Coping Strategies Used by Both Parents of Children Currently Undergoing Cancer Treatment at the Philippine General Hospital

University of the Philippines Manila

College of Arts and Sciences

Department of Behavioral Sciences

Coping Strategies Used by Both Parents

of Children Currently Undergoing Cancer

Treatment at the Philippine General Hospital

An Undergraduate Thesis

Presented to

The Faculty of the Department of Behavioral Sciences

University of the Philippines Manila

In Partial Fulfillment of the Requirements

for the Degree in Bachelor of Arts

Major in Behavioral Sciences

Presented by

Steve R. Arcilla

2007-68603

March 2011

i

UNIVERSITY OF THE PHILIPPINES MANILA

COLLEGE OF ARTS AND SCIENCES

Padre Faura, Ermita, Manila

APPROVAL SHEET

This thesis entitled Coping Strategies Used by Both Parents of Children

Currently Undergoing Cancer Treatment at the Philippine General Hospital,

prepared and submitted by Steve Rojano Arcilla, is hereby accepted and

approved in partial fulfillment of the requirements for the Degree of Bachelor of

Arts Major in Behavioral Sciences.

Professor Nymia P. Simbulan

Thesis Adviser


This undergraduate thesis has been accepted as partial fulfillment of the

course requirements for the Degree of Bachelor of Arts Major in Behavioral

Sciences.

Professor Leonardo R. Estacio, Jr.

Chairperson


ii

Acknowledgements

To my family and friends

who showed their support,

To my respondents

who trusted and helped me out,

To my very supportive and patient thesis adviser,

Prof. Nymia P. Simbulan;

And to you who is sparing some time to read this,

THANK YOU.

iii

Table of Contents

Approval Sheet i

Acknowledgements ii

List of Tables and Figures vi

Abstract vii

Chapter I Introduction 1

General State of the Topic 1

Statement of the Problem 3

Objectives of the Study 6

Hypothesis of the Study 7

Significance of the Study 7

Chapter II Research Frameworks 10

Theoretical Framework 10

Conceptual Framework 11

Operational Framework 13

Chapter III Review of Related Literature 15

Psychological Distress among Parents 15

Socio-demographic Characteristics of Parents

and Their Level of Distress

16

Some Positive Responses by Parents 18

Coping Strategies Adapted by Parents 18

Social Support 19

Communication 19

Search for Meaning 20

Other Coping Strategies 21

Factors Influencing Adjustment or Adaptation 22

Characteristics of Children 23

Characteristics of Parents 24

Coping Resources and Strategies 25

Life Events and Other Stressors 27

iv

Chapter IV Methodology 29

Research Design 29

Reference & Source Population 31

Sampling Design 31

Instrumentation 33

Data Gathering Procedure 38

Ethical Consideration 40

Scope and Limitations 40

Chapter V Presentation of Results 42

Socio-Demographic Profile of Respondents/Parents 42

Socio-Demographic Profile of Children with Cancer 44

Results of the Coping Strategies Questionnaire 46

Coping Strategies of Parents in Relation to

their Socio-Demographic Profile

53

Results of Kessler Psychological Distress Scale (K10) 60

Results of K10 in Relation to the Coping Strategies Adapted 65

Key-Informant Interviews 67

Couple with the Highest Monthly Family Income 68

Couple with the Lowest Monthly Family Income 72

Single Father 76

Single Mother 80

Chapter VI Discussion of Results 84

Socio-Demographic Profile of Parents 84

Common Problems/Difficulties Experienced by Parents 86

Financial Problems 86

Occupational Problems 88

Social-Relational Problems 89

Emotional and Psychological Problems 90

Coping Strategies Adapted by Parents 93

Factors Associated with Type of Coping Strategies Adapted

by Parents

99

Sex of Parent 99

Age of Parent 102

Marital Status of Parent 103

Educational Attainment of Parent 104

Monthly Gamily Income 105

Effects of the Coping Strategies on the Parents 107

v

Chapter VII Summary, Conclusion, and Recommendations 110

Summary 110

Conclusion 113

Recommendations 114

Recommendations to Parents 114

Recommendations to Cancer Institutions 114

Recommendations to Future Researchers 115

Bibliography 116

Appendices 121

Grammarian Letter of Certification 122

English Cover Letter and Informed Consent Form

to Participate in the Survey

123

English Questionnaire 124

Filipino Cover Letter and Informed Consent Form

to Participate in the Survey

128

Filipino Questionnaire 129

English Interview Guide 133

Filipino Interview Guide 134

Biodata ix

vi

List of Tables and Figures

Tables

1 Socio-Demographic Profile of Parents 44

2 Socio-Demographic Profile of Children 45

3 Communicating with Medical Staff and Other Parents 46

4 Acquiring Social Support 47

5 Self-Isolation 48

6 Wishful Thinking 48

7 Seeking Spiritual Support 49

8 Self-blame 50

9 Being Optimistic About the Situation 50

10 Using Passive Appraisal 51

11 Positive Reframing 52

12 Substance Use 52

13 Coping Strategies in Relation to Sex 54

14 Coping Strategies in Relation to Age 55

15 Coping Strategies in Relation to Marital Status 57

16 Coping Strategies in Relation to Educational Attainment 58

17 Coping Strategies in Relation to Monthly Family Income 60

18 Item Scores on Kessler Psychological Distress Scale 63

19 K10 Scores in Relation to Coping Strategies 66

Figures

1 Conceptual Model of the Study 11

2 Total Scores of Parents on K10 65

vii

Abstract

Today, cancer continues to be one of the major chronic illnesses among

children. When a family is confronted with the diagnosis of childhood cancer,

various emotional reactions arise. The word cancer is associated with death,

and for most people cancer cannot be associated with children, especially for the

parents. It is said that for parents, having a child with cancer is both a

psychological and existential challenge that is very difficult to cope with. Hence,

this study focused on the assessment of the coping strategies of both parents, i.e.

the mother and father, of children currently undergoing cancer treatment at the

Philippine General Hospital (PGH).

The purpose of the study was to determine the different coping strategies

and resources that parents of children with cancer use in order to adapt or adjust

to their situation in a healthy and well-balanced manner. It also aimed to

determine the factors associated with the type of coping strategies that they

adapted, as well as to describe the common problems and difficulties

experienced by these parents with regard to their situation. A total of 83 parents,

including 42 mothers and 41 fathers, participated in the study.

The researcher used both quantitative and qualitative methods in

conducting the research. Using the Kessler Psychological Distress Scale (K10),

the depression and anxiety experienced by the respondents was determined, and

using the Coping Strategies Questionnaire, a survey questionnaire created by the

researcher, the different types of coping strategies adapted by the parents were

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identified. Likewise, the researcher conducted Key-Informant Interviews with six

of the 83 respondents to further investigate the coping behavior as well as the

quality of life of the parents after the diagnosis of their childs cancer. Finally,

both descriptive and inferential statistical analysis was performed by the

researcher to analyze the data gathered.

