Development of Children's and Adolescents' Understanding of Their Cancer.

The study examined the development of cancer understanding in pediatric cancer patients on an age continuum from early childhood through adulthood. Patients' cancer understanding was explored from a Piagetian theoretical perspective and in relation with patients' age, receptive language ability, parental understanding of cancer, family socioeconomic status, and disease-related factors. The sample included a male and female cancer patient of each age 3 through 20 years and one parent of each patient (N = 36 patients/36 parents). The primary study instrument was an interview protocol employed to assess the content of patients' and parents' explanations about cancer (cancer knowledge) and the detail provided in those explanations (complexity of cancer knowledge). A second interview instrument was used to assess the cognitive level that appeared to underlie the explanations about cancer and other illness concepts. In addition, a standardized vocabulary test was used as a norm-referenced measure of receptive language ability. Age was the dominant predictor of the pediatric patients' understanding of their cancer. When overall parental cancer understanding was compared to patients', an intergenerational consensus emerged which indicated that cancer understanding becomes increasingly consonant with that of adults as children advance in age. This developmental progression in patients' understanding of their disease paralleled shifts in their cognitive processes, from egocentric and concrete to more abstract and logical reasoning. Across the developmental continuum the types of explanations patients provided for cancer were similar to those offered for colds, headaches, and heart attacks. An association was found between the patients' cancer understanding and their general hearing vocabulary, and between their cancer understanding and family socioeconomic status. An association was also found between the patient's and the patient's own parent's understanding of cancer which suggests the existence of intergenerational transmission of illness understanding. These findings have both important clinical and research application for the practice of pediatric oncology, but also for pediatrics as a whole.PhDDevelopmental psychologyUniversity of Michiganhttp://deepblue.lib.umich.edu/bitstream/2027.42/161649/1/8801308.pd