires measured the youths' hope, anxiety, and HRQoL perceptions. The results revealed that children/adolescents on- and off-treatment only differed in levels of HRQoL, with a more compromised HRQoL found for the on-treatment group. Hope was positively associated with HRQoL, directly and indirectly via anxiety reduction. Moreover, only the association between anxiety and HRQoL was moderated by clinical group, revealing stronger associations for on-treatment patients. Findings highlight the importance of hope as a decisive resource in pediatric cancer adaptation, which may be strategically targeted in psycho-oncological interventions.

Purpose: This study aimed to describe parents' preferences regarding their role in treatment decision-making when a child has cancer and examines whether their preferences were related to the parents (sex and education level), patients' characteristics (age group and treatment status), and healthcare context features (parents' perception of family-centered care). Methods: Two-hundred and twenty-eight parents of children/adolescents with cancer were recruited from two Portuguese pediatric oncology wards. Participants provided sociodemographic and clinical information. The Control Preferences Scale for Pediatrics was used to assess the parents' preferred role in treatment decision-making. The Measure of Process of Care assessed the parents' perception of family-centered care (family-centered services and providing general information subscales). Results: Results showed that parents preferred a passive-collaborative role (44.8%), followed by collaborative (27.8%), passive (20.9%) and active-collaborative (6.5%). None preferred an active role. Chi-square test showed that most of the parents preferring an active-collaborative role had higher education degrees, while those preferring a passive role had lower education degrees. Additionally, groups did not differ according to the parents' sex, patients' age and treatment status. A multivariate analysis of variance showed that parents preferring an active-collaborative role reported lower scores on family-centered services compared to those preferring passive-collaborative and passive roles. Finally, no differences were found concerning providing general information scores. Conclusions: This study's findings may guide professionals in identifying parents' preferences regarding their participation in treatment decision-making process. Mapping their preferences may support professionals in promoting desirable levels of parental involvement when decisions are necessary in pediatric oncology context.