The results revealed that parents significantly used Seeking Spiritual

Support among the other coping strategies, with Substance Use as the least

adapted coping strategy. The remaining coping strategies were Being Optimistic

about the Situation, Communicating with Medical Staff and Other Parents,

Wishful Thinking, Acquiring Social Support, Positive Reframing, Using

Passive Appraisal, Self-blame, and Self-Isolation. Factors identified to have

influence over the type of coping strategies adapted by parents included sex, age,

marital status, educational attainment, and monthly family income. Furthermore,

results of the K10 showed that majority of the parents were likely to be well,

although a significant percentage was observed as likely to have moderate to

severe disorder.

Finally, it was also reported that those parents who adapted the positive

coping strategies were observed to have lower scores on K10, indicating that

they experience less psychological distress. Thus, the hypothesis of the study

stating that familiarity, as well as adequate and proper use, of the appropriate

coping strategies would help the parents cope or adapt with their childs cancer

in a healthy and well-balanced manner was accepted.

ARCILLA (2011) | Coping Strategies Used by Both Parents of Children Currently Undergoing Cancer Treatment at the Philippine General Hospital

1

CHAPTER I Introduction

General State of the Topic

It is likely for children, starting from infancy to their childhood, to have

different health problems. For most children, these problems are mild and do not

interfere with their daily life as well as their development. However, those

children with chronic illnesses may have to suffer from their condition

throughout their childhood.

Today, one of the major chronic illnesses among children is cancer

(Hayman et al., 2002). It strikes randomly, unexpectedly, sparing no age group,

socio-economic status, ethnic group or geographic region. Children as young as a

few months, barely able to talk and walk, can already have cancer (Philippine

Information Agency, 2009). However, despite the major advances in treatment

and supportive care, cancer is still considered to be the leading cause of death

among children aged 14 and below (Philippine Cancer Society, 2007). Childhood

cancer survival rate in developed countries is as high as 95%. However, in the

Philippines, sadly, it is only 10 to 30% (International Union Against Cancer,

2005). Also, according to the Philippine Information Agency (2009), about 3,500

Filipino children fall victim to cancer every year, and every day, eight children

die; one in every three hours. Cases of children diagnosed with cancer continue

to increase annually in our country, and with the diagnosis, comes the long,


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stressful, and painful medical journey that the patient, together with his or her

family, is about to go through.

A childs health concerns the parents as well as the other members of the

family (Warsh & Strong-Boag, 2005). That is why if a child is diagnosed to have

cancer, each member of the family becomes a part of one of the hardest battles

they will ever encounter. The childs parents, however, are the ones greatly

affected by their son or daughters cancer diagnosis and treatment. It is said to be

one of the worst news that a parent could ever receive. The emotional impact of

the diagnosis of cancer is intense and long lasting for them (Hashemi et al.,

2007). It is a psychological and an existential challenge for both of the parents

(Norberg, 2004). Also, with the gender difference between the parents, the effect

on the mother tends to differ with that of the father when confronted with

problems like this. Reactions, as well as adaptation, to the situation differ

between the mother and the father of the child (Magni et al., 1986). But as

parents, both of them try to provide all the support that they can give to their

children as they fight through cancer, and if these parents are not given or do not

receive the sufficient social and spiritual support from other people and if they

do not use the proper coping strategies, they may then experience and suffer

from psychological distress and maladjustments and emotional problems as well

(Hashemi et al., 2007).

For parents, coping with all the physical and emotional demands or

stressors that come along with their childs condition is not a very easy thing to


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do. However, with the proper or appropriate coping strategies, dealing with the

situation might be a little easier for them (Hashemi et al., 2007).

In order to identify these appropriate coping techniques, it is essential to

assess the coping strategies used by the parents of children with cancer as well

as how good they have adapted to the situation using these strategies. It could

provide the coping strategies used by those parents who have already adapted

well and can therefore be used as reference by other parents. Thus, this study

was done to assess the adaptation as well as the coping strategies used by

mothers and fathers of children with cancer. And since the Philippine General

Hospital holds one of the leading cancer institutions in our country, this study

was carried out within its facilities.

Statement of the Problem

Children are the most valued and vulnerable members of a family, and if

one of them falls ill with a serious, life-threatening disease like cancer, the entire

family is thrown in a state of shock (Fromer, 1995).

Cancer is a disease that takes a child's strength, destroys organs and

bones, and weakens the body's defenses against other illnesses (Barrett et al.,

2005). According to Cancer.Net (2010), childhood cancer has become the second

leading cause of death among children, with Leukemia as the most common type

of childhood cancer. Also, the International Union Against Cancer (2005) showed

that about 160,000 children worldwide are diagnosed with cancer annually and

an estimated 90,000 will eventually die of their disease. In the Philippines,


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children comprise 4050% of the population, and the proportion of childhood

cancer patients represents 310% of the total (International Union Against

Cancer, 2005). According to the Philippine Information Agency (2009), 8 kids die

every day because of cancer in the National Capital Region (NCR) alone. Also,

according to Dr. Mae Conception Dolendo (2009), a pediatric oncologist at the

Davao Medical Center (DMC), there are about 80-100% new cases of childhood

cancer at DMC every year. And lastly, the data provided by the Philippine

Information Agency (2009) showed that about 3,500 children fall victim to

cancer every year. These figures show how the incidence of children diagnosed

with cancer is rapidly increasing in the country, and for the family, especially the

parents, of these young children, this diagnosis is a devastating blow that creates

an instant crisis to their lives.

For parents, having a child diagnosed with cancer is not just a medical

journey. For them, it is a very difficult and heart-wrenching emotional

experience. It is learning to cope with seeing their child suffer from so much pain

and leaving them with feelings of helplessness and unable to provide any

solutions to make their child feel better. Also, childhood cancer changes the life

situation of the family and brings about stressors to the parents of varying

duration, predictability, and impact (Norberg, 2004). Normal daily life of the

family stops. The current situation implies demands and changes from the

parents everyday life. These demands include accepting intensity of ones own

reactions as well as handling with the reactions of other people, seeing the child

in pain as they undergo and suffer multiple hospitalizations, chemotherapy, etc.,

concerns about the childs future, the quality of care, aspects of the cancer


5

treatment itself, negative employment and financial consequences, and

supporting siblings of the ill child (Norberg, 2004). All these demands and

stressors become a part of the parents daily life starting from their childs cancer

diagnosis and all throughout his or her treatment. And for parents, this is a lot to

ask.

Most parents do have a hard time moving on with their life after their

child has been diagnosed with cancer. When a child has to stay in the hospital for

a long period of time for his or her treatment, the uncertainty and

unpredictability of the current situation keep both parents in a continuous state

of anxiety, expectation, and fear, making these emotions hard to control and face

in a well-balanced manner (Barrett et al., 2005). According to the study of Kazak

et al. (2005), most parents find their childs treatment traumatic. Results of the

study showed that Posttraumatic Stress Symptoms (PTSS) do seem to be

common among parents of children currently undergoing cancer treatment. Out

of the sample parents, only one parent was reported not to have PTSS. This

shows that most parents really are having a hard time handling this kind of

situation properly which then leads to psychological and emotional problems or

maladjustments. However, with the proper amount of social and spiritual

support as well as the use of the appropriate coping strategies, parents may cope

with the situation in a healthy way. It is then important to know the appropriate

coping strategies that these parents should use.

