misunderstandings and disappointment, however, it is important to discuss and establish each family’s needs and expectations as soon as possible. Responsibilities for the different tasks must be clarified within the treatment team and with the family. In general, one person cannot take on all the psycho-oncological functions (e.g., act as confidant to both patient and a heavily burdened young sibling).

20.3.2.2 Treatment Phase

•Psycho-oncological support or treatment is individual. Standardizing the procedure is difficult, since the needs of families and the course of diseases and therapies differ widely. The provision of help must be low-threshold, and the family must know how, when, and where the staff of the psycho-oncological team is available

•For families with whom no firm collaboration can be agreed, the regular presence of the psycho-oncological staff on the ward can often provide opportunities for chance contacts that help to build trust

20.3.3 Basic Attitudes

In psycho-oncological work, it is not a psychiatric problem that is foremost, but a psychoreactive problem sparked off by the life-threatening illness of a child. The psycho-oncological approach is correspondingly not primarily problem oriented, but resource oriented and informative. The objective is to support an active and constructive coping model and to prevent severe psychological burdens, developmental disorders, or emergencies

Psycho-oncological care requires:

•Benevolent and supportive basic attitudes

•Openness to all subjects

•Respect for any adaptive and defensive mechanisms necessary for survival (e.g., partial repression)

•Honest information that is tailored to the situation and answers to questions that take into account the age and developmental stage of the child and the individual life situation of the family

•No playing down of hard facts, no making of promises that cannot be kept, no premature comfort

•Sensitive handling of cultural differences

•Balance between empathy and distance

20.4Problems and Possible Interventions

The heterogeneity of oncological diseases, the different therapies and courses, the wide developmental spectrum of the patients from infancy to adolescence, and the multifaceted structures, resources, and existing difficulties of the affected families all require a careful individual assessment of psycho-oncological needs.