Poster #101 - Applying the Family Stress Model in the Context of Pediatric Cancer: A Systematic Review

• In Event: 1-061 - Poster Session 02
  In Poster Session: PS 02 Section - Health, Growth, Injury

Integrative Statement

Objectives: Pediatric cancer is a substantive negative life event that triggers a state of chronic stress across the entire family system complicated by the fear of losing a child, sustained medical treatments and hospitalizations that impact family separation, strained caregiver roles, and financial stress (Long & Marsland, 2011; Van Schoors et al., 2017). A systematic review of the pediatric cancer literature was conducted to identify and summarize the variables that influence family-level psychosocial outcomes and to develop a theoretical path model based upon the Family Stress Model (Masarik & Conger, 2017). To date, the Family Stress Model has yet to be applied to families who have a child with cancer. This model serves as a useful framework for families experiencing pediatric cancer due to its emphasis on economic hardship and its mediating and moderating interaction with parenting stress, family functioning and child developmental outcomes. Additionally, the model allows for multi-directional processes where one variable can function as both a predictor and outcome variable lending itself to more sophisticated analytical approaches such as multilevel modeling and structural equation modeling.
Methods: PubMed, PsychInfo, Web of Science, and CINHAL databases were searched between 2007-2017. Articles applicable to this review examined a bidirectional relationship between at least two members within the family (e.g., parent and child) or measured a component of family functioning (e.g., cohesion, adaptability). After screening 2,731 records, 11 review studies and 42 original studies met the criteria for inclusion and were included in using PRISMA (Moher et al., 2009), (see Figure 1).
Results: Variables related to family-level psychosocial outcomes were categorized and synthesized into six main categories with associated subcategories: Family (family functioning; family support), Parent/Caregiver (burden/stress; psychological factors; coping style; parenting style; quality of life), Child with Cancer (functioning/adjustment; illness/disease factors), Sibling (functioning/adjustment), Medical Care Delivery (family-centered care), and Socioeconomic (income, education, financial strain). Studies reviewed indicated mixed findings in determining the degree to which factors significantly influenced parents, children, and family functioning. Moderation effects reported in the studies were caregiver burden/stress, stressful life events, and treatment status and illness severity as illness characteristics. Mediation factors reported included family cohesion, family ritual, family environment, family functioning, and parenting stress and caregiver burden.
Conclusions: While research examining the impact of cancer on young children and families has widened in scope, most studies continue to use cross-sectional designs and less-sophisticated analytical methods to determine mediation and moderation effects. Based upon this review, we developed a conceptual path model illustrating how factors pertaining to pediatric cancer can be applied using the Family Stress Model adapted from Masarik & Conger (2017). The Family Stress Model in the context of pediatric cancer (see Figure 2) integrates the factors of economic stress and pediatric cancer on outcomes related to family functioning and child/sibling psychosocial functioning. This conceptual model illustrates the plausible uni- and bi-directional direct pathways impacting families who have a child with cancer, and can be utilized in future studies to explicate the relative strength and influence of risk and protective factors on those pathways.

Authors

• Christine Neugebauer, Texas Tech University Department of Human Development & Family Studies
  Presenting Author

• Ann Mastergeorge, Texas Tech University
  Non-Presenting Author