title: Grandparents of children with cancer: a controlled study of distress, support, and barriers to care.
abstract: OBJECTIVE
  For families under stress, positive grandparental relationships provide a valued 'safety net'. However, coping with family stressors can place a heavy burden on older individuals who may be experiencing declining health/energy themselves. This mixed-methods study assessed the prevalence of distress in grandparents of children with, and without, cancer, aiming to identify predictors of grandparental distress and quantify their barriers to care.
  
  
  METHODS
  Two hundred twenty-one grandparents [87 cancer group; 134 controls; mean age 65.47 years (SD = 6.97); 33.5% male] completed self-report questionnaires assessing distress, anxiety, depression, anger, 'need for help', support use, and barriers to psychosocial care.
  
  
  RESULTS
  A higher proportion of grandparents in the cancer group reported clinically relevant distress (32.9% vs. 12.7%; p < 0.001), anxiety (48.8% vs. 23.9%; p < 0.001), depression (24.4% vs. 6.0%; p < 0.001), and anger (23.5% vs. 6.8%; p = 0.001). In the cancer group, distress was higher in grandmothers and in families with fewer siblings. Grandparents rarely accessed evidence-based psychosocial support (<5% in both groups), although grandparents of children with cancer were more likely to seek religious/spiritual support. Barriers to help seeking included lack of knowledge and rurality. Grandparents of children with cancer qualitatively described undisclosed feelings of uncertainty and helplessness and provided advice to other grandparents to facilitate their coping.
  
  
  CONCLUSIONS
  Grandparents of children with cancer were clearly more distressed than controls. Grandparents' capacity to support their families may be limited by their own, untreated, distress.
authors.affiliation: School of Women's and Children's Health, University of New South Wales, Kensington, NSW, Australia; Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia.
authors.forename: Claire E
authors.initials: CE
authors.lastname: Wakefield
authors.forename: Donna
authors.initials: D
authors.lastname: Drew
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Ellis
authors.forename: Emma L
authors.initials: EL
authors.lastname: Doolan
authors.forename: Jordana K
authors.initials: JK
authors.lastname: McLoone
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Cohn
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000453:epidemiology*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003863:Depression / Q000453:epidemiology*; D005190:Family / Q000523:psychology*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012424:Rural Population / Q000706:statistics & numerical data; D013315:Stress, Psychological / Q000453:epidemiology*; D014505:Urban Population / Q000706:statistics & numerical data
keywords: cancer; caregivers; child; mental health; oncology; psychosocial