The usage of family audiobooks as a legacy for grieving minor children - an exploratory quantitative analysis

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We find a broad range of interventions such as Dignity therapy or Life Review. There are several studies concerning the effects of biographical interventions in palliative care, but research on the usage of digital reminiscence is sparse. Since 2017, terminally ill parents have been offered the opportunity to record an audio book for their minor children. It also offers parents with a terminal illness the opportunity to use their own voice to influence how and what aspects of themselves they want to be remembered. This professionally supported, voluntary service is free of charge and unique in Germany. The objective of this study was to provide novel insights into the satisfaction with and use of the family audiobook, as well as the effects on children, by surveying the terminally ill parent and their related persons. Methods A survey was conducted online among terminally ill parents and their related persons, who were identified and contacted through the Family Audiobook Association in Germany. The anonymous online survey was accessible between September 2023 and November 2023. A descriptive analysis of the quantitative data was conducted using the statistical software package SPSS. Results 186 respondents, 95 terminally ill parents and 91 related persons, provided responses to the online survey. Almost all terminally ill parents felt eased to have recorded a family audio book. The two groups exhibited differences in the manner in which they used and listened to the family audiobook. The open answers provided insight into the emotional and situational context in which the audiobook was being used. While some children are observed listening to family audiobooks with their parents or friends, other children are not yet ready for this. Conclusions The audiobook offers terminally ill parents with minor children a valuable opportunity to tell their own biographical story, to offer support to the bereaved in remembering and to preserve the voice of the deceased for the children. In addition, this approach could help healthcare professionals to reduce the stress associated with providing end-of-life care for terminally ill parents with minor children. Terminally ill parent with minor children biographical work family audiobook legacy Figures Figure 1 Introduction In Germany, between the ages of 25 and 50, the share of all causes of death due to cancer will range from 62% in 2012 to 50% in 2021.[ 1 ] The terminally ill patients in this age group are at different stages of their lives. One example is the care of terminally ill parents with young children, which can present a significant challenge for patients, young children, and healthcare professionals due to the near-death nature of the disease trajectory in the patient's life. Studies found that caring for and treating parents with young children was a particularly challenging stressor for patients, minor children and healthcare professionals.[ 2 – 7 ] The advanced care planning process, which is designed to be patient-centred and tailored to the specific needs and life planning of patients with incurable cancer, plays a crucial role in the management of these patients.[ 8 – 10 ] Accordingly, in addition to medical, nursing or therapeutic treatment pathways, there are further priorities for a significant number of parents with minor children.[ 1 , 11 , 12 ] Biographical interventions, for example, have been shown to have a positive impact on patients in palliative care, such as improving quality of life, reducing depression and coping with life limitations. [ 13 – 15 ] Also, knowing that positive effects on depression, well-being and quality of life can be achieved through biographical work in gerontology and geriatrics, biographical storytelling was used in search for an intervention for terminally ill parents with minor children. [ 16 , 17 ] We find a broad range of different interventions such as Dignity Therapy, Life Review, and Reminiscing, and these positive effects could be found in overall designs.[ 15 ] Leaving a legacy is one element of most interventions mainly as a written document.[ 18 ] Fang et al. pointed out how important and difficult it is to maintain memories of the deceased parent. Especially the bereaved parents found it difficult to take responsibility for the memory and to give deceased parents’ letters as a reminiscence to the child(ren).[ 16 ] Muriel et al. suggest that bereaved children may benefit from having a video or audio recording of the deceased parent, which “could capture their appearance and voice” [ 19 ]. On the one hand, children desire voice recordings as a means of preserving memories. On the other hand, creating self-selected biographical sequences in the form of audiobooks allows a dying parent to transcend time and shape their own culture of remembrance. Surviving children thus receive an authentic legacy whose interpretation, credibility and reliability is strengthened by the parental voice recording.[ 16 , 19 – 21 ] As an intervention for terminally ill parents with minor children the recording of an audiobook as legacy is offered since the start of the project in 2017. The initiative of Family Audiobooks is a non-profit organization running by fundraising. Terminally ill patients with children younger than 18 years can apply for an audiobook, the preparation is free of charge. The audiobook comprises several chapters organized chronologically, and the patients give headlines to every chapter and add their music or sing songs such as lullabies themselves. In addition, they introduce the audiobook to their family talking about their experience recording and explaining the title of it. The audiobook is completed with a little booklet with a list of content and some photos. Research on the usage of legacy documents is sparse. Grijó et al. looked at the effects of Dignity Therapy on family members and found positive beliefs in the legacy document. [ 22 ] Their review showed that the legacy was considered a source of comfort and in addition, the legacy was supposed to help in the bereavement phase. However, since Waggoner et al. also confirm that legacy and areas of remembering are complex and under-researched in social sciences [ 23 ], we found no further research on audiobooks as a legacy to children. The aim of this exploratory research is to investigate a) how audiobooks are recognised, by whom and in what way. We also want to get a first insight into b) satisfaction with topics related to audiobooks. And finally, since 2017, parents with young children have been offered to create an audiobook (family audiobook) we wondered c) if and how these audiobooks are used by the child(ren). Methods To investigate the potential of family audiobooks as a means of audio-graphic reminiscence of terminally ill parents for their minor children, anonymised online survey was conducted. Study population and recruitment process Study admission criteria for the recording of an audiobook were (1) patients diagnosed with life-limiting disease, (2) fluent in the German language, (3) 18 years of age or older and (4) having at least one child younger than 18 years. Exclusion criterion was psychiatric impairment such as dementia, psychosis, severe depression or diagnosed personality disorder. Family Audiobook Association is a non-profit, voluntary organisation, free of charge to participants and scientifically monitored. While the initial recruitment process came from the project team, the project group received an increasing number of interview requests from those meeting the criteria. This was due to a high level of media attention given to the final product, the recording of a family audiobook by a terminally ill parent for their underage children. The journey of the "Family audiobook" project started in the pilot phase from 2017 to 2020, primarily in North Rhine-Westphalia. Since 2021, the project group received requests from all over Germany and neighbouring countries. At the time of the online survey over 350 terminally ill parents recorded an audiobook. All audiobook participants agreed to scientific monitoring and provided contact details to the Family Audiobook Association for this purpose. The Family Audiobook Association maintains a database of 234 email addresses. But invitations were only sent to those who provided an email address. The association sent invitations requesting participation in anonymous online survey and followed up with three reminders. This procedure ensured data protection agreements with families and guaranteed anonymity of participation. The research ethics committee of the University Hospital Bonn reviewed and approved the study (no.389/16). Data collection methods and research design A snowball sampling procedure was employed, whereby email recipients were requested to forward the link of the anonymous online survey to those who also had access to the family audiobook. The primary data was collected by using a standardised mainly close-ended online survey accessible from 17.09.2023 to 30.11.2023. The quantitative online questionnaire consisted of 40 closed questions and 4 open text input fields. The questionnaire was available in German. In addition to the socio-demographic data, largely close-ended questions were asked about the initiation, the feeling of having done it, the listening, contents of the family audiobook and the sharing procedures. It was also possible to provide information about child(ren)s’ frequency of listening and the influence of the audiobook on the child(ren). Supplementary open-ended