Also, it should not be forgotten that this kind of situation affects the

mother and the father of the child differently. The gender of both parents shows


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differences as to how they adjust and adapt to their childs cancer diagnosis

(Magni et al., 1986). Furthermore, considering the different socio-demographic

statuses of these parents, which also influence the coping strategies that they

adapt, such as socio-economic status, educational attainment, etc., also seems

important to the study.

Objectives of the Study

The main objective of this study is to determine the different coping

strategies and resources that parents, i.e. the mother and father, of children with

cancer use in order to adapt or adjust to the situation in a healthy and well-

balanced manner.

The specific objectives of this study are:

to describe the socio-demographic profile of parents of children

diagnosed with cancer,

to identify the common problems and difficulties, i.e. economic,

psychological-emotional, social-relational, etc. experienced by

parents of children diagnosed with cancer,

to describe the coping strategies adapted by mothers and fathers

of children with cancer,

to determine the factors associated with the type of coping

strategies adapted by parents, and


7

to determine the effects of these coping strategies on them as

parents.

Hypothesis of the Study

The study has the following hypotheses:

Ha: Familiarity, as well as adequate and proper use, of the

appropriate coping strategies would help the parents cope or

adapt with their childs cancer in a healthy and well-balanced

manner.

H0: Familiarity, as well as adequate and proper use, of the

appropriate coping strategies will have no effect on the parents

adaptation or adjustment to the situation.

Significance of the Study

The main focus of this study is the parents, including both the mother and

the father, of children diagnosed with cancer and are currently undergoing

treatment. These parents together with their family are facing one of the hardest

challenges in their life. They may be having the toughest time of their life. Also, as

presented by the Department of Health as well as the Philippine Information

Agency (2009), the number of children diagnosed with cancer in the Philippines

increases every year, which means that without the proper coping strategies, the

number of parents that may suffer from psychological and emotional problems

may increase as well. With all this in mind, it seems vital or important to identify


8

and provide these parents with the proper coping strategies that could help them

deal and cope with the situation in a more positive way.

Also, during the cancer treatment of the child, the parents ability to

manage or balance his or her psychological distress is vital not only to his or her

own consolation or comfort, but it can also influence the childs well-being and

his or her long-term psychological adjustment (Norberg, 2004). Therefore, this

study is not only significant for the parents well-being but is also beneficial to

the children diagnosed with cancer as well as the rest of the family members.

Since the Philippines is a third-world country, having a child in your

family diagnosed with cancer would already mean a big problem financially.

Parents in the family suffering from psychological distress could not afford to go

to a psychiatrist or get any professional help anymore. With this, it seems that

this study is not just significant but it seems practical as well. This study could

provide these parents the information to handle the situation better so as to

lessen any psychological and emotional problems.

Furthermore, this study may also be beneficial to the cancer institution

itself in planning services not just for the patient but also for the parents of the

patient. It may also highlight the areas of practice and administration in which

improvements can be made. This study may also help the institutions create the

necessary facilities to implement these coping strategies. And since coping is one

major concept in nursing, this study may also be significant for the nurses in

helping the parents of the patient adapt in their current situation supporting and

providing them with the proper information about coping. Moreover, this study


9

may also serve as a future reference for other researchers on the subject of

coping strategies of both parents of children with cancer.


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CHAPTER II Research Frameworks

Theoretical Framework

The Family Stress and Coping Theory is used as the framework of this

study. This theoretical foundation provides a broad base from which questions

are presented and responses are analyzed. The Family Stress and Coping Theory

assumes that individuals and families adapt to stress, and that they view

stressors and resources according to their own perception (McCubbin &

Patterson, 1985). It also assumes that their adaptation is affected by the

supposed stressors, the way the situation is perceived, and the resources or

coping strategies available to help deal with the stress.

The Family Stress and Coping Theory uses two models: Hills ABCX Model

(Hill, 1949) and the Double ABCX Model of Family Adaptation and Adjustment

(McCubbin & Patterson, 1985). The ABCX Model, which was designed to explain

the families responses or reactions to war separation and reunion, uses the

interaction of three factors to determine if the family experiences a crisis. These

factors include the stressor, the familys available resources in dealing with the

crisis, and their definition of the stressor event.

On the other hand, the Double ABCX Model of Family Adaptation and

Adjustment assumes that factors, both inside and outside the family, affect or

influence how well families adapt to a chronic stressor, such as chronic illness in


11

a child, and in this case, cancer. It also states that in understanding a familys

response to a stressful life event, the coping process, both cognitive and

behavioral strategies, is a key aspect. Coping strategies that individuals use have

also been categorized as problem-focused or those that moderate or control the

problem, or emotion-focused or those that reduce the emotional distress.

Conceptual Framework

Figure 1. Conceptual Model of the Study

According to the related literature of this study, a childs cancer diagnosis

can bring about various emotional and psychological distresses to the parents

(Magni et al., 1986). This could include depression, anxiety, stress, as well as

insomnia, sleep disturbances, and other somatic symptoms. With all the various

emotional and psychological distresses together with the different demands of

the situation, both parents tend to use the available or preferred coping


12

strategies and resources in order to cope with the situation. However, as

illustrated on Figure 1 above, the dependent variable (DV) of this study or the

coping strategies that parents adapt in coping with the situation is influenced or

is dependent on several factors concerning the parents themselves, which make

up the independent variables (IV) of this study. These factors are basically some

of the socio-demographic information about the parents. One good example of

these is their sex. Since there is an existing gender dimension as to how their

childs cancer diagnosis affects them, mothers and fathers tend to adjust and

adapt differently to the situation, which results to the different coping strategies

used by each parent (Morrow et al., 1984). Other factors involving parents

include their age, attitude towards the disease of their child, educational

attainment, economic status or income, and their family support.

However, another set of variables that may affect the relationship

between the independent and dependent variables of the study have also been

observed by the researcher. These variables, such as sex, age, number of

hospitalizations, and duration of treatment of the child with cancer, are

considered to be the confounding variables (CV) of the study. These factors,

according to the related literature of this study, may also influence the behavior

of parents as they cope with the situation; that is why it is important for the

researcher to control or to minimize the effects of these variables in order to

obtain the proper relationship between the independent and dependent

variables.


13

Taking into account all these factors, the mother and the father now adapt

to the situation using coping strategies that may either help them adjust or adapt

positively, or lead them to a negative adjustment or adaptation. According to the

related literature, some coping strategies really help these parents cope with the

situation in a well-balanced manner thus, helping them adjust or adapt positively

to the situation. However, according to Wittrock et al. (1994), there are also

some coping strategies that instead of helping the parents cope positively with

the situation; they actually increase the parents depression and anxiety. Because

of the lack of proper emotional and social support, some parents tend to use

undesirable coping mechanisms, like alcohol abuse, thus leading them to a

maladjustment or maladaptation.

Operational Framework

Childs cancer diagnosis children, aged 1-14 years, presently diagnosed

with any type of cancer and is being treated at the Philippine General

Hospital (PGH)

Parents sex refers to the biological characteristics that determines the

parents reproductive role (e.g. male or female)

Parents (Mother/Father) age refers to the number of years that the

parent have existed or lived

Parents (Mother/Father) civil status refers to the current marital status

of the parents (e.g. single, married, divorced, etc.)


