Adopting a systems approach, parental cancer has its impact on patients, spouses, and dependent children. The purpose of the current study was to examine family functioning dependent on parental disease stage and on family member perspective in families of cancer patients with adolescent children. The cross-sectional study was conducted within a German multisite research project of families before their first child-centered counseling encounter. The sample comprised individuals nested within N = 169 families. Analyses performed included analysis of covariance (ANCOVA) and intraclass correlation. Open answers were analyzed following quantitative content analysis procedures. Between 15% and 36% of family members reported dysfunctional general functioning scores. Parents indicated more dysfunctional scores on the Family Assessment Device scale Roles, and adolescents more dysfunctional Communication scores. Regarding assessment of family functioning, there was higher agreement in families with parents in a palliative situation. For adolescents with parents in palliation, incidents because of the disease tend to become more dominant, and spending time with the family tends to become even more important. As our study pointed out, parental cancer, and especially parental palliative disease, is associated with both perceived critical and positive aspects in family functioning. Supporting families in these concerns as well as encouraging perceptions of positive aspects are important components of psycho-oncological interventions for families with dependent children.
Keywords: family functioning, palliative care, child of impaired parents, parental cancer, psychosocial oncology, adolescents
"There is so much ahead of us, this is just the beginning"--a suspicion a 16-year-old daughter of a palliative patient suffering from a cancer of unknown primary had even before there was any verbal communication about prognosis within the family. From a systems view, cancer affects the whole family system (McDaniel, Hepworth, & Doherty, 1997; Wein, 2000): patients (Mitchell et al., 2011), spouses (Couper et al., 2006; McLean & Jones, 2007), and dependent children (Grabiak, Bender, & Puskar, 2007; Krattenmacher et al., 2012; Osborn, 2007). The exceptional situation of palliation is reflected in the distress a subgroup of family members reports (Christ et al., 1993; Christ, Siegel, & Sperber, 1994; Northouse et al., 2007).
There are different conceptual approaches on the interplay of disease characteristics, especially stage and prognosis, with familial and individual developmental tasks (e.g., Rolland, 1999; Veach & Nicholas, 1998). The latter author points out that in illness and disability, family relationships either have the "chance of growth" or the "risk of deterioration and distance" (p. 251). Another approach is empirically derived and focuses on the mutual relationships of family members and on their functioning (Kissane, 2000). Family functioning is defined as "the processes engaged in by families in their day-to-day lives to achieve goals, address challenges, and support and enhance individual member's health and development" (Williamson, Skrypnek, & de los Santos, 2011, p. 398).
Studying cancer families, a relation between family functioning and psychosocial distress is frequently reported; however, there seems to be discord about its direction, as well as about potential mediator and moderator variables (Edwards & Clarke, 2004; Kissane, Bloch, McKenzie, McDowall, & Nitzan, 1998; Lewis...