University of the Philippines Manila

College of Arts and Sciences

Department of Behavioral Sciences

AN EXPLORATORY STUDY ON THE COPING MECHANISMS AND SUPPORT

SYSTEM AMONG FILIPINO PARENTS OF LEUKEMIA SURVIVORS

A Research Proposal submitted to Department of Behavioral Sciences in

Partial Fulfillment of the Requirements for the Degree

Bachelor of Arts in Behavioral Sciences

Submitted by:
Michael Ryan Pillado
2013 03875

December 2016
1st Semester, A.Y. 2016 2017

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INTRODUCTION

Leukemia poses a serious threat not just here in the Philippines but to the whole world. It
is a common health problem held by all countries, first world or not. Because of the unknown
nature of the causes of leukemia, medical advancements have not been fast, and all countries are
still prone to this type of cancer. In the United States of America, which ranks 13th in the list of
countries with the highest leukemia mortality rate (World Health Rankings, 2016), more than
232,000 people have leukemia in 2012 alone, with an approximately 44,000 new cases every year
(Life of Cancer Survivor, 2012). Another statistics shows that about 30% of all childhood cancer
in the US were leukemia, which affects about 3,000 young Americans every year.

In the Philippines, during 2005, the Philippine Cancer Society held about 4,202 new cases.
2,243 of them were male, while 1,959 were female. For the same year, about 3,498 deaths were
recorded (Leukemia Facts, 2005). The said cancer was ranked as one of the top eight common
cancers in the country (Cabrera, 2014). However, for the year 2012, according to the Philippine
Council for Health Research and Development, its ranking climbed up to the fourth place, while
according to Philippine Health Advisories Report, it ranked fifth place in terms of overall
mortality. For the said year, there were about 6,858 incident of leukemia (Leukemia, n.d.).

Though the survival rate for leukemia was relatively high (25%) compared to the 1960s
(14%), we can see from the above statistics, which reaches a thousand people, that it still poses a
serious threat to everyone (Leukemia, n.d.). Since children are as prone as the adults, we can say
that a percentage of the above statistics are of young age. They have families that are surely worried
with the plight of their child. Given that they are children and of young age, they need more support
from others compared to adults who already have stronger emotional and mental capacity to
cushion the shock brought by the diagnosis. These family members, though providing emotional
support to these children, often experience emotional problems themselves as well, as backed up
by numerous researches and studies (Landier & Hartrum, 2012; La Clare, 2013; Tifferet, et al.,
2011), and these problems may have negative repercussions to the support they give to their
children.

As a result, it is with utmost importance to discover more specific details regarding the
coping mechanisms these parents have in face of the problems they are currently in, as well as the
nature of the support system that surrounds them. In order to do this, by studying the past coping

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mechanisms of parents of leukemia survivors, we may be able to know the details of coping
strategies that have been useful to these parents, which in turn may help those fathers and mothers
who currently have children undergoing treatment for leukemia.

REVIEW OF RELATED LITERATURE

According to Eiser (1997), there have been little knowledge regarding the responses of
families, especially parents, to the diagnosis of child with a life-threatening illness, especially
leukemia. It has always been common to study the effects of these illnesses to children, as those
explored by Northam (1997) and Lau & Wilson (1993). However, according to researches, distress
among parents are brought by different causes such as poverty, marital conflict, absence of partner,
and other difficulties in life such as children with illnesses. These factors, if not handled well, may
not just bring distress but also depression to them (England & Sim, 2009). If this gets worse, their
depression tendencies, according to studies, will have a major impact on their children, especially
to their children who are ill. It may result to negative parenting styles, or they may not respond to
treatments, or may lead to depression to the children themselves (Hudson, et al., 2014).

