小児癌患者と家族へのアプローチ(死にゆく患者とその家族へのケア)(死の臨床)

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Parental participation, especially maternal one, in clinical practice of pediatrics is quite important which is usually not seen in adult medicine. When the diagnosis of cancer in children is made, the diagnosis must always be told and the disease has to be explained to both parents together in a quiet room.Our attitude in talking with the parents is a most important consideration. Many discussions must be held with the parents even after the first talk and the parents should be told that they should feel free to ask any questions. Particular attention must be paid to the psychological impact that the diagnosis has upon the parents. They should be assured that their child will receive the best treatment currently available and the importance of their cooperation for the welfare and happiness of their child should be stressed. We also tell them that cancer is no longer invariably fatal due to recent medical development. The situation today has changed from expectation of certain death to anticipation of a normal life although this may be uncertain at the time of diagnosis.Another important problem is how to explain the disease to our patient. According to Japanese beliefs, children must not die while their parents remain alive. It appears to be most catastrophic when the order of death by seniority is disrupted. Since death of children evokes utmost fear as human beings, no scientific studies on this subject have been carried out in Japan until recently. For children with cancer, the pattern of open and honest communication is most important. If they ask you specifically about their diagnoses, prognosis or treatment programs, their questions shoud be answered forthrightly.In the terminal stage, a dying child generally regresses to a more primitive level asking the mother just to be there with him. He may be content if the mother holds, comforts and feeds him. When feasible, the best comfort for the child is the mother's active and close care, day and night. Therefore, all of us must support the mother who is living in with the child and carrying much of the care of the dying child. She should be looked after, encouraged and given occasional rest from her heavy duties.The hospital staff also experience the strong emotional reactions. Group meetings and conferences on "approaches to dying children" should be held at intervals and meneuvers and training of the treatment on this subject are mandatory in strengthening the staff's therapeutic and supportive role.
日本心身医学会の論文
1982-12-01

小児癌患者と家族へのアプローチ(死にゆく患者とその家族へのケア)(死の臨床)

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