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Development and Evaluation of the Grief and Communication Family Support Intervention for Parentally Bereaved Families in Sweden
Ersta Sköndal Bräcke University College, Department of Health Care Sciences, Palliative Research Centre, PRC.ORCID iD: 0000-0003-2786-1997
2020 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Each year in Sweden, approximately 6,900 children will have a parent diagnosed with cancer. Of all the children in Sweden born between 1990–1992, 5.6% have a parent with cancer and 1.1% of them have already had a parent die from cancer. Bereavement support is an important component in palliative care, which aims to alleviate the physical, psychological, and spiritual suffering of patients and their family members. Several, but not all families participating in the studies in this thesis came from a palliative care setting. Earlier research has shown that parentally bereaved children often experience psychological problems, physical problems, reduced self-esteem, difficulties communicating,school and behavioral problems, and/or complicated grief, with approximately 10% of parentally bereaved children experiencing some type of clinically significant psychological difficulty. Moreover, a child’s response to a parent’s death is often mediated by how their surviving parent responds to the loss. Still, support for bereaved children and families is limited in Sweden. The overall aim of this research project was to explore and describe psychological health, grief, and family communication among parentally bereaved children and surviving parents and to develop and evaluate a supportive family intervention. Four studies were conducted including an interview study exploring family communication in parentally bereaved families, a questionnaire study examining associations between family communication and psychological health in parentally bereaved children and adolescents, and the adaptation and evaluation of the Grief and Communication Family Support Intervention. Results from these four studies indicated that communication may be an important factor for adjustment following the death of a parent. Specifically, communication in some parentally bereaved families may involve conflict, which may in turn affect child and adolescent psychological health. Results from testing the Grief and Communication Family Support Intervention indicate that it may improve family communication and relationships. Testing the Grief and Communication Family Support Intervention with larger, more diverse samples is necessary to confirm these results. The results imply that helping families find ways to adjust and adapt in healthy ways following the death of a parent, potentially through the Grief and Communication Family Support Intervention, is likely to improve psychological health and communication among bereaved family members.

Place, publisher, year, edition, pages
Stockholm: Ersta Sköndal Bräcke högskola , 2020. , p. 107
Series
Avhandlingsserie inom området Människan i välfärdssamhället, ISSN 2003-3699 ; 2
Keywords [en]
Children, Parental Bereavement, Family Communication, Psychological Health
National Category
Medical and Health Sciences
Research subject
The Individual in the Welfare Society, Palliative Care
Identifiers
URN: urn:nbn:se:esh:diva-7956Libris ID: 4g9kjlz72gwglhjkISBN: 978-91-985808-0-8 (print)OAI: oai:DiVA.org:esh-7956DiVA, id: diva2:1387797
Public defence
2020-02-21, 13:00
Opponent
Supervisors
Available from: 2020-01-28 Created: 2020-01-22 Last updated: 2020-02-20Bibliographically approved
List of papers
1. Communication in families with minor children following the loss of a parent to cancer.
Open this publication in new window or tab >>Communication in families with minor children following the loss of a parent to cancer.
2019 (English)In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 39, p. 41-46, article id S1462-3889(19)30005-5Article in journal (Refereed) Published
Abstract [en]

PURPOSE: Family communication is a known protective factor for minor children's psychological health following the death of a parent, but there is little research describing communication within such families specifically from the perspective of the children. The purpose of this study was therefore to explore communication in parentally bereaved families from the perspective of the children and surviving parent.

METHODS: Interviews with four parents and four children from four families were analyzed using inductive content analysis. Interviews took place in the family's home or at the research center based on the family's wishes 4-14 months after a parent had died. Interviews had an open approach and were based on an interview guide. Each interview was between 60 and 120 min long.

RESULTS: Four categories emerged which were related to family members' experiences of family communication while adjusting to their new circumstances as bereaved: the importance of open and honest communication in the family; new challenges in the family which affect communication; communicating the need for help; and talking about and remembering the deceased parent.

CONCLUSIONS: This study illuminates the connection between family communication and adjustments to new circumstances following the death of a parent. The results suggest that the relationship between family adjustment and communication may be circular whereby the family's ability to adjust to their new circumstances is affected by how the family communicates. Similarly, family communication may be affected by the family's coping strategies and ability to adjust to their new circumstances.

