Family Cohesiveness: A Dying Concern for the Coparent in Families With Parents With Advanced Cancer With Dependent Children

Abstract

BackgroundDying concerns are thoughts expressed by a person diagnosed with a terminal illness or by an individual coping with the impending death of a loved one. Little is known about the dying concerns of parents with advanced cancer (PWACs) with dependent children, and even less is known about the dying concerns of the coparent. Understanding the PWACs’ dying concerns for the coparent can contribute to the overall health of the family when faced with the death of a loved one.ObjectiveThe aim of this pilot descriptive study was to explore the PWACs’ perspective of their dying concerns for their coparent.MethodsFour PWACs were recruited from 2 oncology inpatient units from an urban community hospital within the same hospital system. Semistructured interviews were conducted, audio-recorded, and transcribed with 4 participants. Data analysis used directed content analysis.ResultsParents with advanced cancer expressed concern about the repercussions of advanced cancer on family cohesiveness. Three subthemes within this general structure were “My Weakest Link,” “If I’m Not There, Where Do They Go?” and “Putting Up a Front.”ConclusionsParents with advanced cancer have concerns beyond their role as a parent could make a difference in the overall health of the PWACs, but also the family unit. The PWACs’ concerns are present but may be covered over by use of protective mechanisms to maintain family cohesiveness.Implications for PracticeUnderstanding dying concerns may enhance nurse-initiated communications between family members and healthcare providers to improve psychological distress and enhance family functioning.

Understanding Dying Concerns in Parents With Advanced Cancer With Dependent Children for Their Coparent

“…4,[6][7][8][9]17 Sex of the PWAC may impact this theme based on sex roles in the household and the sex of the children. Similar themes were noticed in Caparso and colleagues' 15 pilot study, where mothers expressed the "My Weakest Link" and "If I'm Not There, Where Do They Go?" in relation to the coparent (male).…”

“…Meaningfulness is the PWACs' feelings that the advanced cancer placed challenges in their family life but was worthy of investment of time and engagement to the family 15 . Based on the family type, meaningfulness differed.…”

“…Research on communication in families with a PWAC focuses on communicating with their dependent children about the cancer. 4,5,9,15 This study acknowledges the communication difficulties about the advanced cancer between patient and the coparent, specifically focused on end-of-life concerns.…”

“…All interviews were audio and video recorded using the online video-conferencing platform, Zoom (Zoom Video Communication, INC., San Jose, California). The interview guide was developed through a literature review, 1 2 authors' previous pilot study experience, 15 and use of the conceptual definitions from McCubbin and McCubbin's 12 theory of Family Resiliency: pileup of stressors, existing family type, and sense of coherence. 12 The model assumes that families are managing not only stressors related to cancer, but also stressors of family life 12 ; thus, a dying concern such as "Will the coparent be able to raise the children?"…”

“…Meaningfulness is the PWACs' feelings that the advanced cancer placed challenges in their family life but was worthy of investment of time and engagement to the family. 15 Based on the family type, meaningfulness differed. Two of the participants in the Discouraged and Conflict family type did not report any meaningful changes in their family because of the cancer diagnosis.…”