Understanding adolescent adjustment to maternal cancer: a study of personal experiences and psychosocial factors that promote adjustment
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Parental cancer is a stressful situation that can have a strong impact on adolescents lives (Su & Ryan-Wenger, 2007; Giesbers et al., 2010; Sieh et al., 2010; Helseth & Ulfsaet, 2003). Objectives The objectives of this research were to (a) explore the subjective experience of adolescents’ psychological adjustment to maternal cancer with particular focus on perceived social support (b) explore mothers’ perceptions of their adolescent’s adjustment to maternal cancer (c) design and pilot an online intervention to enhance adolescent adjustment to maternal cancer (e) examine the role and relative impact of perceived stress, coping, perceived social support, maternal attachment and self -efficacy on adolescent adjustment (mood and wellbeing) (f) explore the mediating and moderating effects of social support in the relationship between perceived stress, coping and adjustment. Method Participants in this study were 40 male and female adolescents (mean age =16.78) whose mothers had been diagnosed with cancer within the previous two years. A subsample of these ( N=14 ) and a group of 10 mothers with cancer (mean age = 48) competed semistructured interviews. All Adolescents completed an online survey assessing perceived stress, coping, perceived social support, attachment, self-efficacy, positive affect, negative affect, satisfaction with life, anxiety and depression. A Pilot study examined the usefulness of an eight week online life skills programme designed to enhance adjustment in adolescents (N= 14 ). The study has a mixed method approach; specifically a fully mixed concurrent equal status design. The qualitative phases consisted of three studies: Meta-ethnography, Thematic Analysis and Interpretative Phenomenological Analysis. The quantitative phase included a multivariate analysis of predictors of adolescent adjustment and the design and piloting of the eight week life skills programme for adolescents. Results The meta-ethnography identified three themes: (i)An individual journey from diagnosis to the future, (ii) My family and me: Our shared experience and (iii) Coping and dealing with the unexpected. The thematic analysis of adolescent interviews identified three themes: (i)The challenge of maternal cancer, (ii)building back my broken world and (iii) my vision of the future. The Interpretative Phenomenological analysis reported two themes: (i)Becoming my mother’s mum and (ii) A family experience. The analysis of maternal interviews revealed two themes: (i) Facing the fear of the unexpected and (ii) I wanted to be a good mother, no matter what. The quantitative analysis described the impact of individual differences in adolescent adjustment. Perceived stress and coping explained 23 % of variance in positive affect (β=-0.31, p<0.05), (β=0.44, p<0.05), 21% of variance in negative affect (β=0.44, p<0.05) and 14% of variance in life satisfaction (β=-0.4, p>0.05), (β=0.2, p>0.05). Perceived social support and attachment explained 14% of variance in life satisfaction (β=0.33, p<0.05). Perceived self-efficacy explained 6% (β=0.31, p<0.05) of variance in life satisfaction and 12% of variance in positive affect (β=0.41, p<0.05).The study identified a moderating effect of perceived social support in the relationship between perceived stress and positive affect. The AMC Programme improved adolescent knowledge, coping skills and social supports. Conclusions Adjustment needs to be understood as a process rather than as an outcome since maternal cancer is a succession of phases that impose different demands on adolescents. Factual information about cancer and to normalize their emotions.were the main needs of Adolescents Adjustment needs to be approached in a holistic manner to understand the influence of environmental factors in adolescent’s experiences particularly family structure and characteristics. Individual differences in perceived stress, coping skills, social support, attachment and self efficacy can have an impact on adolescents adjustment experiences and adolescents with higher levels of social support experience more positive outcomes. Adolescent experiences are influenced by developmental factors, that is age, and gender and this should be taken into consideration when examining the needs of adolescents who experience maternal cancer. Generally adolescents can identify positive experiences from what is a very difficult experience in their lives.