title: "You can only take so much, and it took everything out of me": coping strategies used by parents of children with cancer.
abstract: OBJECTIVE
  This study qualitatively assesses the coping strategies of parents who care for a child with cancer.
  
  
  METHODS
  Semi-structured interviews were conducted with 28 French and English families who had had a child diagnosed with cancer in the last ten years in two Eastern Canadian provinces. Interviews were transcribed verbatim and coded with a focus on parental coping strategies.
  
  
  RESULTS
  Using coping behaviors as described and categorized in the Family Adjustment and Adaptation Response (FAAR) model as a foundation, we found that families used a variety of appraisal-, emotion-, and problem-focused coping. Appraisal-focused coping strategies involved trying to stay "positive" and "making positive comparisons." Problem-focused coping involved behaviors such as being an advocate for the child and seeking information. The majority of parents, however, described using emotion-focused coping behaviors such as trying to avoid "feeling too much" by hiding difficult emotions and "escaping" from problems. Others used more positive emotion-focused coping behaviors such as humor, seeking support (informal or formal), or writing diaries. A small group of parents used ineffective coping strategies (alcohol abuse, misdirected anger) that added to family stress. These ineffective strategies have led to a modification of the FAAR model indicating that not all coping behaviors are beneficial to family adjustment in crisis. Overall, many parents felt that their coping strategies were effective; however, a few described having a complete "coping breakdown".
  
  
  CONCLUSIONS
  Parents used a range of coping strategies of which emotion-focused coping was the most prominent. We have enhanced the FAAR model by including additional coping behaviors as well as a description of how some coping behaviors add to the daily stressors for parents dealing with a child's illness. Professional health care providers need to understand the variability of the coping behaviors in order to appropriately assist parents to avoid coping breakdowns.
authors.affiliation: Dalhousie University Family Medicine Teaching Unit, Dr. Everett Chalmers Regional Hospital, Fredericton, New Brunswick, Canada. bo.miedema@rvh.nb.ca
authors.forename: Baukje
authors.initials: B
authors.lastname: Miedema
authors.forename: Ryan
authors.initials: R
authors.lastname: Hamilton
authors.forename: Pierrette
authors.initials: P
authors.lastname: Fortin
authors.forename: Julie
authors.initials: J
authors.lastname: Easley
authors.forename: Maria
authors.initials: M
authors.lastname: Matthews
mesh_terms: D000223:Adaptation, Psychological; D001294:Attitude to Health; D002648:Child; D017281:Cost of Illness; D004644:Emotions; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D008297:Male; D008960:Models, Psychological; D009369:Neoplasms / Q000523:psychology / Q000628:therapy; D009509:New Brunswick; D009523:Newfoundland and Labrador; D010290:Parents / Q000193:education / Q000523:psychology*; D011340:Problem Solving; D036301:Qualitative Research; D012069:Religion and Psychology; D012424:Rural Population; D020377:Self Efficacy; D012944:Social Support; D011795:Surveys and Questionnaires; D014195:Travel