Studies show that in families with a child diagnosed with cancer, higher parental stress is associated with greater psychosocial difficulties in children. This study examined whether children with cancer and their parents can maintain a high positivity ratio (more positive than negative emotions) during illness, highlighting the mediating role of parental illness perception in the relationship between hope, social support, and positivity ratio in both parents and children.
Method
The study included 108 parent–child dyads (N = 216), where children (ages 7–18) were undergoing cancer treatment. Participants completed self-reports on hope, social support, and positive/negative affect. Parents also reported their perceived impact of the illness. Descriptive statistics and Pearson correlations were performed using IBM SPSS Statistics (Version 29). The theoretical research model was analyzed through structural equation modeling using Mplus (Version 8.6).
Results
Despite the challenges of illness, both children and their parents were found to maintain a high positivity ratio. Path analysis indicated that parents’ perception of illness impact mediated the relationship between parents’ social support and hope and the positivity ratio of both parents and children. Additionally, intergenerational correlations were found for social support and between parents’ illness perceptions and children's positivity ratio.
Discussion
These findings highlight the crucial role of positive emotions during times of distress and offer valuable insights for developing targeted intervention programs aimed at supporting emotional resilience in children with cancer and their parents.
AdornoG.LopezE.BurgM. A.LoerzelV.KillianM.DaileyA. B.IennacoJ. D.WallaceC.SharmaB. D. K.SteinK. (2018). Positive aspects of having had cancer: A mixed-methods analysis of responses from the American Cancer Society Study of Cancer Survivors-II (SCS-II). Psycho-Oncology, 27(5), 1412–1425. https://doi.org/10.1002/pon.4484
2.
Alba-SuarezJ.DavidsonS. L.PriebeC.PatelP.GreenspahnE.BoucherL.RodríguezE. M. (2020). Patient and sibling adjustment to pediatric cancer: The roles of parental relationship adjustment and depressive symptoms. Journal of Psychosocial Oncology, 39(5), 1–16. https://doi.org/10.1080/07347332.2020.1819932
3.
ArabiatD.CollyerD.Hamdan-MansourA.KhalilA.DarawadM. (2018). The impact of a mother’s emotional strains and disclosure of cancer on her child’s defensiveness and adjustment to cancer. Cancer Nursing, 41(4), 290–297. https://doi.org/10.1097/NCC.0000000000000516
4.
BakulaD. M.SharkeyC. M.PerezM. N.EspeletaH. C.GamwellK. L.BaudinoM.DelozierA. M.ChaneyJ. M.AldersonR. M.MullinsL. L. (2019). Featured article: The relationship between parent and child distress in pediatric cancer: A meta-analysis. Journal of Pediatric Psychology, 44(10), 1121–1136. https://doi.org/10.1093/jpepsy/jsz051
5.
BandalosD. L. (2002). The effects of item parceling on goodness-of-fit and parameter estimate bias in structural equation modeling. Structural Equation Modeling, 9(1), 78–102. https://doi.org/10.1207/S15328007SEM0901_5
6.
BenyaminiY.Goner-ShiloD.LazarovA. (2012). Illness perception and quality of life in patients with contact dermatitis. Contact Dermatitis, 67(4), 193–199. https://doi.org/10.1111/j.1600-0536.2012.02071.x
7.
BenyaminiY.MedalionB.GarfinkelD. (2007). Patient and spouse perceptions of the patient’s heart disease and their associations with received and provided social support and undermining. Psychology and Health, 22(7), 765–785. https://doi.org/10.1080/14768320601070639
8.
BrislinR. W. (1980). Translation and content analysis of oral and written material. In TriandisH. C.BerryJ. W. (Eds.), Handbook of cross-cultural psychology (Vol. 2, pp. 389–444). Allyn & Bacon.
Burger-LazarM.MusekJ. (2020). Well-being in parents of children with cancer: The impact of parental personality, coping, and the child's quality of life. Scandinavian Journal of Psychology, 61(5), 652–662. https://doi.org/10.1111/sjop.12653
11.
