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    When cancer strikes a family: Psychosocial issues in pediatric oncology

    A child’s cancer diagnosis affects his or her entire family, and presents psychosocial issues that the community pediatrician needs to assess and treat for the total well-being of the child, siblings, and parents.

     

    The following professionals are available to assist with psychosocial needs in pediatric oncology programs:9

    ·      Social workers—96%

    ·      Child life specialists—93%

    ·      Psychologists—60%

    ·      Neuropsychologists—31%

    ·      Psychiatrists—l19%

    Many programs also report having the services of other professionals such as:9

    ·      Art therapists

    ·      Chaplains

    ·      Educational specialists

    ·      Palliative care specialist

    Only 39% report having at least 1 Spanish-speaking team member able to address psychosocial needs of children with cancer.9

    Rather than beliefs in the concept of psychosocial care, its efficacy, evidence basis, or politics, the challenges are much more pragmatic. Cancer programs commonly cite the following as barriers to delivering more psychosocial care to patients:10

    ·      Time constraints to provide care

    ·      Poor reimbursement for provision of psychosocial care

    ·      Difficulty in recruiting and retaining providers

    One might expect that if these barriers exist in oncology programs, the pediatrician might experience even greater barriers. However, the pediatrician may have an advantage in knowing local resources for children who must travel for their cancer care.

    Parents also describe a number of unmet needs that the pediatrician might not consider when thinking about psychosocial stressors. Parents of children with cancer describe both instrumental and relational needs relating to caring for their child with cancer as well as other members of the family.10

    More: Reimagining chemotherapy

    Instrumental needs are similar to the base of Maslow's hierarchy of physiologic and safety needs.11 Parents often rely food/parking vouchers, dependable childcare for healthy siblings, and flexible work arrangements in order to survive a lengthy hospitalization. If not present, parents risk losing connectedness with either the healthy or ill child and a loss of family income. Parents need and want a hospital environment that allows them support the daily life and care of siblings without cancer.10

    NEXT: What can the pediatric practice do?

    Pat F Bass III, MD, MS, MPH
    Dr Bass is Chief Medical Information officer and professor of Medicine and of Pediatrics, Louisiana State University Health Sciences ...

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