Predisposing, Precipitating, Perpetuating, and Protective Factors Associated With Distress in the Siblings of Children With Cancer: A Systematic Review.

BackgroundSiblings in families caring for a child with cancer have unique childhood experiences, often resulting in high levels of anxiety, depression, and posttraumatic stress symptoms.ObjectiveThis systematic review aims to summarize and categorize factors related to increased and decreased experiences of emotional distress among siblings of children with cancer.MethodUsing the Cochrane method, searches were conducted in six academic databases. Eligible studies included those examining siblings of children with cancer aged 21 years old or younger and on active treatment and reported on factors associated with sibling experiences of distress. Identified factors were categorized in accordance with the 4Ps of case formulation (predisposing, precipitating, perpetuating, and protective factors). Results were reported using a narrative synthesis.ResultsOf 18,059 studies retrieved, we included 12 articles. In total, 19 factors were identified, including 7 predisposing factors (e.g., sibling age), 1 precipitating factor (sibling perception of threat to lifestyle), 8 perpetuating factors (e.g., increased caregiving burden), and 3 protective factors (e.g., greater time elapsed since diagnosis). Predisposing, precipitating, and perpetuating factors increased sibling distress, while protective factors reduced sibling distress.ConclusionWe identified factors associated with distress in siblings of children with cancer. The findings may enable clinicians to identify siblings at greater risk of experiencing distress and inform the creation of psychosocial interventions that decrease experiences of distress in siblings.