CarlssonT.KukkolaL.LjungmanL.HovénE.von EssenL. (2019). Psychological distress in parents of children treated for cancer: An explorative study. PLOS ONE, 14(6), 1–18. https://doi.org/10.1371/journal.pone.0218860
CohenS.MermelsteinR.KamarckT.HobermanH. M. (1985). Measuring the functional components of social support. In SarasonI. G.SarasonB. R. (Eds.), Social support: Theory, research and applications (pp. 73–94). Springer Netherlands.
14.
DienerE.SandvikE.PavotW. (2009). Happiness is the frequency, not the intensity, of positive versus negative affect. In DienerE. (Ed.), Social indicators research series—Assessing well-being: The collected works of Ed Diener (Vol. 39, pp. 213–231). Springer Science + Business Media. https://doi.org/10.1007/978-90-481-2354-4_10
15.
EcheI. J.EcheI. M.PriesC.IsiborC.AchibiriA.AronowitzT. (2020). A systematic mixed-studies review of hope experiences in parents of children with cancer. Cancer Nursing, 45(1), E43–E58. https://doi.org/10.1097/NCC.0000000000000841
16.
FletcherP. C.SchneiderM. A.HarryR. J. (2010). How do I cope? Factors affecting mothers’ abilities to cope with pediatric cancer. Journal of Pediatric Oncology Nursing, 27(5), 285–298. https://doi.org/10.1177%2F1043454209360839
FotiadouM.BarlowJ. H.PowellL. A.LangtonH. (2008). Optimism and psychological well-being among parents of children with cancer: An exploratory study. Psycho-Oncology, 17(4), 401–409. https://doi.org/10.1002/pon.1257
19.
FredricksonB. L. (2013). Updated thinking on positivity ratios. American Psychologist, 68(9), 814–822. https://doi.org/10.1037/a0033584
20.
Gavriel-FriedB.RonenT.AgbariaQ.OrkibiH.HamamaL. (2018). Multiple facets of self-control in Arab adolescents: Parallel pathways to greater happiness and less physical aggression. Youth & Society, 50(3), 405–422. https://doi.org/10.1177/0044118X15606157
21.
GermannJ. N.LeonardD.StuenziT.PopR. B.StewartS. M.LeaveyP. J. (2015). Hoping is coping: A guiding theoretical framework for promoting coping and adjustment following pediatric cancer diagnosis. Journal of Pediatric Psychology, 40(9), 846–855. https://doi.org/10.1093/jpepsy/jsv027
22.
GiseJ.CohenL. L. (2022). Social support in parents of children with cancer: A systematic review. Journal of Pediatric Psychology, 47(3), 292–305. https://doi.org/10.1093/jpepsy/jsab100
23.
HamamaL.Ronen-ShenhavA. (2012). Self-control, social support, and aggression among adolescents in divorced and two-parent families. Children and Youth Services Review, 34(5), 1042–1049. https://doi.org/10.1016/j.childyouth.2012.02.009
24.
HamnerT.LatzmanR. D.LatzmanN. E.ElkinT. D.MajumdarS. (2015). Quality of life among pediatric patients with cancer: Contributions of time since diagnosis and parental chronic stress. Pediatric Blood Cancer, 62(7), 1232–1236. https://doi.org/10.1002/pbc.25468
25.
HarperF. W.AlbrechtT. L.TrentacostaC. J.TaubJ. W.PhippsS.PennerL. A. (2019). Understanding differences in the long-term psychosocial adjustment of pediatric cancer patients and their parents: An individual differences resources model. Translational Behavioral Medicine, 9(3), 514–522. https://doi.org/10.1093/tbm/ibz025
26.
HarperF. W.PetersonA. M.AlbrechtT. L.TaubJ. W.PhippsS.PennerL. A. (2016). Satisfaction with support versus size of network: Differential effects of social support on psychological distress in parents of pediatric cancer patients. Psycho-Oncology, 25(5), 551–558. https://doi.org/10.1002/pon.3863
27.