14

Parents (Mother/Father) socio-economic status refers to the

employment, income, as well as the social status in the community of the

parent

Parents (Mother/Father) educational attainment refers to the level of

education that the parent have achieved (e.g. primary, secondary, etc.)

Childs age refers to the number of years that the child diagnosed with

cancer have existed or lived

Childs sex refers to the biological characteristics that determines the

childs reproductive role

Number of hospitalizations refers to the number of times the child

diagnosed with cancer was hospitalized due to his/her illness

Duration of treatment refers to the length of time the child diagnosed

with cancer has been undergoing treatment

Coping strategies of parents refers to the different available or preferred

coping techniques or styles that the parents use as a response to their

childs cancer diagnosis

Positive adjustment a well-balanced psychological and emotional

adjustment or adaptation of parents to the demands and stress brought

about by the childs cancer diagnosis

Negative adjustment when parents engage in processes leading to poor

or negative adaptation or those that has become harmful than helpful


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CHAPTER III Review of Related Literature

Psychological Distress among Parents

In a family, the children are the most cherished and vulnerable, and when

cancer strikes among them, various emotional reactions from the family will take

place. According to the studies of Dahlquist et al. (1993), and Magni et al. (1986),

most parents of children diagnosed with cancer, or children who are in

treatment, showed increased signs of psychological and emotional distress as

compared to the normative data of the studies. Also, in some longitudinal studies

(Fife et al., 1987; Sawyer et al., 1993), results showed that even months after the

diagnosis, parents still suffer from psychological distress such as anxiety,

depression, insomnia, as well as somatic symptoms. Feelings of depression as

well as sleep disturbances were reported among parents even after 8 months

since the diagnosis of their children (Magni et al., 1986), and according to

Sawyers et al. (1993) study, depression and somatic symptoms are still higher

one year after the diagnosis. Lastly, Powazek et al. (1980) reported that families,

one year after the diagnosis, still suffer from high levels of stress.

Other studies concerning parents with children undergoing active cancer

treatment also reported psychological distress among the parents (Larson et al.,

1994; Brown et al., 1993). Psychiatric disorders were diagnosed among 34% of

the mothers of children with cancer during the different phases of their childs

treatment (Brown et al., 1993). Also, results of the Beck Depression Inventory


16

(BDI) showed that the mothers diagnosed with psychiatric disorder got higher

scores on depression than those who were not diagnosed with any psychiatric

disorder.

Studies by Morrow et al. (1984) and Brown et al. (1993), also analyzed

parents of those children that were off treatment. Morrow et al. (1984) reported

these parents having the lowest scores on a scale measuring the psychological

adjustment to the illness. Brown et al. (1993) also found out that mothers of

children who were off treatment had significantly lower depression scores

compared to the mothers of children newly diagnosed with cancer, and mothers

of children one year after diagnosis.

For those parents with children that have survived cancer, emotional

disturbances were lesser compared to the normative data (Kazak et al., 1994).

However, Kazak et al. (1994) also reported that if the illness-related concerns of

the children of these parents will be taken into consideration, these parents still

seem to experience posttraumatic symptoms, feelings of uncertainty, and fear for

relapses. Worries about infertility, and uncertainties about the future are also

very common (Leventhal-Belfer et al., 1993).

Socio-demographic Characteristics of Parents and Their Level of Distress

Some of the socio-demographic characteristics of those parents of

children with cancer have been observed as factors in the difference in the levels

of distress that they experience. One major example of this is the sex of the

parent. Difference between the psychological distress experienced by the

mothers and the fathers of children diagnosed with cancer have been recorded in


17

some studies; for example, in a study made by Sloper (1998), 51% of mothers

were observed with high levels of distress, while only around 40% of fathers

displayed the same levels of distress. She also reported that predictors of

distress for mothers differ with that of the father. For mothers, their appraisal of

the strain of the illness, their own ability to deal with it, and family cohesion

were the significant predictors of distress while for the fathers, predictors of

distress included the risk factors of employment problems, and the number of

the child's hospital admissions (Sloper, 1998). Furthermore, a study by Brown et

al. (1993) showed that a year after the diagnosis, the emotional problems

experienced by mothers and fathers differ as well. Results of the study showed

that a high percentage of mothers were diagnosed as overanxious while fathers,

on the other hand, were diagnosed with major depression or increased feelings

of depression.

Another socio-demographic characteristic of parents that affects the

psychological distress that they experience is their socio-economic status (SES).

Parents with a low SES, or lower income, are said to have greater risks of having

psychological and emotional problems (Van Dongen-Melman et al., 1995).

Mothers with lower SES are also said to suffer from increased maladjustments

compared to those with higher SES.

Age and civil status are also considered to be factors affecting the parents

psychological distress. As Morrow et al. (1984) reported, younger parents had

significant greater psycho-social adjustment difficulties, while those parents that


18

were married tended to have moderately lower levels of depression and anxiety

than those who were currently not married.

Some Positive Responses by Parents

On another note, some positive responses are also reported by parents as

a result of their childs illness. These include their good support systems,

increased closeness within the family, strengthened marital relationships, and

new values and attitudes in life, as well as reports on how they value life more

(Peck et al., 1979). This shows that even this kind of event can still bring about

positive reactions in a family. Having said this, however, we cannot deny the

hardship brought about by the childs condition to their parents. This is where

appropriate coping strategies become significant and helpful.

Coping Strategies Adapted by Parents

Most of the studies related to this research have used similar scales or

questionnaires in measuring or assessing the coping strategies used in coping

with the cancer diagnosis among children. Three scales were used in more than

one study, and these are Social Support Questionnaire (SSQ), The Coping Health

Inventory for Parents (CHIP), and the Ways of Coping Scale and its adapted

version, the Coping Strategy Inventory (CSI). Different conceptualizations of

coping strategies such as positive and negative type of coping, disengagement

and engagement coping, and emotion and problem focused coping have been

identified from the different studies using these scales. Common coping

strategies observed in studies were social support (Morrow et al., 1984),


19

communication (Brown et al., 1993), and search for meaning (Bearison et al.,

1993).

Social Support

Social support refers to the emotional and physical comfort given to an

individual to help him or her cope with stress (Overholser and Fritz, 1990). A

study by Morrow et al. (1984) showed that support from family and friends of

parents have been very helpful to them. They reported that support from the

medical community as well as the other parents in the help group were

recognized by the parents as the most efficient sources of support. Also,

according to the study of Larson et al. (1994), among the parents, the mothers

are the ones that use social support more often. They reported that mothers of

children with cancer and even those of healthy controls receive more overall

informational as well as emotional support than did fathers. They also added that

mothers appeared to have more contact with their relatives and friends than

fathers do.

Communication

Communication also plays a vital role in the parents coping.

Communication here does not only refer to communication between the parents

and the child about the illness but it also refers to the communication between

the parents and their family and friends about their emotional experiences

(Leventhal-Belfer et al., 1993). Also, according to Brown et al. (1993),

understanding of the childs medical condition through communication with the

other parents going through the same situation as well as communication with


20

the medical staff that are a part or helps with the treatment of the child are also

seen by other parents as a good coping strategy. They reported that a good

relationship with the medical team is important for parents of children with

cancer. Parents try to build their trust on them as their childrens lives mostly

depend on their treatment. Magnis et al. (1986) study also reported that

parents of children with cancer gave more importance to their relationship with

their childrens medical team than the parents of children with other conditions.

