Determinants and Consequences of Parental Uncertainty in Childhood Cancer: A Systematic Review.

Abstract

Purpose: Although illness uncertainty has been widely studied in adults, little is known about this issue in childhood cancer, particularly from parents' perspectives. Unaddressed parental perception of illness uncertainty (parental uncertainty) may undermine both parental well-being and children's treatment outcomes. This systematic review aims to synthesize existing evidence on the determinants and consequences of parental uncertainty in childhood cancer.

Methods: Following PRISMA guidelines, six databases (Scopus, SAGE, Taylor & Francis, MEDLINE Ultimate, PubMed, and ScienceDirect) were systematically searched. Eligible studies were appraised using the Mixed-Methods Appraisal Tool (MMAT), and data were narratively synthesized.

Results: From 979 initially identified records, 14 studies met the inclusion criteria. Parental uncertainty was found to be influenced by both risk and protective factors. Risk factors include older parental age, lower educational attainment, lower income, maternal unemployment, barriers to healthcare access, shorter time since diagnosis, and higher treatment intensity. Protective factors include active coping skills, parental education support, communication support from healthcare providers, and positive parent-child communication. Parental uncertainty was consistently associated with adverse psychological outcomes, such as anxiety, depression, rumination, post-traumatic stress symptoms (PTSS), parenting stress, and dysfunctional problem-solving, while reducing positive outcomes such as resilience, mastery, constructive coping, and health-related quality of life (HRQoL).

Conclusion: Parental uncertainty in childhood cancer is driven by multiple factors and linked to significant psychological burdens, with PTSS as the most prominent consequence. Early interventions targeting parental mental health soon after diagnosis are essential to reduce long-term risks, including PTSD.