Making Sense through Story: A Structural Narrative Analysis of Maternal Grief in Childhood Cancer

Background and Purpose: Research attention to the psychosocial impacts of childhood cancer has increased in recent years, deepening our understanding of families’ experiences. However, few studies have applied a grief lens and fewer still have focused on mothers specifically. Given the unique nature of maternal connection and identity, the mothers of children with cancer face profound disruptions to their sense of self and the world. Narrative Identity Theory (McAdams, 1985; 2019) posits that individuals make meaning of experiences and renegotiate their identity by constructing their stories in a manner that enables a sense of coherence over time. In this study, a structural narrative approach was used to address the question, what narrative elements shape how mothers of a child with cancer describe, process, and find meaning in their experiences? Structural narrative analysis focuses on how a story is told rather than on what is told, enabling the identification of narrative elements that support the reconstruction of meaning and self over time.

Methods: Structural narrative analysis was used to examine two narrative interviews with a sample of mothers who had a child in their care who had been diagnosed with cancer within the previous three years. Availability sampling was used to recruit participants through pediatric oncology networks. At the first interview, participants were asked to tell their stories from pre-diagnosis to the present. At the second (N=5), they engaged in a memory elicitation interview (Brown, 2019) that involved sharing their reflections about symbolic items they had collected for a memory box between interviews (e.g., hospital wrist bands, memory beads, pill bottles). Aiming to identify narrative elements that revealed the processes embedded in meaning-making (Labov & Waletzky, 1997), the analysis focused on: 1) Identifying the plot structure (e.g., story arc, sequencing, characters); 2) Coding for narrative elements (e.g., orientation, turning points, evaluation, resolution).

Results: Narratives followed a common story arc beginning with the early signs of illness and progressing through diagnosis, the treatment process, turning points toward resolution (e.g., remission or relapse), and in many cases – a climax and the aftermath of the cancer journey. Key findings included the use of temporal and spatial markers to orient the listener to time and space, and the use of “complicating action” to introduce challenges or turning points in the narrative. The analysis highlighted the agency of the speaker. Evaluation was also central to the story-telling process, as participants conveyed the significance of events through their interpretations and judgments.

Conclusions and Implications: This study advances the current literature by showing how participants structured their narratives of loss, thus achieving a sense of coherence in identity over time. Findings demonstrate the value of structural narrative analyses in generating insights into the meaning-making and identity-related dimensions of grief. More broadly, this work highlights the potential utility of grief-support models that move beyond the emotional expression of grief to engage the storyteller’s sense of agency in narrative construction as a tool for meaning-making (Neimeyer et al., 2014).