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n Article

A Support Group for Fathers Whose Partners

Died From Cancer
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Justin Michael Yopp, PhD, and Donald Lee Rosenstein, MD

Men who are raising dependent children after their spouses or partners have died from can-
cer face unique challenges adjusting to single parenthood while managing their grief and the
grief of their children. Unfortunately, the needs of those widowers have been overlooked in
the clinical literature and no published interventions are designed specifically for that popu-
lation. The current article details the creation and implementation of a peer support group
for fathers recently widowed because of their wives’ deaths from cancer. Initial observations
and emergent themes from the group are described. Group members suggested that they
benefited from participation in the support group and that this form of psychosocial support
© iStockphoto.com/digitalskillet
is a promising intervention for fathers in similar circumstances.
Justin Michael Yopp, PhD, is an assistant professor and Donald Lee Rosenstein, MD, is a professor, both in the Department of Psychiatry at the University of North
Carolina at Chapel Hill. The authors take full responsibility for the content of the article. This work was supported, in part, by the University Cancer Research Fund
at the University of North Carolina. The content of this article has been reviewed by independent peer reviewers to ensure that it is balanced, objective, and free
from commercial bias. No financial relationships relevant to the content of this article have been disclosed by the independent peer reviewers or editorial staff.
Yopp can be reached at justin_yopp@med.unc.edu, with copy to editor at CJONEditor@ons.org. (Submitted September 2012. Revision submitted November
2012. Accepted for publication November 16, 2012.)
Digital Object Identifier: 10.1188/13.CJON.169-173

S
ocial support intervention groups have been effective
in improving the psychosocial functioning of individu-
als affected by cancer (Adler & Page, 2008; Gottlieb &
Wachala, 2007; Legg, Occhipinti, Ferguson, Dunn, &
Chambers, 2011). Patients who participated in cancer-
related support programs demonstrated improved coping skills,
self-efficacy, knowledge, and decreased feelings of isolation
(Campbell, Phaneuf, & Deane, 2004; Newell, Sanson-Fisher, &
Savolainen, 2002). Support groups for family members of patients
with cancer also led to positive outcomes (Levy, 2011; Northouse,
Katapodi, Song, Zhang, & Mood, 2010; Scott, Halford, & Ward,
2004). Peer support programs have benefited patients with can-
cer and their family members during active treatment (Schnei-
der, 2006); however, the efficacy of interventions for bereaved
spouses whose partners died from cancer has not been examined
fully. In addition, peer support groups for bereaved spouses,
regardless of cause of death, have been limited to women or an
older population of widows and widowers (Boerner & Silverman,
2001; Walter, 2004).
Men who have dependent children and whose spouses
or partners died from cancer are an overlooked population.
Those widowed fathers must help their children adjust to
their mothers’ deaths while confronting their own grief and
adapting to the challenges of single parenthood (Yopp &
Rosenstein, 2012). During the terminal stage of their spouses’
illnesses, husbands assumed increased caregiving responsibili-
ties (Lewis, Fletcher, Cochrane, & Fann, 2008), and the pres-
ence of children in the home was associated with increased
depression and anxiety in bereaved spouses (Nilsson et al.,
2009). Boerner and Silverman (2001) hypothesized that men
traditionally do not play the role of the more nurturing parent;
therefore, as widowed parents, fathers may be less likely to
employ child-centric or nurturing parenting styles and more
likely to feel unprepared than widowed mothers. In addition,
children living with widowed fathers experience more dis-
ruption in their daily lives than children living with widowed
mothers (Silverman & Worden, 1992). The importance of
attending to widowers’ coping has been underscored by the
well-established link between the mental health of the sur-
viving parent and the adjustment of the parentally bereaved
child (Saldinger, Porterfield, & Cain, 2004; Wolchik, Ma, Tein,
Sandler, & Ayers, 2008). Those findings highlight the need to
develop specific psychosocial interventions for fathers wid-
owed because of cancer.

Clinical Journal of Oncology Nursing • Volume 17, Number 2 • A Support Group for Fathers Whose Partners Died 169
 The current article describes a peer support group for
fathers who were recently widowed because of their wives’
deaths from cancer. The goal of the current article is to fa-
cilitate the formation of similar groups to help men and, by
extension, their children through the bereavement process.
The potential benefits of support groups are highlighted by
Allen and Hayslip (2001), who showed that the absence of so-
cial support during the bereavement process related to poorer
psychosocial outcomes. In addition, O’Neill and Mendelsohn
(2001) posited that widowed fathers placed more value on
support received from peers in similar situations. A support
group for widowed fathers may combat social and emotional
isolation and offer an antidote to men who otherwise may
suffer in silence.
