Stress and coping in the siblings of children with cance.

This study was developed from a clinical curiosity about what children do and think in an effort to cope with the stressors imposed on them since the diagnosis of cancer in their brother or sister. Theories on stress and coping were reviewed. Although none of the theories specifically addressed or researched the issue of stress and coping in children, the stress, appraisal, and coping theory described by researchers was selected for its comprehensive treatment of the subject. A review of the psychosocial literature on pediatric oncology revealed a number of studies identifying the stressors and stress responses (primarily maladaptive outcomes) for the siblings. There was a paucity of research on the actual coping efforts employed by children and no research on the appraisal process. The present study was designed to qualitatively explore the cognitive and behavioral coping efforts used by a selected sample of siblings of cancer patients in three different treatment phases (induction, remission, and relapse). Data were collected from parent interview, parent questionnaire, two sibling interviews, sibling cartoon storytelling, and a sibling Sentence Completion Test. All data were subjected to content analysis. The parent data identified themes of stress relating to anger, ambivalence, gratitude, and denial. Sibling data revealed major stressor themes of loss, fear of death, and change. Further, content analysis of sibling data pertinent to coping efforts led to the development of a taxonomy of cognitive and behavioral coping efforts. The taxonomy consisted of 6 domains, 12 themes, and 33 categories of coping efforts. The taxonomy is considered to be a tentative beginning for a line of investigations on the coping process in children. The results of this study support findings from previous studies which identified the sibling's major stressors. Coping efforts identified in three previous studies were also identified in this study. The findings from this study suggest that appropriate Nursing; interventions should be based on a thorough assessment of the individual's perspective of the illness experience. Future research needs to be designed to evaluate the entire process of stress, appraisal, and coping not just the separate parts of the process.