questions and/or text entry boxes allowed participants to give reasons and/or more detailed answers in their own words. Some questions were only posed to patients who were terminally ill, as the questions pertained to the process and satisfaction with creating a family audiobook. Analysis This is the inaugural attempt to gain insight into the usage of family audiobooks as a means of reminiscing from the perspective of the terminally ill parents and the ones left behind. Consequently, the anonymous quantitative data was grouped into two respondent groups: terminally ill parents and related persons. This was since a smaller number of bereaved children participated. The exploratory analyses entail frequencies and bivariate distributions in the context of cross-tabulations. The open-ended response fields were recoded and grouped. Content-related illustrative quotations were selected and grammatically corrected when necessary. The analyses were performed using a statistical software platform (IBM® SPSS® 29.0 software platform). Results From 17.09.2023 to 30.11.2023, the Family Audiobook Association sent an e-mail to 234 addresses containing a link to an anonymous online questionnaire. Of the 234 emails sent, 214 email addresses were successfully reached. Nevertheless, the precise number of individuals reached remains uncertain, as the email cover letter requested email recipients to forward the online survey link at their own initiative to those to whom the family audiobook is addressed. The aim was to reach as many as possible rather than to be representative. Finally, 186 respondents filled in the online survey. Half of these 186 respondents were a terminally ill patient with minor children (95) and the other half were related persons (91). Most of the terminally ill parents (82%) and 60% of the responding related persons are female. (Fig. 1) The question regarding familial status was posed only to patients themselves. The majority are married (82%), 12% are in a partnership and a minority are widowed, single or live separated. Using a 5-point scale (with 1 ‘burdens me’ to 5 ‘eases me’), the question 'How do you feel about the family audiobook?’ having achieved it, having received it and being able to pass it on was asked only to patients. On all three of these aspects, almost all respondents with a terminal illness feel at ease. (Table 1 ) Table 1 Terminally ill parents’ feelings of terminally ill parents about the family audiobook; percentages (n = 90) Having achieved it Having received it Being able to pass on 1 Burdens me 5% 3% 3% 2 0% 6% 2% 3 3% 7% 6% 4 11% 13% 13% 5 Eases me 81% 71% 76% Source: FHB_2023, terminally ill parents’ responses only, own data, own calculations and representation. Table 2 gives an insight into our main focus, whether and how often the audiobook was used. This question was posed to patients and related persons (Table 2 ) and at the level of the child(ren) as an external assessment by the respondents (Table 3 ). Up to 60% of all respondents listened to the audiobook immediately after receiving it, more than 30% at least within six months and 9% after 6 months. More terminally ill parents (68%) stated that they listened to the family audiobook right after right after receiving it than related persons (49%). The frequency of listening was measured using a four-point scale, with responses ranging from "often" to "never". Table 2 demonstrates that, a total of 45% of the related persons and 20% of the terminally ill parents listened to the family audiobook “sometimes”. A total of 20% of parents and 8% of relatives indicated that they had never listened to the audiobook at the time of the survey. Most listened to the audiobook in Chaps. (69%, n = 145) and 30% of all respondents listened from the beginning to the end. A multiple-response option was provided to ascertain the potential accompanying persons while listening. This analysis is based on a scale of 100%, which represents the totality of 192 responses. The results indicated that 60% of respondents listened to the content independently, 16% with a partner, 13% with children, and 5% with parents. This raises the question “How do you feel when you listen to the family audiobook?”. Of all respondents, 57% indicated that they felt partly sad or happy. The remaining 43% expressed a range of emotions, including (very) sadness and happiness, in varying degrees (18% vs. 26%). Parents with terminal illnesses and minor children were more likely to report high levels of happiness (33%) than the related individuals (17%). (Table 2 ) Table 2 Post receival listening period and listening frequency; percentages Post receival listening period Terminally ill parent (n = 72) Related person (n = 75) Total (n = 147) Immediately upon receival 68% 49% 59% 1 month after receival 19% 11% 15% 1 to 6 months after receival 11% 23% 17% 6 months to 1 year after receival 1% 11% 6% More than 1 year after receival 0% 7% 3% Listening frequency Terminally ill parent (n = 72) Related person (n = 74) Total (n = 146) Often 1% 8% 5% Sometimes 20% 45% 33% Rarely 54% 38% 46% Never 25% 8% 16% Feelings during listening Terminally ill parent (n = 72) Related person (n = 75) Total (n = 147) Very happy 15% 8% 12% Happy 18% 9% 14% Partly-partly 57% 57% 57% Sad 7% 9% 8% Very sad 3% 16% 10% Source: FHB_2023, own data, own calculations and representation However, 23 of 186 respondents who indicated that they had never listened to the final product explained this by using a multiple response scale and an option to write in their own words. The option that was selected most often (n = 13) was "other (please write in)," with "needed distance to it" being the second-most (n = 6) selected. The afore mentioned emotional aspect (6) is one of the reasons followed by a diverse mixture of ‘recordings have been stopped or have not yet been received’ (n = 3). But then there are statements such as "I took part in the recordings", "It was not possible to contact the father" or the rule that the recordings should only be listened to a year after the death, which explain why the family audiobook was not listened to at the time of the online survey. Finally, as a reason not to listen to it, one wrote: “Then you think of too many things you would have liked to have said or done differently.” So, when all respondents were asked who will pass the reminiscent ‘family audiobook’ on to children, 32% said the terminally ill parent, followed by the partner or father of the children at 54% and family members at 9% and others at 2.5%. A further minority of 2.5% of the patients responded “don’t know” at the time of the survey. 38% of all respondents do not know when they will pass the family audiobook on. According to 24% of the respondents, the children have already received the family audiobook, a further 24% will receive it after the death of the terminally ill parent and 12% will pass it on when the children reach a certain age. In a multiple-choice option, respondents indicated who had already listened to the audiobook. Based 100% on all answers and in descending order, these were mainly the partner, followed by a family member or a friend. In those cases where the family audiobook was already given to the children or the children listens, 85% of respondents said that the children had already listened to it. On a four-point scale from often to never, 48% think that the children listen to the family audiobook rarely, 29% sometimes and 12% often. (Table 3 ) Table 3 Estimation of child(ren)’ listening frequency; percentages Terminally ill parent (n = 14) Related person (n = 28) Total (n = 42) Often 14% 11% 12% Sometimes 29% 29% 28% Rarely 36% 54% 48% Never 0% Don’t know 21% 7% 12% Source: FHB_2023, own data, own calculations and representation Those who take the opportunity to tell us about the impact on children range from emotionally sad to happy, going hand in hand with a wide range of usage, mixed feelings and different impact on individual grieving children, as can be seen from the quotes below. Still, the overall tenor is, that they see it as a treasure to be cherished and the family audiobook as an enriching legacy. This is emphasised by the personal, carefully selected stories on the audiobook and the experience of the dead or dying parent's voice through the medium of the audio book, which will therefore not be forgotten. “Two of the three children occasionally listen to the audiobook that my husband has recorded. However, this depends very much on their mood and stage of grief. The eldest doesn't want to listen to anything at all.” (related person) “Mixed, one chapter the child didn't want to continue listening to. Now she listens to individual chapters more often, as I have made a part on a Tonie [an audio player brand, authors’ note]” (related person) “I'm still here. That's why the kids don't hear it that often. But they know that when I'm no longer there, they can hear my voice. I think that's very important for the children. I'm sure it makes them sad too, but they're glad that I've recorded this audio book. That way I'm always there somehow.” (terminally ill parent) “My children are 5 and 7 years old. After their father died, they said at some point that they couldn't remember Dad's voice, so we listened to the audio book. The 5-year-old was two years old at the time of my husband's death, he can't do much with it yet, but the 7-year-old asks about it from time to time.” (related person) “My son listens very attentively. And when friends come to play, it is also listened to.” (related person) “Very good, I listen to it again and again. Mum's voice is good.” (related person) “On the positive side, I have the impression that it is seen as a "treasure" for "later".” (terminally ill parent) “We always listen to the family audiobook on the day of death when we go away together as a family for a weekend.” (related person) Source: FHB_2023, anonymous online survey, own data, selected quotes in response to open questions. Conclusion A review of the existing literature revealed a research gap in the field of digital audiobooks and their use by bereaved minor children. [ 6 , 19 , 20 ] Since 2017, patients with a terminal illness and minor children have been offered the option of having a family audiobook recorded as part of their legacy. So, six years following the initiation of the program, the first formal assessment was carried out to ascertain the usage and the impact of the family audiobook on terminally ill parents and related persons. The lack of knowledge about the individuals at the registered contact addresses led to a non-representative survey. Therefore, it was of the utmost importance to conduct a carefully designed and sensitive survey in order to gain novel insights into the use of family audiobooks. The preservation of memories, the liveliness beyond death, is created through biographical storytelling about people by related persons or, in our case, through professionally supported audiobooks as a legacy for bereaved children. Not everyone finds it easy to talk about their own life as a legacy, so the subjective, meaningful moments were chosen as the starting point for biographical narratives from a terminally ill parent with minor children. This made it possible to give the terminally ill parent a guide and horizon for the narrative flow. Our data illustrates a wide spectrum, from the relief of being able to pass it on to the children, to the mixed feelings of having a family audio book, which is understandable when knowing that the occasion for the recording is a very sad situation, namely being confronted with the death. On the one hand most of the responding parents with a terminal illness are highly comfortable with having achieved it, having received it and having the opportunity to pass it on. However, a moderate listening frequency and mixed feelings are prevalent in both groups of respondents, the dying parent and related persons. Those who are still alive and have listened to it with children are more likely to report a positive impact, reflecting on the situation of being alive and sharing togetherness and belonging. The greatness and power lie in being the creator of memory content in one's own voice. The latter, remembering the voice, is mentioned much more often by respondents bereaved of the deceased parent, consistent with Muriel et al. [ 19 ] Our research indicates that there are both opportunities and risks associated with leaving a legacy of the dying parent in the form of a family audiobook. The family audiobook is regarded as a valuable and sad remembrance of the deceased parent. Our results reflect this great ambivalence in the turmoil of the respondents' emotional worlds. But still, it's good to have a family audiobook as a voice and legacy to hear the important and pressing issues of the dying parent. Furthermore, it provides insight into the lives of the deceased parent and their knowledge, as well as their advice to the child in certain situations. The audiobook keeps memories alive, even so it would be better to "make memories yourself". The findings of our study suggest that audiobooks may be an invaluable resource for supporting and preparing reminiscence for parents who are terminally ill and their related individuals. [ 19 – 21 ] In particular, they can assist bereaved parent in preserving memories. In addition, this approach might help healthcare professionals to reduce the stress associated with providing end-of-life care for terminally ill parents with minor children. Further research utilising a child-appropriate questionnaire would enhance our understanding not only of the long-term usage, but also the challenges, overall effects, and emotional risks associated with digital reminiscences for children. Strengths/limitations The strength of this study lies in the visualisation of satisfaction with the realisation and receiving of the family audiobook on the part of terminally ill parents, which was achieved through our inquiry. Concurrently, and in nearly identical proportions, the related persons mainly family members responded to our questionnaire. The results of the study indicate that the family audiobook usage varies considerably, with a tendency towards infrequent listening. This is likely due to the nature of confronting the death of a parent. Consequently, the study found that the transfer of ownership and responsibility for a family audiobook is a highly emotional and sensitive process. The ambivalences become visible on the part of the family members and can now be better addressed and supported. However, this requires sensitive further research into the effects on the children left behind. Especially since the effects on the children are reported by third parties, this study is limited. The absence of a list of respondents for full surveys or a representative sampling prevents the study from being generalisable. A further limitation is that the anonymised responses cannot be grouped into families. This implies that only a single individual may have provided responses to one audiobook, while in other cases multiple individuals may have provided responses to one audiobook. Additionally, there are individuals who have been contacted but did not answer the survey since they have not yet received the audiobook. The diverse motivations for participation in the survey also introduce bias and a limitation to the studies. There is limited prior research in this area, so that the exploratory nature of this study has an impact on the depths of the data. Further accessibility could be achieved through multilingual questionnaires that encourage the participation of people with non-German language skills. As this is also the case with the measurement instrument, which reaches mainly digitally connected ones. Further (semi-structured) in-depth interviews could provide further insight into the impact and effects of the creation process on the owners of Family Audiobook. As previously observed, a significant number of terminally ill parents involve their children or partners during the recording process. A mixed methods approach would address some of these limitations, but is more resource intensive. Declarations Funding The authors declare that no funds or grants were received for conducting this study and during the preparation of this manuscript. Competing interests The authors have no competing interests to declare that are relevant to the content of this article. Author contributions All authors contributed to the study conception and design of this work. G.A. performed the data preparation, and analysis. G.A. and M.H. interpreted the data. The first draft of the manuscript was written by G.A. and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Compliance with Ethical Standards and Ethics approval This study was performed in line with the principles of the Declaration of Helsinki. The research ethics committee of the University Hospital Bonn reviewed and approved the study (no.389/16). Consent All participants gave their informed consent before answering the anonymous online questionnaire. Data availability Data and material are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request. Authors and Affiliations Institute for Digitalization and General Medicine, Center for Rare Diseases Aachen (ZSEA), University Hospital Aachen, Pauwelsstr. 30, 52074 Aachen, Germany Dr. Gülay Ateş and Dr. Michaela Hesse Department of Palliative Medicine, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany Dr. Henning Cuhls Acknowledgements We would like to thank Judith Grümmer and Petra Steinbach from the Family Audiobook Association for their support with the online survey. Furthermore, we are grateful to all the participants in the study for their time and sharing of their experiences. References Bundesamt DS: Death rates by cause and age for the reporting years 2012 to 2021. In. Edited by Gesis-Online Db–. https://www-genesis.destatis.de/ ; 2024. Grenklo TB, Kreicbergs UC, Valdimarsdóttir UA, Nyberg T, Steineck G, Fürst CJ: Communication and Trust in the Care Provided to a Dying Parent: A Nationwide Study of Cancer-Bereaved Youths. Journal of Clinical Oncology 2013, 31(23):2886–2894. Müller M, Pfister D, Markett S, Jaspers B: Wie viel Tod verträgt das Team? Der Schmerz 2009, 23(6):600–608. Rauch PK, Muriel AC, Cassem NH: Parents With Cancer: Who’s Looking After the Children? Journal of Clinical Oncology 2002, 20(21):4399–4402. Park EM, Jensen C, Song M-K, Yopp JM, Deal AM, Rauch PK, Greer JA, Rosenstein DL: Talking With Children About Prognosis: The Decisions and Experiences of Mothers With Metastatic Cancer. JCO Oncology Practice 2021, 17(6):e840-e847. Semple CJ, McCaughan E, Smith R, Hanna JR: Parent’s with incurable cancer: ‘Nuts and bolts’ of how professionals can support parents to communicate with their dependent children. Patient Education and Counseling 2022, 105(3):775–780. Sheehan S, Hanna JR, Drury A, McCance T, Semple CJ, O'Neill C: A Systematic Review of Educational Interventions to Equip Health and Social Care Professionals to Promote End-of-Life Supportive Care when a Parent with Dependent Children is Dying with Cancer. Semin Oncol Nurs 2023, 39(5):151474. Martin K, Schatz AA, White JS, Muss H, Didwania A, Gallo L, Carlson RW: NCCN Virtual Patient Advocacy Summit: Cancer Across the Lifespan. Journal of the National Comprehensive Cancer Network 2021, 