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Broadening the Scope ofPractice in Pediatric Oncology
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Epidemiology,Br2iinTumor,Less than 1 y o C SdiSC2SC. Multiple factors Cranial irradiation dose,Ages 1 4 y o Child s age young. Malignant neopla ms 3 8 children at grcalcr risk,Time since end of. Ages 5 14 treatment, Malignant neoplasms 2 15 4 Intrathecal chemotherapy. S slcmic chemo to a,Ages 15 19 lesser degree, Malignant neoplasms 4 5 4 Frequent school absences.
Neurocognitive Deficits Risk Factors Psychopharmacology in Pediatric Oncology. Among Children Trea cd for ALL and Malignant Brain Tumors. 8cJttet MuINm 2005,MClhrlphcnidate for ADHD, l eUfocogruDve De6ers nennon oWuIIum 2O U Kaz 2005. U man IT P,Miduolam or procedural anxiety discomfon pain. SecondU Srmproms,adcIruc Wluft oanorW iOCaa1 pfOblianf. IQ loss l plrnM fit 2000, Midazolam psychological interventions for procedural. RJ k Factors fOt De6ats distress,iLL teRT Intmhcal rY 0 Young age at trcarment.
Con cQl lnDldt F Typical anti psychotics for steroid induced psychosis. Brain TumQrs CRT Tumor Im uoun, Traunu at b ntroccpb tcu ura Young age at trcarment Typical anti depressant for mood symplom second ary 10. sensory motor conico leroids rJg M Spnro GeI w m,Female Gender. un pa1t1l1 l l1 ts, Illness Trajectory and Palliative Care Timing of understanding that there is. no realistic chance for cure,Other Important Elements in. Pediatric Palliative and End of Life Care,Developmental considerations.
E llcrience with cancer,Experience with death,Style of child s infonnation gaLhering. and questions about Lhe disease,Style of parent s respon e. Adapting to the cancer culture Working in pediatric palliative care. 011 beillg a temporary guest ill all existillg sill atioll. Time out strategies for yourself,The pre eslablished Compas ion fatigue. Rourb 2007 e nowsJu 2006,organizational climate, medical turfs and hierarchic It is the defense against the loss that hUrlS not Lhe. notion of social services psychologists, Giving yourself the freedom to experience the full range.
prior experiences the history wiLh you oremotions,Need to articulate in talking listening. CesHl 1OOl l,Stress in Pediatric Palliative Care,Personal Characteristics. DAVID ARISTOTli HAUGHTON,VlIOCaMr Bntlsh Col,perfectionism. over involvement with patients,identification wiLh patients. self esteem,sense of m astery, 1m eoo I lrelra ose OfCl ltiC1 DlIlN eRe w of I ct lhlrrn s olt I wltnrnr purpose in life.
etItlorttllll peln tflllnn ng Tht or lI lO lplrs wn Il lt COI I I Itl1td me 10 In. lht 1 11Ider tDtenlw f un of tttflln s w lrrtO Ol1 fIl OIls t lOt fIPm lrIJ llr llnltl1Cf. unreali tic c pectations, llOllIIt I I lOl2tm Il lI IC1 In tillS cr ge 9 SInn of l OI U I ltYt III O J1llt Ihr I lln In regt. st OIIt I I fIat I tImlll say lOUCl,Stress in Pediatric Palliative Care. Personal Characteristics,feclings of inadequacy,history of psychiatric illness. emotional demands,increased awareness of own losses. vulnerabilities and fear of own,cumulative losses,Overcoming medical data fears.
in an intense work schedule,When in Rome,Learn the language. Preparedness, Strengthening communication Strengthening communication. liaison work liaison work,CAHO Standards Regarding CoUaboration. Communicating impression assessment, Standard PC 5 5 Care and services arc provided in an results and treatment. interdisciplinary collaborative manner, Rationale Cor PC 5 5 itA coUabor u oc CASE EXAMPLE OF COLLABORATIO.
intuclisciplinary appro2ch to muting the paricnr ts. needs goals hdps to coordin2tc care ue auncnr,services 2chit c optim21 outcomes The mix o f. clisciplines inten lIy orcoU2bor ujon win vary as,Slppropriarc to c2cb paDent and we SCO ofservices. provided by the hospital U,JCAHO 2OO5,Strengthening communication. liaison work,elf Identification,Reason for referral. Pt Identification, Strengthening communication Strengthening communication.
liaison work liai on work, Sample items of handout for referring Other examples of potential referrals. physicians,high emotional distress,tearfulness, complaints our of proportion to physical pathology. behavioral issues during intervention,repeatedly rai cd issues already addressed. resistance to ean of some mcds, Strengthening communication Strengthening communication. liaison work liaison work present lion bRsed on the GIL model. The SBAR Technique o commun cating v ith the health eat t am. HPI Hi tory of Present Illness,1 Situation,PMH Past Medkal History.
