A COMPARISON OF STRESS AND COPING FOR CHILDREN WITH CANCER IN THE UNITED KINGDOM AND THE UNITED STATES
This study sought to (a) explore and compare the nature of stressors of everyday life and disease that children with cancer in the UK and the US experience, (b) explore and compare the coping measures they use to manage these stressors, and (c) examine the use of drawing to enhance communication. Participants included 22 children ages 7-18 years, males (n=13) and females (n=9), receiving treatment for cancer at a hospital in the Midlands region of England in the UK and at a hospital in the Mid-Atlantic region of the United States. Quantitative and qualitative methods were used within a grounded theory approach (Glaser & Strauss, 1967), and included six instruments: (a) Interview; (b) Observation; (c) Drawing of a Person Picking an Apple from a Tree (PPAT) assessed using four scales (i.e.. Prominence of Color, Implied Energy, Space, Problem Solving) from the Formal Elements Art Therapy Scale (FEATS) (Gantt & Tabone, 1999); (d) Scariest Image Drawing (Sourkes, 1995); (e) Closure Drawing; and (f) Background Information Form. Findings indicate that children, regardless of their ethnicity and other cultural components, respond to the childhood cancer experience in a similar manner. The use of drawing enhanced communication through direct visual expression and/or through verbal expression via the “campfire effect”—the result of an activity or experience that provides a focal point shared by the individuals involved that serves to increase conversation in both quantity and intensity. Two stressors themes—negotiating}’ the roadmap, missing’ out—and four coping themes—being prepared, being connected, shutting it out, working it through—emerged. The physical environment was found to foster different types of support for children and their families. An ecological theory of stress and coping in childhood cancer emerged that spotlights the Lise of drawing at five distinct points. It considers all of the persons in the healthcare setting (e.g., family members, nurses, doctors, other healthcare professionals) as potentially more than resources for children with cancer; but as actual companions to children as they negotiate the difficult roadmap of childhood cancer. The theory proposes that children find the connected relationship a significant element in coping, and that the physical environment affects both the opportunity for and nature of these supportive relationships. Healthcare environments that provide spaces for children and their families to interact with other children and families promote social interaction, which leads to a higher level of informal support than hospital environments that do not provide these spaces, or that provide them in less accessible areas.
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