In addition, Shapiro and Shumaker (1987), found that compared to the

fathers, mothers of children with cancer tend to have more open and more

frequent communication with their sick child. They also found that those parents

who were less well-educated and those that use passive coping tend to have

better relationships with the medical staff. Because parents can acquire

information and get support with their communication with other parents and

the medical staff, communication and support were seen as related to one

another (Brown et al. 1993).

Search for Meaning

Another common coping mechanism observed on parents of children

with cancer was searching for meaning. Bearison et al., (1993) stated that in

times of traumatic events, people try to search for the reason on why and how

the event occurred in order to understand and make sense about it and thus,

cope with it emotionally and gain some sense of control. They, however, found

that most of the parents resort in internal types of attributions and especially

self-blame in their search for meaning of their childs condition. In the study, it


21

was observed that mothers blamed themselves for their childs illness more

often. Fathers, on the other hand, often tend to accept that there was no reason

for the childs illness (Bearison et al., 1993). Other attributions such as

environmental factors as the cause of their childs illness were also observed in

their study.

Other Coping Strategies

Other coping strategies used more often by parents of children diagnosed

with cancer have also been mentioned or identified in some related literature.

This includes withdrawal (Fife et al., 1987), and wishful thinking, (Sawyer et al.,

1993). Petermann et al. (1986) also identified praying and religion as a coping

strategy. They found in their study that the fathers were the ones who most often

used praying as a coping strategy.

Other studies reported about coping strategies in terms of emotion or

problem-focused type of coping (Wittrock et al., 1994). Wittrock et al. (1994), for

example, identified five emotion-focused coping strategies, such as maintaining

emotional balance, relying on religion, being optimistic, denial and acceptance,

and three problem-focused coping strategies such as information seeking,

problem solving and help seeking. However, no correlations were found in using

these eight coping strategies.

Furthermore, Grootenhuis et al. (1996) also identified different types of

control strategies as the parents means of coping with childhood cancer. These

control strategies included predictive, vicarious, illusory and interpretative

control. Grootenhuis et al. (1996) reported that mothers tend to depend more on


22

interpretative and illusory control than fathers do. They also found that parents

of children in remission relied more on vicarious and predictive control than

those parents of children with a relapse.

Wishful thinking and attribution of special characteristics to the child

with cancer by their parents were also considered and investigated as a coping

strategy by Grootenhuis et al. (1996). This attribution of positive characteristics

to the child provides the parents with an image of their child as being special and

vital, which leads them to develop or create the illusion that fate will be kind to

them. Also, with the parents believing that their child is strong and can handle

the situation, their confidence that their child will survive increases (Grootenhuis

et al. 1996).

Factors Influencing Adjustment or Adaptation

These coping strategies may be helpful for some parents regarding their

adaptation and adjustment to the situation. However, there are still other factors

that may influence how well they adapt to their childs condition. According to

some studies, factors like the characteristics of the child with cancer (Van

Dongen-Melman et al., 1995), characteristics of the parents (Magni et al. 1986),

the kind of coping strategies these parents use (Morrow et al. 1984), and other

life events and stressors (Kalnins et al. 1980) all contribute or influence the

adjustment or coping of parents with children diagnosed with cancer.


23

Characteristics of Children

Some child-related factors have been reported to have affected the

parents adaptation and adjustment (Van Dongen-Melman et al., 1995). These

factors were reported to cause more emotional and psychological problems to

the parents. These include the number of hospitalizations of the child, and the

childs functional impairment. These factors are said to have caused more

depression among mothers as well as increased problems in both parents (Van

Dongen-Melman et al., 1995). Also, a lesser survival perspective of the child,

which is indicated by a relapse or second malignancy, was associated to more

emotional problems in both parents (Van Dongen-Melman et al., 1995).

Furthermore, the duration of the childs treatment was found to have a positive

correlation with maternal posttraumatic stress symptoms by Stuber et al.

(1994).

Other child-related factors like the age and sex of the child diagnosed with

cancer have also been reported to influence the parents adjustment. Kupst et al.

(1995), found that there is a relation between the parents adjustment to their

childrens age. According to the results of the study, parents with younger

children had difficulty coping than those parents with older children. Brown et

al. (1993), on the other hand, reported that parents, especially the mothers, with

male children diagnosed with cancer have shown higher levels of depression and

view their sons cancer diagnosis as having greater impact on them.

Lastly, Mulhern et al. (1992) also investigated the emotional reactions of

the children with cancer as a factor influencing the parents adaptation to the


24

situation. They reported that children showing higher levels of depression cause

depressive symptoms among mothers. They also found that the childrens

behavior problems as well as their difficulties in adjusting to their illness were

predictors for the mothers adjustment problems.

Characteristics of Parents

Factors involving the parents themselves were also seen to have

influenced their adjustment and adaptation. Of the parent-related factors, gender

is considered to be one of the most significant and has received the most

attention. According to the study of Magni et al. (1986), sex differences among

parents also show variances in adjustment and adaptation to the childs cancer

diagnosis. They reported that there is an increasing evidence of differences in the

levels of depression and anxiety for mothers and fathers. Also, according to their

study, fathers reactions to the situation differ in several ways. It was described

that fathers tend to have increased drinking and avoiding discussion of the

subject. Lastly, Magni et al. (1986) also reported that these differences may be

caused by the fathers tendency to deny or their failure to report the actual

distress that they are experiencing, and that this does not necessarily mean that

fathers experiences less distress.

Other factors affecting the parents adjustment to childhood cancer

include some of their socio-demographic background such as their age, civil

status, and socio-economic status. In a study made by Van Dongen-Melman et al.

(1995), the significance of the socio-economic status of the parents in their

adjustment to the situation was investigated. They have observed that parents


25

with lower income or low socio-economic status have higher risks of having

problems. They also found that those mothers with lower socio-economic status

adapted higher degrees of emotion-focused coping, which unfortunately was

associated with increased maladjustments. In addition to that, compared to those

parents in the study with higher socio-economic status, those parents with lower

socio-economic status were observed to have more self-criticism as well as self-

blame (Van Dongen-Melman et al. 1995).

Furthermore, Morrow et al. (1984) reported in their study that younger

parents, or those below the age of 30, had more difficulty coping or adjusting

than those older parents. They also suggested in their study that being married is

another factor influencing parents adjustment. They reported that parents

currently married had lesser emotional or psychological distress than those who

were not married.

Coping Resources and Strategies

Also, as mentioned earlier, the coping resources and the kind of coping

strategies that the parents use also affect the parents coping with the situation.

Coping strategies play a vital role on the parents adjustment and parents use

different or various coping strategies. One of the coping resources that really

helped the parents was the social support that they received. According to

Morrow et al. (1984), support from friends and relatives are really helpful for

parents of children with cancer to cope better with their situation especially

after diagnosis and during treatment. Sex differences were also visible in the use

of social support as a coping strategy. According to study of Larson et al. (1994),


26

for both parents, social support was observed to be inversely related to anxiety

and depression, but it also appeared that mothers placed greater importance on

social support than the fathers.

