The Impact of Family Functioning on Children's Adaptation During a Parent's Bone Marrow Transplantation

Abstract

Bone marrow transplant (BMT) is being used ever more widely for advanced and refractory malignancies. The family unit and individual members are profoundly affected by this treatment process. Few studies have examined the effect of parental BMT on the family, and there are no known studies which have investigated the impact of parental BMT on children. A descriptive design with longitudinal data from 61 children, ages 10-18, examined children’s adaptation, characterized as emotional and behavioral response, during the acute phase of parental BMT. The study included 3 time points: pre-transplant, during parental hospitalization, and one month after transplantation. The Response to Stress Questionnaire, and subscales from the Child Health Questionnaire and Family Environment Scale were used to assess child, parent, and family variables associated with child adaptation. Child emotional and behavioral response significantly improved over the course of the parent’s transplant, and significant changes in children’s use of coping strategies at each time point were found. The model accounted for 27% to 46% of the explained variance in child behavioral response, and accounted for 41% of the explained variance in emotional response prior to the parent’s BMT and one month after BMT. The model did not explain the variance of child emotional response, however, during the parent’s hospitalization. Family structural change, family conflict, and disengagement coping were found to be the predominant variables significantly associated with more negative child behavioral response across the transplant trajectory. Female child gender and increased use of disengagement coping before the parent’s BMT, autologous BMT during the parent’s hospitalization, and increased family structural change when the parent returned home one month later were significantly associated with more negative emotional response in children. Additional cross-sectional and longitudinal studies, using mixed methods, and include both parent and child data, are needed to substantiate the validity of findings. The data also suggests that significant variables in this model could be further studied for their association with one another and for refining a more accurate and inclusive model that may better explain children’s adaptation.