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Palliative care
Original research
Thematic analysis of spousal interaction patterns among Asian parents of children with chronic life-threatening illness
  1. Andy Hau Yan Ho1,2,3,
  2. Oindrila Dutta1,
  3. Geraldine Tan-Ho1,
  4. Ping Ying Choo1,
  5. Xinyi Casuarine Low1,
  6. Poh Heng Chong4,
  7. Carolyn Ng5,6,
  8. Sashikumar Ganapathy7
  1. 1 Psychology, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
  2. 2 Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
  3. 3 The Palliative Care Centre for Excellence in Education and Research (PalC), Singapore, Singapore
  4. 4 Star PALS, HCA Hospice Care, Singapore, Singapore
  5. 5 Portland Institute for Loss and Transitiom, Portland, Oregon, USA
  6. 6 Children's Cancer Foundation, Singapore, Singapore
  7. 7 Club Rainbow, Singapore, Singapore
  1. Correspondence to Oindrila Dutta; oindrila001{at}e.ntu.edu.sg

Abstract

Objective This is the first known study which examines the evolutionary nature of spousal interaction patterns among Asian parents of children with chronic life-threatening illness, from the time of providing care to their child through bereavement. This study is informed by earlier findings that when a child is diagnosed with a chronic life-threatening illness, parents are faced with multiple stressors, leaving them with little time to invest in their spousal relationship.

Participants and setting A constructivist-phenomenological research paradigm was adopted and meaning-oriented interviews were conducted with 20 parental units (i.e., 6 couples, 12 lone mothers and 2 lone fathers) of Chinese, Malay and Indian ethnicities who lost their child to chronic life-threatening illness in Singapore.

Results Qualitative thematic analysis of the data revealed four themes, which describe the evolutionary nature of spousal interaction patterns among Asian parents of children with chronic life-threatening illness, from caregiving through bereavement. Findings reveal participants’ tendency to concentrate on pragmatic, solution-focused communication during the period of caregiving (pragmatic interaction), avoid discussion about their emotional pain as a means of protecting their spouse (partner-oriented self-regulation), respect and acknowledge their spouse’s personal coping strategies (empathic responding) and show greater appreciation and emotional expression within the spousal relationship after their child’s death (affective appreciation).

Conclusion Engaging in pragmatic discussions, deferring emotion-focused and potentially distressing conversations, and acknowledging their spouse’s need for personal space are important coping strategies for Asian couples facing their child’s chronic life-threatening illness and in the immediate aftermath of his/her death. Bereaved couples who have processed their grief individually feel ready to share their reflections with their spouse, deriving meaning and greater relational closeness through such disclosure. These findings are discussed from a cultural lens, with recommendations for healthcare professionals working with Asian parents of children with chronic life-threatening illness.

  • bereavement
  • paediatric palliative care
  • spousal relationship
  • thematic analysis
  • qualitative research
  • Asia

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2019-032582

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    Footnotes

    • Contributors AHYH and OD conceived and designed the study and obtained funding for it. OD, GT-H and PYC conducted interviews with the participants. OD, GT-H, PYC and CXL analysed and interpreted the data, and drafted and revised the article. PHC, CN and SG assisted in recruiting participants, and revised the article. AHYH is the guarantor and assisted in finalising of themes and revision of the article. All authors gave final approval of the revision to be published.

    • Funding This work was supported by the Singapore Ministry of Education Academic Research Tier 1 Fund (2017-T1-001-034) and the Temasek Foundation Innovates’ Singapore Millennium Foundation Grant (M4062472.SS0).

    • Disclaimer The funders played no role in the study design, collection, analysis or interpretation of data, or preparation of the manuscript.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval This study was approved by the Institutional Review Board of Nanyang Technological University (IRB-2017-03-044). All participants endorsed an informed consent form before the researchers proceeded with data collection.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement No additional data is available for this study.