Helping the parents of children with malignancy

Assistance to Parents who have Lost their Child with Cancer

Aims and background

To assess the psychological needs of parents after the death of their child from cancer.

Methods

The study comprises a preliminary retrospective phase to identify parents who spontaneously contacted the medical staff, followed by a prospective phase in which families were contacted by telephone and were invited to a meeting.

Results

The retrospective study demonstrated that more than 50% of the families spontaneously sought contact with the department. In the prospective study, 17 families were contacted and the majority of them subsequently decided to come to the department for a talk.

Conclusions

Our experience shows that parents have a strong need to have further contact with the team that took care of their children for months. In the process of coping with bereavement, anxiety and depression are common and not necessarily pathological, though there may be psychopathological reactions that can interfere with the parents’ quality of life.

Meetings with parents after the death of their child from leukemia

There is a growing interest in the emotional status of parents and siblings after the death of a child with chronic disease. For the past 7 years physicians at our center have systematically contacted parents who lost a child because of leukemia within the first few months after the death. From this experience it appears that most parents needed to talk at least once with the physicians who took care of their child. As expected, some parents and siblings were found to have significant psychological problems and to need psychologic support. We suggest that the opportunity to talk with a physician of the attending staff should be provided routinely to parents shortly after the death of a child from leukemia.

Psychological staging of pediatric cancer patients and their families

Advances in the treatment of childhood cancer have required a shift in our approach to the patient and family. Previously parents were helped to cope with the inevitable decline of the child's health over a rather short period of time; the child was acutely ill and crisis-oriented intervention was utilized. Today, the family unit can be helped to maintain normal life amidst intensive medical treatment; the child is acutely ill at times, but also chronically ill, and even well. Crisis intervention is still appropriate, but so is education, ego-supportive counseling, and insight-oriented psychotherapy. Psychological staging of pediatrics cancer patients and their families is essential in order to properly anticipate psychological adjustment and plan appropriate interventions. Assessment and staging require a multi-dimensional perspective including stage of disease, socioeconomic vulnerability, degree of psychopathology, family cohesion, and personal/family history. This article discusses this multi-dimensional perspective and implications for intervention. Illustrative case material is utilized.

Psychosocial problems in families of a child with cancer

Eighty-one children with malignancies and their families were investigated for the psychosocial changes that take place during the course of the disease. Seventeen patients were in the initial phase of treatment, 24 were in first remission, 14 were long-term survivors already off therapy, 11 were in relapse, and 15 children died 1-5 years before this study. Detailed personal interviews with the parents showed profound changes in the families' life and severe problems in adapting to the new situation. Marital problems, neglecting the healthy siblings, and a loss of interest in work occurred in the majority of parents, especially in mothers. Younger siblings suffered more from the strains imposed on the family than did elder ones. Psychosocial care is felt to be helpful for all families in adjusting to the altered circumstances and emotional upheavals.

Alternative professional roles in health care delivery: leadership patterns in self-help groups

The increasing professionalization of health care delivery systems, improved client awareness, funding cutbacks, and an emphasis on voluntarism have led recipients of health services to turn increasingly to self-help groups. This article examines the leadership and organizational pattern of such groups, using a study of 43 self-help groups from around the U.S. whose members are parents of children with cancer. Three leadership patterns emerged: groups were independent and parent-led, were led by professionals, or had a shared leadership of parents and professionals. Data indicate that the professionally led groups were the smallest, least formal, and had the narrowest range of activities. The groups with shared leadership had the greatest longevity, tended most often to retain as members parents of deceased children. The authors conclude that such coalitions of clients and professionals are vital for ensuring proper service delivery at a time when health care systems will likely remain bureaucratic and public resources for professional care are being reduced.

Sources of support perceived by parents of children with cancer: implications for counselling

Providing social support for families of pediatric cancer patients remains a challenge. The perceived helpfulness of 11 potential support sources was assessed by 107 parents of children with cancer. They rated the spouse, the medical community, and parents from a mutual help group as the most helpful. Mental health professionals and the church were seen less frequently and perceived as less helpful. No significant differences were found in the patterns of social support among parents with children in different stages of treatment. More than half the parents responding to a question on what they needed most during their children's illness mentioned emotional support and counselling. Mental health professionals may find that crisis/supportive and educative models and frequent contact are useful counselling approaches in dealing with families of cancer patients. A team approach to pediatric oncological treatment, consisting of a primary physician, nurse, and psychological consultant, may be a way to optimize the early and flexible involvement of psychosocial staff in total care.

Successful 'normalizing' tactics of parents of chronically-ill children

To be or to parent a chronically-ill child is a difficult experience. Parents can initiate 'normalizing' tactics that alleviate the child's feeling of being different and enable a sense of control with the possibility to influence the quality of life of the child and the family. Following up among 20 parents of chronically-ill children, the author was able to identify a number of principles which underlined the 'normalizing' tactics. These principles, it is suggested, should be helpful to nurses and other health workers when guiding and advising parents and others who come into daily contact with chronically-ill children.