Another example of coping strategy is communication. Brown et al.

(1993) reported that open and frequent disease-specific communication

between the parents and the medical staff, as well as communication between

the mother and the father were found to be positively correlated with good

adjustment as well as marital quality.

Other coping strategies that seem to be related to a positive adjustment

were also identified by Bearison et al., (1993). They included external types of

attributions and acceptance of the physicians advice that the cause was

unknown. These coping strategies are under the idea suggested by Bearison et

al., (1993) about searching for meaning in a traumatic event like this. They also

found that those parents who understand their childrens medical condition

better experience less distress. Furthermore, Petermann et al. (1986) have also

identified five coping techniques and reported that families tend to be more

stable and stress-resistant if they see their childs disease as a challenge.

According to their study, having a positive outlook about the childs disease will

bring about positive adjustment as well.

However, there are also some particular coping strategies which were

found to have caused maladjustments increasing the parents depression and

anxiety. These were found by Wittrock et al. (1994) to be disengaged coping and

emotion-focused coping styles.


27

In a study, however, made by Baskin et al. (1983), no relations between

coping strategies and adjustment or adaptation were reported. They stated that,

although parents experience high level of stress and say that they are coping

well, no correlations were found between coping strategies and adjustment.

They also reported that problem-focused coping and communication have no

relation whatsoever to adjustment.

Life Events and Other Stressors

The factors mentioned above all affect or contribute as to how well the

parents will cope with their childs condition. However, there are also other life

events or stressors that still continue to occur with the parents lives. As these

parents continue to face the demands brought about by their childrens

condition, most of them also continue dealing with other life events or

concurrent stressors. This was observed in the study made by Kalnins et al. in

1980. Kalnins et al. (1980) classified these problems as illness in other family

members, other major complications related to the childs illness, death of

another befriended child with cancer or other significant person, changes in their

occupation, and financial problems. According to Kalnins et al. (1980), financial

problems have the greatest impact on families. Overholser and Fritz (1990) also

found that financial problems experienced by parents were related to setbacks in

the mothers occupation or career. They also found that the mothers were the

ones who suffered setbacks in their occupation more often compared to the

fathers.


28

Furthermore, Brown et al. (1993) found that compared to those parents

with physically healthy children, parents of children with cancer encounter more

stressful life events. They also found that parents of children newly diagnosed

with cancer experience greater familial stressors. Moreover, it was found by

Kupst et al. (1995) that those parents who experience less additional life events

or stressors experience better adjustment or coping.


29

CHAPTER IV Methodology

Research Design

In this study, the researcher decided to use both quantitative and

qualitative designs. The quantitative part of the study was covered or provided

by the data collected after letting the participants of the study answer two

questionnaires, one of which is the Kessler Psychological Distress Scale, also

known as K10, and the other is the Coping Strategies Questionnaire, a survey

questionnaire created by the researcher so as to obtain the specific and

necessary data needed for the study. The questionnaire created by the

researcher was used to determine the coping strategies that the participants use

in relation to their current situation. The K10, on the other hand, was used to

determine the levels of psychological distress that they experience as an effect of

the situation.

Socio-demographic information about the participants, such as age, sex,

educational attainment, etc., was also obtained by the researcher. Also, as

observed in the related literature of the study, some information regarding the

child, such as their age, sex, number of hospitalizations, duration of treatment,

etc., also affects the parents adjustment and adaptation; that is why the

researcher has also decided to obtain the necessary information about the child

diagnosed with cancer.


30

Furthermore, correlations between all the observed factors affecting the

adaptation and adjustment of the participants, and the observed type of coping

and adjustment that the participants display were also provided by the

researcher as part of the quantitative data. To determine whether there is a

statistically significant association (represented by the P-value) between the

variables, the researcher applied the statistical tests such as the Independent

Samples T-Test, and One-way ANOVA on the data. Furthermore, a P-value of less

than 0.05 was considered significant.

On the other hand, the qualitative part of this study included Key-

Informant Interviews. These interviews were conducted in order to obtain other

information that may not have been covered by the quantitative part of the

study. They were also used to describe the quality of life of the parents after the

diagnosis of their childs cancer. Through these interviews the researcher has

obtained more candid and in-depth answers from the respondents regarding

their situation. Furthermore, with the help of the selected key-informants, the

researcher has assessed further the coping behavior of parents of children with

cancer.

The researcher has chosen both quantitative and qualitative designs in

order to have both the quantitative and qualitative data that are essential to this

study. The quantitative design is important in this study as it creates a statistical

model in an attempt to assess and explain the coping strategies used by the

participants. This design may also provide a precise measurement and analysis

of the levels of stress that the participants experience in relation to the coping


31

strategies that they adapt. The qualitative design, on the other hand, was also

chosen by the researcher so as to create a deeper analysis or understanding of

the participants current situation. Also, according to Gilgun (1992), the amount,

richness and depth of data acquired by the very nature of qualitative designs

help to fill in existing gaps in research through a focus on experiences within as

well as between families and outside systems.

Reference & Source Population

The participants of this study included the parents, both the mother and

father of children diagnosed with cancer who are currently being treated at the

Philippine General Hospital. The researcher also chose this specific setting where

the sample participants were obtained because of the fact that the PGH houses

one of the leading cancer institutions in the Philippines and also because PGH

offers a very cheap treatment, which means that people from different places

from the country tend to go here and get their treatment. Having said this, it

seems that the researcher has obtained or gathered respondents from a wide

range of participants, which somehow helped enrich the data of the research.

Sampling Design

The study employed a purposive sampling technique. Purposive sampling

is based on the assumption that one wants to discover, understand, gain insight;

therefore one needs to select a sample from which one can learn the most

(Merriam, 1988).


32

Purposive sampling is also criterion-based and the criteria used for the

selection of the participants are that their sons or daughters diagnosed with

cancer should be at the age of 18 years or below. Their son or daughter should

also be currently undergoing cancer treatment at the PGH and should be under

the supervision of an oncologist. No age limit was set for the participants.

With this, a total of 83 respondents participated in the study. This number

or sample size should be enough to represent the total population of parents of

children with cancer at the PGH.

With regard to the Key-Informant Interviews, the researcher decided to

have the couple with the highest monthly income, the couple with the lowest

monthly income, a single mother, and a single father among the respondents as

the key-informants of the study. Since according to the related literature, the

socio-economic status of parents is considered to be one of the major factors

influencing them as to what type of coping strategies they adapt with regard to

the situation, the researcher chose the couples with the highest and lowest

monthly income as key-informants. Also, the researcher chose a single mother

and father as key-informants because according again to the related literature,

marital status and sex also greatly affects the coping mechanisms of parents.

Furthermore, the researcher believed that these people are enough to represent

the respondents of the study and provide the necessary and significant

additional information about the topic.


33

Instrumentation

After getting the appropriate sample for the study, quantitative and

qualitative data was then gathered from the participants using the selected

instruments of the researcher. The instruments used in this study included

Coping Strategies Questionnaire, a questionnaire created by the researcher,

which covered the coping strategies used by the parents, the Kessler

Psychological Distress Scale (K10), a psychological screening tool which

determined the levels of psychological distress experienced by the parents in the

past month prior to taking the test, and an open-ended, semi-structured

interview guide, which was used by the researcher to further assess the coping

behavior of the participants in the Key-Informant Interviews conducted.

