Supporting Children's Grief within an Adult and Pediatric Palliative Care Program
Providing comprehensive, whole-person care to palliative patients with children/youth in their care ought to include psychoeducation and support for all members of the family. As professionals caring for people who are dying, we have a responsibility to mediate this impact to the best of our ability. By communicating openly and honestly and including children/youth, informed care team members can offer many supportive interventions that a family can benefit from during the time leading up to and following the death. These interventions foster the best outcomes when they are offered early on in the palliative trajectory.
Accepted for publication April 2011
Correspondence Heather O'Brien, BA, CCLS, Max and Beatrice Wolfe Children's Centre, Temmy Latner Centre for Palliative Care, 60 Murray St, Room L4-000, Box #13, Toronto, Ontario, Canada, M5T3L9; telephone (416) 586-4800, ext. 1535; fax: (416) 586-4804
Disclosures The authors report no disclosures/conflicts of interest.
Citation J Support Oncol. 2011;9(4):136-140
Copyright © 2011 Elsevier Inc. All rights reserved.
Children are too often the forgotten mourners in the homes of dying patients. Children, even young children, and youth grieve and mourn the threatened and, then, actual loss of a dying parent, sibling, or other significant family member.1 At a time when the family resources and focus are pulled away and taxed, caregivers are tasked with the difficult job of sorting through their own emotions and a wealth of advice. Caregivers must decide how they will communicate with, include, and support the children/youth in their care.
Although evidence is incomplete and there is a clear need for further studies, links between unresolved childhood grief, or an inability to adequately process their grief, and subsequent psychiatric conditions such as depression and anxiety have been presented as far back as Freud.[2], [3], [4] and [5] In addition, prevalent feelings of responsibility and exclusion and poor communication are consistently identified by researchers interviewing bereaved children/youth about their own experience over the last couple of decades.[6], [7] and [8] Therefore, given the risk of negative psychological and social outcomes associated with children's grief and the struggles communicated by children themselves, it is critical to recognize the important and preventive role of supportive interventions, especially prior to the death of a significant family member.
Looking at caregivers' experiences, there is still a large divide between the advice given by many family and friends in this situation (see Table 1) and what has become accepted within the palliative and grief counseling fields as “best practice.”[6], [7] and [8] In addition, family members' access to professionals trained or knowledgeable in this area is growing but usually still limited.9 Many children/youth are left uninformed, unprepared, and cut off from their family's support.
,Table 1. Myths and Realities about Speaking to Children about Grief and Dying. Adapted from MacPherson C.10
