{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T23:03:35Z","timestamp":1784588615197,"version":"3.55.0"},"reference-count":39,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T00:00:00Z","timestamp":1779494400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T00:00:00Z","timestamp":1784592000000},"content-version":"vor","delay-in-days":59,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Health Serv Res"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Children undergoing chemotherapy experience significant psychosocial stress; however, limited research has examined how cultural and relational contexts shape stress appraisal and coping within pediatric oncology services in China. Understanding these mechanisms is essential for developing culturally responsive psychosocial care models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A qualitative descriptive study was conducted using individual semi-structured interviews with 22 children aged 7\u201314 years undergoing chemotherapy for haematological cancers in a tertiary children\u2019s hospital in China. Data were analysed using thematic analysis following Braun and Clarke\u2019s framework. Reporting adhered to the Standards for Reporting Qualitative Research (SRQR).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Children\u2019s stress during chemotherapy was shaped not only by physical discomfort and emotional distress, but also by concerns about family burden, disrupted schooling, and loss of normality in everyday life. Children coped mainly through emotion-focused strategies, including holding emotions in, engaging in creative activities, and reframing illness in more manageable terms. These coping practices were influenced by developmental stage as well as cultural and relational contexts, particularly expectations around endurance, emotional restraint, and maintaining stability in family relationships. Coping was also supported through interactions with family members, peers, and healthcare professionals, who provided emotional reassurance, connection, and a sense of safety throughout treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Coping among Chinese children undergoing chemotherapy was shaped by cultural and relational contexts, with important implications for pediatric oncology service delivery. Psychosocial care should move beyond symptom management to include culturally sensitive assessment of family- and school-related stress, support for emotional expression, guidance for caregivers, and opportunities for creative, non-verbal coping within routine care. Strengthening culturally responsive, family-centred services may help support children\u2019s emotional well-being during chemotherapy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12913-026-14733-6","type":"journal-article","created":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T12:24:04Z","timestamp":1779539044000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cultural influences on coping among Chinese children aged 7\u201314 undergoing chemotherapy: implications for pediatric oncology service delivery"],"prefix":"10.1186","volume":"26","author":[{"given":"Shishuang","family":"Zhou","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huiyuan","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haiying","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao","family":"Pin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mimi Wai Man","family":"Chan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuan","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cho Lee","family":"Wong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,23]]},"reference":[{"key":"14733_CR1","volume-title":"CureAll Framework: WHO Global Initiative for Childhood Cancer. Increasing Access, Advancing Quality, Saving Lives","author":"WHO","year":"2021","unstructured":"WHO. CureAll Framework: WHO Global Initiative for Childhood Cancer. Increasing Access, Advancing Quality, Saving Lives. 1st ed. Geneva: World Health Organization; 2021.","edition":"1"},{"issue":"10357","key":"14733_CR2","doi-asserted-by":"publisher","first-page":"1020","DOI":"10.1016\/S0140-6736(22)01541-0","volume":"400","author":"X Ni","year":"2022","unstructured":"Ni X, Li Z, Li X, Zhang X, Bai G, Liu Y, Zheng R, Zhang Y, Xu X, Liu Y, et al. Socioeconomic inequalities in cancer incidence and access to health services among children and adolescents in China: a cross-sectional study. Lancet. 