Coping skills are defense mechanisms to distress in life, such as having a child with an
illness, disease, or disorder. Specifically, according to a study on parents of children with ADHD
by Durukan (2008), the most common coping skill parents use is the repression of other activities
in order to avoid distractions from other life events and pour all their attention to their children.
The type of coping mechanism they use, as found in researches, is related to the sociodemographic
characteristics of these parents. For one in a study, parents of lower income tend to use avoidance
as their coping strategy (Zelikovsky et.al., 2007, as cited in Cage-Bouchard, Devine & Heckler,
2013). Additionally, sex of the parent was also found to have an effect on their coping mechanism,
when a research by Enskar (2011) about parents of children with cancer showed that mothers
perceive their experience differently from the fathers, thus resulting in different coping responses
(Cage-Bouchard, Devine & Heckler, 2013). Moreover, in a study by Kumar (2008), educational
level plays a significant role on it, as well as contact with their support systems such as other
members of the family or friends (Mancil, Bedesem, Boyd, 2009). From these, we could say that
aside from the knowledge or perception of these parents regarding their plight, the
sociodemographic profile of the parents is related to their coping mechanisms, which is also
related, according to literatures, to the support system of the parents.

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 Given the above studies, though elaborate in giving details regarding the different coping
mechanisms of parents, they were not conducted to parents of patients with leukemia. Moreover,
as these were conducted to parents of children experiencing the illness or disorder during the data
collection of the researchers, there is no guarantee that these are effective strategies against
distress. Given these, this study will address the said problems by focusing on finding the effective
ones that helped parents of leukemia survivors during the times when they are experiencing the
distress brought by the illness.

A. Research Problem
What were the specific coping strategies used by parents of leukemia survivors and the
support system they had during the height of the illness? Moreover, what are the nature of the
underlying factors, such as demographic characteristics, that had an effect on these coping
mechanisms and support system?

B. Rationale
According to Hudson (2014), distress among parents may bring depression, and may lead to
negative parenting styles, or worse, may lead to depression of the children as well. Moreover, it
was found out that children undergoing treatment may not respond well with their rehabilitation
when affected by the depression of their fathers and mothers. With this, it is evident that the nature
of their coping mechanisms and support system should be studied as these factors tells us how
these parents handle the distress brought by the illness of their children. With the seriousness of
the phenomenon, surprisingly, there are not enough studies regarding the coping mechanisms of
these parents against distress brought by leukemia. In the hopes that this research regarding the
coping mechanisms and support system of parents of leukemia survivors will start the pursuit of
more knowledge that will address the problem, policies, interventions, or support groups may be
formed in order to help them develop effective coping strategies and utilize their support system
well in the face of the eminent distress the illness may bring to them.

C. Research Objectives
General Objective

The study aims to explore the different factors such as their sociodemographic profile that
contributed to the coping mechanisms and support system of parents of leukemia survivors during
the height of the illness.

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Specific Objectives

To determine the socio-demographic profile of Filipino parents of leukemia survivors

To explore the coping behaviors they had during the run of the illness of their offspring
To explore the nature of the support system of these parents
To explore the past manifestations of their distress brought by the illness of their children
D. Significance of the Study
Leukemia is becoming a more serious issue with the illness reaching fourth place in the top
common cancers in the Philippines (Leukemia, n.d.). As stated earlier, there are no enough
studies regarding effective coping mechanisms and support systems for parents with offspring
diagnosed with leukemia. Given the serious distress that parents may get from the situation of their
children and the possibility that this may affect the rehabilitation of their sons and daughters, it is
important to determine what are the most effective strategies that may help them cope from the
distress, and how their support system may help them cushion it. In order to do this, the study will
focus on past experiences of parents of leukemia survivors by determining what coping
mechanisms and support system help them most during the time of the height of illness. With the
completion of the study, the results may not just help shed light on the effective coping strategies
but also help develop interventions, therapies, or support groups that may help current parents of
patients with leukemia towards effective coping mechanisms and establish better connection to
their support systems.

E. Limitations of the Study

The study will be conducted on one hospital, namely the Lung Center of the Philippines due to the
already established connection of the researcher to the institution. Moreover, the study will focus
on parents of leukemia survivors and tackle their past experiences, specifically their past coping
mechanisms and support system. As a result, the findings of the study may not represent the overall
present condition of parents of children diagnose with leukemia in the country.

