The Secure Base in the Storm: How Parent-Child Bonds Shape Coping in Pediatric Cancer Caregiving

A paediatric cancer diagnosis is a profound stressor for the entire family system. Although coping strategies are well-studied, their link to the quality of the parent-child attachment relationship remains less explored. In this study, we investigated whether dyadic attachment dynamics-specifically closeness and conflict between parent and child-are associated with the use of adaptive or maladaptive coping strategies in caregivers of children undergoing active treatment for oncohaematological diseases.

We conducted a multicentre, cross-sectional study across three Italian paediatric oncohaematology centres. A total of 165 caregivers of 91 paediatric patients aged 3-17 years completed self-report measures assessing parent-child relationship quality (Child-Parent Relationship Scale-CPRS), coping strategies (COPE-NVI), perceived social support (MSPSS), and resilience (RS-14). We tested whether the quality of the parent-child attachment relationship is associated with caregivers' coping strategies. We hypothesised that Attachment Closeness would be associated with adaptive coping (Positive Attitude, Social Support, Problem Orientation), whereas Attachment Conflict would be associated with maladaptive coping (Avoidance). We conducted multiple linear regression models, adjusted for key covariates and with robust standard errors clustered at the family level, to test these hypotheses.

Higher levels of emotional closeness (CPRS) were significantly associated with greater use of adaptive coping strategies, specifically Positive Attitude (β = 0.20, p = 0.049) and Problem Orientation (β = 0.26, p = 0.002), even after controlling for sociodemographic factors, social support, and resilience. Conversely, higher levels of relational conflict were significantly associated with greater use of the maladaptive Avoidance strategy (β = 0.14, p = 0.015). The hypothesis linking closeness to Social Support seeking was not supported.

The findings suggest that the parent-child attachment relationship is a significant correlate of caregiver coping strategies in caregivers of children with cancer. Interventions aimed at supporting the caregiver-child dyad by fostering emotional closeness and reducing conflict may promote more adaptive parental coping mechanisms, thereby enhancing family resilience and psychological adjustment throughout the treatment journey.