2022;400(10357):1020\u201332.","journal-title":"Lancet"},{"issue":"1","key":"14733_CR3","doi-asserted-by":"publisher","first-page":"1647","DOI":"10.1186\/s12889-023-16226-1","volume":"23","author":"K Lin","year":"2023","unstructured":"Lin K, Jia H, Cao M, Xu T, Chen Z, Song X, Miao Y, Yao T, Dong C, Shao J, et al. Epidemiological characteristics of leukemia in China, 2005\u20132017: a log-linear regression and age-period-cohort analysis. BMC Public Health. 2023;23(1):1647.","journal-title":"BMC Public Health"},{"issue":"3","key":"14733_CR4","first-page":"221","volume":"46","author":"RS Zheng","year":"2024","unstructured":"Zheng RS, Chen R, Han BF, Wang SM, Li L, Sun KX, Zeng HM, Wei WW, He J. Cancer incidence and mortality in China, 2022. Zhonghua Zhong Liu Za Zhi. 2024;46(3):221\u201331.","journal-title":"Zhonghua Zhong Liu Za Zhi"},{"issue":"2","key":"14733_CR5","doi-asserted-by":"publisher","first-page":"114","DOI":"10.1177\/27527530211056001","volume":"39","author":"LS Al-Saadi","year":"2022","unstructured":"Al-Saadi LS, Chan MF, Al-Azri M. Prevalence of Anxiety, Depression, and Post-Traumatic Stress Disorder among Children and Adolescents with Cancer: A Systematic Review and Meta-Analysis. J Pediatr Hematology\/Oncology Nurs. 2022;39(2):114\u201331.","journal-title":"J Pediatr Hematology\/Oncology Nurs"},{"key":"14733_CR6","doi-asserted-by":"crossref","unstructured":"Lewandowska A, Zych B, Papp K, Zrubcov\u00e1 D, Kadu\u010d\u00e1kov\u00e1 H, \u0160up\u00ednov\u00e1 M, Apay SE, Nag\u00f3rska M. Problems, Stressors and needs of children and adolescents With Cancer. Children. 2021.","DOI":"10.3390\/children8121173"},{"issue":"6","key":"14733_CR7","first-page":"1103","volume":"67","author":"G Michel","year":"2020","unstructured":"Michel G, Brinkman TM, Wakefield CE, Grootenhuis M. Psychological Outcomes, Health-Related Quality of Life, and Neurocognitive Functioning in Survivors of Childhood Cancer and Their Parents. Pediatr Clin. 2020;67(6):1103\u201334.","journal-title":"Pediatr Clin"},{"issue":"11","key":"14733_CR8","doi-asserted-by":"publisher","first-page":"7013","DOI":"10.1007\/s00520-021-06253-2","volume":"29","author":"F Menger","year":"2021","unstructured":"Menger F, Mohammed Halim NA, Rimmer B, Sharp L. Post-traumatic growth after cancer: a scoping review of qualitative research. Support Care Cancer. 2021;29(11):7013\u201327.","journal-title":"Support Care Cancer"},{"issue":"8","key":"14733_CR9","doi-asserted-by":"publisher","first-page":"853","DOI":"10.1037\/hea0000083","volume":"33","author":"BE Compas","year":"2014","unstructured":"Compas BE, Desjardins L, Vannatta K, Young-Saleme T, Rodriguez EM, Dunn M, Bemis H, Snyder S, Gerhardt CA. Children and adolescents coping with cancer: Self- and parent reports of coping and anxiety\/depression. Health Psychol. 2014;33(8):853\u201361.","journal-title":"Health Psychol"},{"key":"14733_CR10","doi-asserted-by":"crossref","unstructured":"Matos JR, Coutinho APM, Gon\u00e7alves ALM, Motta AB. Quality of life and coping in children with cancer. Estudos de Psicologia (Campinas). 2023;40.","DOI":"10.1590\/1982-0275202340e200210"},{"key":"14733_CR11","doi-asserted-by":"crossref","unstructured":"Chun C-A, Moos RH, Cronkite RC. Culture: A fundamental context for the stress and coping paradigm. Handb multicultural Perspect stress coping 2006:29\u201353.","DOI":"10.1007\/0-387-26238-5_2"},{"issue":"3","key":"14733_CR12","doi-asserted-by":"publisher","first-page":"280","DOI":"10.1037\/cdp0000311","volume":"26","author":"J Chang","year":"2020","unstructured":"Chang J, Wang S-w, Mancini C, McGrath-Mahrer B, Orama de Jesus S. The complexity of cultural mismatch in higher education: Norms affecting first-generation college students\u2019 coping and help-seeking behaviors. Cult Divers Ethnic Minor Psychol. 2020;26(3):280.","journal-title":"Cult Divers Ethnic Minor Psychol"},{"key":"14733_CR13","unstructured":"Lazarus RS, Folkman S. Stress, appraisal, and coping. Springer publishing company; 1984."},{"issue":"1","key":"14733_CR14","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1002\/nur.21768","volume":"40","author":"H Kim","year":"2017","unstructured":"Kim H, Sefcik JS, Bradway C. Characteristics of qualitative descriptive studies: A systematic review. Res Nurs Health. 2017;40(1):23\u201342.","journal-title":"Res Nurs Health"},{"issue":"9","key":"14733_CR15","doi-asserted-by":"publisher","first-page":"1245","DOI":"10.1097\/ACM.0000000000000388","volume":"89","author":"BC O\u2019Brien","year":"2014","unstructured":"O\u2019Brien BC, Harris IB, Beckman TJ, Reed DA, Cook DA. Standards for Reporting Qualitative Research: A Synthesis of Recommendations. Acad Med. 2014;89(9):1245\u201351.","journal-title":"Acad Med"},{"issue":"5","key":"14733_CR16","doi-asserted-by":"publisher","first-page":"533","DOI":"10.1007\/s10488-013-0528-y","volume":"42","author":"LA Palinkas","year":"2015","unstructured":"Palinkas LA, Horwitz SM, Green CA, Wisdom JP, Duan N, Hoagwood K. Purposeful Sampling for Qualitative Data Collection and Analysis in Mixed Method Implementation Research. Adm Policy Ment Health. 