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Adolescents who distrust cancer care for a dying parent likely to face psychological problems
Adults who did not trust health care professionals after losing a parent to cancer during adolescence had a higher risk for negative long-term outcomes, such as self-destructiveness and psychological problems, than those who trusted their parent’s care, according to findings from a study conducted in Sweden.
“The early loss of a parent to death is among the most traumatic events that can occur in childhood, and it places children at risk for a number of negative outcomes, both in the short and long terms,” Kim Beernaert, PhD, of Vrije Universiteit Brussel and Ghent University, Brussels, Belgium, and colleagues wrote. “The role of trust in the medical setting has been acknowledged for many years and generally is considered a central part of the patient-physician relationship — in particular, in end-of-life care. However, knowledge about the role of trust in the child-physician relationship in the care for the parent is limited.”
The researchers used the Swedish Cause of Death Register to identify and survey 622 people who, between the ages of 13 and 16 years, had a parent die of cancer. All deaths had occurred 6 to 9 years before the survey, and all participants were aged 18 years or older at the time of the survey.
Most participants reported moderate or “very much” trust in the care provided to their parents (82%), whereas 18% (n = 105) reported little or no trust.
A lack of trust in care provided to the dying parent appeared associated with significantly higher risks for negative outcomes. These included bitterness, either at health care professionals for not doing everything possible to save the parent (crude risk ratio = 3.5; 95% CI, 2.3-5.1), or for stopping treatment (crude risk ratio = 3.4; 95% CI, 2.1-6), as well as self-destructiveness, such as self-injury (crude risk ratio = 1.7; 95% CI, 1.2-2.4) and psychological problems, such as moderate or severe depression (crude risk ratio = 2.3; 95% CI, 1.5-3.5).
Those who did not trust the care their parents received appeared more likely to report not having found “a way to grieve that felt okay” within 6 months of their parent’s death (crude risk ratio = 1.2; 95% CI, 1-1.4) and to report feeling “dammed up grief” at least once a week at the time of the survey (crude risk ratio = 2.2; 95% CI, 1.3-3.8).
“If surviving former adolescents show indications of bitterness or psychological problems, surviving parents and other adults (e.g., school staff) should be aware that these problems might be post-loss manifestations of distrust in the health care provided,” the researchers wrote. “To ascertain if and how trust in the health care provided to a dying parent can be improved for adolescents and whether this could prevent various negative outcomes later when they are young adults, additional studies are needed.” – by Andy Polhamus
Disclosures: The researchers report no relevant financial disclosures.