20.4.11.4 Interventions

•Support of the patient and their family, taking into account family needs and possibilities

•Continuous supportive relationship

•Tolerating resentment and the “unanswerable questions”

•Encouragement of sibling involvement in the dying and mourning process

•Support of open communication and verbal and nonverbal dialogue (e.g., drawing, body contact, silent presence)

•Helping to prepare appropriate palliative treatment

•Follow-up talk(s) with the family of the child who has died

20.5Treatment Team

•Engage with children and their families in situations of major existential difficulty. Pediatric oncology requires collaboration with other professional fields, departments, and often hospitals

•The work makes heavy demands on all team members and on interdisciplinary communication:

–Processes of therapy and care are intensive and complex

–The workload can change drastically within short periods (new illnesses, relapse, complications)

–The outcome of the disease is unknown; cure and death are often in close proximity

–Professional groups are perceived differently by affected families because of differential distribution of tasks

–In addition to the treatment of the patient, there is often also an intensive engagement with their family

–Dying and death, and the confrontation by one’s own limits, are omnipresent

•The challenges contain the risk of individuals overworking and conflicts within the treatment team, especially at the interfaces between somatic and psychosocial medicine

•To minimize the risk of misunderstandings, the apportioning of blame or projections, psycho-oncological work must take place within the framework of the whole oncological treatment plan. This integration requires structured and regular exchange of information (e.g., team conferences). In addition, and particularly in situations of crisis (e.g., medical complications, relapse, escalation of intrafamilial conflict), rapid and informal interdisciplinary communication must be possible. Otherwise there is the risk of multitrack care with loss of interface between or, in extreme cases, splitting of the team

•The prerequisites for constructive cooperation are knowledge of the individual tasks and respect for the way the other professionals work. Experience shows that collaboration does not happen by itself, but must be actively and continuously fostered by all those involved

•Regular departmental meetings, team supervisions, and joint training events are components of the work

20.6Further Reading

Schroeder M, Lilienthal S, Schreiber-Gollwitzer BM, Griessmeier B (2007) Psychosoziale Versorgung in der paediatrischen Onkologie und Haematologie: AWMF-Leitlinien der Gesellschaft für Paediatrische Onkologie und Haematologie

SIOP-Working-Committee on Psychosocial Issues in Pediatric Oncology. Guidelines: 1993–2004 and ICCCPO 2002

www.awmf.org/uploads/tx-szleitlinien/025-002k.pdf www.icccpo.org/articles/psychosocial.html www.icccpo.org/articles/standards-of-care.html