Children's Positive Dispositional Attributes, Parents’ Empathic Responses, and Children's Responses to Painful Pediatric Oncology Treatment Procedures

Abstract

Pain/distress during pediatric cancer treatments has substantial psychosocial consequences for children and families. The authors examined relationships between children's positive dispositional attributes, parents’ empathic responses, and children's pain/distress responses to treatment procedures. Participants were 41 pediatric cancer patients and parents. Several weeks before treatment, parents rated children's resilience and positive dimensions of temperament. Parents’ pretreatment empathic affective responses to their children were assessed. Children's pain/distress during treatments was rated by multiple independent raters. Children's resilience was significantly and positively associated with parents’ empathic affective responses and negatively associated with children's pain/distress. Children's adaptability and attention focusing also showed positive relationships (p < 0.10) with parents’ empathic responses. Parents’ empathic responses mediated effects of children's resilience on children's pain/distress. Children's positive dispositional attributes influence their pain/distress during cancer treatments; however, these effects may be mediated by parents’ empathic responses. These relationships provide critical understanding of the influence of parent–child relationships on coping with treatment.

KEYWORDS:

• families
• pediatric
• cancer
• pain/distress
• resilience
• temperament
• empathy

Acknowledgments

This research was supported by grants from the National Cancer Institute (#1R03CA141992–01; PI: F. Harper; #1R01CA138981–01A1; PI: L. A. Penner; #1R01CA100027– 03, PI: T. L. Albrecht). Portions of this research were presented at the 27th Annual Meeting of the Society for Behavioral Medicine, San Francisco, CA and 116th Annual Convention of the American Psychological Association, Boston, MA. The authors have no financial relationships relevant to this article to disclose.

Notes

1. Although 41 children were observed, complete pain/distress ratings or questionnaire data was not available on three cases; therefore, the number of cases included in the analyses was 38.

2. Parents and nurses rated children's pain and distress, children rated their own pain, and trained observers rated the child's distress during the procedure, leading to differences in dimensions rated across sources. At the outset of the study, nurses strongly maintained that child treatment-related pain and distress were related but distinct dimensions. Therefore, parents and nurses rated child pain and distress. However, it was expected that especially younger children would have difficulty distinguishing between pain and distress; therefore children rated only their pain. Observers, because they were not present in the treatment room, rated only child distress and not pain. Despite these differences in dimensions rated, correlations among all ratings of pain and distress (r = .64) suggested they could be combined into a single dimension, hereafter called “pain/distress.”

3. Analyses using empathic concern and state anxiety separately showed a similar pattern of results.