title: Two worlds: Adolescents' strategies for managing life with a parent in hospice.
abstract: This study aimed to generate an explanatory model of the coping strategies that adolescents employ to manage the stressors they experience in the final months of their ill parent's life and shortly after their death.
  
  
  
  The sample included 26 families of adolescents with a parent receiving care in a large hospice program in northeastern Ohio. A semistructured interview was conducted with 14 ill parents, 17 well parents/guardians, and 30 of their adolescent children before the parent's death and, additionally, with 6 of these families after the death. The interviews were audiotaped, transcribed verbatim, and analyzed using a grounded-theory approach.
  
  
  
  The participants described two worlds that constituted the lives of the adolescents: the well world of normal adolescence and the ill world of having a parent near the end of life. The adolescents experienced a common challenge of living in two worlds and responded to the challenge with a process we labeled "managing two worlds." Five stages through which adolescents manage their worlds were identified: keeping the ill world and the well world separate; having the ill world intrude into the well world; moving between the ill world and the well world; being immersed in the ill world; and returning to the well world having been changed by the ill world.
  
  
  
  The explanatory model of "managing two worlds" outlines a complex and nuanced process that changes over time. The model can be used by health professionals who seek to help adolescents navigate this critical time when their parents are dying or have recently died. These results can also be used to inform the development of interventions that assist families with strategies tailored to an adolescent's specific needs. Future research should investigate associations among the process of "managing two worlds" and outcomes related to adolescent bereavement.
authors.affiliation: Kent State University College of Nursing,Kent,Ohio.
authors.forename: Denice Kopchak
authors.initials: DK
authors.lastname: Sheehan
authors.affiliation: Ursuline College,The Breen School of Nursing,Pepper Pike,Ohio.
authors.forename: M Murray
authors.initials: MM
authors.lastname: Mayo
authors.affiliation: Columbia University School of Social Work,New York,New York.
authors.forename: Grace H
authors.initials: GH
authors.lastname: Christ
authors.affiliation: Department of Hematology/Oncology,Akron General Medical Center Physicians Partner Group,Akron,Ohio.
authors.forename: Kim
authors.initials: K
authors.lastname: Heim
authors.affiliation: Kent State University College of Nursing,Kent,Ohio.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Parish
authors.affiliation: Kent State University College of Nursing,Kent,Ohio.
authors.forename: Ghada
authors.initials: G
authors.lastname: Shahrour
authors.affiliation: Indiana University School of Nursing,Indianapolis,Indiana.
authors.forename: Claire Burke
authors.initials: CB
authors.lastname: Draucker
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D000328:Adult; D002648:Child; D005260:Female; D066296:Grounded Theory; D006738:Hospices / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009820:Ohio; D010287:Parent-Child Relations; D010290:Parents / Q000523:psychology; D036301:Qualitative Research; D013315:Stress, Psychological / Q000209:etiology / Q000523:psychology
keywords: Adolescents/youth; Advanced cancer; Hospice; Parental death; Qualitative research