2 Background FMH Family Medkal History,3 Assessment PPH Past Psychiatric History. FPH Family Psychiatric HislOry,4 Recommendation,PSH Patient s Social Hislory. MSE Mental Status Exam,Strengthening communication. Communicating,liaison work prrs nt2uon b d on rbr GIL mood. effectively with accurate,information without,overwhelming the.
Dx lmpresion child and family to the,Reconunendations point of breaking. Common Communication Barriers,You had me at,Leading Qs. unfortunately the treatment Talking about neutral issues physical sx. results were not as good as we had Giving only elected attention to cues. hoped Premature or inappropriate advise,Communicating empathy. Other Common Communication Barriers trust to children. Ignoring cues,scoot down to eye level honesty,False reassurance. Topic m itch sit down reliability, Passing the buck respond to feelings updated accurate.
Premature problem solving information ith,parental consent. Avoiding the patient,You ve 6een sucn a,super nero. Consultation in Pediatric Psycho Oncology Common Pain Assessment lues. Establishing a therapeutic relationship with,role of parents in pain assessment. The consult as an intervention, Referral pain from different etiologies with similar. Etiology clinical indicators,Differential Diagnosis.
Common Pain Asse sment Issues Common Pain Assessment Issues. Adolescents with chronic recurrent pain, resulting from a long term life threatening children unable to report their pain. condition verbally, asse ing physiological cognitive emotional observing bebavioral and physiological. components of a patient s pain perception indicators even in children who have the. adequate pain history capacity for verbal communication. Common Pain Assessment Scale Sample of assessment option. ChildrPn who art 100Joung 10 o pftJJ poin mO d monJlralt. ill J brhatior hongtJ,Psychomotor alonja cluld adopls a postille thaI. rrunimizcs pain or ov r arne appears to become,resigned to it. Sample of assessment option Sample of assessment option. Distress Tbermometer,As essment,Selected medical problems complications that.
can present witb psycbo nemological,Brain neoplasms Vitamin deficiencies. Hypo hyperthyroidism POSI op delirium,Hypercalcemia Opiod s. AIDS Se eral chemo agentS,Hepatic encephalopathy Injuries trauma. Historical Historical, Evidence Based Treatments Evidence Based Treatment. Selected Well Established Trearmcots Possibly Efficacious. Chambless Crileria,Interventions for procedure related pain.
Bebaviorallntcrventions,Breathing e ercises olber,Rclax distraction for decreasing. distraction rela xation,cherno side effects anticipatory n v. Filmed modeling Powwn 1m,Reinforcement incentive,Behavioral rehearsal. Coaching by psychologist parent,and or other medical staff m. Historical,Evidence Based Treatments,Behavioral Interventions.
Video games for decrea ing chemo side,effects anticipatory n v. AkOuMt Nnuu fPW,Broadening the Scope of Practice,in Pediatric Oncology. the little grasses,crack through,stone and they are Considerations for. green with life Palliative and End of Life Care Interventions. Regina Melchor Beaupre Psy D, Oinical PI cho ogy Anociau of OM Central Florida PA. FPA 2008 CONVENTION,OVERVlEWOF,PEDIATRIC PSYCHO O COLOGY.
PALLIATIVE END OF UFE CARE,Broadening the,Scope of Practice. Treatmen1 Case,Family Dynamics,Guidelines Prescnlalions. PsYCHOlOGtCAl,ASSOO TION,Report of the Children and AdoJe cents Ta k. Force of the Ad Hoc Committee,on End of Life Issues. Highlights,APA Tm Fore 200S, SlOP Working Committee on SlOP Working Committee on.
Psychosocial Issues in Pediatric Psychosocial Issues in Pediatric. Oncology Oncology,Highlights 2 time periods, curative to palliative palliative to death The personal philosophical and cultural values. of the family and the bospital bealth care team,Key issues member aU influenee what happens. udurariDn and qualiO ofremaining life,Dghu of the child to careful. compasr jDoare managemen,Important Elements in, Overview of death and dying in children Pediatric Palliative and End of Life Care. Why is caring or children and their amilies Developmental considerations. clifljculr, What makes caring or children meaningful E perience Vttith cancer.
HOnT competent are oncologists in terms ofend Experience with death. o life care witb children,Style of child s information gathering. Whar are the barriers to optimal care and que tions about the disease. Style of parent s response, Developmental considerations Developmental Considerations. on decision making,Understanding of Death School age child 6 9 years. irreversibility of death,There is evidence that children are. focus on the physical bio a pects of death,capable of decision making about their.
alternately confront and deny their grief own palliative care. may not question or discu s death and appear to,be unaffected. may encounter strong feelings of loss yet it is,difficult for them to express these emotion. Developmental Considerations Developmental Considerations. on decision making on decision making,A 17 y o emancipated minor with sarcoma. An 8 Y 0 boy th neurohlastoma Ox at 2 5 Ox 6 months prior with a young baby was. y 0 told his mother that he was too tired to offcrcd the option of radiation therapy for. fight anymore tumor shrinkage pain control She said. JIm scared because 1 don t want to disappoint, It ll be O K Mom 1 1 bave ro continue my dad He wants me to h nre radiation but. burring I would rather go to heaven it huns if they even mo re me to h n c the. radialion My mom tdl me to do barel er I,ul is best or me I know Pm not going to.