19(12):1395–1400. Beernaert K, Kreicbergs U, Fürst CJ, Nyberg T, Steineck G, Bylund-Grenklo T: Distrust in the End-of-Life Care Provided to a Parent and Long-Term Negative Outcomes Among Bereaved Adolescents: A Population-Based Survey Study. Journal of Clinical Oncology 2017, 35(27):3136–3142. Caparso C, Bowen Z, Choi SW: HSR24-126: “Share the Fear”: Communication Concerns of Parents With Cancer With Dependent Children for Their Co-Parent: A Qualitative Study. Journal of the National Comprehensive Cancer Network 2024, 22(2.5):HSR24-126. Rocque GB, Patel MI, Wallner LP, Bailey SC, Schear R, Gunn CM, Rivers J, Wilson R, Freeman EC, Buckingham TL et al : Patient-Centered Decision-Making in Metastatic Breast Cancer Care Delivery: A Call to Action. Journal of the National Comprehensive Cancer Network 2024, 22(1):e237113. Beale EA, Sivesind D, Bruera E: Parents dying of cancer and their children. Palliative and Supportive Care 2004, 2(4):387–393. Hesse M, Forstmeier S, Mochamat M, Radbruch L: A Review of Biographical Work in Palliative Care. Indian J Palliat Care 2019, 25(3):445–454. Cuhls H, Hesse M, Ates G, Radbruch L: Audiobooks from terminally ill parent for their children – a qualitative evaluation. BMC Palliative Care 2021, 20(1):172. Chochinov HM, Hack T, Hassard T, Kristjanson LJ, McClement S, Harlos M: Dignity therapy: a novel psychotherapeutic intervention for patients near the end of life. J Clin Oncol 2005, 23(24):5520–5525. Fang C, Comery A, Carr S: “They want you to know who they really are inside of the old visage”—biographical storytelling as a methodological tool to explore emotional challenges in old age. BMC Geriatrics 2023, 23(1):386. Allen RS, Hilgeman MM, Ege MA, Shuster JL, Jr., Burgio LD: Legacy activities as interventions approaching the end of life. J Palliat Med 2008, 11(7):1029–1038. Keall RM, Clayton JM, Butow PN: Therapeutic life review in palliative care: a systematic review of quantitative evaluations. J Pain Symptom Manage 2015, 49(4):747–761. Muriel AC, Moore CW, Beiser M, Park ER, Lim CT, Rauch P: What do surviving children wish for from a dying parent? A qualitative exploration. Death Studies 2020, 44(5):319–327. Semple CJ, McCaughan E, Beck ER, Hanna JR: 'Living in parallel worlds' - bereaved parents' experience of family life when a parent with dependent children is at end of life from cancer: A qualitative study. Palliat Med 2021, 35(5):933–942. McCaughan E, Semple CJ, Hanna JR: 'Don't forget the children': a qualitative study when a parent is at end of life from cancer. Support Care Cancer 2021, 29(12):7695–7702. Grijó L, Tojal C, Rego F: Effects of dignity therapy on palliative patients' family members: A systematic review. Palliat Support Care 2021, 19(5):605–614. Waggoner B, Bering JM, Halberstadt J: The desire to be remembered: A review and analysis of legacy motivations and behaviors. New Ideas in Psychology 2023, 69:101005. Additional Declarations No competing interests reported. Supplementary Files CSTROBEchecklistcrosssectional.docx Cite Share Download PDF Status: Published Journal Publication published 25 Oct, 2024 Read the published version in Supportive Care in Cancer → Version 1 posted Editorial decision: Revision requested 15 Jul, 2024 Reviews received at journal 15 Jul, 2024 Reviewers agreed at journal 15 Jul, 2024 Reviews received at journal 12 Jul, 2024 Reviewers agreed at journal 03 Jul, 2024 Reviewers invited by journal 03 Jul, 2024 Editor assigned by journal 03 Jul, 2024 Submission checks completed at journal 30 May, 2024 First submitted to journal 24 May, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4471159","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":308460703,"identity":"ec0b5495-e360-40dc-a6ec-2546e56f1c53","order_by":0,"name":"Gülay Ateş","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0ElEQVRIiWNgGAWjYNCCCgYDIMkGYjI2EFbODMRnSNbC2EaKFnn38wcf/px32Ji//fCzBx93MMj2E9JieCaZ2Zh322EziTNp5oYzzzAYzyRkjWFDMps047bDNgwHctikedsYEjccIKSl/zH7z59zDtvIn3/DJv0XqGU/IS3yEslsDLwNh80MbgBtYQTZQsgvBhKPjaV5jqUbG954ZibZ2yZhPIOgLf2JDz/+qLE2nHc++ZnEzzYb2f4GQragmSlByFlAWwiZOQpGwSgYBaOAAQB9RUD+NdmkHwAAAABJRU5ErkJggg==","orcid":"","institution":"University Hospital Aachen","correspondingAuthor":true,"prefix":"","firstName":"Gülay","middleName":"","lastName":"Ateş","suffix":""},{"id":308460704,"identity":"e0d5cd0f-3f7f-45bb-ac9b-235968822d96","order_by":1,"name":"Michaela Hesse","email":"","orcid":"","institution":"University Hospital Aachen","correspondingAuthor":false,"prefix":"","firstName":"Michaela","middleName":"","lastName":"Hesse","suffix":""},{"id":308460705,"identity":"1e8df1a4-3849-4898-823d-9f5b005ad7e1","order_by":2,"name":"Henning Cuhls","email":"","orcid":"","institution":"University Hospital Bonn","correspondingAuthor":false,"prefix":"","firstName":"Henning","middleName":"","lastName":"Cuhls","suffix":""}],"badges":[],"createdAt":"2024-05-24 08:40:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4471159/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4471159/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00520-024-08945-x","type":"published","date":"2024-10-25T15:57:54+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":58307553,"identity":"c3acc558-2d86-4f3d-b6fc-b0321677bdf0","added_by":"auto","created_at":"2024-06-13 18:43:40","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":19888,"visible":true,"origin":"","legend":"\u003cp\u003eSample size and distribution\u003c/p\u003e\n\u003cp\u003eSource: FHB_2023, own data, own calculations and representation\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4471159/v1/16ee6d84f69ede612af83d95.png"},{"id":67682674,"identity":"d25bfcad-e570-4b9f-b6a2-b0c9ab8016bd","added_by":"auto","created_at":"2024-10-28 16:14:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":537401,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4471159/v1/f26dad35-c47e-4946-890c-50270a32fb6d.pdf"},{"id":58307554,"identity":"38f0eafc-b8f0-4c69-9f26-073d97bb76b1","added_by":"auto","created_at":"2024-06-13 18:43:41","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":33213,"visible":true,"origin":"","legend":"","description":"","filename":"CSTROBEchecklistcrosssectional.docx","url":"https://assets-eu.researchsquare.com/files/rs-4471159/v1/389129537a96091b1143529a.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"The usage of family audiobooks as a legacy for grieving minor children - an exploratory quantitative analysis","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIn Germany, between the ages of 25 and 50, the share of all causes of death due to cancer will range from 62% in 2012 to 50% in 2021.[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] The terminally ill patients in this age group are at different stages of their lives. One example is the care of terminally ill parents with young children, which can present a significant challenge for patients, young children, and healthcare professionals due to the near-death nature of the disease trajectory in the patient's life. Studies found that caring for and treating parents with young children was a particularly challenging stressor for patients, minor children and healthcare professionals.[\u003cspan additionalcitationids=\"CR3 CR4 CR5 CR6\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] The advanced care planning process, which is designed to be patient-centred and tailored to the specific needs and life planning of patients with incurable cancer, plays a crucial role in the management of these patients.[\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] Accordingly, in addition to medical, nursing or therapeutic treatment pathways, there are further priorities for a significant number of parents with minor children.[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eBiographical interventions, for example, have been shown to have a positive impact on patients in palliative care, such as improving quality of life, reducing depression and coping with life limitations. [\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] Also, knowing that positive effects on depression, well-being and quality of life can be achieved through biographical work in gerontology and geriatrics, biographical storytelling was used in search for an intervention for terminally ill parents with minor children. [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] We find a broad range of different interventions such as Dignity Therapy, Life Review, and Reminiscing, and these positive effects could be found in overall designs.[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] Leaving a legacy is one element of most interventions mainly as a written document.[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eFang et al. pointed out how important and difficult it is to maintain memories of the deceased parent. Especially the bereaved parents found it difficult to take responsibility for the memory and to give deceased parents\u0026rsquo; letters as a reminiscence to the child(ren).[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] Muriel et al. suggest that bereaved children may benefit from having a video or audio recording of the deceased parent, which \u0026ldquo;could capture their appearance and voice\u0026rdquo; [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. On the one hand, children desire voice recordings as a means of preserving memories. On the other hand, creating self-selected biographical sequences in the form of audiobooks allows a dying parent to transcend time and shape their own culture of remembrance. Surviving children thus receive an authentic legacy whose interpretation, credibility and reliability is strengthened by the parental voice recording.