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

Background: A paediatric cancer diagnosis is a profound stressor for the entire family system. While coping strategies are well-studied, their link to the quality of the parent-child attachment relationship remains less explored. This study investigates 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. Methods: A multicentre, cross-sectional study was conducted across three Italian paediatric oncohaematology centres. A total of 165 caregivers of 91 paediatric patients 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). The study aimed to test 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). Hierarchical multiple linear regressions, adjusted for key covariates and clustered by centre, were conducted to test these hypotheses. Results: 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. Conclusions: The quality of the parent-child attachment is significantly and independently associated with coping styles 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.