F. Framework
Theoretical Framework

Operant Conditioning. According to this theory, distress may be a result of a severance of

ties with a positive reinforcement for a person. In the case of the parents of children with
leukemia, their child could be considered as the positive reinforcement, given that they could

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 give emotional and social support to these parents in some ways. After the diagnosis of their
child, these parents experience the thought of losing their children, or having their perception
that leukemia crippled their child and that the reinforcement they receive from their children
could be lost. Moreover, depressive symptoms brought by the distress may be reinforced by
different factors in the environment such as those in their support system. As the theory
suggests, continuous giving of sympathies and attention may reinforce distress and depressive
symptoms.
Learned Helplessness. According to this theory by Martin Seligman (1974), distress and
depression may occur when a person learns that his/her attempts to escape negative situations
are futile. As a result, their coping mechanisms turn from active to passive, and will endure the
negative situation even if active coping strategies are now possible. Specifically, in the
situation of the study, after the diagnosis of their child, at first they may exhibit active coping
mechanisms that will address the impact of the situation, but after some time, these coping
strategies may transform into passive ones such as keeping the emotional feelings within
themselves and just endure the situation.
Conceptual Framework

PARENTS EXPERIENCE MANIFESTATIONS of

DISTRESS
Sociodemographic Coping Mechanism
Profile Support System Behaviors
Thoughts

From the conceptual framework above, the research suggests that parents of leukemia patients,
under different sociodemographic profiles such as socioeconomic status, educational attainment,
or gender, may exhibit different forms of coping mechanisms and may have different nature of
support system. With the differences in the strategies they use to handle the situation, together with
their support system, they may eventually exhibit differences in manifestations of distress as well
in terms of behaviors or their thoughts.

G. Definition of Variables
o Parents of Leukemia Survivors
Conceptual Definition father or mother of a person who survived leukemia

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 Operational Definition any person with a paternal or maternal role over the leukemia
survivor
o Coping Mechanisms
Conceptual Definition - cognitive and behavioral efforts to manage specific external
and/or internal demands that are appraised as taxing (Folkman & Lazarus, n.d.)
Operational Definition strategies used by parents of leukemia survivors in the face of
distress caused by the illness; will be measured using the evaluation of Coping
Behavior (COPE).
o Support System
Conceptual Definition - a group of people who give someone help, money,
encouragement, etc. (Merriam-Webster, 2016)
Operational Definition institutions or individuals surrounding and helping the parents
cope emotionally and mentally during the time of their offsprings illness.
I. Methodology
A. Research Design
The study will be an exploratory research, wherein qualitative research will be first utilized
in order to examine the subject, and conduct further quantitative data gathering in order to support
the information gathered in the first part. The research will use a phenomenological design for its
qualitative part in order to focus deeper on the phenomenon and see it through the eyes of the
participants. Using this, we would be able to know the specific details and delve deeper into their
past coping mechanisms and support system during the illness of their offspring. To reinforce the
data gathered from the interview, a scale for the quantitative part, specifically the Scale for
Evaluation of Coping Behavior (COPE Inventory) by Carver (2013) will be used to categorically
assess their coping strategies.

B. Study Population
Inclusion Criteria

The inclusion criteria for the study are: should be parents of a past leukemia patient who
are medically-proven survivors of leukemia ; currently living in the Philippines; not separated from
the spouse during the time of the illness in order to remove the probability that the distress they
are experiencing are the result of raising the family alone; should not have past psychological

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diagnosis of depression in order to remove the probability that it may have an effect on the
manifestations of their distress

Exclusion Criteria

The exclusion criteria for the study are: parents of current leukemia patients; parents of
offsprings who died due to leukemia ; living outside the country; separated from the family; have
past history of depression.

C. Study Setting
The study will be conducted in hospitals in Metro Manila, where diversity of background
of patients is evident.

D. Sampling Scheme
Using Creswells (1998) ideal number of participants for phenomenological studies to
saturate the data, the study will gather 25 participants whose criteria are within the points set by
the inclusion and exclusion criteria mentioned above. The said participants will be acquired
through non-probability, purposive sampling, and will be selected through the guidelines of the
research, as well as their availability or schedule during the data collection period.

E. Instrumentation
The study will mainly use a semi-structured interview for the informants. The said
interview will be divided into domains: sociodemographic profile, coping mechanisms, and
support system. Within these domains, their experience will be properly assessed and easier to
analyze. Questions about past manifestations of their distress will be asked in terms of their
behavior and thought. The interview will be in Filipino or English, depending on the language they
are comfortable, in order for them to fully understand the questions and express their thoughts
freely as well. For the scale, the study will utilize the Scale for Evaluation of Coping Behavior by
Carver (2013) to quantitatively categorize the coping strategies these parents have used. Again,
this will be available either in Filipino or English, depending on their preference.