[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eAs an intervention for terminally ill parents with minor children the recording of an audiobook as legacy is offered since the start of the project in 2017. The initiative of Family Audiobooks is a non-profit organization running by fundraising. Terminally ill patients with children younger than 18 years can apply for an audiobook, the preparation is free of charge. The audiobook comprises several chapters organized chronologically, and the patients give headlines to every chapter and add their music or sing songs such as lullabies themselves. In addition, they introduce the audiobook to their family talking about their experience recording and explaining the title of it. The audiobook is completed with a little booklet with a list of content and some photos.\u003c/p\u003e \u003cp\u003eResearch on the usage of legacy documents is sparse. Grij\u0026oacute; et al. looked at the effects of Dignity Therapy on family members and found positive beliefs in the legacy document. [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] Their review showed that the legacy was considered a source of comfort and in addition, the legacy was supposed to help in the bereavement phase. However, since Waggoner et al. also confirm that legacy and areas of remembering are complex and under-researched in social sciences [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], we found no further research on audiobooks as a legacy to children. The aim of this exploratory research is to investigate a) how audiobooks are recognised, by whom and in what way. We also want to get a first insight into b) satisfaction with topics related to audiobooks. And finally, since 2017, parents with young children have been offered to create an audiobook (family audiobook) we wondered c) if and how these audiobooks are used by the child(ren).\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eTo investigate the potential of family audiobooks as a means of audio-graphic reminiscence of terminally ill parents for their minor children, anonymised online survey was conducted.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy population and recruitment process\u003c/h2\u003e \u003cp\u003eStudy admission criteria for the recording of an audiobook were (1) patients diagnosed with life-limiting disease, (2) fluent in the German language, (3) 18 years of age or older and (4) having at least one child younger than 18 years. Exclusion criterion was psychiatric impairment such as dementia, psychosis, severe depression or diagnosed personality disorder.\u003c/p\u003e \u003cp\u003eFamily Audiobook Association is a non-profit, voluntary organisation, free of charge to participants and scientifically monitored. While the initial recruitment process came from the project team, the project group received an increasing number of interview requests from those meeting the criteria. This was due to a high level of media attention given to the final product, the recording of a family audiobook by a terminally ill parent for their underage children. The journey of the \"Family audiobook\" project started in the pilot phase from 2017 to 2020, primarily in North Rhine-Westphalia. Since 2021, the project group received requests from all over Germany and neighbouring countries. At the time of the online survey over 350 terminally ill parents recorded an audiobook.\u003c/p\u003e \u003cp\u003eAll audiobook participants agreed to scientific monitoring and provided contact details to the Family Audiobook Association for this purpose. The Family Audiobook Association maintains a database of 234 email addresses. But invitations were only sent to those who provided an email address. The association sent invitations requesting participation in anonymous online survey and followed up with three reminders. This procedure ensured data protection agreements with families and guaranteed anonymity of participation. The research ethics committee of the University Hospital Bonn reviewed and approved the study (no.389/16).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eData collection methods and research design\u003c/h2\u003e \u003cp\u003eA snowball sampling procedure was employed, whereby email recipients were requested to forward the link of the anonymous online survey to those who also had access to the family audiobook. The primary data was collected by using a standardised mainly close-ended online survey accessible from 17.09.2023 to 30.11.2023. The quantitative online questionnaire consisted of 40 closed questions and 4 open text input fields. The questionnaire was available in German.\u003c/p\u003e \u003cp\u003eIn addition to the socio-demographic data, largely close-ended questions were asked about the initiation, the feeling of having done it, the listening, contents of the family audiobook and the sharing procedures. It was also possible to provide information about child(ren)s\u0026rsquo; frequency of listening and the influence of the audiobook on the child(ren). Supplementary open-ended questions and/or text entry boxes allowed participants to give reasons and/or more detailed answers in their own words. Some questions were only posed to patients who were terminally ill, as the questions pertained to the process and satisfaction with creating a family audiobook.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eAnalysis\u003c/h2\u003e \u003cp\u003eThis is the inaugural attempt to gain insight into the usage of family audiobooks as a means of reminiscing from the perspective of the terminally ill parents and the ones left behind. Consequently, the anonymous quantitative data was grouped into two respondent groups: terminally ill parents and related persons. This was since a smaller number of bereaved children participated.\u003c/p\u003e \u003cp\u003eThe exploratory analyses entail frequencies and bivariate distributions in the context of cross-tabulations. The open-ended response fields were recoded and grouped. Content-related illustrative quotations were selected and grammatically corrected when necessary. The analyses were performed using a statistical software platform (IBM\u0026reg; SPSS\u0026reg; 29.0 software platform).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eFrom 17.09.2023 to 30.11.2023, the Family Audiobook Association sent an e-mail to 234 addresses containing a link to an anonymous online questionnaire. Of the 234 emails sent, 214 email addresses were successfully reached. Nevertheless, the precise number of individuals reached remains uncertain, as the email cover letter requested email recipients to forward the online survey link at their own initiative to those to whom the family audiobook is addressed. The aim was to reach as many as possible rather than to be representative. Finally, 186 respondents filled in the online survey. Half of these 186 respondents were a terminally ill patient with minor children (95) and the other half were related persons (91). Most of the terminally ill parents (82%) and 60% of the responding related persons are female. (Fig.\u0026nbsp;1)\u003c/p\u003e \u003cp\u003eThe question regarding familial status was posed only to patients themselves. The majority are married (82%), 12% are in a partnership and a minority are widowed, single or live separated. Using a 5-point scale (with 1 \u0026lsquo;burdens me\u0026rsquo; to 5 \u0026lsquo;eases me\u0026rsquo;), the question 'How do you feel about the family audiobook?\u0026rsquo; having achieved it, having received it and being able to pass it on was asked only to patients. On all three of these aspects, almost all respondents with a terminal illness feel at ease. (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTerminally ill parents\u0026rsquo; feelings of terminally ill parents about the family audiobook; percentages (n\u0026thinsp;=\u0026thinsp;90)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHaving achieved it\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHaving received it\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBeing able to pass on\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1 Burdens me\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5 Eases me\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e76%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eSource: FHB_2023, terminally ill parents\u0026rsquo; responses only, own data, own calculations and representation.\u003c/em\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e gives an insight into our main focus, whether and how often the audiobook was used. This question was posed to patients and related persons (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) and at the level of the child(ren) as an external assessment by the respondents (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Up to 60% of all respondents listened to the audiobook immediately after receiving it, more than 30% at least within six months and 9% after 6 months. More terminally ill parents (68%) stated that they listened to the family audiobook right after right after receiving it than related persons (49%).\u003c/p\u003e \u003cp\u003eThe frequency of listening was measured using a four-point scale, with responses ranging from \"often\" to \"never\". Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e demonstrates that, a total of 45% of the related persons and 20% of the terminally ill parents listened to the family audiobook \u0026ldquo;sometimes\u0026rdquo;. A total of 20% of parents and 8% of relatives indicated that they had never listened to the audiobook at the time of the survey. Most listened to the audiobook in Chaps.\u0026nbsp;(69%, n\u0026thinsp;=\u0026thinsp;145) and 30% of all respondents listened from the beginning to the end.