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February 27, 2013
Sarah Sinclair OUTLINE Pediatric palliative care aims to reduce the physical, psychological and spiritual suffering experienced by children and their families, from initial diagnosis through to the end of life and into bereavement (WHO, 1998) Palliative Care -What are ethical considerations that a health psychologists should consider when working with this population?
-Directions for future research?
-What role do you see for psychologists in the palliative care setting? Discussion Broaden staff’s understanding of how psychological interventions can be used
Introducing standardized screening instruments
Critical incident debriefing Psychologists on Interprofessional Teams -Existential Concerns?
-Patient’s attitude towards their impending death, meaning of death
-How can this be relevant for children?
-Preservation versus letting go?
(Kars, et al., 2009) Psychological Interventions Pharmacological Interventions
-Stress management techniques Treatment Alternatives Depression
Illness related stressors
Grief Psychological Symptoms Haley, W.E., Larson, D.G., Kasl-Godley, J., Neimeyer, R.A., & Kwilosz, D.M. (2003). Roles for psychologists in end-of-life care: Emerging models of practice. Professional Psychology: Research and Practice, 34, 626-633. doi: 10.1037/0735-7028.34.6.626 Additional readings Family centered approach
Cultural considerations Recommendations -Majority of people cope effectively with bereavement and do not require interventions
-Need to be alert to the signs of complicated, protracted and intense grief
-Often associated with the death of a child Psychological Interventions:
Bereavement Family Assessment Device (Epstein, Baldwin, & Bishop, 1983)
-Subscales: Problem Solving; Communication; Roles; Affective Responsiveness; Affective Involvement; Behaviour Control; General Functioning Assessment Tools Family
Group Mode of Delivery Parents and siblings should be offered treatment prior to the bereavement stage
The level of service required may depend on the family dynamic
Assessments should examine the level of functioning of the family; tailor treatment based on the level of need Family Distraction?
-Children who were playing video games rated nausea lower
-Storytelling or fantasy Ideas for potential treatments Turk & Feldman, 2000 Anxiety and expectation can influence the experience of physical symptoms
Combination of: shortness of breath, fear of pain, symptoms can lead to anxiety
Provide interventions which decrease symptom intensity and increase a sense of control
Cognitive coping skills: relaxation techniques
Communication skills and goal setting Psychological Interventions Need to consider the age:
-Decision-making, treatment options
-Children made decisions about the end of their life based on the impact on family Patient Stress related to time constraints
Team Approach (Key worker)
Opportunities for debriefing
Acknowledge your limitations Caregivers Experiences Haley, Larson, Kasl-Godley, Neimeyer, & Kwilosz, 2003 Moving from curative treatment to pain and symptom management
Requires significant adjustment
Anticipatory grief, adjustment reactions, emotional reactions, unresolved issues
Pain, depression and delirium can increase Palliative Transition Caregiver, Family and Patient Experiences
Psychologists on Interprofessional teams