Psychological resilience and anticipatory grief in the parents of children with cancer: The mediating role of pain catastrophizing and the moderating role of family resilience.

OBJECTIVE

To investigate the status of anticipatory grief, psychological resilience, family resilience, and parental pain catastrophizing about the child's pain in parents of children with cancer, and to identify factors associated with anticipatory grief. The study also explored the potential mediating role of parental pain catastrophizing about the child's pain in the relationship between psychological resilience and anticipatory grief, as well as the moderating role of family resilience.

METHODS

A total of 236 parents of children with cancer were recruited from four Grade A tertiary hospitals in China between November 2024 and April 2025. The participants were assessed using the Anticipatory Grief Scale (AGS), Connor-Davidson Resilience Scale (CD-RISC), Family Resilience Scale (FRS), and Pain Catastrophizing Scale (PCS).

RESULTS

The parents of pediatric cancer patients reported a mean AGS score of 76.74 (standard deviation [SD] = 16.92). Multiple linear regression showed that educational level, psychological resilience, family resilience, and pain catastrophizing were significantly associated with anticipatory grief, explaining 63.5% of the variance. Parental pain catastrophizing about the child's pain partially mediated the relationship between psychological resilience and anticipatory grief (indirect effect: B = -0.125, 95% confidence interval [CI]: [-0.182,-0.070]). Furthermore, family resilience moderated the pathway from psychological resilience to pain catastrophizing, with a significant psychological resilience × family resilience interaction (B = -0.319, P < 0.001). The index of moderated mediation was also significant (index = -0.061, 95% CI: [-0.102, -0.026]).

CONCLUSIONS

Anticipatory grief in parents of children with cancer was directly associated with psychological resilience and indirectly associated with parental pain catastrophizing about the child's pain. Family resilience moderated the relationship between psychological resilience and pain catastrophizing, suggesting that higher family resilience may strengthen the protective association of psychological resilience against pain catastrophizing. These findings suggest that strengthening the protective function of family resilience may inform future supportive interventions and provide potential targets for clinical support aimed at alleviating anticipatory grief in parents and promoting overall family adjustment.