Family rituals when children have cancer: A qualitative study.

Family rituals serve important functions for families, especially at times of change and stress, such having a child diagnosed with cancer. No studies have investigated how family rituals may be impacted during pediatric cancer treatment. This qualitative study explored the impact of pediatric cancer and its treatment on family rituals. Semistructured interviews with 19 mothers of children with cancer, ages 8-17 years old, were conducted and analyzed using grounded theory strategies. The interviews revealed two main types of changes in rituals: Loss; and Transformation. The Loss of Family Rituals included two subcategories (Nonattendance at Ongoing Family Rituals, Disruption of Family Rituals). The Transformation of Family Rituals included three subcategories (Readjustment of Family Rituals, Creation of New Family Rituals, Reestablishing Old Family Rituals). Seven general functions of family rituals were identified (Celebrating, Family Cohesion, Family Communication, Respite, Sense of Predictability, Sense of Security, Rhythm of Life) and five illness-related functions (Grounding in Life, Hope, Marking the Course of Treatment, Sense of Normalcy, Treatment Adherence). Although pediatric cancer may compromise family rituals (nonattendance and/or disruption) and their functions, families develop adaptive strategies (readjustment, creation, and/or reestablish) to transform rituals and facilitate their potentially protective functions. Discussion of rituals can be integrated into interventions to optimize family interactions in the adverse context of pediatric cancer, via the readjustment of existing rituals, the creation of new ones and the reestablishing of old rituals. (PsycINFO Database Record

Parents' Romantic Attachment Predicts Family Ritual Meaning and Family Cohesion Among Parents and Their Children With Cancer.

Objective: Family functioning is associated with adaptation in pediatric illness. This study examines the role of parents' relationships (specifically romantic attachment) as a predictor of family ritual meaning and family cohesion for parents and their children with cancer. Methods: The dyads, 58 partnered Portuguese parents and their children in treatment, reported on family ritual meaning and family cohesion at Time 1 (T1) and after 6 months (T2). Parents also completed the questionnaire assessing romantic attachment at T1. Results: Parents' avoidant attachment, but not anxious attachment, predicted lower family ritual meaning and family cohesion after 6 months. T2 family ritual meaning mediated the relationship between T1 avoidant attachment and T2 family cohesion. Conclusions: Parents' avoidant attachment may have a negative effect on family functioning in parents and children. Clinical intervention to address avoidant attachment or/and to promote family ritual meaning may help strengthen family ties.

Family rituals, financial burden, and mothers' adjustment in pediatric cancer.

The financial burden of childhood cancer may contribute to the distress that parents experience during and after treatment. Inconsistent relationships between financial burden and parental psychological distress highlight the need to identify psychosocial factors that may moderate this relationship. In this study, we aimed to determine if family ritual meaning moderates the relationship between financial burden and anxiety and depression symptoms among mothers of children with cancer. Portuguese mothers of children with cancer on-treatment and off-treatment (N = 244) completed measures of financial burden, anxiety and depression symptoms, and family ritual meaning. Moderating effects were tested using hierarchical multiple regression analyses. Family ritual meaning buffered the effect of financial burden on anxiety, but not on depression symptoms. The relationship between financial burden and anxiety symptoms was not significant when mothers endorsed higher levels of family ritual meaning. Although preliminary, the current findings suggest that high levels of perceived family ritual meaning may constitute a protective factor against the effect of financial burden on mothers' anxiety symptoms. Promoting family ritual meaning might be an effective approach to reducing anxiety symptoms of mothers of children with cancer in the context of financial burden. (PsycINFO Database Record

Psychometric study of the European Portuguese version of the PedsQL 3.0 Cancer Module.

BACKGROUND: Health-related quality of life (HRQoL) is an important outcome to assess the impact of cancer. This article examines the psychometric properties of the European Portuguese self-report version of the Pediatric Quality of Life Inventory™ Cancer Module (PedsQL™ 3.0 Cancer Module) in children and adolescents with cancer. METHODS: The participants, 332 children/adolescents diagnosed with cancer (8-18 years old), completed measures to assess HRQoL (PedsQL™ 3.0 Cancer Module and DISABKIDS Chronic Generic Measure; DCGM-12) and anxiety (Revised Children's Manifest Anxiety Scale - second edition; RCMAS-2). A subsample (n = 52) completed the PedsQL™ 3.0 Cancer Module a second time following one-week. The pediatric oncologists completed the Intensity of Treatment Rating Scale 3.0 (ITR 3.0). RESULTS: For the whole sample, the PedsQL™ 3.0 Cancer Module demonstrated good item discrimination (rs = .30 to .54). The confirmatory factor analysis testing the presence of eight first-order factors loading significantly in a second-order factor revealed an acceptable fit (CFI = .91; RMSEA = .05). The correlation of PedsQL™ 3.0 Cancer Module with DCGM-12 (rs = .17 to .58), and with RCMAS-2 (rs = -.16 to-.51) attested convergent validity. This inventory demonstrated minimally acceptable to very good internal consistency (αs = .65 to .87) and temporal stability (ICCs = .61 to .81). CONCLUSIONS: These findings demonstrate that the European Portuguese self-report version of the PedsQL™ 3.0 Cancer Module is a valid and reliable instrument for assessing HRQoL in pediatric cancer.

Family Rituals and Quality of Life in Children With Cancer and Their Parents: The Role of Family Cohesion and Hope.

OBJECTIVE: Family rituals are associated with adaptive functioning in pediatric illness, including quality of life (QoL). This article explores the role of family cohesion and hope as mediators of this association in children with cancer and their parents. METHODS: Portuguese children with cancer (N = 389), on- and off-treatment, and one of their parents completed self-report measures. Structural equation modeling was used to examine direct and indirect links between family rituals and QoL. RESULTS: When children and parents reported higher levels of family rituals, they also reported more family cohesion and hope, which were linked to better QoL. At the dyadic level, children's QoL was related to parents' family rituals through the child's family cohesion. This model was valid across child's age-group, treatment status, and socioeconomic status. CONCLUSIONS: Family rituals are important in promoting QoL in pediatric cancer via family cohesion and hope individually and via family cohesion in terms of parent-child interactions.