The medical context of parental coping with childhood cancer

This research assessed the extent to which contextual factors, especially the medical context, are related to the use of specific coping strategies by 74 parents of surviving children with cancer. Parents reported that they coped reasonably well by using information-seeking, problem-solving, help-seeking, maintaining emotional balance, relying on religion, being optimistic, denying, and accepting. More highly educated parents tended to use problem solving, optimism, and information seeking significantly more and denial significantly less than well-educated parents. However, gender and income were unrelated to coping. The use of specific coping strategies was not related to severity of the child's medical condition, stress level, or parents' own evaluations of their coping effectiveness. However, the quality of relations with the medical staff was strongly related to coping strategies. Use of passive coping strategies was positively related to good relations with the medical staff.     

Mother-child patterns of coping with anticipatory medical stress

Maternal influences on children's fear and coping behaviors during a medical examination were studied in a pediatric outpatient clinic using the Dyadic Prestressor Interaction Scale (DPIS) to measure anticipatory reactions just prior to contact with the physician. Analysis of 50 mother-child dyads, including children from 4 to 10 years of age, revealed that the behaviors emitted by mother and child are likely to influence the child's ability to tolerate the medical experience. Maternal use of distraction and low rates of ignoring were associated with lower child distress and increased prosocial behaviors. Children's active exploration of the situation was more likely to occur when mothers provided their children with information, and was less likely when mothers reassured their children. Maternal reassurance of children and overt maternal agitation were associated with more maladaptive child responses. Age trends were also found in interactive patterns. Younger children were more likely to receive reassurance from mothers when they showed attachment. There was a stronger association between mother's information giving and child's exploring for children under 5 years, 9 months of age. Results supported the usefulness of the DPIS for investigation of child management techniques in this situation. Theoretical extension to attachment and stranger-approach situations was made. Suggestions for future studies to clarify the reciprocity of interactions or to determine causal direction between mother and child behaviors, as well as to evaluate the specificity or generality of these findings, were provided.     

Reducing Parent Distress and Increasing Parent Coping-Promoting Behavior During Children's Medical Procedure

The study investigated whether involving parents in their child's cognitive-behavioral intervention would effectively reduce parent distress during their child's medical procedure. Parents participating with their 3- to 7-year-old children prior to a voiding cystourethrogram were randomly assigned to an intervention (N = 20) or a standard care (N = 20) condition. The intervention included provision of information, coping skills training, and parent coaching. Parents participating in the intervention had a significant reduction in anxiety following the intervention relative to parents in standard care. Trained parents displayed fewer distress-promoting and more coping-promoting behaviors during the procedure, even though parents in both conditions reported similar levels of anxiety during the procedure. Involving parents in children's interventions is crucial to reduce parent distress and prepare parents to assist their child during the medical procedure.     

Coping skills training for children: effects on distress before, during, and after hospitalization for surgery

Thirty-three parent-child dyads (children's mean age = 7.2 years, SD = 1.2) were randomly assigned to information, anxiety reduction, or coping skills presurgical preparatory interventions. All groups received the "information" procedure that described typical hospitalization and surgery experiences via a puppetry film viewed 1 week prior to hospital admission. In the anxiety reduction group, parents also learned procedures (e.g., relaxation) to help them reduce their own distress. Parents in the coping skills group learned how to help their children use coping self-talk and related techniques. The coping skills intervention was expected to assist children most effectively, although the anxiety reduction procedure was also expected to improve adaptation relative to the information condition. These hypotheses were generally supported. Anxiety reduction and coping skills groups, compared to the information group, reduced children's self-reported fearfulness and parents' reported distress. Furthermore, only the coping skills group, compared to the information group, exhibited fewer maladaptive behaviors during hospitalization (ratings by observers) and less problematic behavior in the preadmission week and second postdischarge week (daily parental diaries). Theoretical explanations for these results are discussed in light of the similar findings obtained by Peterson and Shigetomi (1981).     

Preparing children for medical examinations: the importance of previous medical experience

The relationship between past medical experience and children's response to preparation for medical examinations was investigated in 79 pediatric outpatients aged 3 to 12 years. Children were randomly assigned to one of five preparation conditions prior to receiving a medical examination and a throat culture: sensory information about the exam, training in coping skills (deep breathing and positive self-talk), combined sensory information and coping skills training, attention control, and no-treatment control. The results indicated that children with previous negative medical experiences demonstrated more behavioral distress during a throat culture examination that did children with previous positive or neutral medical experiences. In addition, the attention control condition appeared to increase the distress of children with previous negative medical experiences. Amount of past exposure to the specific medical procedure was not related to observed distress. The implications of these findings for the preparation of children for medical procedures are discussed.     

