Psychotherapeutic Interventions in Pediatric Oncology throughout
the Illness and Developmental Trajectories
(Intervenciones Psicoterapéuticas en Oncología Pediátrica a lo Largo del Proceso de Enfermedad y de la Trayectoria Evolutiva)

Monday, 9 June 2008 - 8:30 am - 4:30 pm
presented by Joanna Breyer PhD and Aurora Sanfeliz PhD

Presented in English with Spanish translation / En Inglés con traducción al Español

Target Audience:

Clinical psychologists, social workers, nurses, nurse practitioners, oncology fellow, medical residents, nursing assistants and school nurses.

Workshop Objectives:

1. The attendee shall be able to name three cultural assumptions that influence the delivery of health care in general and cancer care in particular.

2. The attendee shall be able to identify barriers to and practice having age appropriate, honest communication with children relevant to their cancer diagnosis, treatment and end of life.

3. The attendee shall be able to describe three psychotherapeutic interventions that could help children with cancer tolerate treatment and role play an individualized intervention.

4. The attendee shall be able to describe a psychotherapeutic intervention helpful to:

a. Siblings of a child with cancer
b. Teachers and peers of a child with cancer
c. The family of a dying child
d. A childhood cancer survivor

5. The attendee shall be able to identify one or two interventions most appropriate to his or her institution or practice, identify barriers and make initial plans to implement them.

Workshop Description:

Different cultural traditions impact expectations of doctors and families about what is disclosed about cancer and to whom. We will describe the cultural expectations that are prevalent at our own institution and will note throughout the workshop what happens when these expectations are not those of the families with whom we work.

The morning session will focus on psychotherapeutic interventions that are offered at the child’s diagnosis of cancer and during treatment.

• Age appropriate, honest communication about the diagnosis and treatment is encouraged. We will describe how to address parents’ concerns and give case examples to illustrate the type of information given. Participants will be involved in communication exercises.

• Psychosocial support for the family, sometimes family or couples counseling, will be described. Specifically:

a. For the parents, psycho education, parent guidance and emotional support
b. For the patient appropriate to their age. Therapy, play or puppet therapy, medical play, behavioral plans, learning behavioral skills. (Some interventions will be demonstrated and case examples discussed.)
c. For the siblings, advocacy with parents and services for sibling.

• A program to enlist support from teachers and peers and to help the child return to school will be demonstrated.

• Cross cultural initiatives will be described.

• Psychotherapeutic work within the medical team such as clarifying cultural misunderstandings and improving coordination of care will be outlined.

The afternoon session will cover:

1. Psychotherapeutic interventions with emphasis on communication during end of life care. We will describe the cultural attitudes and practices of our own institution, how these have evolved in recent years and how we respond when encountering families with different cultural traditions and assumptions.

   • The goal is age appropriate, honest communication while preserving hope for as long as possible and respecting parents’ wishes. Case examples, phrases sometimes used and ways to address parents’ concerns will be given.

   • Considerations in talking about death. Caregivers are encouraged to:

a. Be aware of children’s concepts of death at different ages
b. Be open to ongoing conversations during treatment
c. Ask hypothetical or indirect questions
d. Use language of family
e. Expect back and forth quality to conversations about death

   • Examples will be given of age appropriate, honest answers to direct questions from children about death.

   • Caregivers are also encouraged to recognize that different styles, religious and cultural traditions will impact way in which goodbyes are said – directly, indirectly or not at all. For some families other concerns like a pain free and peaceful death may be more important. Examples will be given of indirect goodbyes.

   • Other psychotherapeutic interventions will be described.

2. Brief description will be given of psychotherapeutic interventions offered to families as they transition to off treatment and continue with their lives as cancer survivors with potential serious late effects.

3. The final task will be to identify one or two interventions described during the workshop that might be applicable to each participant’s institution or practice and to brainstorm with others about how to implement them, identifying barriers and planning strategies.

Participants will be encouraged throughout the workshop to identify cultural differences, to role play and to practice different interventions. They will receive feedback from presenters. Discussion and sharing experiences will be encouraged.