\u003c/p\u003e \u003cp\u003e A multiple-response option was provided to ascertain the potential accompanying persons while listening. This analysis is based on a scale of 100%, which represents the totality of 192 responses. The results indicated that 60% of respondents listened to the content independently, 16% with a partner, 13% with children, and 5% with parents.\u003c/p\u003e \u003cp\u003eThis raises the question \u0026ldquo;How do you feel when you listen to the family audiobook?\u0026rdquo;. Of all respondents, 57% indicated that they felt partly sad or happy. The remaining 43% expressed a range of emotions, including (very) sadness and happiness, in varying degrees (18% vs. 26%). Parents with terminal illnesses and minor children were more likely to report high levels of happiness (33%) than the related individuals (17%). (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePost receival listening period and listening frequency; percentages\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003ePost receival listening period\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTerminally ill parent (n\u0026thinsp;=\u0026thinsp;72)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eRelated person (n\u0026thinsp;=\u0026thinsp;75)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(n\u0026thinsp;=\u0026thinsp;147)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImmediately upon receival\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e68%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1 month after receival\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1 to 6 months after receival\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6 months to 1 year after receival\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMore than 1 year after receival\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eListening frequency\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTerminally ill parent (n\u0026thinsp;=\u0026thinsp;72)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eRelated person (n\u0026thinsp;=\u0026thinsp;74)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(n\u0026thinsp;=\u0026thinsp;146)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOften\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSometimes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRarely\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eFeelings during listening\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTerminally ill parent (n\u0026thinsp;=\u0026thinsp;72)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eRelated person (n\u0026thinsp;=\u0026thinsp;75)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(n\u0026thinsp;=\u0026thinsp;147)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVery happy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHappy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePartly-partly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e57%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSad\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVery sad\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eSource: FHB_2023, own data, own calculations and representation\u003c/h2\u003e \u003cp\u003eHowever, 23 of 186 respondents who indicated that they had never listened to the final product explained this by using a multiple response scale and an option to write in their own words. The option that was selected most often (n\u0026thinsp;=\u0026thinsp;13) was \"other (please write in),\" with \"needed distance to it\" being the second-most (n\u0026thinsp;=\u0026thinsp;6) selected. The afore mentioned emotional aspect (6) is one of the reasons followed by a diverse mixture of \u0026lsquo;recordings have been stopped or have not yet been received\u0026rsquo; (n\u0026thinsp;=\u0026thinsp;3). But then there are statements such as \"I took part in the recordings\", \"It was not possible to contact the father\" or the rule that the recordings should only be listened to a year after the death, which explain why the family audiobook was not listened to at the time of the online survey. Finally, as a reason not to listen to it, one wrote: \u0026ldquo;Then you think of too many things you would have liked to have said or done differently.\u0026rdquo;\u003c/p\u003e \u003cp\u003e So, when all respondents were asked who will pass the reminiscent \u0026lsquo;family audiobook\u0026rsquo; on to children, 32% said the terminally ill parent, followed by the partner or father of the children at 54% and family members at 9% and others at 2.5%. A further minority of 2.5% of the patients responded \u0026ldquo;don\u0026rsquo;t know\u0026rdquo; at the time of the survey. 38% of all respondents do not know when they will pass the family audiobook on. According to 24% of the respondents, the children have already received the family audiobook, a further 24% will receive it after the death of the terminally ill parent and 12% will pass it on when the children reach a certain age. In a multiple-choice option, respondents indicated who had already listened to the audiobook. Based 100% on all answers and in descending order, these were mainly the partner, followed by a family member or a friend.\u003c/p\u003e \u003cp\u003eIn those cases where the family audiobook was already given to the children or the children listens, 85% of respondents said that the children had already listened to it. On a four-point scale from often to never, 48% think that the children listen to the family audiobook rarely, 29% sometimes and 12% often. (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEstimation of child(ren)\u0026rsquo; listening frequency; percentages\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTerminally ill parent (n\u0026thinsp;=\u0026thinsp;14)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRelated person (n\u0026thinsp;=\u0026thinsp;28)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;42)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOften\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSometimes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRarely\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDon\u0026rsquo;t know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eSource: FHB_2023, own data, own calculations and representation\u003c/h2\u003e \u003cp\u003eThose who take the opportunity to tell us about the impact on children range from emotionally sad to happy, going hand in hand with a wide range of usage, mixed feelings and different impact on individual grieving children, as can be seen from the quotes below. Still, the overall tenor is, that they see it as a treasure to be cherished and the family audiobook as an enriching legacy. This is emphasised by the personal, carefully selected stories on the audiobook and the experience of the dead or dying parent's voice through the medium of the audio book, which will therefore not be forgotten.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabb\" border=\"1\"\u003e \u003ccolgroup cols=\"1\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ldquo;Two of the three children occasionally listen to the audiobook that my husband has recorded. However, this depends very much on their mood and stage of grief. The eldest doesn't want to listen to anything at all.\u0026rdquo; (related person)\u003c/p\u003e \u003cp\u003e\u0026ldquo;Mixed, one chapter the child didn't want to continue listening to. Now she listens to individual chapters more often, as I have made a part on a Tonie [an audio player brand, authors\u0026rsquo; note]\u0026rdquo; (related person)\u003c/p\u003e \u003cp\u003e\u0026ldquo;I'm still here. That's why the kids don't hear it that often. But they know that when I'm no longer there, they can hear my voice. I think that's very important for the children. I'm sure it makes them sad too, but they're glad that I've recorded this audio book. That way I'm always there somehow.\u0026rdquo; (terminally ill parent)\u003c/p\u003e \u003cp\u003e\u0026ldquo;My children are 5 and 7 years old. After their father died, they said at some point that they couldn't remember Dad's voice, so we listened to the audio book. The 5-year-old was two years old at the time of my husband's death, he can't do much with it yet, but the 7-year-old asks about it from time to time.\u0026rdquo; (related person)\u003c/p\u003e \u003cp\u003e\u0026ldquo;My son listens very attentively. And when friends come to play, it is also listened to.\u0026rdquo; (related person)\u003c/p\u003e \u003cp\u003e\u0026ldquo;Very good, I listen to it again and again. Mum's voice is good.\u0026rdquo; \u003c/p\u003e \u003cp\u003e(related person)\u003c/p\u003e \u003cp\u003e\u0026ldquo;On the positive side, I have the impression that it is seen as a \"treasure\" for \"later\".\u0026rdquo; (terminally ill parent)\u003c/p\u003e \u003cp\u003e\u0026ldquo;We always listen to the family audiobook on the day of death when we go away together as a family for a weekend.\u0026rdquo; (related person)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eSource: FHB_2023, anonymous online survey, own data, selected quotes in response to open questions.\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eA review of the existing literature revealed a research gap in the field of digital audiobooks and their use by bereaved minor children. [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] Since 2017, patients with a terminal illness and minor children have been offered the option of having a family audiobook recorded as part of their legacy. So, six years following the initiation of the program, the first formal assessment was carried out to ascertain the usage and the impact of the family audiobook on terminally ill parents and related persons. The lack of knowledge about the individuals at the registered contact addresses led to a non-representative survey. Therefore, it was of the utmost importance to conduct a carefully designed and sensitive survey in order to gain novel insights into the use of family audiobooks.