Hospitalization stress in children: sensitizer and repressor coping styles

To examine the effects of individual sensitizer/repressor coping styles on responses to hospital procedures, 56 children (mean age = 6.5 years) were observed during hospitalization for minor surgery. Although the sensitizer children, as classified by their mothers, did not differ from the repressor children on baseline measures including hospital preparation, they were more talkative, expressive, and active during hospital play observations. During blood tests and preoperative injections, the sensitizers, compared with the repressors, were reported by their mothers to observe the procedures, to seek additional information about the procedures, and to show more protest behaviors. Finally, the sensitizer children required fewer hours of intensive care.     

Psychological adjustment of children in the pretransplant phase of bone marrow transplantation: Relationships with parent distress,parent stress,and child coping

Families of 22 children preparing to undergo bone marrow transplantation (BMT) provided information concerning parent-reported major negative life stress, child coping strategies, parental psychological symptomatology, and child adjustment. Immediately prior to BMT, children and families are confronted with multiple stresses which challenge the child's coping and strain the parents' ability to assist the child with coping. Hence, stress, parental adjustment (distress), and child coping may be important factors affecting the child's overall psychological adjustment. Results showed that 15–25% of children and parents experienced clinically significant levels of psychological distress. Parent and child psychological distress were closely related. Major negative life stresses experienced by the parent and use of avoidant coping by the child significantly predicted child adjustment problems in the pretransplant period. Coping skills interventions targeting avoidant coping and management of parental stress/distress may reduce child psychosocial risk prior to BMT.     

Analysis of child and parent behavior during painful medical procedures

Examined (a) the impact of demographic, medical, and psychological factors on overall child distress during an invasive medical procedure required for pediatric cancer treatment and (b) the relationship of individual parent behaviors to child distress across phases of the procedure. Seventy 3- to 10-year-old pediatric cancer patients receiving outpatient venipuncture and their parents participated. Overall distress was greater in younger children who had fewer previous venipunctures and poorer venous access and whose parents rated them prior to the procedure as less likely to be cooperative. Providing explanations regarding the procedure was the parent behavior most clearly associated with child distress. The impact of parent explanation depended on when the explanation was given and on the child's level of distress at the time.     

Seeking urgent pediatric treatment: factors contributing to frequency, delay, and appropriateness

The present study explored the factors that contribute to mothers' decisions to seek urgent medical attention for their children when symptoms are not of a traumatic nature. One hundred mothers seeking treatment for their children at a prepaid clinic completed a questionnaire eliciting their expectations regarding the course of their children's problems, seriousness of the problems, perceived responsibility for the symptoms, and extent to which a variety of factors contributed to their decisions to seek treatment. Demographic data and information about each child's symptoms and medical history were also obtained. Four major "reasons for seeking treatment" factors were identified: family history of the presenting complaint, worry regarding the symptoms, situational variables, and the extent of the child's illness behavior. The appropriateness of the visit, delay in seeking treatment, and frequency of mothers' use of the pediatric clinic were predicted by the nature of the presenting symptoms (particularly the presence of fever), the ages of the mother and child, and two of the reasons for seeking treatment factors (i.e., family history and child's illness behavior). The present study suggests that mothers pay more attention to presenting symptoms and to the children's behavior than to psychosocial stressors in deciding to seek urgent care.     

Impact of symptoms and aging attribution on emotions and coping

Two experimental studies and a large field study were designed to examine how symptom severity, symptom duration, symptom ambiguity, and the association of symptoms with aging affected emotional responses and coping with illness threats. In Study 1, 280 respondents from the surrounding community reported the emotional and coping responses they would manifest to scenarios that varied the severity, duration, and ambiguity (i.e., labeled vs. unlabeled) of a common set of symptoms. Severity had more of an impact on coping strategies than did duration or illness label; severe symptoms elicited stronger emotional upset and a higher incidence of both self-care behaviors and seeking of medical care. Symptoms of longer duration also resulted in increased seeking of medical care. Responses of the 334 adults participating in Study 2 replicated and extended these findings: A closed-ended item asking participants whether the symptoms could be attributed to aging showed that attribution of symptoms to aging increased with age, was more frequent for mild symptoms, and was associated with reduced emotional response to symptoms and a tendency to delay seeking treatment. Participants in the field study (168 patients seeking medical care for a variety of symptoms) completed interviews tracing symptom processing and emotional and coping reactions. The results provided evidence for the external validity of the scenario studies, as the attribution of symptoms to aging was greater for older than younger patients and resulted in a significant tendency to delay seeking medical care. Results of these studies suggest that symptom experience and symptom interpretation must be considered in the study of coping responses to illness threats.     

