A diagnosis of childhood cancer is one of the most challenging experiences a family can face. This event initiates a trajectory that involves the the entire family and disturbs family functioning, including communication (West, Bell, Woodgate, & Moules, 2015).The concept of double protection is used to describe a communication process of avoidance used by parents and their child or adolescents with cancer in attempts to protect the other against disease-related stress and emotions resulting from communication about the cancer, its treatment, thoughts about the future (Last, 1992). This theme in parent-child communication has the potential to develop negative patterns at the individual and family level (Bell et al., 2018; Jankovic et al., 2008; Kreicbergs, Valdimarsdóttir, Onelöv, Henter, & Steineck, 2004; Nuss, 2014).This concept has received limited attention in the research literature. Therefore, the purpose of this paper is to clarify use of the concept of double protection in parent-child communication in the childhood cancer context and contribute to an explanation of its defining characteristics, applicability, and significance. In addition, this paper distinguishes the concept’s unique meaning and usefulness compared to other related terms.
Methods:
Rodgers’ evolutionary method of concept analysis provided the framework for this analysis. Data were retrieved from the Cumulative Index of Nursing and Allied Health Literature (CINAHL) and MEDLINE databases (PubMed) and the PschyINFO database. The literature review was conducted to search the phenomenon of interest, rather than finding the exact concept, because there has been lack of use of the concept of “double protection” in parent-child communication in the context of childhood cancer . The literature search used the keywords “parent,” “child/adolescent,” and “cancer.” The sample included 12 papers published in English between 2007 and 2018. In addition, to provide empirical data to enhance the concept of double protection, additional data were collected through an ongoing pilot study using qualitative descriptive study design, including semi-structured interviews with 10 dyads of Korean adolescents with cancer and their parents. The findings from this descriptive study supported the concept of double protection. Data were then collected from the sample of retrieved literature and interviews on antecedents, attributes, and consequences of double protection. Mutual pretense as a related concept was also explored for purposes of comparison and to situate the understanding of double protection in context.
Results:
Over two decades, the concept of double protection hardly changed and rarely documented. Exploration of its defining attributes revealed that double protection may be characterized as: bi-direction, intention of protecting each other against unexpected distress from engaging in communication about cancer-related topic and involvement of self-disclosure. Antecedent embodied the knowledge of parents and children concerning the child’s cancer diagnosis and the belief that communication about topics related to that cancer would cause distress. The consequences of double protection were major impacts on the family at the individual level on the entire family system. Individually, children and adolescents with cancer suffer from isolation, loneness, fear, and did not receive necessary interventions to relieve their psychological suffering. In addition, when parents failed to engage in open and clear parent-child communication, those parents also suffered from life-long regret Finally, the failure to engage in parent-child communication because of double protection prevented development of family cohesion and adaptability.
Conclusion: The concept of double protection has been found to be a relevant challenge in communication. The concept has persisted for decades and not been limited to any specific culture. Rodgers (1989) stated that a concept’s ability to assist in resolving problems is an important criterium for judging significance. The concept of double protection highlights the nature of the urgent communication issue in families of children with cancer and provides us with insight on how to manage this issue. However, considering that concept is evolving, application and continued analysis in communication in the context of childhood cancer is required. In addition, this concept should be analyzed in the broader context of chronic illness rather than being limited to childhood cancer.