HovénE.GrönqvistH.PöderU.Von EssenL.NorbergA. L. (2017). Impact of a child’s cancer disease on parents’ everyday life: A longitudinal study from Sweden. Acta Oncologica, 56(1), 93–100. https://doi.org/10.1177%2F1043454217741875
28.
HuL. T.BentlerP. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6(1), 1–55. https://doi.org/10.1080/10705519909540118
29.
HyeranA.SunheeL. (2019). Returning to social life: Development of social identity for adolescent and young adult survivors of leukemia in Korea. Journal of Pediatric Oncology Nursing, 36(1), 35–43. https://doi.org/10.1177%2F1043454218810145
30.
JohnsonK. J.WaughC. E.FredricksonB. L. (2010). Smile to see the forest: Facially expressed positive emotions broaden cognition. Cognition & Emotion, 24(2), 299–321. https://doi.org/10.1080/02699930903384667
31.
KazakA. E.RourkeM. T.NavsariaN. (2009). Families and other systems in pediatric psychology. In RobertsM. C.SteeleR. G. (Eds.), Handbook of pediatric psychology (pp. 656–671). Guilford Press.
32.
KeyesC. L. (2012). Mental well-being: International contributions to the study of positive mental health. Springer Science & Business Media.
33.
LaurentJ.CatanzaroS. J.JoinerT. E.Jr.RudolphK. D.PotterK. I.LambertS.OsborneL.GathrightT. (1999). A measure of positive and negative affect for children: Scale development and preliminary validation. Psychological Assessment, 11(3), 326–338. https://doi.org/10.1037/1040-3590.11.3.326
34.
LindJ.GhirlandaS.EnquistM. (2019). Social learning through associative processes: A computational theory. Royal Society Open Science, 6(3),Article 181777. https://doi.org/10.1098/rsos.181777
35.
LitzelmanK.CatrineK.GangnonR.WittW. P. (2011). Quality of life among parents of children with cancer or brain tumors: The impact of child characteristics and parental psychosocial factors. Quality of Life Research, 20(8), 1261–1269. https://doi.org/10.1007/s11136-011-9854-2
36.
LiuC. Y.ZhangS.WangF.NiZ. H. (2024). Hope experiences in parents of children with cancer: A qualitative meta-synthesis. European Journal of Oncology Nursing, 70,Article 102583. https://doi.org/10.1016/j.ejon.2024.102583
37.
Makhoul KhouryS.Ben-ZurH.Ben-ArushM. (2018). Mastery and social support moderate the effects of educational level on adjustment of Arab mothers of children diagnosed with cancer. European Journal of Cancer Care, 27(6),Article e12906. https://doi.org/10.1111/ecc.12906
38.
MarshH. W.HauK. T. (1996). Assessing goodness of fit: Is parsimony always desirable?The Journal of Experimental Educational Research, 364–390. https://doi.org/10.1080/00220973.1996.10806604
39.
MartinsA. R.CrespoC.SalvadorÁ.SantosS.CaronaC.CanavarroM. C. (2018). Does hope matter? Associations among self-reported hope, anxiety, and health-related quality of life in children and adolescents with cancer. Journal of Clinical Psychology in Medical Settings, 25(1), 93–103. https://doi.org/10.1007/s10880-018-9547-x
40.
McArthurB. A.StrotherD.SculteF. (2017). Positive schemas, psychopathology, and quality of life in children with pediatric cancer: A pilot study. Journal of Psychosocial Oncology, 35(3), 362–375. https://doi.org/10.1080/07347332.2017.1283655
41.
