26th, EAFONS 2023

EXPLORATORY STUDY ON FACTORS ASSOCIATED
WITH SUPPORT PROVIDED BY ELEMENTARY SCHOOLTEACHERS TO CHILDREN HAVING A PARENT WITH CANCERYuko Akagawa 1, Taichi Hatta2, Kaori Osawa3, Mai Narita4,5, Kingo Endo6, Tomoko Ito1, Hideaki Andoh1,5, Sachiko Makabe1
1 Department of Nursing, Akita University Graduate School of Health Sciences, Akita, Japan
2 Shizuoka Graduate University of Public Health, Shizuoka, Japan
3 Tokyo Kyosai Hospital, Cancer Consultation Support Center, Tokyo, Japan

4 Akita Mental and Developmental Clinic for Children, Akita, Japan
5 Center of Palliative Care, Akita University Hospital, Akita, Japan
6 Akita High School, Akita, Japan

Keywords: Children with a parent who has cancer, Elementary school, Emotional support, Knowledge, and Anxiety

Background & Aim
In Japan, elementary school students represent the largest proportion of children with a parent who has cancer. Therefore, appropriate support
in schools is important. This study aimed to explore the backgrounds of teachers and staff members and to determine their ability torecognize need for providing support, knowledge of cancer, and anxiety regarding provision of support to children having a parentwith cancer. Factors associated with the availability of support to children were also explored.

Methods

Conceptual diagramResults

Study design: A cross-sectional questionnaire survey (mail survey method)
Subjects: Elementary school teachers and staffs in Akita City.
Survey period: August 2022 to October 2022
Survey: Characteristics（gender, current position, age, and cancer experience, etc.),
Recognition of support (5 items), knowledge (9 items), and concerns (3 items)
were rated using a 10-point Likert scale. Degree of difficulty, reasons for providing
support (free description), and details of support.
Analysis: Descriptive statistics were performed for examining staff’s backgroundand details of support. Objective variables were availability of support andexplanatory variables included: teacher’s characteristics and staff and their recognition,knowledge, and anxiety, and factors related to providing support.
Logistic regression analysis was performed using JMP🄬13.0 (SAS Institute) statistical software.

Experience with a family
member with cancer
Bereavement experience
due to cancer＊National average: 78.3-682.5

Cronbach’s alpha: 0.85Cronbach’s alpha: 0.84

Anxiety(3 tems)

Cronbach’s alpha: 0.96

Contents
Number of individuals (%)
Female344 (68.8)
Male155 (31.0)
Present310 (62.6)
Absent185 (37.4)
Teacher
459 (91.8)
Manager
32 (6.4)
Nurse-teacher
9 (1.8)Yes
38 (7.6)
No461 (92.4)

Median

32.0

42.0

27.0

Yes
NoHigh score
items

Need for support for children

Comprehension of children needs
about their parent's cancer

All items

Low score
items

Support in cooperation withmedical staffs

Information resources such assupport and consultation agencies

350 (70.3)
148 (29.7)

YesNo

274 (55.0)
224 (45.0)

Total: 5 to 50 points

Total: 3 to 30 points

Total: 9 to 90 points

Numberof people

Own cancer experience

Knowledge(9 items)

Numberof people

Position

Recognition of support(5 items)

Number ofrespondentsChildren

The number of 30~50‘scancer incidence rate per
100,000 people in Akita
is 105.0~762.1.

▶ Teachers accounted for the largest proportion of participants at 91.8%, with 70% having prior experience
with a family member with cancer.
▶ Anxiety about providing support was high.

Table 1. Participant characteristics N = 500
Sex【Cancer incidence rate
was higher thannational average rate】

Overall, 21 elementary schools in Akita City participated (52.5%), and 500 participants responded (response rate: 91.6%) .

1. Characteristics of participants

Item

Akita City, Japan

Total score

Total score

Total score

NoneFig. 1 Distribution of total scores (recognition of support, knowledge, and anxiety )2. Support ▶ Experience with support for 270 respondents (54.0%).

▶ Overall, 461 respondents (94.3%) had difficulties in providing support.
▶ Children most frequently requested consultation (67.0%) . ▶Teachers and staff ensured that children felt safe.

・Consultants: A total of 176 children (67.2%) and 50 mothers diagnosed withcancer (19.1%), and 15 spouses without cancer (5.7%)・Parental status: Overall, 179 (67.0%) parents recently diagnosed with cancer
・ Consultation concerns from children: Overall, 258 (52.3%) had concerns

Reasons for difficulties in providing support (freely stated) N = 461
・Difficulty in understanding needs due to concerns about how far they should do.
・Do not know how to provide appropriate support.
・I, myself sense the despair.
・Busy daily schedule does not allow time for support, etc.

about daily of life with their parents

3. Factors associated with support ▶ Four knowledge and two awareness factors were relevant. ▶ Background was not relevant.
Table 2. Results of six factors related to support availability N = 500

Knowledge: Children’s understanding of their parent’s cancer
Recognition: Support for families
Recognition: Support for children

Beta
2.20
1.63
0.88

SE
0.42
0.50
0.41

OR9.06
5.11
2.42

Multivariate
95% Confidence Interval
3.95–20.75
1.93–13.50
1.07–5.43

Knowledge: Physical effects on children
Knowledge: Impact on family relationships

1.17
1.24

0.42
0.40

3.22
3.46

1.42–7.31
1.59–7.53

<0.01
<0.01

1.74
2.68

Knowledge: Considerations in communication with children

0.93

0.42

2.54

1.12–5.72

0.03

2.02

P-value
<0.01
<0.01
0.03

VIF
2.46
2.05
2.42

Logistic regression analysis was performed on 24 items, with 25 forced explanatory variables and one variable with high VIF was excluded. r-square = 0.73.
In this table, only significant variables are shown.

Discussion
The highest number of consultations from children was noted when theirparents were diagnosed with cancer.
The reason was that parents themselves are upset that their lives are changing.
Children were also prone to experience anxiety.
Those with support experience had more in-depth knowledge and recognition.
The specific learning content for gaining knowledge was based on the teacher'sbackground. The limitations identified included the need for individualized
support for children. The number of individuals requesting use of the service washigh; thus, a collection of practical examples of the types of support to provide isneeded.
Regardless of the presence or absence of support, there was a high level ofanxiety about providing support among staff
Schools and medical caregivers should collaborate to provide support tochildren in terms of dealing with anxiety. In addition, it is important to provide
reliable resources and information on counseling agencies.

Conclusion
Factors related to support were "understanding the child," "physical impact on thechild," "impact on family relationships," and "communication with the child" withregard to information and "support for the child" and "support for the family" withregard to awareness.

Cooperation between schools and medical caregivers is important toenhance support in schools.
In the future, medical and nursing staffs will provide schools with information on thediagnosis of a parent’s cancer and the child's reaction to the diagnosis as well as onintervention approaches. It is important to establish a contact point with health care
professionals that is available to teachers for consultation whenever they need help.
Ethical considerations and conflicts of interest
This study protocol was approved by the Ethics Committee of Akita University (No. 2838).
This work was supported by JSPS KAKENHI Grant-in-Aid for Early-Career Scientists Number 20K19164.
Declaration of Interest: none.