Physical recovery in Arthroscopic knee surgery: unique contributions of coping behaviors to clinical outcomes and stress reactivity

Few studies have examined whether certain coping behaviors are associated with physical outcomes following surgery. This prospective, longitudinal study investigated the effect of active and avoidant coping behaviors on two physical outcomes over time, pain and knee function, in a group of patients experiencing knee arthroscopic surgery (n = 81). Structured interviews and physician clinical assessments were conducted preoperatively and at 3 and 24 weeks postoperatively. Coping behavior was assessed during the preoperative interview, and patients were divided into high and low avoidant and active coping groups. Using repeated measures MANCOVA/ANCOVA, avoidant coping was significantly associated with knee pain and active coping was associated with knee function. Serum cortisol levels were available for a patient subset (n = 16); higher cortisol was related to both avoidant coping and poorer functioning during early recovery. Results suggest that these divergent coping behaviors are differentially associated with stress reactivity and physical outcomes in healthy patients undergoing minor knee surgery.     

Coping with AIDS: Psychological and Health Implications1

The current study explored the relationship of coping to both psychological and health parameters in 50 gay men recently (within three months) diagnosed with AIDS. Three methods of coping (active behavioral, active cognitive, and avoidance) and eight different coping strategies (positive involvement, expressive/ information seeking, reliance on others, positive understanding/create meaning, passive/ruminative, distraction, passive resignation, and solitary/passive behaviors) were assessed. Findings indicate that avoidance coping is not protecting these people from distressful feelings, mood disturbance, and concerns. The three coping methods evidenced distinctly different associations with measures of psychological and health variables. Active-behavioral coping was related to lower total mood disturbance and higher self-esteem, while avoidance coping was inversely related to self-esteem and positively correlated with depression. The frequencies of specific coping strategies indicate men in this study were using cognitive strategies most frequently. Suggestions for interventions to help people cope with AIDS are given.     

Extraversion: A “Hidden” Personality Factor in Coping?

Recent evidence suggests a larger role for personality determinants of the coping response than has been traditionally held. In the two studies presented here, we examined the influence of personality on the use of social support and other coping strategies in samples of undergraduate students. The first study surveyed a range of coping responses to naturally occurring stressors and found that Extraversion was related to social support seeking, optimism (identified as germane to coping in prior research) was related to problem solving, and both dispositions were negatively related to avoidance. The second study used an experimental approach and multiple personality measures to correct for possible methodological problems in the first. Extraversion again proved to be associated with help seeking; moreover, this relationship accounted for that of another disposition, self-esteem—a construct considered crucial in the literature. The utility of personality variables, particularly Extraversion, in predicting and explaining the choice of a coping strategy is discussed.     

Adult-child interaction during invasive medical procedures.

Adult-child interactions during stressful medical procedures were investigated in 43 pediatric patients videotaped during a venipuncture procedure in the course of cancer treatment. Relations among six adult behavior categories (explain, distract, command to engage in coping behavior, give control to the child, praise, and criticize/threat/bargain) and three child behavior categories (momentary distress, cry/scream, and cope) were examined using correlational and sequential analysis. Results indicated that adult distraction resulted in increased child coping and reduced momentary distress and crying. Adult explanations, although a likely response to child distress and crying, did not result in a reduction of these behaviors. Attempts to give the child control reduced child crying. Implications for clinical interventions during painful medical procedures are discussed.     

Communication styles of children of mothers with affective disorders,chronic medical illness,and normal controls: A contextual perspective

Research has demonstrated impaired parent-child relationships in families with affective disorders. The present study examines the association of children's interactional style during a direct conflict-solving task to both the mother's interactional style and the child's diagnostic status. The sample includes 63 children, ages 8 to 16, of mothers with affective disorders, chronic medical illness, and normal controls. Children's dominant coping style profile (CS) (autonomous, neutral, or critical) was related to their mother's affective style (AS) (benign or negative). Affective disorder in the child at 6-month followup was associated with a critical CS profile at intake, while the child's nonaffective symptomatology was unrelated to CS. Findings indicate that children's affective disturbance is linked to interpersonal deficits in affectively charged situations. Results suggest that the child's CS is more strongly predicted by maternal aa than by either the child's or the mother's diagnostic status.This research was supported in part by an award from the William T. Grant Foundation. We are grateful for the contributions of Dorli Burge, Lori Briganty, Jennifer Kim, and Heidi Fink to the project. We also acknowledge the helpful comments of Angus Strachan and Michael Goldstein.     

