What Adult Cancer Care Can Learn From Pediatrics.

Abstract

Focus on Families, Not Just Patients No one doubts the importance of patientcentered care, but pediatric cancer centers know that true patient centerednessmeans having clinicians work in dynamic partnership with sick children’s families. As a child’s primary source of strength and support, the family is a vital part of the health care team. When the family is fully integrated into the care process, the child is more likely to thrive. Indeed, more than a decade ago, pediatric hospitals started using familycentered rounds toactively involvepatients and their families in decision making. By helping the family understand both the inpatient care plan and the discharge plan, family-centered rounds improve efficiency and staff satisfaction. Overall, families are more likely to be considered members of the care team in pediatric than in adult cancer care—a missed opportunity in the adult setting. Pediatric cancer teams recognize that thechild’swell-being and the family’swellbeing aremutually reinforcing. Indeed, the “Standards for the Psychosocial Care of Children With Cancer and Their Families” call for routine assessment of the psychosocial needs of pediatric oncology patients, parents and caregivers, and siblings. Evidence also shows that cognitive behavioral interventions reduce distress in parents and other family members. It is critical to identify which members of the adult patient’s personal network can best inform care planning and provide support during the diagnosis, treatment, and follow-up phases of care. In pediatric and adult cancers alike, support must extend beyond the walls of the medical facility. This support often includes nursing-like duties, such as ongoing medication management, injections, and wound care. An important early service is to train key members of the patient’s support system in how to provide safe, effective in-home care. Pediatric cancer centers are more likely than adult centers to prepare a patient’s family and friends for these roles. One adult care organization that actively pursues family centeredness is Maggie’s, a 17-center network in the United Kingdom that offers adults with cancer and their families a range of free financial, informational, emotional, and social support services. For example, Maggie’s organizes so-called kitchen table venues where patients and families meet and talk with one another and with other families, as well as stress-management sessions for the entire family. At Maggie’s Kids’ Days and Teen Days events, children whose parents have cancer participate in support, informational, and play activities.