Parent-adolescent communication and relationships in the context of childhood cancer

Abstract

Childhood cancer raises issues as profoundly daunting as they are important for children and adolescents and their parents to discuss with each other while navigating feelings of vulnerability and grief. Research has illuminated parents’ and children’s desires to protect one another from difficult conversations and the impacts of effective communication or avoidance on psychosocial and relational outcomes. However, a crucial gap exists in the literature surrounding children and adolescents’ and their parents’ experiences of and approaches to communicating in the context of childhood cancer. Therefore, this study aimed to explore adolescents’ and parents’ common and unique approaches to talking with each other about topics they identified as important or difficult to discuss, as well as perceived changes over time in communication, relationships, roles, and identities in the context of childhood cancer. Recognizing the inseparability of parent-adolescent communication and relationships, this study was informed by theories of relational dialectics and family communication patterns. Interpretive descriptive methodology guided study design, whereby joint and individual interviews incorporating novel, play-based elicitation strategies with six adolescents with cancer and nine of their parents generated data through doing and talking about communication. Constant comparative analyses of 18 interviews generated two sets of findings. First, reflecting interpretive description’s emphasis on clinical relevance, a thematic summary addressed the research objectives, highlighting: the primary importance of discussing adolescents’ wellbeing; difficulty with conversations that focused on or stirred feelings of vulnerability, grief, and helplessness; and approaches to discussing difficult topics when participants “had to.” Second, a conceptual analysis examined established dialectic tensions in participants’ experiences: integration (e.g. autonomy-connection), expression (e.g. openness- closedness), and freedom-responsibility. The resulting analytic frame illuminated the need for an additional crucial dialectic: vulnerability-resilience. These findings offer a lens through which to understand varied approaches to communication driven by a common relational goal: the mutual reduction of suffering. Parents and adolescents guarded against vulnerability and bolstered resilience through their active presence with each other, as well as efforts to protect and to prepare one another. This conceptualization invites a strengths-based foundation for clinicians seeking to understand and nurture parent-adolescent communication and relationships in the context of childhood cancer.