Background
The motivation for developing a group intervention specifi-
cally for widowed fathers stemmed from the authors’ clinical ex-
periences following a series of young mothers dying from cancer.
Most of the women and their families received psychosocial
support services during their illnesses and end-of-life care. Key
themes from the counseling sessions included concerns about
how their husbands and children were coping during the ter-
minal stage of their
Although the group members are illnesses and how
encouraged by each other’s successes, their families would
manage after they
they provide support, guidance, and died. Following the
share their personal experiences women’s deaths, the
during individual setbacks. authors explored the
availability of clinical
services specifically for surviving husbands that could address
their adjustment to single parenthood while managing their
grief and that of their children. Not only were no local services
available, but the needs of those fathers were overlooked in can-
cer- and bereavement-related literature.
Focus Group
A small focus group was conducted and comprised of re-
cently widowed fathers whose wives were treated at a cancer
hospital. The session occurred several months after their wives’
deaths. The focus group had the following goals: (a) gain a
deeper understanding of the fathers’ most pressing concerns
about adjusting to single fatherhood and managing their chil-
dren’s grief, (b) explore whether the needs of fathers widowed
because of cancer were different from other widowers or be-
reaved parents, and (c) gauge interest in developing a support
group intervention to address the men’s concerns.
The fathers experienced reactions characteristic of having
recently lost a spouse but also described concerns specific to
the challenges of being alone in their parenting role. They re-
ported struggling to transition from having devoted their focus
and emotional energy to their wives’ health and daily care needs
to modifying their lives and redefining their parental roles. That
adjustment was made more difficult by shaken confidence in
their parenting ability and uncertainty as to whether family life
would feel normal again.
170 April 2013 • Volume 17, Number 2 • Clinical Journal of Oncology Nursing
A central theme that emerged from the focus group was the
feeling of profound aloneness as a parent that extended beyond
the loss of a spouse. The men were emotionally drained from
their wives’ treatment and death and had no access to others in
similar situations. Although their situations had some similari-
ties to friends who were divorced single fathers, the men in the
focus group felt a lack of kinship given the circumstances of
how they became single parents. One father referred to himself
as a “sole parent” rather than a single parent, as all parental
responsibilities now fell solely on him. The men shared a sense
of “being in this alone” with no viable road map or peers who
could understand their struggles.
Constructing the Support Group
Feedback from the focus group suggested that the fathers
faced mourning and parenting challenges simultaneously.
That observation was consistent with the understanding that
these men represent a distinct and neglected subgroup of
the bereaved population. As such, developing and offering
an intervention tailored to their specific needs was a priority.
The support group format was selected because of potential
advantages over individual counseling such as decreasing
social and emotional isolation by connecting widowed fathers
with their peers.
Many aspects of the support group formation were consid-
ered in the development of the intervention. A hybrid model
that combined a supportive-expressive approach was used to
promote the exchange of shared experiences in an emotionally
supportive environment with a psychoeducational component
that offered practical and concrete information (Spiegel, Bloom,
& Yalom, 1981). That model was chosen to address two themes
that emerged from the focus group: the fathers’ sense of alone-
ness and their perceived lack of competence across several do-
mains (e.g., managing a household, addressing their children’s
grief). The intervention was conceptualized as a support group
rather than group therapy.
A time-limited intervention was planned for seven meetings
with the authors, a licensed psychiatrist and a licensed clinical
psychologist, serving as co-facilitators. Each meeting would
include a brief didactic session focused on a different psychoso-
cial aspect of widowed parenthood. Fathers in the focus group
recommended spacing out the frequency of group meetings to
avoid overwhelming their already stretched schedules; there-
fore, group meetings were scheduled to take place on a monthly
basis. Meetings were scheduled to be 90 minutes, with the first
30 minutes devoted to didactic presentations and the final hour
allowed for group discussion.
Potential Obstacles
Fathers in the focus group noted that a possible barrier to at-
tending the meetings would be their need to arrange for child
care; therefore, on-site child care was provided. University-
affiliated undergraduate student volunteers were recruited to
care for the children in an adjacent room for the duration of the
meeting. In preparation for the first meeting, the facilitators
discussed developmentally appropriate strategies to handle
situations where the children may discuss sensitive topics with
the volunteers. The volunteers and co-facilitators debriefed
together after every meeting to troubleshoot any concerns.
Group meetings were held during early evening hours to al-
low for the greatest attendance and not delay bedtime routines.
Given the time of the meetings, dinner was provided for the
fathers and children in attendance. The group was offered at
no cost to reduce financial burden. Group meetings also were
scheduled to take place at a clinic off hospital grounds to avoid
requiring fathers to return to the location where some of their
wives received treatment and died.