Family Coping During Hospitalization of Children with Chronic Illnesses

Information about family coping when a child with a chronic illness is hospitalized for procedures related to his or her illness is needed. The current research presents the results of two pilot studies designed to assess family resilience and coping, during a hospitalization for medical procedures for a child with a chronic condition. Sixty-one parents participated in the first study and reported on their child’s hospital experiences and completed a survey designed to assess family coping. Twelve mothers and one grandmother completed interviews examining their perceptions of their coping, siblings’ coping, and coping of the child with an illness for study two. Results of Study 1 indicated parents’ perceived the family as resilient. Cognitive strategies were used to see the hospital stay as positive for the child or to accept what had to occur as having the possibility of improving the child’s life. Some of the mothers mentioned financial stress as being difficult for the family. Results of Study 2 also supported resilient functioning for mothers, siblings, and children with illnesses. Mothers reported they stayed strong for their child. Siblings could serve as protectors, helpers, and companions and were described as adapting well. Children with illnesses used distraction (e.g., play, art, music) to facilitate their coping. Findings of this study indicated parents perceived the family as coping well and supporting the child with an illness. Future research will need to assess perceptions of siblings and fathers and assess family members’ perspectives at different times over the course of children’s illnesses.     

Children's emotions and coping with interpersonal stress as correlates of social competence

Identifying correlates of children's emotional reactions and coping can provide information about developmental processes and identify useful strategies for improving children's adaptation to stress. We investigated associations of social competence with children's responses to standardised, controllable interpersonal stressors. The stressors included bullying, arguing with a parent, and not being picked for a team sport. We expected greater competence to be associated with certain coping responses, and expected that coping would be better explained by also considering emotional reactions. Children (N = 230, Grades 3 to 7) reacted to three videotaped stressors, and children and parents completed questionnaires. Children rated as more competent used active and challenge coping strategies, such as problem solving and support seeking, more than other children, and they also responded with more sadness. Children's competence was associated with fear, but only in bivariate correlations, and was not associated with angry responses. In a structural equation model, emotions were associated with more coping responses, and the emotional reaction of sadness accounted for the link between children's social competence and adaptive (i.e., challenge) coping. Findings suggest that competent children use more adaptive coping, and this is accounted for by their greater feelings of sadness when dealing with controllable interpersonal stressors.     

Information Seeking and Avoiding in Health Contexts

Information management is an important component of coping with illness and illness‐related uncertainty. Normative theory and research on information seeking and avoiding in health contexts can help explain why some information management activities are more adaptive than others. Challenges and dilemmas of information management include relational demands (e.g., the need to coordinate the behaviors and goals of the participants) and contextual features (e.g., cross‐cultural considerations or channels available for information seeking and providing). Issues that need to be addressed in a normative approach include (a) how information management goals can be accomplished while still accounting for other goals (e.g., identity management or relational maintenance), (b) what roles interpreters can play to facilitate effective cross‐cultural information exchange (e.g., as cultural informants), and (c) how information seekers can best manage conflicting or overwhelming information when confronted with messages from multiple channels.     

Children's perceptions of parental behaviors

Children's perceptions of positive and negative parental behaviors were assessed using a newly-developed scale, the Parent Perception Inventory (PPI). Reliability and validity were examined across a sample of 75 children aged 5 to 13 using additional measures administered to the children and measures completed by their parents. The scale showed acceptable levels of internal consistency. No effects of children's age were apparent, but effects of the child's and parent's gender were found. Boys reported more positive parental behaviors, particularly for fathers, and children reported more negative (disciplinary) behaviors by mothers. PPI scores were predictably related to child's self-concept and behavior problems (convergent validity) and generally unrelated to measures of child's achievement (discriminant validity). As predicted by family systems theory, children from nondistressed families viewed their parents as behaving more similarly on the PPI than did children from distressed families.     

Coping with adverse drug events in patients with heart failure: Exploring the role of medication beliefs and perceptions

This study describes coping strategies that patients with heart failure (HF) use to manage adverse drug events (ADEs). The included coping strategies were social support seeking, information seeking, non-adherence and taking alleviating medication. The role of beliefs about medication and ADE perceptions in explaining these coping strategies was assessed using the Self-Regulation Model. We performed a cross-sectional study including 250 HF patients who experienced an ADE. Patients completed validated questionnaires assessing their coping strategies, ADE perceptions and medication beliefs. Social support (60%) and information seeking (32%) were the most commonly used strategies to cope with ADEs. Non-adherence was reported by 7% of the patients. Multivariate linear regression analysis showed that demographics, clinical factors and medication beliefs explained only a small amount of the variance in coping strategies, whereas ADE perceptions explained a substantial amount of variance. Path analysis showed that patients' perceptions about the timeline, consequences and controllability of ADEs by the health care provider were directly related to their coping behaviour. The effect of patients' medication beliefs on their coping strategies was consistent with mediation through their ADE perceptions. Our results support the value of the Self-Regulation Model in understanding patients' coping behaviour with regard to ADEs.