F. Data Collection
During the data collecting period of the study, 25 participants will be selected as informants
to participate in the in-depth interview. After confirming their participation, they will be debriefed
regarding their rights as key informants and their anonymity. They will be given the choice to

8
refuse to participate. Moreover, they will have the option to review the questions before the
interview in order for them to have an overview of the whole session and to avoid surprising them
with questions that may cause triggers. Also, they will always be given the option to refuse to
answer questions deemed very sensitive for them. After the debriefing, they will be asked if they
are comfortable having the interview on record. Next, they will be individually interviewed using
guide questions. The session will be in Filipino or English, depending on the language where they
can freely express themselves. After the interview, they will be given the option to participate on
the quantitative part of the study wherein they will need to answer the COPE scale that will
quantitatively assess their coping behaviors. Again, consents will be given and their right to refuse
or withdraw from the study will be given emphasis. Moreover, they will have the option to review
the questionnaire first before agreeing and participating. After the session with the participants,
interviews will be transcribed and questionnaires will be scored in order to be ready for the analysis
of data.

G. Data Analysis
Proceeding the collection of data will be the analysis. The transcribed interviews will be
analyzed through thematic analysis. Themes will be extracted from their responses and will be
analyzed by looking on the relationship between their sociodemographic characteristics and the
coping strategies and support system they had during the time of the illness. Next, their scores
from the COPE scale will be analyzed side by side and in relation to the themes and responses
derived from the transcribed interviews. These scores will help validate and reinforce the data
gathered from the qualitative part of the study. The summary of the scores may also help in
determining the dominant coping behavior among these parents. Moreover, the manifestations of
their distress will also be analyzed in relation to the said domains in order to see how these
strategies and support systems have been effective in handling the distress.

H. Ethical Consideration
Rights of the participants will always be strictly observed. Consents will always be
provided before the start of the tests and interviews. Within the consent, they will have the free
will to participate or not, and they will not be forced to take part. Whenever they feel
uncomfortable with the questions in the test and interviews, they can always refuse to answer or
even withdraw from the test. They will also be reassured always that their identities will be kept

9
in secret, and all information that will be gathered from them will be confidential and used for
research purposes only.

I. Timeline
Activity DEC JAN FEB MAR APR
Translation of Scale
Data Collection
Data Encoding
Data Analysis
Final Paper Writing
WEEKS 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4

J. Proposed Budget
Transportation expenses Php1,000
Token expenses Php1,500
Reproduction of questionnaire Php500
TOTAL= Php3,000

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APPENDIX A INFORMED CONSENT
In English
Dear respondent,
Good day. I am Michael Ryan Pillado and I am on my 4th year in the BA Behavioral Sciences
program of the University of the Philippines Manila. My current research, entitled An Exploratory
Study on the Coping Mechanisms and Support System Among Filipino Parents of Leukemia
Survivors will assess the coping behaviors and the support system of parents of leukemia patients
during the time of the illness. The results of this study will help in formulating interventions and
policies that will help parents of current leukemia patients.
For the research to be fruitful, I would like to ask your participation in the said study by answering
the questionnaire patiently, honestly and cooperatively, and by being a participant in the interview.
But participation is voluntary. The questions would revolve mainly on your past experience during
the height of the illness, as well as your thoughts and behaviors that time and I know that it could
be very personal. In line with this, I strongly assure you that all information gathered from the
research would be kept with utmost confidentiality. But if you feel uncomfortable with some
questions, you may leave it and proceed to the next or withdraw from the study but it would be
greatly appreciated if you complete this set of questions.
If you have questions, comments and suggestions regarding this set of questions or my research,
do not hesitate to contact me thru text (+63977 012 9549) or thru email
(michaelryan723@hotmail.com). Thank you for your time and cooperation.
Yours truly,

Michael Ryan Pillado

Researcher
Informed Consent
[ ] I have read and understood the details regarding the research and I would answer the questions
with honesty and cooperation. I have understood that my participation is voluntary and I can
withdraw from the research anytime. I also know that some questions would make me feel
uncomfortable and free to not answer it anytime. I also understood that all information I will part
in this research will be treated with utmost confidence.
[ ] I do not want to participate in the study.
_________________________ Date: ____________
Signature of Respondent