Collaborative Process
The facilitators anticipated that the participating fathers would
provide new insight about their experiences and supportive
needs; therefore, to promote a spirit of collaboration, that dy-
namic was acknowledged explicitly. The aim was to create a
partnership in which facilitators would assist in-session group
discussion and offer expertise about relevant subject matter and
the men would provide education on the experiences of being
a widowed father.
Efforts to recruit participants began by contacting fathers
the authors had met during the wives’ illnesses. In addition,
the availability of the support group was communicated to
caregivers in the authors’ hospital as well as local hospice or-
ganizations. A total of 13 widowed fathers were identified for
recruitment, and invitations were extended via phone and mail.
Contact was made with six fathers who all expressed interest
in attending the group. The remaining seven fathers were un-
able to be reached by phone and did not respond to mailings.
Intervention
Participants
Six fathers, aged 30–50 years, attended the initial support
group meeting. Most of their wives had died 7–11 months prior
to the group’s first meeting. Each father had multiple children
ranging from 18 months to 19 years of age. Two group members
participated in individual grief counseling before joining the
group. One father was involved with a grief support group but
stopped attending because he felt a lack of connection with the
other group members who were predominately older and female.
The first group meeting began with facilitator introductions
and a description of the group structure. Because no established
template existed for the intervention, the facilitators consid-
ered the group model and structure malleable and open to the
fathers’ input. The fathers were encouraged to be active partici-
pants in shaping the group so that it best addressed their needs.
The fathers were asked to introduce themselves to the group
and share the circumstances that led to being single fathers. The
men described their wives’ illnesses and treatments, the chal-
lenges they faced in caring for themselves and their families as
their wives’ health deteriorated, the heartbreak of their wives’
deaths, and the struggle to find their footing as single parents.
The fathers intently listened to the succession of heartbreak-
ing stories, which was an emotionally challenging experience
for the participants and facilitators. The intensity of the first
meeting raised the concern that the experience would discour-
age some from remaining with the group. As a result, after
Clinical Journal of Oncology Nursing • Volume 17, Number 2 • A Support Group for Fathers Whose Partners Died 171
introductions were complete, the facilitators processed with
the fathers how difficult the first session must be and shared
that they did not anticipate it to be the nature of every session.
Months later, when reflecting on that first meeting, the fathers
acknowledged the anguish of the session; however, they de-
nied that the experience dissuaded them from staying with the
group. In fact, all fathers present for the first meeting returned
the following month.
During the first meeting, the fathers clearly valued talking
with and hearing from each other. The opportunity to share
their experiences with a group of their peers seemed immedi-
ately helpful. The fathers would nod at each others’ descriptions
and often comment, “I know exactly what you mean,” which
served as evidence that listening to the other men talk about
their struggles was beneficial. The group format offered what
neither individual therapy or talking with family and friends
could: a forum to discuss and process their experiences with
others who could identify with what they were going through.
Keeping with the collaborative nature of the group, altering
the structure of the sessions was proposed so the entire meet-
ing would be devoted to facilitator-led group discussion. The
psychoeducational component would be added to discussion
instead of delivered separately. The men in the group also
proposed changing the group model from a seven-session com-
mitment to an open-ended model. These changes were adopted
by the support group.
Since then, the group has met consecutively for two years and
continues to meet on a monthly basis, much longer than initially
planned, which reflects the participants’ sense that they benefit
from their involvement. The fathers reported that the support
group has been an invaluable resource in their healing process.
Periodically, facilitators and fathers discuss their interest and
desire in continuing to meet. The facilitators expressly com-
municated that the fathers are not expected to remain in the
group in perpetuity and each man may reach a point when his
involvement in the group no longer is warranted. However, those
discussions have ended with the fathers expressing collective
interest in continuing the group.
The group is characterized by remarkable stability in its mem-
bership. Of the six fathers who attended the initial meeting,
five remain with the group and one stopped attending after the
second meeting. No additional concerted efforts were made to
recruit new participants; however, the group remained open,
and three new fathers joined.