MeppelderM.HodesM.KefS.SchuengelC. (2015). Parenting stress and child behavior problems among parents with intellectual disabilities: The buffering role of resources. Journal of Intellectual Disability Research, 59(7), 664–677. https://doi.org/10.1111/jir.12170
MurphyL. K.BettisA. H.GruhnM. A.GerhardtC. A.VannattaK.CompasB. E. (2017). Resilience in adolescents with cancer: Association of coping with positive and negative affect. Journal of Developmental & Behavioral Pediatrics, 38(8), 646–653. https://doi.org/10.1097/DBP.0000000000000484
Nap-van der VlistM. M.van der WalR. C.GrosfeldE.van de PutteE. M.DalmeijerG. W.GrootenhuisM. A.van der EntC. K.van den Heuvel-EibrinkM. M.SwartJ. F.BodenmannG.FinkenauerC.NijhofS. L. (2021). Parent-child dyadic coping and quality of life in chronically diseased children. Frontiers in Psychology, 12,Article 701540. https://doi.org/10.3389/fpsyg.2021.701540
48.
NicolaouC.KoutaC.PapathanasoglouE.MiddletonN. (2015). Perceived social support among Greek-Cypriot mothers of children with cancer and mothers of healthy children. International Journal of Caring Sciences, 8(2), 241–255.
49.
OrkibiH.HamamaL.Gavriel-FriedB.RonenT. (2018). Pathways to adolescents’ flourishing: Linking self-control skills and positivity ratio through social support. Youth & Society, 50(1), 3–25. https://doi.org/10.1177/0044118X15581171
50.
OrkibiH.RonenT.AssoulinN. (2014). The subjective well-being of Israeli adolescents attending specialized school classes. Journal of Educational Psychology, 106(2), 515–526. https://doi.org/10.1037/a0035428
PennantS.SimonC.LeeS. C.HolmS.TriplettK. N.Howe-MartinL.CampbellR.GermannJ. (2020). The role of social support in adolescent/young adults coping with cancer treatment. Children, 7(1), 2–25. https://doi.org/10.3390/children7010002
RobinsonK. E.GerhardtA. G.VannattaK.NollR. B. (2007). Parent and family factors associated with child adjustment to pediatric cancer. Journal of Pediatric Psychology, 32(4), 400–410. https://doi.org/10.1093/jpepsy/jsl038
56.
RonenT. (2021). The role of coping skills for developing resilience among children and adolescents. In KernM.WehmeyerM. L. (Eds.), The Palgrave handbook of positive education (pp. 345–368). Palgrave Macmillan.
57.
RonenT.HamamaL.RosenbaumM.Mishely-YarlpA. (2016). Subjective well-being in adolescence: The role of self-control, social support, age, gender, and familial crisis. Journal of Happiness Studies, 17(1), 81–104. https://doi.org/10.1007/s10902-014-9585-5
58.
SalvadorÁ.CrespoC.MartinsA. R.SantosS.CanavarroM. C. (2015). Parents’ perceptions about their child’s illness in pediatric cancer: Links with caregiving burden and quality of life. Journal of Child and Family Studies, 24(4), 1129–1140. https://doi.org/10.1007/s10826-014-9921-8
59.
SantosS.CrespoC.CanavorroC.KazakA. E. (2015). Family rituals and quality of life in children with cancer and their parents: The role of family cohesion and hope. Journal of Pediatric Psychology, 40(7), 664–671. https://doi.org/10.1093/jpepsy/jsv013
60.
Schwartz-AttiasI.KrulikT.Amit AharonA.RonenT. (2023). Perceptions of children with cancer and their parents regarding illness: A qualitative study. Journal of Pediatric Nursing, 71, 32–41. https://doi.org/10.1016/j.pedn.2023.03.006
61.
Schwartz-AttiasI.KrulikT.RonenT. (2024). Well-being in parents of children with cancer: Illness perceptions’ mediating role for hope and social support. Frontiers in Psychology, 15,Article 1206520. https://doi.org/10.3389/fpsyg.2024.1206520
62.
