Interaction Patterns Between Parents with Advanced Cancer in Hospice and Their Adolescent Children

Cancer profoundly affects the lives of those with the diagnosis and their families. When the life of a parent is threatened by advanced cancer, the children are faced with living their lives first with a seriously ill parent and then without the physical presence of the parent. The purpose of this study was to develop a theoretical framework to describe interaction patterns between parents with advanced cancer and their adolescent children. The sample included 26 participants from 9 families; 7 parents with advanced cancer enrolled in a hospice program, 9 spouses, and 10 adolescents (12-18 years old). Grounded theory methods using unstructured interviews were used to illuminate the processes ill parents and adolescents used to manage their lives within the context of the parent’s impending death, and to respond to changes over time. The adolescents and their ill parents described a process of becoming closer to each other by spending more time together. Participants described their experiences as a conscious effort made in direct responses to the parent’s impending death. Limited time together was the core concept that led to spending more time together and developing means to extending their time together after the parent’s death. For some adolescents the process culminated in a choice to give up their time with their ill parents when dying became too difficult to watch. The ill parents made a concerted effort to remain close to their adolescents after death by writing letters to them, and by giving them other tangible objects by which to remember them. Several ill mothers identified specific women to serves as guides and role models for their daughters after the mother’s death. There are a number of direct implications for clinical practice that arose from this study. Generally, adolescents need guidance in traversing this new and unexpected experience of facing their parent’s impending death from clinicians who convey empathy and understanding and help adolescents begin a conversation with the ill parent. Clinicians should be aware that friends are a major source of support and should appreciate their contributions by including them in adolescent support groups.