Findings
After relatively few group meetings, a sense of community
emerged among the fathers. Their cohesiveness was grounded
in common experiences, and they noted that for all the support
Exploration on the Go
Learn more about the psychosocial needs of caregivers with the
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 the family grief and meeting the challenges of daily life as a
Implications for Practice single father. Progress was slow and uneven at times; however,
the general trajectory has been toward better and more adap-
u Clinicians, including oncology nurses, should have a better
tive coping.
understanding of the psychosocial challenges facing widowed
fathers.
u Healthcare staff should promote open and honest discus- Conclusion
sions with patients and their partners in the time leading up
Fathers widowed by their wives’ cancer face considerable
to the patients’ deaths.
hurdles in their bereavement and adaptation to single parent-
u Clinicians are encouraged to create and implement similar ing and appear to have unique needs that largely have been
support groups for fathers whose partners died from cancer. overlooked in clinical literature. The fathers expressed that
their participation in the psychoeducational support group
facilitated their adjustment to single parenthood and helped
them manage their grief and that of their children. The sup-
they received from friends and family, something was different
port group has been characterized by a collaborative spirit in
about processing their experiences with their peers. One father
which the fathers have shaped the contours of the group so it
described their connection as one where words often are not
best meets their needs. In the process, they have educated the
needed; instead, they intuitively know what the others are feeling.
group facilitators on the specific challenges relevant to fathers
Determining how to be a single parent in the context of
widowed by their wives’ cancer. The support group format was
grieving a spouses’s death can be a confusing and overwhelm-
an excellent avenue for providing clinical services to that subset
ing process and, at various times, each father questioned his
of the bereaved population.
parental competence. Meeting with others who experienced
The open-ended nature of the support group raises interest-
the same doubts and uncertainties helped to normalize those
ing questions about how long the fathers will choose to stay
experiences. The men developed a sense of closeness and trust,
involved and to what degree the focus of the group may change
which has been reflected in their authentic exchanges.
as members continue to adapt and become comfortable manag-
As the fathers’ bond strengthened, they assumed increasing
ing the challenges they face. A survey of the fathers revealed that
stewardship of group discussions. Accordingly, the facilitators’
they are very interested in having new fathers join, even as the
stance as group leaders evolved from selecting and introduc-
discussion content shifts to issues more relevant to men further
ing topics to yielding the floor for open discussion. Often,
along in their adjustment. The fathers have embraced the chance
fathers come to the meeting with issues they want to discuss or
to help others and are drawn to the notion of mentoring fathers
specific incidents they have been waiting to process with the
more recently widowed. Veteran group members carry much
group. Although the group members are encouraged by each
of the meeting and often bring content from their daily lives
other’s successes, they provide support, guidance, and share
for focused discussions, which raises the prospect that future
their personal experiences during individual setbacks. The
groups co-facilitated by a father and a mental health professional
participants reported that the opportunity to learn from their
may expand care.
peers has been invaluable in sustaining them and their families
Empirical research on the benefits of support groups for
through difficult times.
fathers widowed by their wives’ cancer is needed to promote
The group’s cohesiveness also is reflected in the feedback
optimal adjustment for their lives and for the lives of young
and advice the fathers provide to each other. As the group ma-
children who have lost their mothers. Areas in need of study are
tured, the fathers were more likely to challenge each other in a
ideal group size, the benefits of open- or close-ended group com-
supportive manner. For example, when hearing other fathers
position, the appropriate amount of time following the wife’s
make maladaptive statements or indicate they are feeling undue
death to join the group, and considerations of non-traditionally
guilt, the fathers openly and directly challenged these assump-
structured families (e.g., not married, same sex couples). The
tions. An interesting intragroup dynamic was the relationship
experiences of the current support group illustrated that men in
between the fathers more veteran to the group for whom more
crisis, when given a safe and supportive environment, express
time had elapsed since their wives’ deaths and the fathers newer
deep emotions, establish psychological bonds with other men,
to the group who were earlier in their grieving and adaptation
and use those connections and encouragement for healing.
processes. At times, veteran members assumed mentorship roles,
The authors’ vision is that the experiences and information
often describing their own struggles to help normalize newer
shared will spur the development of peer support groups at
members’ experiences.
other cancer centers. Nurses and nurse educators in the oncology
Common themes emerged from the group on the challenges
setting are well positioned to play vital roles in the expansion
of being a sole parent following a wife’s death: (a) a lack of
and facilitation of such support groups and to conduct research
preparedness to be single parents, (b) coping with their grief
studies about the experiences of those families and how best to
and that of their children, and (c) adjustment to the demands
serve them. For more information on fathers widowed because
of single parenthood. The group validated and supported the
of cancer visit www.singlefathersduetocancer.org.
fathers’ attempts to gain confidence in addressing those issues
and mastering new parenting responsibilities. To a large degree, The authors gratefully acknowledge the insightful contribu-
the content and emotional tenor of the group discussions mir- tions of the fathers in the support group. Their input has been
rored the fathers’ general improvement with working through invaluable and is very much appreciated.

172 April 2013 • Volume 17, Number 2 • Clinical Journal of Oncology Nursing
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