SerbinL. A.KarpJ. (2004). The intergenerational transfer of psychosocial risk: Mediators of vulnerability and resilience. Annual Review of Psychology, 55(1), 333–363. https://doi.org/10.1146/annurev.psych.54.101601.145228
63.
SloperP. (2000). Predictors of distress in parents of children with cancer: A prospective study. Journal of Pediatric Psychology, 25(2), 79–91. https://doi.org/10.1093/jpepsy/25.2.79
64.
SnyderC. R. (Ed.). (2000). Handbook of hope: Theory, measures, and applications. Academic Press.
65.
SnyderC. R.HozaB.PelhamW. E.RapoffM.WareL.DanovskyM.HighbergerL.RubinsteinH.StahlK. (1997). The development and validation of the Children’s Hope Scale. Journal of Pediatric Psychology, 22(3), 399–421. https://doi.org/10.1093/jpepsy/22.3.399
66.
SnyderC. R.IrvingL.AndersonJ. R. (1991). Hope and health: Measuring the will and the ways. In SnyderC. R.ForsythD. R. (Eds.), Handbook of social and clinical psychology: The health perspective (pp. 285–305). Pergamon Press.
67.
SnyderC. R.SympsonS. C.YbascoF. C.BordersT. F.BabyakM. A.HigginsR. L. (1996). Development and validation of the state Hope Scale. Journal of Personality and Social Psychology, 70(2), 321–335. https://doi.org/10.1037/0022-3514.70.2.321
68.
Steliarova-FoucherE.ColombetM.RiesL. A. G.MorenoF.DolyaA.BrayF.HesselingP.ShinH. Y.StillerC. A. (2017). International incidence of childhood cancer, 2001-10: A population-based registry study. Lancet Oncology, 18(6), 719–731. https://doi.org/10.1016/S1470-2045(17)30186-9
69.
StraehlaJ. P.BartonK. S.Yi-FrazierJ. P.WhartonC.BakerK. S.BonaK.WolfeJ.RosenbergA. R. (2017). The benefits and burdens of cancer: A prospective longitudinal cohort study of adolescents and young adults. Journal of Palliative Medicine, 20(5), 494–501. https://doi.org/10.1089/jpm.2016.0369
70.
SzentesA.KokonyeiG.TorokS. (2018). Differences in illness perception between children with cancer and other chronic diseases and their parents. Clinical Child Psychology and Psychiatry, 23(3), 365–380. https://doi.org/10.1177%2F1359104517731899
71.
ThoitsP. A. (2011). Mechanisms linking social ties and support to physical and mental health. Journal of Health and Social Behavior, 52(2), 145–161. https://doi.org/10.1177%2F0022146510395592
72.
TsimicalisA.GenestL.StevensB.UngarW. J.BarrR. (2018). The impact of a childhood cancer diagnosis on the children and siblings’ school attendance, performance, and activities: A qualitative descriptive study. Journal of Pediatric Oncology Nursing, 35(2), 118–131. https://doi.org/10.1177/1043454217741875
73.
WatsonD.ClarkL. A.TellegenA. (1988). Development and validation of brief measures of positive and negative affect: The PANAS scales. Journal of Personality and Social Psychology, 54(6), 1063–1070. https://doi.org/10.1037/0022-3514.54.6.1063
74.
Wijnberg-WilliamsB. J.KampsW. A.KlipE. C.Hoekstra-WeebersJ. E. (2006). Psychological distress and the impact of social support on fathers and mothers of pediatric cancer patients: Long-term prospective results. Journal of Pediatric Psychology, 31(8), 785–792. https://doi.org/10.1093/jpepsy/jsj087
75.
WilliamsA. H.RivasS.FuentesL.Cáceres-SerranoA.FerraraG.ReevesT.Antillon-KlussmannF.Rodriguez-GalindoC.MackJ. W.GraetzD. E. (2023). Understanding hope at diagnosis: A study among Guatemalan parents of children with cancer. Cancer Medicine, 12(8), 9966–9975. https://doi.org/10.1002/cam4.5725
