Terminal Phase

Illness relapse and progression despite treatment are accompanied by the child's deterioration and ultimate demise. This is clearly an emotionally challenging time for the patient, the family, and the medical team. Physical deterioration combined with the need for decisions about the continuation and intensity of care is emotionally challenging for all. Entry into the terminal phase can portend a complex and difficult period in the relationship between the family and medical team. These relationships have the potential to become conflictual and polarized. Medical decisions to limit or withhold care can be problematic. Second opinions may be sought, and all-or-nothing decisions may be desired. Respectful and collaborative plans are sought but may be difficult to achieve. In these situations, the involvement of the mental health consultant and/or referral to a family therapist can be helpful. Yet, at the same time, the strength of the working relationship between the medical team and family often proves useful in successfully navigating the terminal phase and leads to the greatest acceptance of and meaning in the child's death.

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