The researcher also provided a demographic sheet that the participants

filled out with socio-demographic information, as well as other information that

was needed for the study, about themselves and their child, who was diagnosed

with cancer. The socio-demographic information gathered included the parents

name, age, gender, religion, occupation, monthly family income, educational

attainment, civil status, and number of children, as well as the childs name, age,

gender, and birth order. Other information about the childs illness included the

hospitalization times, duration of stay in the hospital, and the duration when

their child was diagnosed with cancer. All these information were seen by the

researcher, as well as some of the related literature of this study, to be significant

variables affecting both the mother and the fathers coping mechanism.


34

After that, the participants proceed to the Kessler Psychological Distress

Scale (K10). The K10 is a brief, simple, valid, and reliable screening tool

developed in 1992 by Professors Ron Kessler and Dan Mroczek that measures

non-specific psychological distress in the anxiety-depression spectrum (Kessler

et al., 1994). It has been widely used in researches and in population health

surveys in United States, Australia, as well as in other countries. It has also been

included in the WHO World Mental Health surveys, which are being carried out

in 30 countries around the world. Also, several translated versions of the K10,

including Arabic, Chinese, German, Dutch, Italian, Japanese, and other languages,

have already been developed. For this study, the K10 will also be translated into

Filipino by the researcher in order to get more accurate results from the Filipino

participants.

The Kessler Psychological Distress Scale consists of 10 questions about

non-specific psychological distress that seeks to determine the level of current

symptoms of depression and anxiety that a person may have experienced in the

past four weeks prior to the interview (Kessler et al., 1994). Items of the scale

cover different emotional states like feeling nervous, hopeless, restless or fidgety,

depressed, and worthless. It is a self-administered tool wherein a person

responds using a five-level response scale based on the amount of time that the

person reports experiencing the particular problem in each item. The response

categories for each of the items include: none of the time, a little of the time,

some of the time, most of the time, and all of the time. Some examples of the

items in the K10 are: 1) In the past 4 weeks, about how often did you feel tired out

for no good reason; 2) In the past 4 weeks, about how often did you feel nervous;


35

and 3) In the past 4 weeks, about how often did you feel so nervous that nothing

could calm you down. Completing the questionnaire may only take about 2-3

minutes.

As stated, the main function of K10 is to determine the level of current

psychological distress experienced by an individual. With regard to the

objectives of this study, this instrument is a good tool in collecting data regarding

the severity of psychological distress that the parents of children with cancer

experience as a result of their childs illness. Also, reliability tests on the K10

resulted values of the kappa and weighted kappa scores that ranged from 0.42 to

0.74 which indicates that K10 is a moderately reliable instrument.

Upon completing the K10, participants proceed to the Coping Strategies

Questionnaire created by the researcher which gathered data about the coping

strategies that they use as they adapt to the situation of being the parents of

children diagnosed with cancer. The questionnaire consisted of 30 statements or

phrases that will describe their reaction, behavior, or attitude in response to

their childs cancer diagnosis. It is self-administered and may take the

respondents 5-10 minutes to complete. The prefix for all the statement or phrase

in each item is, When my child was diagnosed with cancer I started, and each

item is rated by the participants based on how well each statement or phrase

describes their reaction, behavior, or attitude. Using a five-point Likert scale, the

participants choose from a range of 1-5, where 1 is Strongly Disagree and 5

means Strongly Agree.


36

The aim of this questionnaire is to determine which coping strategies that

the sample participants use. The researcher used ten types of coping strategies

as the scales of this questionnaire, with each scale represented by three items.

The researcher chose the ten coping strategies based on the related literature of

this study, as well as on some of the questionnaires that were used in most of the

related studies such as the Social Support Questionnaire (SSQ), The Coping

Health Inventory for Parents (CHIP), and the Ways of Coping Scale and its

adapted version, the Coping Strategy Inventory (CSI). Some of the items in this

questionnaire are also just revised versions of the ones found on the

questionnaires mentioned, while some were created by the researcher himself.

The coping strategies used by the researcher included Communicating with

Medical Staff and Other Parents (items 9, 3, 26), Acquiring Social Support (items

29, 14, 4), Wishful Thinking (11, 17, 1), Seeking Spiritual Support (items 5, 24,

18), Being Optimistic about the Situation (items 10, 28, 15), Using Passive

Appraisal (items 8, 22, 30), Substance Use (items 19, 6, 27), Self-blame (16, 12,

23), Positive Reframing (items 20, 2, 13), and Self-isolation (Items 7, 21, 25).

Some example of the items in the questionnaire are: 1) Hoping a miracle will

happen; 2) Trying to see my childs illness in a different light, to make it seem more

positive; and 3) Talking with the medical staff (nurses, social worker, etc.) about

my childs illness when we visit the medical center. Furthermore, after pretesting

the questionnaire, reliability of the scales of the questionnaire ranged from 0.692

to 0.831, which basically indicates that the instrument was relatively reliable.


37

The last instrument used in this study was the in-depth, semi-structured

interview guide for the Key-Informant Interviews, which provided the

qualitative data needed in this research. This interview guide, which took about

20-30 minutes, was used to determine the quality of life of these parents and

their family (through the help of the selected key-informants) as they go through

their situation in life. It consists of 10 open-ended questions about how the

childs cancer diagnosis affected their lives, about the problems and difficulties

that they have experienced, and about how they manage to cope with their

situation. The first and second questions were about their initial reactions when

their child was diagnosed with cancer, and the difficulty of accepting the

diagnosis. The third, fourth, and fifth questions, however, tackled concerns about

how the childs cancer diagnosis changed or impacted their lives as parents, as

well as the different problems and difficulties it brought to them. The fourth

question determines the effects of childs cancer diagnosis on more specific

aspects of the parents lives like their psychological-emotional health,

economical status, social relationships, etc. The sixth, seventh, and eighth

questions, on the other hand, were about the coping behavior that they adapt in

relation to their current situation. The ninth question asked the parents to

describe their current condition in relation to their childs illness, and lastly, the

tenth question was about the positive effect that might have been brought about

by the situation. Furthermore this interview guide was used by the researcher to

strengthen or support, as well as to fill the gaps of the data gathered in the

quantitative part of the study.


38

Data Gathering Procedure

The following instruments that were used in this study as mentioned

above have all been administered at the Philippine General Hospital itself. The

administration of tests, as well as the Key-Informant Interviews, was done in

certain length of time so as to achieve the desired number of participants as the

parents of children with cancer come and go to the cancer institute for their

treatment.

The quantitative data was first gathered by providing self-administered

questionnaires to the selected participants. The participants were first asked to

read a letter asking for their consent to participate in the study. This letter also

contained information about the whole process of the study such as the tests that

they have to undergo. If they agree to take part in the study, the participants

were given a pen and a copy of the questionnaire. First, participants complete the

socio-demographic information asked from them; this is basically the first part of

the questionnaire. After that, they proceed to answering the Kessler

Psychological Distress Scale (K10), which makes up the second part of the

questionnaire. Lastly, the participants complete the Coping Strategies

Questionnaire created by the researcher. While the participants were answering

the questionnaires, the researcher leaves the participants alone so as not to

affect or influence their answers. After a few minutes or so, the researcher

returns to the participant to see if he/she has already finished answering the

questionnaire.


