Date of Award


Document Type

Campus Access Dissertation

Degree Name

Doctor of Philosophy (PhD)



First Advisor

Teri Aronowitz

Second Advisor

Ling Shi

Third Advisor

Margaret McCabe


Objectives of this longitudinal exploratory study were to characterize the relation between parental uncertainty and parent-proxy report of health-related quality of life (HRQOL) in children with cancer as well as to examine influences of covariates (parental trait anxiety, parental depression, and perceived parental social support) on this relationship. Cancer diagnosis in a child may lead to psychological distress in their parents. Parents can experience psychological symptoms even though there are not ill themselves. Parents with trait anxiety and depression may struggle more with their child’s cancer diagnosis compared to parents without trait anxiety and depression. Due to this vulnerability, parents with mood disturbances (trait anxiety and depression) are prone to reporting bias and may likely perceive that their children have lower HRQOL compared to parents without mood disturbances. Social support, however, may be particularly protective for those parents who have mood disturbances. Utilizing Roy Adaptation Model (RAM) and Mishel Uncertainty in Illness Theory (UIT) as the guiding theoretical frameworks for this study, proposed relations were examined in 55 parent-child dyads receiving active cancer treatment at Boston Children’s Hospital from September 2016 to March 2018. Study findings revealed that parents perceived that their children with cancer experienced multiple impairments in their HRQOL dimensions during cancer treatment. Furthermore, findings also suggested that uncertainty in parents of children with cancer is prevalent and may negatively impact parents’ perception of HRQOL several months following cancer diagnosis. However, high levels of perceived parental social support appeared to buffer the negative effects of parental uncertainty on parental perception of child’s HRQOL. Nurse clinicians play a critical role in early identification of parents who are struggling to adapt psychologically following their children’s cancer diagnosis. Future research studies utilizing a dyadic approach to study this relationship is important as this will help inform development of targeted interventions to reduce uncertainty in parents of children with cancer.


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