Diego Cortinovis MD; San Gerardo Hospital, MedicalOncology
We are a team ofItalian hemato oncologist pediatricians, adult
oncologists, and psychologists that,for quite some time, havebeen
involved in clinical research on communication strategies between cancer
patients and their children.
Based on our experience, we strongly feel that it is an ethical duty for
all clinicians to make children awareof what is happening to one of
their parents when they are diagnosed with cancer. Thus, in our opinion,
the issue is not whether to talk with the children about their parent’s
illness or not, but rather how to do that in a tactful and effective
manner. To this end, we carried out a series ofparent-child
dialogue-based interventionsthrough a multidisciplinary approach. The
successful outcome of our interventions was measured and validated
through qualitative assessment of a self-reported questionnaire
administered to parents and children—even shortly after the death of
the ill parent.
The lesson we have learned from this 20-year-long survey is that
listening to what the children have to sayabout their hopes, fears and
worriesas well as answering to their many questions is crucial tomake
them understand and accept the unfortunate event that has happened toone
of their parents. In our experience, it is up to the clinician to build
a relationship of mutual trust with the child—it is primarily the
clinician’s responsibility.
This interventionalso requires the presence of a psychologist—but not
that of any of the two parents—that will offer guidance toall family
members throughout the illness trajectory. Once the psychologistagrees
to undertake this task, he/shehasto strongly believe in it, and this
will give him/her the strength needed to face the hardship of this
journey. The two other members of the multidisciplinary team (MDT), a
pediatrician and an oncologist,are not just supposed toensure the best
medical care. They should guarantee the psychophysical well-being of the
entire family unit, including the children.
In the end—we cannot deny it—,we feel empty inside but,at the same
time, happy to have contributed to tackling such a challenging issue,
which is still a taboo that we need to break by making it an integral
part of our healthcare system.
Let’s not forget that ”the moon” (we, the healthcare providers) and ”the
stars” (all the people who dedicate time and resources to the patient)
work together to light upthe ”dark” path (the disease) of a child or an
adult. As clinicians,our main goal is to improve the quality of lifeof
all family members we assist—those who recover and those who
die—before, during, and after the disease course, regardless of the
outcome.
Elizabeth Kubler-Ross wrote:“People are like stained-glass
windows. They sparkle and shine when the sun is out, but when the
darkness sets in, their true beauty is revealed only if there is a light
from within.” … and even children have this inner light. Let’s
help them keep it lit even when facing the pain caused by the death of
one of their parents.