Psychological distress and communication with children about a parent's advanced cancer: A mixed-methods study.

236 Background: Cancer affects 1.6 million parents with dependent children in the United States, many of whom experience heightened distress related to the impact of their illness on children. Palliative medicine and oncology providers frequently recommend open communication with children. However, there is little empirical research on the relationship between illness-related communication with children and parental psychological distress. The objective of this study was to explore the association between parental psychological distress and communication with children about a parent's advanced cancer.

METHODS: This was a cross-sectional, mixed-methods observational study of patients with stage IV solid tumor malignancies who had at least one dependent biologic or adopted child. Participants completed the Hospital Anxiety and Depression Scale (HADS) and a semi-structured interview. Reports of illness-related communication with children were categorized as "minimal," "partial," or "full." We conducted linear regression models to evaluate the association between extent of communication and HADS scores.

RESULTS: Of the 42 parents, 7 participants (17%) had minimal illness-related communication with their children, 13 (31%) had partial communication, and 22 (52%) had full communication including discussion of their prognosis. HADS Anxiety scores, but not HADS Depression scores, were higher with greater extent of communication (4.1 vs. 7.6 vs. 10.4, p = 0.003), even when controlling for performance status and children's age.

CONCLUSIONS: In this pilot study, parents who had more extensive communication with children about their advanced cancer and prognosis also reported more symptoms of general anxiety. Palliative and supportive care interventions should address psychological distress relevant to parenting and should provide guidance for communicating with children.