2015;42(5):533\u201344.","journal-title":"Adm Policy Ment Health"},{"issue":"1","key":"14733_CR17","doi-asserted-by":"publisher","first-page":"20","DOI":"10.4103\/ijpvm.IJPVM_321_19","volume":"12","author":"V Renjith","year":"2021","unstructured":"Renjith V, Yesodharan R, Noronha JA, Ladd E, George A. Qualitative methods in health care research. Int J Prev Med. 2021;12(1):20.","journal-title":"Int J Prev Med"},{"issue":"1","key":"14733_CR18","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1177\/1525822X05279903","volume":"18","author":"G Guest","year":"2006","unstructured":"Guest G, Bunce A, Johnson L. How many interviews are enough? An experiment with data saturation and variability. Field methods. 2006;18(1):59\u201382.","journal-title":"Field methods"},{"key":"14733_CR19","unstructured":"Algorani EB, Gupta V. Coping mechanisms. StatPearls [Internet]. edn.: StatPearls Publishing; 2023."},{"issue":"6","key":"14733_CR20","doi-asserted-by":"publisher","first-page":"E395","DOI":"10.1097\/NCC.0000000000000865","volume":"44","author":"N Belpame","year":"2021","unstructured":"Belpame N, Kars MC, Deslypere E, Rober P, Van Hecke A, Verhaeghe S. Coping Strategies of Adolescent and Young Adult Survivors of Childhood Cancer: A Qualitative Study. Cancer Nurs. 2021;44(6):E395\u2013403.","journal-title":"Cancer Nurs"},{"issue":"4","key":"14733_CR21","doi-asserted-by":"publisher","first-page":"974","DOI":"10.1016\/j.pec.2021.07.034","volume":"105","author":"N Bradford","year":"2022","unstructured":"Bradford N, Cashion C, Holland L, Henney R, Walker R. Coping with cancer: A qualitative study of adolescent and young adult perspectives. Patient Educ Couns. 2022;105(4):974\u201381.","journal-title":"Patient Educ Couns"},{"issue":"3","key":"14733_CR22","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1177\/146879410100100307","volume":"1","author":"J Attride-Stirling","year":"2001","unstructured":"Attride-Stirling J. Thematic networks: an analytic tool for qualitative research. Qualitative Res. 2001;1(3):385\u2013405.","journal-title":"Qualitative Res"},{"issue":"2","key":"14733_CR23","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1191\/1478088706qp063oa","volume":"3","author":"V Braun","year":"2006","unstructured":"Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Res Psychol. 2006;3(2):77\u2013101.","journal-title":"Qualitative Res Psychol"},{"key":"14733_CR24","doi-asserted-by":"publisher","first-page":"100051","DOI":"10.1016\/j.glmedi.2024.100051","volume":"2","author":"SK Ahmed","year":"2024","unstructured":"Ahmed SK. The pillars of trustworthiness in qualitative research. J Med Surg Public Health. 2024;2:100051.","journal-title":"J Med Surg Public Health"},{"issue":"1","key":"14733_CR25","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1177\/1473325010368316","volume":"11","author":"L Tufford","year":"2012","unstructured":"Tufford L, Newman P. Bracketing in qualitative research. Qualitative social work. 2012;11(1):80\u201396.","journal-title":"Qualitative social work"},{"issue":"2","key":"14733_CR26","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1177\/10434542211041919","volume":"39","author":"L Cheng","year":"2021","unstructured":"Cheng L, Zhao X, Ge Y, Wang Y, Kang Q. The Experiences of Chinese Children 5- to 7-year-old during Cancer Treatment Reflected Through Interviews and Drawings. J Pediatr Hematology\/Oncology Nurs. 2021;39(2):88\u201398.","journal-title":"J Pediatr Hematology\/Oncology Nurs"},{"key":"14733_CR27","doi-asserted-by":"crossref","unstructured":"Li R, Ma J, Chan Y, Yang Q, Zhang C. Symptom clusters and influencing factors in children with acute leukemia during chemotherapy. Cancer Nurs. 2020;43(5).","DOI":"10.1097\/NCC.0000000000000716"},{"key":"14733_CR28","doi-asserted-by":"publisher","first-page":"389","DOI":"10.1007\/s11218-010-9146-7","volume":"14","author":"J Tan","year":"2011","unstructured":"Tan J, Yates S. Academic expectations as sources of stress in Asian students. Soc Psychol Educ. 2011;14:389\u2013407.","journal-title":"Soc Psychol Educ"},{"issue":"4","key":"14733_CR29","doi-asserted-by":"publisher","first-page":"527","DOI":"10.1188\/18.ONF.527-544","volume":"45","author":"L Jibb","year":"2018","unstructured":"Jibb L, Croal L, Wang J, Yuan C, Foster J, Cheung V, Gladstone B, Stinson J. Children\u2019s Experiences of Cancer Care: A Systematic Review and Thematic Synthesis of Qualitative Studies. Oncol Nurs Forum. 