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In Filipino
Mahal na Kalahok,
Magandang araw. Ako po si Michael Ryan Pillado at ako po ay nasa ika-apat na taon na ng kursong
BA Behavioral Sciences ng Unibersidad ng Pilipinas sa Maynila. Ang aking kasalukuyang
pagaaral na may pamagat na An Exploratory Study on the Coping Mechanisms and Support
System Among Filipino Parents of Leukemia Survivors, ay sinusubukang alamin ang ibat ibang
reaksyon sa kabila ng hirap na nadama ng mga magulang ng leukemia survivors, pati na rin ang
mga epekto ng mga institusyon, tulad ng pamilya, o mga kaibigan, sa pagharap nila sa nasabing
pagsubok na dulot ng leukemia ng kanilang anak. Ang mga resulta ng pagaaral na ito ay
makatutulong ng malaki sa pagbuo ng mga programa o polisiya na makakatulong sa mga magulang
ng mg batang kasalukuyang lumalaban sa nasabing sakit.
Para magbunga ang nasabing pananaliksik, hinihingi ko po ang inyong partisipasyon sa pagaaral
sa pamamagitan ng paglahok sa panayam na gagawin, at pagsagot sa ibibgay na questionnaire.
Pero ang inyong partisipasyon po ay boluntaryo. Ang mga sumusunod na katanungan ay iikot sa
inyong mga karanasan, mga bagay na tumakbo sa inyong isipan, at sa mga bagay na inyong ginawa
noong mga panahong sinasamahan niyo ang inyong anak sa kanilang laban sa leukemia. Alam ko
pong personal ang mga tanong na ito. Dahil dito, sinisigurado ko po na ang lahat ng impormasyong
makakalap sa pagaaral na ito ay mananatiling lihim. Ngunit kung kayo may hindi naging
kompurtable sa ilang katanungan, maaari nyo po itong iwang blanko at sagutan ang susunod, o
kaya naman ay umatras mula sa pag-aaral. Ngunit mas mainam sa pagaaral kung lahat ng tanong
ay masasagutan.
Kung kayoy may katanungan, komento, o suhestyon, maaari po lamang na ako ay kausapin sa
pamamagitan ng text (+63977 012 9549) o e-mail (michaelryan723@hotmail.com). Salamat sa
inyong oras at partisipasyon.
Sumasainyo,

Michael Ryan Pillado

Mananaliksik

Informed Consent
[ ] Nabasa ko at lubos kong naintindihan ang mga detalye ukol sa pagaaral at sasagutan ko ang
mga katanungan ng tapat at kooperasyon. Naintindihan ko rin na ang partisipasyon ko ay
boluntaryo at maaari akong umalis sa nasabing pagaaral. Alam ko rin na ang ilang katanungan ay
maaaring hindi maging kompurtable para sa akin at pwede ko itong hindi sagutan. Naintindihan
ko rin na ang lahat ng impormasyong ibibigay ko dito ay ituturing na sikreto.
[ ] Ayokong sumali sa nasabing pagaaral.
Lagda: ______________________________ Petsa: ___________________

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APPENDIX B - Guide Question Matrix for Semi-Structured Interview

OBJECTIVES DOMAINS QUESTIONS

To determine the socio-
demographic profile of Filipino
parents of leukemia survivors
To explore the coping behaviors Coping Mechanisms
they had during the run of the
illness of their offspring
Sociodemographic Profile What is your name?
How old are you?
Where do you live?
How many offspring do you have?
What is your current employment status?
What is our monthly income?
How old was your son/daughter when he/she was
diagnosed with leukemia?
How long was the duration of the treatment?
What did you feel immediately after you learned about the
illness of your son/daughter?
What did you do immediately after this?
Whenever you think about the situation of your
son/daughter, what do you do?
Whenever the topic of your conversations was leukemia,
what did you feel?
What did you do whenever you feel this?
Whenever the topic of conversations was your
son/daughter, what do you feel?
What did you do whenever you feel this?

To explore the nature of the Support System Who are the members of your immediate family?
support system of these parents Did they know about the illness of your son/daughter?
What did they think about the situation of your child?