Keywords
Bereavement; Family communication; Parental death
National Category
Nursing
Identifiers
urn:nbn:se:esh:diva-7358 (URN)10.1016/j.ejon.2019.01.005 (DOI)30850137 (PubMedID)
Available from: 2019-03-13 Created: 2019-03-13 Last updated: 2020-02-20Bibliographically approved
2. Family Communication and Psychological Health in Children and Adolescents Following a Parent's Death From Cancer.
Open this publication in new window or tab >>Family Communication and Psychological Health in Children and Adolescents Following a Parent's Death From Cancer.
2019 (English)In: Omega, ISSN 0030-2228, E-ISSN 1541-3764, article id 30222819859965Article in journal (Refereed) Epub ahead of print
Abstract [en]

Parentally bereaved children and adolescents are at risk of developing psychological health problems. Evidence for a correlation between communication and broad measures of psychological health exists in other populations. The aim of this study was to examine associations between family communication and specific aspects of psychological health for children and adolescents following a parent’s death from cancer using parent-proxy and adolescent self-reports. Parent-proxy reports for children and adolescents, and adolescent self-reports for Parent–Adolescent Communication, Strengths and Difficulties Questionnaire, and Prolonged Grief-13 child were analyzed using descriptive statistics and Spearman’s correlation. Parents rated communication as moderate in quality and reported good psychological health for children and adolescents. Adolescent self-reports indicated low-quality communication with their parent and poor psychological health. Significant associations between Parent–Adolescent Communication subscales and Strengths and Difficulties Questionnaire subscales were found for each group. Prolonged grief was associated with emotional problems but not communication for all three groups.

Keywords
childhood bereavement, externalizing problems, family communication, internalizing problems, prolonged grief
National Category
Nursing
Identifiers
urn:nbn:se:esh:diva-7687 (URN)10.1177/0030222819859965 (DOI)31256707 (PubMedID)
Available from: 2019-08-20 Created: 2019-08-20 Last updated: 2020-02-20Bibliographically approved
3. Adaptation of a Grief and Communication FamilySupport Intervention for Parentally Bereaved Families in Sweden
Open this publication in new window or tab >>Adaptation of a Grief and Communication FamilySupport Intervention for Parentally Bereaved Families in Sweden
2019 (English)In: Death Studies, ISSN 0748-1187, E-ISSN 1091-7683Article in journal (Refereed) Published
Abstract [en]

This article aims to describe the adaptation of the evidence-based Family BereavementProgram to a Swedish context. Empirical support indicating that family communication is aprotective factor for parentally bereaved children was used to motivate the focus of theintervention. Modules from the Family Bereavement Program manual were translated, culturallyadapted, and modified to fit a family format. The manual for the Grief andCommunication Family Support Intervention was pilot-tested with two families, whichresulted in minor modifications being made to the manual. Therapists reported that theycould follow the manual and adapt it to children’s varying ages.

National Category
Medical and Health Sciences
Research subject
The Individual in the Welfare Society, Palliative Care
Identifiers
urn:nbn:se:esh:diva-7953 (URN)10.1080/07481187.2019.1661883 (DOI)
Available from: 2020-01-22 Created: 2020-01-22 Last updated: 2020-02-20Bibliographically approved
4. The Grief and Communication Family Support Intervention: Intervention Fidelity, Participant Experiences, and Potential Outcomes
Open this publication in new window or tab >>The Grief and Communication Family Support Intervention: Intervention Fidelity, Participant Experiences, and Potential Outcomes
(English)Manuscript (preprint) (Other academic)
Abstract [en]

This study aimed to evaluate intervention fidelity and explore participants’ experiences andpotential outcomes after participating in the intervention. Using a pre-test post-test pilot study,10 parentally bereaved families completed the three-session manual-based intervention with afamily therapist. Sessions were audio-recorded. Therapists completed an adherence checklistto assess fidelity. Assessments via questionnaires and interviews occurred at one month postinterventionand via questionnaires at baseline and six months post-intervention. This studyshowed a high level of fidelity. The study shows preliminary evidence of the intervention’scapacity to improve communication and relationships in parentally bereaved families.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:esh:diva-7954 (URN)
Available from: 2020-01-22 Created: 2020-01-22 Last updated: 2020-02-20Bibliographically approved

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5678910118 of 12
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