39

In scoring the K10, a mark or a score of 1 was given to any question

answered with none of the time, a mark of 2 was given to any question answered

with a little of the time, and so on up to 5 for questions answered with all of the

time. The researcher then got the sum of the scores given by the respondents in

all 10 items to get the total score, which may yield a minimum score of 10 and a

maximum score of 50.

Generally, low scores on K10 indicate low levels of psychological distress

and high scores indicate high levels of psychological distress. However, more

specific interpretations of scores were also done using a set of cut-off scores

provided by the instrument. People who got a score under 20 were likely to be

well, those who score 20-24 were likely to have a mild mental disorder, those

who score 25-29 were likely to have a moderate mental disorder, and people

who score over 30 were likely to have a severe mental disorder.

On the other hand, the questionnaire created by the researcher, which

took the participants about 5-10 minutes to complete, was scored by the

researcher by simply getting the sum of the item scores for each scale. High

scores on some certain scale indicate the more frequent use of that specific

coping strategy.

After gathering all the data from the quantitative part of the study, the

researcher then selected the key-informants for the Key-Informant Interviews

from the respondents. The researcher contacted these people and conducted the

interviews on the date and place agreed upon by the researcher and the key-


40

informant. Interviews were also taped or recorded for more accurate

transcription.

Ethical Consideration

Prior to participating in the study, the participants were asked to read a

letter asking for their informed consent. No participant was forced to partake in

the study. All necessary information about the study, as well as the questionnaire

that the participants have to complete, was also be discussed by the researcher

to the participant beforehand. Also, as mentioned on the letter, information that

were given out by the participants were handled with great confidentiality and

were only used to achieve the objectives of the study that the researcher hopes

to somehow benefit them in return.

Scope and Limitations

This study focused on the assessment of coping strategies of the parents

of children with cancer that are currently undergoing treatment at the Philippine

General Hospital including how well they have adapted or adjusted

psychologically and emotionally to the situation using these strategies. It covered

and provided information about the importance of the coping strategies in

dealing and coping with this kind of situation. The study, however, was only

limited to the parents of the patient. It did not include other members of the

family. It was also restricted to those parents of children diagnosed with cancer

and are currently undergoing treatment. It did not include those parents of


41

children who have already survived cancer. It did not also deal with the effects of

the childs illness on the marital relationship of the parents. Furthermore, the

data of the study were limited only to the information that the respondents from

the selected institution, which is the PGH, have provided based on the

questionnaire and interview, as well as the data and information from the

related literature that were cited and reviewed.


42

CHAPTER V Presentation of Results

Socio-Demographic Profile of Respondents/Parents

A total of 83 parents participated in the study. As Table 1 below shows,

the sex distribution of the participants is closely even with 41 fathers (49%) and

42 mothers (50%). This is basically because most of the respondents are married

couples giving an even distribution of mothers and fathers. The age profile of the

parents showed that most of them are middle-aged adults. As presented, the

largest proportion of the respondents is in the 30-39 age category, which

comprises 37% of the respondents. Next to it is the 40-49 age category with 35%

of the respondents. Lastly, parents who belonged to the older age group of 50

and above only consisted of 9%.

Also, as mentioned earlier, majority of the parents who participated are

married couples. As presented below (Table 1), among the 83 parents who

participated, there were a total of 33 married couples, which comprises 80% of

the total respondents. The remaining parents were single, divorced, or widowed.

Overall, there were 33 couples, 5 single fathers, 2 widowed fathers, 1 divorced

father, 5 single mothers, 3 widowed mothers, and 1 divorced mother.

Regarding the parents educational background, as shown on the table,

only 41% of the participants have reached college or the tertiary level of

education, while more than half of the participants (52%) only reached the


43

secondary level (high school). The remaining 7%, on the other hand, have

reached only the primary or the elementary level. In addition, none of the

parents who participated was illiterate. Also, a total of 39 parents (47%) are

employed with only one parent (1%) unemployed. However, since majority of

the respondents are married couples, almost all of these employed parents are

fathers being the chief provider for the family. This explains the large number of

housewives in the respondents, which comprises 34% of the total respondents.

Occupations of those employed include government employee, police officer,

teacher, saleslady, driver, laborer, etc. Furthermore, as shown below, more than

half of the respondents (57%) are earning only about P5, 000-P9, 999 every

month. Only 26% of the respondents are earning P10, 000-P14, 999 monthly,

while 17% are earning less than P5, 000 every month. This just shows that most

of the families who go to PGH for the cancer treatment of a child in the family are

not really that well-off.

With regard to the parents religion, as presented below, a total of 86%

were Roman Catholic with the remaining 14% divided into Christian (1%),

Iglesia ni Cristo (6%), Muslim (1%), Ang Dating Daan (3%), Methodist (1%), and

Seventh-Day Adventist (2%). Obviously, large majority of the participants are

Roman Catholic since it is the dominant religion in the country.

Lastly, majority of the parents (37%) have three children, while about

23% have two children. Furthermore, 13% of the parents have only one child

and a total of 17% have five or more children.


44

Table 1. Socio-Demographic Profile of Parents (N=83)

Characteristics NO. %

Sex Male (Father) Female (Mother)

41 42

49 51

Age 20-29 Years 30-39 Years 40-49 Years 50 Years

16 31 29 7

19 37 35 9

Marital Status Single Married Divorced Widowed

6 66 5 6

7 80 6 7

Educational Attainment Elementary Level High School Level College Level

6 43 34

7 52 41

Occupational Status Employed Business Housewife Unemployed

39 15 28 1

47 18 34 1

Monthly Family Income < P5,000 P5,000-P9,999 P10,000-P14,999

14 48 21

17 57 26

Religion Roman Catholic Christian Iglesia ni Cristo Muslim Ang Dating Daan Methodist Seventh-Day Adventist

71 1 5 1 2 1 2

86 1 6 1 3 1 2

No. of Children 1 2 3 4 5

11 19 31 8

14

13 23 37 10 17

Socio-Demographic Profile of Children with Cancer

Since there are 33 married couples, 9 single mothers, and 8 single fathers

who participated, a total of 50 children with cancer have been a part of the study.

As presented on the Table 2 below, 62% of these children are males and 38% are

females. Majority of them (40%) are aged 6 years or below, while about 26% are


45

aged 13-18 years. 34%, on the other hand, belonged to the 7-12 age category.

Furthermore, the youngest age among the children is 1 year old, while the oldest

age is 18 years old. Furthermore, as presented, 28% of these children are the

youngest child in the family, and about 34% are the eldest child. However,

majority of these children (38%) is the middle child of the family, meaning that

they were born as the second, third, etc. child in the family.

Table 2 below also shows the duration since when these children were

diagnosed with cancer. As shown below, 42% of these children have been

diagnosed with cancer for just less than a year, while only 20% were diagnosed

with can

Documents

Coping Strategies Used by Both Parents of Children Currently Undergoing Cancer Treatment at the Philippine General Hospital