Living with uncertainty: the psychological adjustment and coping by parents of children with cancer in Taiwan

The prognoses of childhood cancers have improved over the last few decades. Nevertheless, parental uncertainty about the absolute cure and possible relapse pervades the entire illness trajectory. The perception of uncertainty has been previously identified as a significant factor correlating to psychological distress. The influence of coping processes on psychological outcomes in parents of children with cancer has not been investigated vigorously. The continual uncertainty may serve as a catalyst for positive psychological changes and personal growth especially in the context of chronic illnesses. The purpose of this study was to develop and examine a conceptual model depicting the psychological adjustment and coping of Taiwanese parents by living with continual uncertainty about their child's cancer. This study was a secondary data analysis of 205 mothers and 96 fathers of 226 children who had been diagnosed with cancer in Taiwan. A cross-sectional design was utilized to examine the relationships among proposed variables. Some variables were measured by culturally sensitive instruments developed in Taiwan. The proposed alternative models fit adequately to the data via structural equation modeling tests. Parental uncertainty was directly correlated to psychological distress whereas parents' perceived social support and coping did not mediate the relationship between parental uncertainty and psychological distress. However, parental uncertainty and parents' perceived social support were associated with psychological growth mediated by parents' coping such as interacting with families and maintaining an optimistic state of mind. Based on the current research findings, reducing illness-related uncertainty may decrease psychological distress directly and increase psychological growth indirectly though more coping in Taiwanese parents of children with cancer. Furthermore, perceived social support did not directly help parents to reduce psychological distress or increase psychological growth. However, the availability of social support may improve the reduction of psychological distress by lowering parental uncertainty and increase psychological growth by lowering parental uncertainty and encouraging more coping. The psychological adjustment of Taiwanese parents to childhood cancer has effectively conceptualized by the adaptation of Mishel's (1998, 1990) Uncertainty in Illness Theory and Reconceptualization of Uncertainty in Illness Theory as shown in the present study. The findings may provide possible guidelines for nurses in delivering a more competent health care for Taiwanese parents of children with cancer