title: Impact of childhood cancer on parents' relationships: an integrative review.
abstract: OBJECTIVE
  The diagnosis of cancer and the treatment decisions associated with it may cause uncertainty, stress, and anxiety among parents. Emotional tensions can affect parents' relationships during the trajectory of the child's cancer illness. We conducted an integrative review to examine the evidence related to the effects of childhood cancer on parents' relationships.
  
  
  METHODS
  An integrative literature search of studies published between 1997 and 2009 was conducted in the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Psychology Information (PsycINFO), PubMed, Scopus, CUIDEN, and Latin American and Caribbean Health Science Literature (LILACS). The key words used were neoplasms, child, marriage, spouses, family relations, and nursing. Articles were reviewed if the (a) topic addressed parents' relationships during childhood cancer; (b) participants were mothers, fathers, or both; (c) design was either qualitative or quantitative; (d) language was English, Portuguese, or Spanish; (e) date of publication was between January 1997 and October 2009; and (f) abstract was available.
  
  
  RESULTS
  Fourteen articles met the search criteria and were reviewed using Cooper's framework for integrative reviews. Four themes emerged: (a) changes in the parents' relationship during the trajectory of the child's illness; (b) difficulty in communication between couples; (c) gender differences in parental stress and coping; and (d) role changes.
  
  
  CONCLUSIONS
  Findings revealed positive and negative changes in parents' relationships, communication, stress, and roles. Nurses need to assess the impact of cancer diagnosis and treatments on parent relationships, offer support and encouragement, and allow expression of feelings. Future research is needed to develop and test interventions that increase parents' potentials and strengthen relationships during the challenging trajectory of their children's cancer and treatment.
  
  
  CONCLUSIONS
  The multiple sources of stress and uncertainty associated with a child's cancer diagnosis and treatment affect parents' relationships. Difficulties in communication appear frequently in parents' relationship. Our findings may guide healthcare professionals in identifying parents at risk for developing conflicts, communication problems, and lack of alignment between parents that could interfere with providing optimal care for their child with cancer. Healthcare professionals may promote dialogue and encourage parents to express their feelings, seek mutual support, and establish a partnership in dealing with the child's illness.
authors.affiliation: University of São Paulo at Ribeirao Preto College of Nursing, São Paulo, Brazil.
authors.forename: Fernanda Machado
authors.initials: FM
authors.lastname: da Silva
authors.forename: Eufemia
authors.initials: E
authors.lastname: Jacob
authors.forename: Lucila Castanheira
authors.initials: LC
authors.lastname: Nascimento
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001294:Attitude to Health; D002648:Child; D017281:Cost of Illness; D005195:Family Relations; D005260:Female; D006801:Humans; D008297:Male; D008393:Marriage / Q000523:psychology*; D009369:Neoplasms / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D024802:Nurse's Role / Q000523:psychology; D015404:Nursing Methodology Research; D010290:Parents / Q000523:psychology*; D036301:Qualitative Research; D012107:Research Design; D012380:Role; D012737:Sex Factors; D013315:Stress, Psychological / Q000523:psychology; D014481:United States