make it but ir s important to my dad that I,continue to 5ght. Child s Experience with Cancer,Comparison in terms of exposure. Child s Experience with Cancer,Bylowl NB 17 ylo wi aggressive. dealing 1 it since sarcoma Dx about 3 generally accelerates the development of a. age 2 I 4 mo ago requiring child s maturity but the reverse may be. labor induction to true for some children particularly those. Long te nn e Po ure,commenceTx whose illness impacts cognition. to cancer and death,Shortcr tenn,exposure to cancer.
Child Experience with Cancer Child Information Gathering Style. Other manifestation,U har is de arb,You can talk here I have the heart of. regression to previous developmental stage an adult and can understand. irritability Indirect,UI ve had as many re lap es as he has. They ve moved her to a room by,herself so she must be dying. Child s Experience with Cancer Parental Response Styles. Facets of awareness of prognosis as a socialization process Parental decision to talk about dying with their child. Q Did parents talk to their children about their,imminent death. 2 3 4 5 Q Did they have regrets about it,Diagnosis 1 1.
fu s lIl1i,Majority did DOt talk to their child,o pareDt who did had regrets. 1 3 bo did not talk to their child regretted it,KrelcOwvs fit NEJIrA 2004. Parental Re ponse Styles Selected Contributions of. Parental decision to talk about dying with their child Family Dynamics on EOL Is ue. 8 ylo Child,l Ulbat is death Decision making,Parental care tenor. Early artachment,Death is when your hean stops and. the person s breath stops But my Jove I won t,Family life cycle.
call it death I will say that you are just resting. because you are in so much pain,Pre Conception,Pre Birth Artachment. CASE PRESENTATION,Family Social Risk Factors,8 year old male with metastatic NB. Low income,Dx 6 yrs prior,Overcrowding,sip ehemo RT surgery BMT Maternal depression. Ref for agitation toward mother Paternal antisocial behavior. psychomotor agitation mood angry Parcntal conflict. affect labile thought processes evasj rc Removal of child from home. pressured speech hi vol poor a ttention conc,Peers neighborhoods societal influences. poor memory,Reciprocal socialization bern eeo parenting.
Expression of anger 1 want to kill her child behavior. P H ADHD F PH Conflict incon istent discipline,Risk Factors for Attachment Problems. abuse physical emotional,maternal ambivalence toward pregnancy. sudden separation from primary carc1 3 ker,i e illness or death of mother or sudden illness. or hospitalization of child,rfrcquent moves and or placements morc. The Effects of Abuse Neglect on the, Developing Brain during Children s Differences Between G J.
First Few Years G,n house behavioral plan,Dyadic intervention. WIho will I 5ght ith f Vhar if 1 cry,Exploration of potential adaptation of innovative. intervention Dignity Therapy to pediatric,foUowed his lead read together from their. TIIChw 2000, Similarities Between G J IPsychological Symptoms of Impending Death. EOL Issues in Pediatric Oncology Delirium,Nausea Adult Delirium in Ca Pts APA 2000 2005.
Considerable variation,Adult vs Childhood Delirium gos. Constipation, Dyspnea o reliable estimates of the incidence of delirium. in children LiNtIC IS 2005, Psychological Symptoms of Impending Death PsychologicaJ Symptoms of Impending Death. Delirium in Children Delirium in Children,Symptoms Assessmenl I Eliology I Differential Ox. Observed behavior carelaker info,Psychomotor rctardation I agi lation.
Infections medications mosl freq etiology, Anxicty Medication wid multiple contributing factors. Difficulty gelting the child s attention SloddMd WllenJ 10Sl5. Regression with loss of previously acquired skills. Dyspraxia Dyspha ia T rzepacz Delirium Rating Scale. seful in evalualing delirium in children,TIH1 eI Tnep z 200J. ruth T 200J, Psychological Symptoms of Impending Death Psychological Symptoms of Impending Death. Pediatric Dyspnea Pediatric Dyspnea,f ssessment,Role of psycho education Clarify the symptoms. The limits of psycho education What is the child saying is happening. as a psychologist,lbat do tbe parent ay is happening.
Cbeck child s behavior,Is there an underlying ear,Psychological Symptoms of Impending. Death Pediatric Dyspnea Pediatric Dyspnea,Assessment Assessment. Is there a functional impairment,Must frequently reassess blc ifit is a. OTHER QUESTIONS TO CONSIDER,delirium it rill have a fluctuating course. Is the child able to perfonn hu usual activio cs,some most Icuviues stopJXd.
Wb did the ch mge occur,What are the child s usual activities nonnaJ. activities for me a group short walks outside on,lcvd ground only indoors only sLi1l able 10 climb. stairs only n d u alking and cssarti d ADLsi,silting or lying only.


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