Maria Romare Strandh: Navigating parenting and cancer: Understanding parenting concerns, challenges, and supporting psychological well-being in parents with cancer

Abstract

Many adults diagnosed with cancer are parents of dependent children. Balancing the roles of a patient and a parent is a stressor, with parenting concerns linked to elevated psychological distress. Despite this, the psychosocial support needs of parents with cancer are oftentimes not met. Addressing these gaps in support is essential to promote the psychological well-being of both parents and their families.

The overall aim of this thesis was to explore parenting concerns, challenges, and psychological distress among parents with cancer, assess psychosocial support needs, and evaluate the feasibility of a psychological intervention for parents. First, a systematic review was conducted to identify existing psychosocial interventions for parents with cancer (study I). Then, parents’ experiences and challenges in relation to cancer was explored in interviews (study II), and a cross-sectional survey examined levels of psychological distress and associated factors, including parenting concerns, self-efficacy, and emotion regulation (study III). A psychometric evaluation assessed the Swedish version of the Parenting Concerns Questionnaire (PCQ, study IV), and finally, a pilot study of online affect-focused psychodynamic psychotherapy for parents explored its feasibility, acceptability, safety and preliminary effects (study V).

The findings show that parenting concerns are central in parents’ lives. Study I identified 22 psychosocial interventions, some of which were promising but most were not formally evaluated. Study II highlighted the difficulties being both a parent and a patient, and how cancer impacted parenting and roles in the family. Parenting could serve as a source of stress or resilience. In study III, one in three parents reported symptoms above cut-off for depression, anxiety, or stress, and 16% experienced all three. Higher parenting concerns, low self-efficacy, and maladaptive emotion regulation were associated with increased psychological distress. Study IV assessed the Parenting Concerns Questionnaire (PCQ) as valid and reliable overall. In study V, affect-focused psychodynamic psychotherapy (AFT) was experienced as feasible, relevant, and beneficial in reducing psychological distress.

This thesis underscores that parenting with cancer reflects a complex interplay of individual, relational, and structural factors, highlighting the need for holistic psychosocial support that acknowledges parents not only as patients but as part of a family.