13

To explore the past
manifestations of their distress
brought by the illness of their
children
How did they show their support towards your
son/daughter?
How did they show their support towards you?
Aside from your family, who else showed their support?
How did they show their support towards you and your
son/daughter?
How do you feel about all the support you received from
them?
Manifestation Whenever you thought about the situation of your child,
do you feel any fatigue or exhaustion that keeps you from
doing your everyday activities?
Whenever you think about your son or daughter, did it
affect your job? In what ways?
During those times, were you still interested in doing your
hobbies?
How did the situation of your child affected your
relationship towards other people such as other family
members or friends?
After learning about the illness of your child, what was
the first thing that came into your mind?
Did the illness change your feelings toward yourself as a
parent?
During those times, what are the things that always
occupy your mind?
Did it change your view about life? If yes, what are these
changes?
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APPENDIX C Scale for Evaluation of Coping Behavior

Answer the questions and check the number that applies to you.

A. Personal and Educational Background

1. Name (Optional): __________________________________________
2. Age: _____
3. What is your sex?
[1] Male
[2] Female
4. What is your current employment status?
[1] Employed. What is your current job? __________________________
[2] Unemployed
5. How old was your child when he was diagnosed with leukemia? _________
6. How long is the duration of the treatment? ___________________
B. Scale for Evaluation of Coping Behavior
The following scale will assess the nature of the coping mechanisms you have used during the
time of the illness of your offspring. In line with this, the statements that will follow will be in
the context of your past experience and not in your current state. Please answer the questions
thoughtfully. There are no right or wrong answers, as long as the responses will reflect YOU.
Please check on the box that corresponds to your answer.
1 I did not do this at all
2 I did this a little bit
3 I did this a medium amount
4 I did this a lot
1 2 3 4

1. I try to grow as a person as a result of the experience.

2. I turn to work or other substitute activities to take my mind off

things.
3. I get upset and let my emotions out.

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4. I try to get advice from someone about what to do.

5. I concentrate my efforts on doing something about it.

6. I say to myself "this isn't real."

7. I put my trust in God.

8. I laugh about the situation.

9. I admit to myself that I can't deal with it, and quit trying.

10. I restrain myself from doing anything too quickly.

11. I discuss my feelings with someone

12. I use alcohol or drugs to make myself feel better

13. I get used to the idea that it happened.

14. I talk to someone to find out more about the situation.

15. I keep myself from getting distracted by other thoughts or

activities.
16. I daydream about things other than this.

17. I get upset, and am really aware of it.

18. I seek God's help

19. I make a plan of action.

20. I make jokes about it.

21. I accept that this has happened and that it can't be changed

22. I hold off doing anything about it until the situation permits

23. I try to get emotional support from friends or relatives.

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24. I just give up trying to reach my goal.

25. I take additional action to try to get rid of the problem

26. I try to lose myself for a while by drinking alcohol or taking

drugs
27. I refuse to believe that it has happened.

28. I let my feelings out.

29. I try to see it in a different light, to make it seem more positive.

30. I talk to someone who could do something concrete about the

problem
31. I sleep more than usual.

32. I try to come up with a strategy about what to do.

33. I focus on dealing with this problem, and if necessary let other
things slide a little.
34. I get sympathy and understanding from someone.

35. I drink alcohol or take drugs, in order to think about it less.

36. I kid around about it.

37. I give up the attempt to get what I want

38. I look for something good in what is happening.

39. I think about how I might best handle the problem

40. I pretend that it hasn't really happened.

41. I make sure not to make matters worse by acting too soon

42. I try hard to prevent other things from interfering with my

efforts at dealing with this

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43. I go to movies or watch TV, to think about it less.

44. I accept the reality of the fact that it happened.

45. I ask people who have had similar experiences what they did.

46. I feel a lot of emotional distress and I find myself expressing

those feelings a lot.
47. I take direct action to get around the problem

48. I try to find comfort in my religion.

49. I force myself to wait for the right time to do something.

50. I make fun of the situation.

51. I reduce the amount of effort I'm putting into solving the
problem
52. I talk to someone about how I feel.

53. I use alcohol or drugs to help me get through it

54. I learn to live with it.

55. I put aside other activities in order to concentrate on this

56. I think hard about what steps to take.

57. I act as though it hasn't even happened

58. I do what has to be done, one step at a time.

59. I learn something from the experience.

60. I pray more than usual.

THANK YOU FOR YOUR PARTICIPATION

18
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