\u003c/p\u003e \u003cp\u003eThe preservation of memories, the liveliness beyond death, is created through biographical storytelling about people by related persons or, in our case, through professionally supported audiobooks as a legacy for bereaved children. Not everyone finds it easy to talk about their own life as a legacy, so the subjective, meaningful moments were chosen as the starting point for biographical narratives from a terminally ill parent with minor children. This made it possible to give the terminally ill parent a guide and horizon for the narrative flow. Our data illustrates a wide spectrum, from the relief of being able to pass it on to the children, to the mixed feelings of having a family audio book, which is understandable when knowing that the occasion for the recording is a very sad situation, namely being confronted with the death.\u003c/p\u003e \u003cp\u003e On the one hand most of the responding parents with a terminal illness are highly comfortable with having achieved it, having received it and having the opportunity to pass it on. However, a moderate listening frequency and mixed feelings are prevalent in both groups of respondents, the dying parent and related persons. Those who are still alive and have listened to it with children are more likely to report a positive impact, reflecting on the situation of being alive and sharing togetherness and belonging. The greatness and power lie in being the creator of memory content in one's own voice. The latter, remembering the voice, is mentioned much more often by respondents bereaved of the deceased parent, consistent with Muriel et al. [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eOur research indicates that there are both opportunities and risks associated with leaving a legacy of the dying parent in the form of a family audiobook. The family audiobook is regarded as a valuable and sad remembrance of the deceased parent. Our results reflect this great ambivalence in the turmoil of the respondents' emotional worlds. But still, it's good to have a family audiobook as a voice and legacy to hear the important and pressing issues of the dying parent. Furthermore, it provides insight into the lives of the deceased parent and their knowledge, as well as their advice to the child in certain situations. The audiobook keeps memories alive, even so it would be better to \"make memories yourself\".\u003c/p\u003e \u003cp\u003eThe findings of our study suggest that audiobooks may be an invaluable resource for supporting and preparing reminiscence for parents who are terminally ill and their related individuals. [\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] In particular, they can assist bereaved parent in preserving memories. In addition, this approach might help healthcare professionals to reduce the stress associated with providing end-of-life care for terminally ill parents with minor children. Further research utilising a child-appropriate questionnaire would enhance our understanding not only of the long-term usage, but also the challenges, overall effects, and emotional risks associated with digital reminiscences for children.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eStrengths/limitations\u003c/h2\u003e \u003cp\u003eThe strength of this study lies in the visualisation of satisfaction with the realisation and receiving of the family audiobook on the part of terminally ill parents, which was achieved through our inquiry. Concurrently, and in nearly identical proportions, the related persons mainly family members responded to our questionnaire. The results of the study indicate that the family audiobook usage varies considerably, with a tendency towards infrequent listening. This is likely due to the nature of confronting the death of a parent. Consequently, the study found that the transfer of ownership and responsibility for a family audiobook is a highly emotional and sensitive process. The ambivalences become visible on the part of the family members and can now be better addressed and supported. However, this requires sensitive further research into the effects on the children left behind. Especially since the effects on the children are reported by third parties, this study is limited.\u003c/p\u003e \u003cp\u003eThe absence of a list of respondents for full surveys or a representative sampling prevents the study from being generalisable. A further limitation is that the anonymised responses cannot be grouped into families. This implies that only a single individual may have provided responses to one audiobook, while in other cases multiple individuals may have provided responses to one audiobook. Additionally, there are individuals who have been contacted but did not answer the survey since they have not yet received the audiobook. The diverse motivations for participation in the survey also introduce bias and a limitation to the studies. There is limited prior research in this area, so that the exploratory nature of this study has an impact on the depths of the data. Further accessibility could be achieved through multilingual questionnaires that encourage the participation of people with non-German language skills. As this is also the case with the measurement instrument, which reaches mainly digitally connected ones. Further (semi-structured) in-depth interviews could provide further insight into the impact and effects of the creation process on the owners of Family Audiobook. As previously observed, a significant number of terminally ill parents involve their children or partners during the recording process. A mixed methods approach would address some of these limitations, but is more resource intensive.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that no funds or grants were received for conducting this study and during the preparation of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no competing interests to declare that are relevant to the content of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the study conception and design of this work. G.A. performed the data preparation, and analysis. G.A. and M.H. interpreted the data. The first draft of the manuscript was written by G.A. and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompliance with Ethical Standards and Ethics approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was performed in line with the principles of the Declaration of Helsinki. The research ethics committee of the University Hospital Bonn reviewed and approved the study (no.389/16).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants gave their informed consent before answering the anonymous online questionnaire.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData and material are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors and Affiliations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInstitute for Digitalization and General Medicine, Center for Rare Diseases Aachen (ZSEA), University Hospital Aachen, Pauwelsstr. 30, 52074 Aachen, Germany\u003c/p\u003e\n\u003cp\u003eDr. G\u0026uuml;lay Ateş\u0026nbsp;and Dr. Michaela Hesse\u003c/p\u003e\n\u003cp\u003eDepartment of Palliative Medicine, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn,\u0026nbsp;Germany\u003c/p\u003e\n\u003cp\u003eDr. Henning Cuhls\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank Judith Gr\u0026uuml;mmer and Petra Steinbach from the Family Audiobook Association for their support with the online survey. Furthermore, we are grateful to all the participants in the study for their time and sharing of their experiences.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBundesamt DS: Death rates by cause and age for the reporting years 2012 to 2021. In. Edited by Gesis-Online Db\u0026ndash;. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www-genesis.destatis.de/\u003c/span\u003e\u003cspan address=\"https://www-genesis.destatis.de/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e; 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGrenklo TB, Kreicbergs UC, Valdimarsd\u0026oacute;ttir UA, Nyberg T, Steineck G, F\u0026uuml;rst CJ: Communication and Trust in the Care Provided to a Dying Parent: A Nationwide Study of Cancer-Bereaved Youths. Journal of Clinical Oncology 2013, 31(23):2886\u0026ndash;2894.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eM\u0026uuml;ller M, Pfister D, Markett S, Jaspers B: Wie viel Tod vertr\u0026auml;gt das Team? Der Schmerz 2009, 23(6):600\u0026ndash;608.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRauch PK, Muriel AC, Cassem NH: Parents With Cancer: Who\u0026rsquo;s Looking After the Children? Journal of Clinical Oncology 2002, 20(21):4399\u0026ndash;4402.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePark EM, Jensen C, Song M-K, Yopp JM, Deal AM, Rauch PK, Greer JA, Rosenstein DL: Talking With Children About Prognosis: The Decisions and Experiences of Mothers With Metastatic Cancer. JCO Oncology Practice 2021, 17(6):e840-e847.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSemple CJ, McCaughan E, Smith R, Hanna JR: Parent\u0026rsquo;s with incurable cancer: \u0026lsquo;Nuts and bolts\u0026rsquo; of how professionals can support parents to communicate with their dependent children. Patient Education and Counseling 2022, 105(3):775\u0026ndash;780.