Background: Being a parent with malignancy presents unique challenges for patients, families and treating clinicians. It is unclear to what degree parenting considerations feature in routine care, how clinicians approach these discussions and resources they draw upon.
Objective: To explore perceptions and experience of doctors who treat cancer patients with dependent children. Specific objectives included: experience of discussions with patient-parents, perceived doctor role/s, confidence in providing support and awareness of referral resources.
Methodology: Exploratory, qualitative design utilising semi-structured focus group and in-depth interviews to ascertain views amongst SVHM doctors involved in treating cancer patients with children. Responses were audio-recorded, transcribed and thematically analysed using grounded theory framework.
Results: Twenty-eight doctors participated: medical oncology (7), haematology (10), palliative care (8) and psychiatric-oncology (3). Participants observed malignancy impacted upon parenting across several domains: practical (symptoms, side-effects, competing responsibilities), psychological impacts, implications of genetic-associated cancers, planning around death. Having dependent children was perceived to impact experience of cancer: treatment decision-making (greater treatment uptake, increased resource investment by clinicians, judicious opioid use) and observation of heightened denial in some patients. Perception of doctors’ roles varied: facilitating communication, providing information, psychological support, prompting future-planning, and referrals. Awareness of helpful resources varied. Many identified managing these patients as emotionally challenging; and described limited confidence and training in paediatric communication except for the psychiatrists. Scenarios identified as particularly challenging: single-parent and non-English speaking families, patients with poor insight.
Conclusion: Having children alongside malignancy was observed to influence a patient’s cancer experience in addition to having implications for parenting. Whilst recognised as important by clinicians, the degree of experience, training, awareness of resources and confidence in approaching these issues appeared limited for most. Greater understanding of physician experience and perceptions in assisting patients with parenting concerns may inform development of resources to assist clinicians and their patients.