A Three Factor Model of Parental Coping With Childhood Cancer

Objectives: Parents of children with cancer are at increased risk for anxiety, depression, and post-traumatic stress, although wide variability among parents has been documented. This cross-sectional study was designed to examine the individual contributions and simultaneous interaction of three coping constructs—coping strategy, repertoire of coping techniques, and flexibility in applying these techniques—in parental distress related to childhood cancer. Methods: A sample of 88 mothers and 57 fathers (N = 145) of children undergoing active cancer treatment were recruited from a pediatric hematology-oncology department. Parents' ages ranged from 22 to 58 years. Parents completed standardized measures including the Brief COPE, Coping Flexibility Scale-Revised, the Pediatric Parenting Stress Inventory, and the Profile of Mood States. Results: Avoidance-focused coping strategy, repertoire of coping techniques, and coping flexibility were individually found to be significantly correlated with parental distress. Bootstrap mediation analysis revealed that the collective model explained 37%–43% of the variance in parental distress, with avoidance-focused coping strategy emerging as the most significant predictor, accounting for approximately 29% of the total variance. Conclusions: These results suggest that clinical interventions should prioritize identifying and reducing parental reliance on avoidance-focused coping techniques as a primary target. Subsequently, expanding parents' repertoire of problem- and emotion-focused coping techniques and enhancing flexibility in their application could lead to better distress reduction. However, the cross-sectional design limits causal interpretation, and future longitudinal studies employing larger sample sizes are needed to establish the relationships between these constructs.