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSheehan S, Hanna JR, Drury A, McCance T, Semple CJ, O'Neill C: A Systematic Review of Educational Interventions to Equip Health and Social Care Professionals to Promote End-of-Life Supportive Care when a Parent with Dependent Children is Dying with Cancer. Semin Oncol Nurs 2023, 39(5):151474.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMartin K, Schatz AA, White JS, Muss H, Didwania A, Gallo L, Carlson RW: NCCN Virtual Patient Advocacy Summit: Cancer Across the Lifespan. Journal of the National Comprehensive Cancer Network 2021, 19(12):1395\u0026ndash;1400.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBeernaert K, Kreicbergs U, F\u0026uuml;rst CJ, Nyberg T, Steineck G, Bylund-Grenklo T: Distrust in the End-of-Life Care Provided to a Parent and Long-Term Negative Outcomes Among Bereaved Adolescents: A Population-Based Survey Study. Journal of Clinical Oncology 2017, 35(27):3136\u0026ndash;3142.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCaparso C, Bowen Z, Choi SW: HSR24-126: \u0026ldquo;Share the Fear\u0026rdquo;: Communication Concerns of Parents With Cancer With Dependent Children for Their Co-Parent: A Qualitative Study. Journal of the National Comprehensive Cancer Network 2024, 22(2.5):HSR24-126.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRocque GB, Patel MI, Wallner LP, Bailey SC, Schear R, Gunn CM, Rivers J, Wilson R, Freeman EC, Buckingham TL \u003cem\u003eet al\u003c/em\u003e: Patient-Centered Decision-Making in Metastatic Breast Cancer Care Delivery: A Call to Action. Journal of the National Comprehensive Cancer Network 2024, 22(1):e237113.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBeale EA, Sivesind D, Bruera E: Parents dying of cancer and their children. Palliative and Supportive Care 2004, 2(4):387\u0026ndash;393.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHesse M, Forstmeier S, Mochamat M, Radbruch L: A Review of Biographical Work in Palliative Care. Indian J Palliat Care 2019, 25(3):445\u0026ndash;454.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCuhls H, Hesse M, Ates G, Radbruch L: Audiobooks from terminally ill parent for their children \u0026ndash; a qualitative evaluation. BMC Palliative Care 2021, 20(1):172.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChochinov HM, Hack T, Hassard T, Kristjanson LJ, McClement S, Harlos M: Dignity therapy: a novel psychotherapeutic intervention for patients near the end of life. J Clin Oncol 2005, 23(24):5520\u0026ndash;5525.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFang C, Comery A, Carr S: \u0026ldquo;They want you to know who they really are inside of the old visage\u0026rdquo;\u0026mdash;biographical storytelling as a methodological tool to explore emotional challenges in old age. BMC Geriatrics 2023, 23(1):386.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAllen RS, Hilgeman MM, Ege MA, Shuster JL, Jr., Burgio LD: Legacy activities as interventions approaching the end of life. J Palliat Med 2008, 11(7):1029\u0026ndash;1038.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKeall RM, Clayton JM, Butow PN: Therapeutic life review in palliative care: a systematic review of quantitative evaluations. J Pain Symptom Manage 2015, 49(4):747\u0026ndash;761.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMuriel AC, Moore CW, Beiser M, Park ER, Lim CT, Rauch P: What do surviving children wish for from a dying parent? A qualitative exploration. Death Studies 2020, 44(5):319\u0026ndash;327.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSemple CJ, McCaughan E, Beck ER, Hanna JR: 'Living in parallel worlds' - bereaved parents' experience of family life when a parent with dependent children is at end of life from cancer: A qualitative study. Palliat Med 2021, 35(5):933\u0026ndash;942.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcCaughan E, Semple CJ, Hanna JR: 'Don't forget the children': a qualitative study when a parent is at end of life from cancer. Support Care Cancer 2021, 29(12):7695\u0026ndash;7702.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGrij\u0026oacute; L, Tojal C, Rego F: Effects of dignity therapy on palliative patients' family members: A systematic review. Palliat Support Care 2021, 19(5):605\u0026ndash;614.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWaggoner B, Bering JM, Halberstadt J: The desire to be remembered: A review and analysis of legacy motivations and behaviors. New Ideas in Psychology 2023, 69:101005.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"supportive-care-in-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jscc","sideBox":"Learn more about [Supportive Care in Cancer](https://www.springer.com/journal/520)","snPcode":"520","submissionUrl":"https://submission.nature.com/new-submission/520/3","title":"Supportive Care in Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Terminally ill parent with minor children, biographical work, family audiobook, legacy","lastPublishedDoi":"10.21203/rs.3.rs-4471159/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4471159/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003e Terminally ill parents with minor children require comprehensive support. We find a broad range of interventions such as Dignity therapy or Life Review. There are several studies concerning the effects of biographical interventions in palliative care, but research on the usage of digital reminiscence is sparse. Since 2017, terminally ill parents have been offered the opportunity to record an audio book for their minor children. It also offers parents with a terminal illness the opportunity to use their own voice to influence how and what aspects of themselves they want to be remembered. This professionally supported, voluntary service is free of charge and unique in Germany. The objective of this study was to provide novel insights into the satisfaction with and use of the family audiobook, as well as the effects on children, by surveying the terminally ill parent and their related persons.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA survey was conducted online among terminally ill parents and their related persons, who were identified and contacted through the Family Audiobook Association in Germany. The anonymous online survey was accessible between September 2023 and November 2023. A descriptive analysis of the quantitative data was conducted using the statistical software package SPSS.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003e186 respondents, 95 terminally ill parents and 91 related persons, provided responses to the online survey. Almost all terminally ill parents felt eased to have recorded a family audio book. The two groups exhibited differences in the manner in which they used and listened to the family audiobook. The open answers provided insight into the emotional and situational context in which the audiobook was being used. While some children are observed listening to family audiobooks with their parents or friends, other children are not yet ready for this.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe audiobook offers terminally ill parents with minor children a valuable opportunity to tell their own biographical story, to offer support to the bereaved in remembering and to preserve the voice of the deceased for the children. In addition, this approach could help healthcare professionals to reduce the stress associated with providing end-of-life care for terminally ill parents with minor children.\u003c/p\u003e","manuscriptTitle":"The usage of family audiobooks as a legacy for grieving minor children - an exploratory quantitative analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-13 18:43:36","doi":"10.21203/rs.3.rs-4471159/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-07-15T19:44:53+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-15T13:50:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"118712183944950226858055377284678136321","date":"2024-07-15T07:56:26+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-12T13:35:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"203981938344560627604616934714385225206","date":"2024-07-03T21:56:51+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-07-03T14:44:01+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-07-03T14:37:25+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-05-30T04:15:46+00:00","index":"","fulltext":""},{"type":"submitted","content":"Supportive Care in Cancer","date":"2024-05-24T08:38:41+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"supportive-care-in-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jscc","sideBox":"Learn more about [Supportive Care in Cancer](https://www.springer.com/journal/520)","snPcode":"520","submissionUrl":"https://submission.nature.com/new-submission/520/3","title":"Supportive Care in Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"0b905c65-2b3c-4a1d-b063-223d314c6d57","owner":[],"postedDate":"June 13th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-10-28T16:11:59+00:00","versionOfRecord":{"articleIdentity":"rs-4471159","link":"https://doi.org/10.1007/s00520-024-08945-x","journal":{"identity":"supportive-care-in-cancer","isVorOnly":false,"title":"Supportive Care in Cancer"},"publishedOn":"2024-10-25 15:57:54","publishedOnDateReadable":"October 25th, 2024"},"versionCreatedAt":"2024-06-13 18:43:36","video":"","vorDoi":"10.1007/s00520-024-08945-x","vorDoiUrl":"https://doi.org/10.1007/s00520-024-08945-x","workflowStages":[]},"version":"v1","identity":"rs-4471159","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4471159","identity":"rs-4471159","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}