Interventions for improving communication with children and adolescents about a family member's cancer.

BACKGROUND A diagnosis of cancer creates multiple problems for affected families, including major changes in living patterns, roles and relationships. It has not been common practice for families and health practitioners to share information with children or adolescents about a family member's cancer, or to allow them to express their feelings about this. In recent years, however, researchers and practitioners have begun to recognise that children and adolescents might appreciate and benefit by being better informed about, and having more opportunity to communicate their responses to, cancer in the family. OBJECTIVES To examine the effects of different ways of enhancing communication with children and/or adolescents about a family member's cancer and its treatment. SEARCH STRATEGY We searched the following sources: Cochrane Central Register of Controlled Trials (CENTRAL), The Cochrane Library, Issue 1 2003; MEDLINE (1966 to January week 2 2003); EMBASE (1985 to 2003 week 6); CINAHL (1982 to February Week 1 2003); ERIC (1966 to 23 January 2003); PsycINFO (1985 to February week 1 2003). For the original (1999) version of this review we also searched the following databases: CancerLIT, Health Management Information Consortium, British Nursing Index, IAC Health & Wellness, JICSTE-Plus, Pascal, Linguistics and Language Behavior Abstracts, Mental Health Abstracts, AMED, HUMN, MANTIS and ASSIA. Bibliographies of identified studies were also checked and contact made with experts in the field. SELECTION CRITERIA Randomised and non-randomised controlled trials, and controlled and uncontrolled before and after studies that evaluated the effects of interventions to enhance communication with children and/or adolescents about a family member's cancer and its treatment. DATA COLLECTION AND ANALYSIS Data on knowledge and understanding, coping, adjustment and wellbeing were extracted by one reviewer and checked by another reviewer. Study quality was assessed using six criteria. A qualitative synthesis of the results is presented. MAIN RESULTS Five studies satisfied the selection criteria: one non-randomised controlled before and after study, and four uncontrolled before and after studies. They differed in terms of the interventions evaluated and the outcomes measured. One study of a camping program and two studies of structured group interventions reported improvements in cancer-related knowledge. One out of two structured group intervention studies found significant reductions in psychological and social problems. The camping program study reported significant improvements in siblings' behaviour. One structured group intervention study reported significantly more positive mood states after the intervention. Another structured group intervention study reported significantly lower levels of anxiety after the intervention. REVIEWER'S CONCLUSIONS Different methods of communicating with children and adolescents about a family member's cancer have not been widely evaluated in controlled trials. There is weak evidence to suggest that some interventions, such as structured group interventions, may lead to improvements in knowledge and understanding, in coping, anxiety, adjustment and wellbeing. More research is needed to investigate the comparative value of these interventions.