"It is today that counts, and today everything is fine": coping strategies utilized by parents of children treated for cancer who seek psychological support - a qualitative study

Abstract

Background: Childhood cancer treatment completion is a period of vulnerability for parents and is associated with depression, anxiety, restrictions on daily life, and negative socioeconomic consequences. Understanding what helpful and unhelpful coping strategies parents utilize to manage cancer-related distress and concerns may inform the development of tailored psychological support. However, coping strategies used by parents who seek psychological support related to their child's cancer are not well described. To address this gap, we conducted an embedded semi-structured interview study with parents enrolled into the feasibility study ENGAGE. The overall aim of ENGAGE was to examine the acceptability and feasibility of an internet-administered, guided, low intensity cognitive behavioral therapy based self-help intervention, EJDeR. Study aims were to: (1) describe coping strategies used by parents who seek psychological support after end of treatment to cope with cancer-related distress and concerns and (2) consider these coping strategies to inform ongoing adaptations to the EJDeR intervention, taking potential gender differences in coping and subsequent support needs into consideration.

Method: Seventy-three semi-structured interviews were conducted. Data was coded using inductive manifest content analysis and subsequently triangulated with a secondary theory-driven data analysis guided by the control-based model of coping.

Results: Parents used three primary control coping strategies: utilizing tools and techniques, striving for a healthy and balanced lifestyle, and seeking support. Parents used three secondary control coping strategies: accepting and refocusing, adapting to the situation with help from others, and distracting temporarily. Parents used one disengagement-focused coping strategy: avoiding and distancing.

Conclusions: Parents adopted both primary and secondary control coping strategies as well as disengagement-focused coping strategies in accordance with the control-based model of coping. Findings supported the choice of low intensity cognitive behavioral therapy techniques used in the EJDeR intervention to target behavioral and experiential avoidance (i.e., disengagement-focused coping). A need to emphasize the importance of seeking social support in future EJDeR adaptations was identified. Understanding coping strategies used by parents of children off treatment who seek psychological support may inform the development of other psychological interventions for the population.

Trial registration: ISRCTN57233429 ( https://doi.org/10.1186/ISRCTN57233429 ; registration date 19/04/2018).

Keywords: Cancer; Childhood cancer; Cognitive behavioral therapy; Coping strategies; Internet-administered intervention; Qualitative research.

Fig. 1

Illustration of control-based model of coping [25]

Fig. 2

Istration of the two-step data analysis procedure analysis. lluNote. The dotted blue and the solid blue arrows indicate the main direction of the analysis, with an increased level of abstraction moving from transcript to finalized categories