Understanding the use of metaphors by parents of children with cancer in blogs: a qualitative analysis

Childhood cancer poses a major global health burden and is a leading cause of death among children. Parents experience profound psychological (depression, anxiety, grief, guilt, helplessness) and financial stress due to treatment costs and care demands. Prior research in health communication highlights the benefits of metaphors for patients and provider–patient communication, but largely focuses on clinicians and patients rather than caregivers. This study addresses that gap by examining how parents of children with cancer use metaphors in blogs to articulate experiences and emotions, with the goal of informing public and clinical support to alleviate parental stress.

Grounded in Conceptual Metaphor Theory (Lakoff and Johnson, 1980), the paper frames metaphor as a cognitive tool mapping a familiar source domain to an abstract target domain via cross-domain mappings based on perceived similarities. The theory suggests metaphors shape conceptualization, can foreground certain aspects (e.g., competition in “argument is war”) while backgrounding others, and form systematic, unified networks. In health contexts, war, journey, and other metaphors are common and can aid understanding, coping, and communication. The paper also notes that game metaphors may be particularly suitable for pediatric contexts by creating a playful frame for treatment, and that plant metaphors connect both to cultural models of child growth and to oncologic descriptions of tumor growth and spread.

Design: Qualitative content analysis (Graneheim & Lundman, 2004) guided by Conceptual Metaphor Theory and COREQ reporting. Data source: Public blogs on Xiaohongshu (Little Red Book) authored by parents of children with cancer. Inclusion criteria: posts from 2019–2022; parent of a child aged 0–14 with cancer; actively supporting treatment; publicly available information. Sampling: Keyword search and snowballing identified 33 parents (29 female, 4 male), ages 25–45; children aged 1 month to 10 years; neuroblastoma and leukemia most common. Corpus size: ~16,027 Chinese words collected; 2,890 translated English words for sentences with metaphors. Procedure: Sentences were the unit of analysis. The first author identified metaphorical words sentence-by-sentence, then determined source/target domains and mappings; the second author reviewed. Disagreements were resolved by discussion. Identified metaphors were grouped into subthemes and themes; frequencies were counted. Steps included familiarization (triple reading), open coding of metaphorical words, determining mappings, translation with verification, categorization into themes/subthemes, frequency counting, and gender-based exploratory comparison. Rigor: Credibility via meticulous review and consensus checking; dependability via regular team meetings; transferability via detailed descriptions. Ethics: Public posts only; de-identified data; translated to non-searchable English to enhance privacy; consent deemed not required for public content per prior guidelines.

A total of 181 metaphor instances were identified. Four main categories (n=132, 73% of all metaphors) dominated: Game (48; 36%), War (46; 34%), Journey (19; 15%), and Plant (19; 15%). Themes/subthemes: Game (cancer as a monster; treatment as a game), War (treatment as war; battling negative emotions), Journey (life as a journey; treatment as a journey; psychological journey), Plant (human body/child as plant; tumor as plant). Game and war metaphors were most prevalent; journey and plant metaphors were less frequent but meaningful. Parents frequently used mixed metaphors (e.g., war + journey; game + plant). Individual variability existed: a few parents predominantly used journey or plant metaphors; two showed dominance of plant metaphors with no war/game use. Exploratory gender comparison (Table 3): Men—Game 5 (19%), War 11 (42%), Journey 7 (27%), Plant 3 (12%); Women—Game 43 (40%), War 35 (33%), Journey 12 (12%), Plant 16 (15%).

Focusing on caregiver (parent) language fills a gap in metaphor research dominated by clinician and patient perspectives. Game metaphors, though often treated as a subtype of war metaphors, warrant distinct attention in pediatric contexts for their potential to create a playful, less threatening frame that may ease children’s participation and emotion regulation during treatment. Plant metaphors illuminate parental hopes for growth and flourishing despite illness and align with both cultural models of child development and medical descriptions of tumor growth and spread. War metaphors are ubiquitous and can motivate resilience and coordinated action, but may also harm emotional well-being if overused or if treatment setbacks are framed as defeat; careful, context-sensitive use is advised. Mixed metaphors allow parents to capture multifaceted experiences. Preliminary gender patterns suggest men may favor war metaphors while women may prefer game metaphors, but small male sample cautions against strong inferences. Overall, recognizing parents’ metaphor use can aid understanding their inner world and inform supportive communication by healthcare professionals and the public.

Parents of children with cancer commonly use game, war, journey, and plant metaphors—often in combination—to articulate experiences and emotions related to treatment and coping. Understanding these metaphor patterns can inform supportive communication strategies and potentially alleviate parental stress. Future work should use larger, more balanced samples to examine differences by gender and age, track how metaphor use evolves over the illness trajectory, and compare caregivers of older patients.

Key limitations include: substantial gender imbalance (29 women, 4 men) limiting generalizability and gender comparisons; reliance on a single platform (Xiaohongshu) and public bloggers, which may not represent all parents; potential subjectivity inherent in qualitative content analysis; translation from Chinese to English may introduce subtle inaccuracies; age-related differences and temporal evolution of metaphors were not analyzed. Additionally, qualitative interpretive variability may affect comparability across studies.