20.4.10 Relapse

20.4.10.1Problems

• Existential threat

• Deep insecurity (“it’s all starting again”)

• Knowledge that the first treatment has been unsuccessful

• Serious or hopeless prognosis

• Preparation for further burdensome curative therapy and/or engagement with palliative care, dying, and death

20.4.10.2Requirements

•Ability to take in and process the information

•Emotional control, rebuilding motivation and hope

•Engagement with the new situation and the new therapeutic protocol

•Communication within and outside the family

•Adaptation of family life to the new situation

20.4.10.3 Reactions

•Irruption of violent feelings: shock, fear, despair, impotence, anger, resignation, blame

•Desire to run away

•Interventions

•Orientation aids

•Empathetic acceptance of emotions without premature giving of advice (an existing relationship with the family is often very helpful)

•Support in the rebuilding of trust and motivation

•Encouragement of open and honest communication that includes the siblings

20.4.11 Dying, Death, Mourning

20.4.11.1 Problems

•Disease symptoms: pain, dyspnea, paralysis, etc.

•Loss of comprehension, feelings of meaninglessness

•Existential loss

•Separation and isolation

20.4.11.2 Requirements

•Leave-taking, letting go

•Accompanying the dying process at home or in hospital

•Mourning

•Finding new structures

20.4.11.3 Reactions

•Denial, fear, despair, anger, longing, guilt

•Clinging to the lost relationship, inability to reorientate oneself, pathological mourning