| Summary: | 碩士 === 臺灣大學 === 護理學研究所 === 98 === Background and purposes: According to an estimate of Childhood Cancer Foundation of Republic of China in 2009, approximately 550 children are diagnosed as cancer each year. When children are diagnosed, their parents always focus on cancer treatment and care, and sometimes neglect other healthy children, which may result in depressed emotion, loneliness and jealousy among healthy siblings. These negative emotions may affect the relationship between siblings. The purpose of the study was to explore the point of views by means of in-depth interview, projective play and drawing to understand the life adjustment of the healthy siblings of children with cancer.
Methods: Qualitative study using phenomenology approaches was conducted at a medical center of northern Taiwan. Purposive and snowball sampling methods were applied to recruit subjects from November, 2009 to April, 2010. The criteria of recruitment were: children newly diagnosed as cancer from six months to two years and currently received cancer chemotherapy; sibling of sick child aged less than 18 years old. Five healthy siblings who participated at the study were between 2 and 14 year old. Ten significant caregivers were invited to the study. Each schooler was interviewed lasted from 30 and 60 minutes; however, preschoolers and toddlers varied depending on their conditions. Data were recorded during the interviewing process, transcribed into verbatim right after interview, and then extracted the essences of the phenomenon iteratively. In order to illuminate siblings their own experience a qualitative data analysis method proposed by the Nvivo 8.0 qualitative software was used.
Results: Four domains were generated by Colaizzi (1978) method as follows: Encountering the impact of siblings with cancer, inevitable changes of the family life, mood fluctuation in daily life and reconstruction of the family life.
First, encountering the impact of siblings with cancer includes two themes: 1. Realizing the fact that cancer happens in the siblings; the subthemes includes the astonishing response to the fact and informed by their parents. 2. Perception of the sick siblings; the subthemes include surmising the causes and outcomes of the disease, worrying loss of the siblings, responding to the appearance changes of the ill children, and reluctant to mention the sick siblings.
Second, inevitable change of the family life includes three themes: 1. Separating from the beloved mother; the subthemes includes forcedly removed mother, silent tearing and grief relieve by phone. 2. Unbalance and adjustment of living; the subthemes include changing caregivers, dietary habit, quality of sleep, and leisure activities. 3. Shifting between independence and dependence; the subthemes include living alone, lack of restriction and regression of school performance.
Third, mood fluctuation in daily life includes two themes: 1. Unequal love; the subthemes include granted privilege of the ill siblings and different disciplines among siblings. 2. Less conflict with the ill siblings; caring suffering of the sick siblings, self-sacrificing and tolerating inappropriate emotion and behavior of the ill siblings.
Fourth, reconstruction of the family life includes two themes: 1. Cherishing relationship with siblings; the subthemes include close relation to each other and pleasure of having siblings. 2. Becoming mature; the subthemes include caring efforts of the beloved mother, assisting in caring and accompanying siblings, self-conscientiousness and self-care, experiencing strength of life and expecting health of the siblings.
Conclusion: The study findings indicated that parents play a vital role during child development period, and the challenges for siblings of children with cancer might be particularly more stressful than cancer children themselves and their parents. Health professionals must understand healthy sibling feelings and situations. The more supports those siblings got, the better coping abilities they might have and improving the interactions among family members.
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