Taqyah Cucu, Abidin Fitri Ariyanti, Iskandarsyah Aulia
Postgraduate Program in Psychology, Faculty of Psychology, Universitas Padjadjaran, Sumedang, West Java, Indonesia.
Department of Psychology, Faculty of Psychology, Universitas Padjadjaran, Sumedang, West Java, Indonesia.
Cancer Manag Res. 2025 Sep 18;17:2049-2068. doi: 10.2147/CMAR.S538600. eCollection 2025.
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.
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.
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).
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.
尽管疾病不确定性在成年人中已得到广泛研究，但对于儿童癌症中的这一问题却知之甚少，尤其是从父母的角度。未得到解决的父母对疾病不确定性的认知（父母不确定性）可能会损害父母的幸福感和孩子的治疗效果。本系统综述旨在综合关于儿童癌症中父母不确定性的决定因素和后果的现有证据。
遵循PRISMA指南，对六个数据库（Scopus、SAGE、泰勒与弗朗西斯、MEDLINE Ultimate、PubMed和ScienceDirect）进行系统检索。使用混合方法评估工具（MMAT）对符合条件的研究进行评估，并对数据进行叙述性综合分析。
从最初识别出的979条记录中，有14项研究符合纳入标准。发现父母不确定性受到风险因素和保护因素的影响。风险因素包括父母年龄较大、教育程度较低、收入较低、母亲失业、获得医疗保健的障碍、诊断后时间较短以及治疗强度较高。保护因素包括积极的应对技巧、父母教育支持、医疗保健提供者的沟通支持以及积极的亲子沟通。父母不确定性始终与不良心理结果相关，如焦虑、抑郁、反复思考、创伤后应激症状（PTSS）、育儿压力和功能失调的问题解决方式，同时会降低诸如心理韧性、掌控感、建设性应对方式和健康相关生活质量（HRQoL）等积极结果。
儿童癌症中的父母不确定性由多种因素驱动，并与重大心理负担相关，其中PTSS是最突出的后果。在诊断后尽早针对父母心理健康进行早期干预对于降低包括创伤后应激障碍在内的长期风险至关重要。
