TERMINAL CARE OF THE DYING CHILD - PSYCHOSOCIAL IMPLICATIONS OF CARE

Cancer and death have so often been synonymous in the minds of many. W e who dedicate ourselves to the treatment of children realize that thi s is no longer true and work diligently to help the public see that in deed many children are cured of their malignancies. It is important to do this because the view that cancer is a terminal event is simply no t true. However, how do we prevent the pendulum from swinging in the o pposite direction? For it cannot be denied that care of the dying and bereaved is unavoidable in the professional life of health-care provid ers in pediatric oncology. This article is not meant to review physica l care for the terminally ill child, although the importance of pain a nd symptom control will be addressed. Rather, the purpose is to identi fy issues that are central in the treatment of dying children and thei r families. This is born of a belief that the management of the termin al phase of illness has a dramatic effect on the psychosocial recovery of the family. Bereavement follow-up care of parents and siblings, an integral part of terminal care, will be discussed. The issue of careg iver bereavement will also be addressed. Specific attention is given t o home care as an option for terminal care. Current practice, research , and problems will be presented followed by recommendations to improv e care.