2018;45(4):527\u201344.","journal-title":"Oncol Nurs Forum"},{"key":"14733_CR30","doi-asserted-by":"crossref","unstructured":"Posa S, Moola F, McPherson A, Kontos P. Exploring illness identity among children and youth living with cancer: a narrative review. Pediatr Blood Cancer. 2021;68.","DOI":"10.1002\/pbc.29251"},{"issue":"5","key":"14733_CR31","doi-asserted-by":"publisher","first-page":"1099","DOI":"10.1007\/s10826-021-01928-0","volume":"30","author":"C Neugebauer","year":"2021","unstructured":"Neugebauer C, Mastergeorge AM. The Family Stress Model in the Context of Pediatric Cancer: A Systematic Review. J Child Fam stud. 2021;30(5):1099\u2013122.","journal-title":"J Child Fam stud"},{"key":"14733_CR32","doi-asserted-by":"crossref","unstructured":"Ozdemir Koyu H, Tas Arslan F. The effect of physical and psychosocial symptoms on caregiver burden of parents of children with cancer. Eur J Cancer Care. 2021;30(6).","DOI":"10.1111\/ecc.13513"},{"issue":"2","key":"14733_CR33","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1111\/jnu.12126","volume":"47","author":"AM Sposito","year":"2015","unstructured":"Sposito AM, Silva-Rodrigues FM, Sparapani Vde C, Pfeifer LI, de Lima RA, Nascimento LC. Coping strategies used by hospitalized children with cancer undergoing chemotherapy. J Nurs Scholarsh. 2015;47(2):143\u201351.","journal-title":"J Nurs Scholarsh"},{"key":"14733_CR34","doi-asserted-by":"crossref","unstructured":"Spaggiari S, Calignano G, Montanaro M, Zaffani S, Cecinati V, Maffeis C, Di Riso D. Examining coping strategies and their relation with anxiety: implications for children diagnosed with cancer or type 1 diabetes and their caregivers. Int J Environ Res Public Health. 2024;21(1).","DOI":"10.3390\/ijerph21010077"},{"key":"14733_CR35","doi-asserted-by":"crossref","unstructured":"Can YS, Iles-Smith H, Chalabianloo N, Ekiz D, Fern\u00e1ndez-\u00c1lvarez J, Repetto C, Riva G, Ersoy C. How to relax in stressful situations: a smart stress reduction system. Healthcare: 2020. MDPI; 2020. p. 100.","DOI":"10.3390\/healthcare8020100"},{"key":"14733_CR36","unstructured":"Romas JA, Sharma M. Practical stress management: a comprehensive workbook. Academic; 2022."},{"key":"14733_CR37","doi-asserted-by":"crossref","unstructured":"Jiang X, Chen XJ, Xie Q, Feng Y, Chen S, Peng J. Effects of art therapy in cancer care: a systematic review and meta-analysis. Eur J Cancer Care. 2020.","DOI":"10.1111\/ecc.13277"},{"key":"14733_CR38","unstructured":"Fancourt D, Finn S. What is the evidence on the role of the arts in improving health and well-being? A scoping review. World Health Organization. Regional Office for Europe; 2019."},{"key":"14733_CR39","doi-asserted-by":"publisher","first-page":"102725","DOI":"10.1016\/j.ctim.2021.102725","volume":"59","author":"SSI Da","year":"2021","unstructured":"Da SSI, Schveitzer MC, Dos SM, Ghelman R, Filho VO. MUSIC INTERVENTIONS IN PEDIATRIC ONCOLOGY: Systematic review and meta-analysis. Complement Ther Med. 2021;59:102725.","journal-title":"Complement Ther Med"}],"container-title":["BMC Health Services Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12913-026-14733-6","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12913-026-14733-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12913-026-14733-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T22:44:50Z","timestamp":1784587490000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12913-026-14733-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,23]]},"references-count":39,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["14733"],"URL":"https:\/\/doi.org\/10.1186\/s12913-026-14733-6","relation":{},"ISSN":["1472-6963"],"issn-type":[{"value":"1472-6963","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,23]]},"assertion":[{"value":"19 February 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 May 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 May 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Our study was conducted following the Declaration of Helsinki. Ethics approval was obtained from the Survey and Behavioural Research Ethics of the Chinese University of Hong Kong (P84709870). The assent forms were obtained from the children, and written informed consent was obtained from their guardians before the interviews. Participants were assured of confidentiality and the right to withdraw from the study at any time without any negative consequences.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"1002"}}