Liaison Between Family and Medical Team

When a child becomes aware of the diminishing curative or life-prolonging options that he or she faces, the child may ask anxiously about the options remaining if the treatment is unsuccessful (Sourkes 1982). Families are confronted by a series of decisions regarding the nature and intensity of medical interventions they wish to pursue. As a liaison between the family and medical team, the mental health clinician can serve to clarify both experimental and palliative options and their consequences. In most instances, the parents make the decision; however, to varying degrees, the ill child or adolescent is involved in such discussions. In such circumstances, the clinician must rely on clinical judgment to assess children's understanding of the contingencies they are facing.

Given that a child may express thoughts about treatment options and awareness of living with the threat of death to individuals other than his or her parents or primary care clinician, the mental health clinician can be an important liaison at critical junctures in the illness trajectory. This involvement is particularly helpful when the child's wishes or goals for treatment differ from those of the parents or treatment providers. On the one hand, physicians may recommend an aggressive course of treatment, while the child and parents are concerned about the pain and suffering associated with such an approach. On the other hand, physicians may encourage a transition to palliative care while the family still wishes to exhaust every possible life-prolonging option. Under such circumstances, the mental health clinician can clarify these differing perspectives and their implications and facilitate discussions toward a common treatment goal. Furthermore, the mental health clinician can serve to reduce the risk of miscommunications and misunderstandings (albeit unintended) that may have lasting emotional repercussions for the family.

Differing priorities may lead to misunderstandings, especially when curative care and palliative care are perceived as mutually exclusive. For example, an adolescent's behavior might be perceived as nonadherent and oppositional when he or she misses medications or procedures that are time consuming or painful. However, the adolescent may be asserting that quality of life and/or comfort is more important than curative efforts. By evaluating the unique characteristics of each child and family (e.g., personal and religious beliefs, hopes related to treatment), the mental health clinician is able to advocate for the individual needs of each patient.

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