Helping Families to Cope Tool
Helping families to cope begins with how you deliver bad news about a child’s health. Delivering such news in pediatrics ranges from the routine, such as telling a parent that a child will have to have blood drawn, to the serious, such as discussing a new diagnosis of a chronic illness. Less commonly, physicians must also tell parents that their child has died. Practice, whether simulated or real, is the best way to become comfortable delivering bad news, but the following tools may aid your communication.
Delivering Bad News
Key components of communicating distressing news are listed below and detailed on a Printable Pocket Card.
- Timing – As soon as a diagnosis is known, or a treatment has been planned, the child and the parents should be informed.
- Setting – Choose a calm, quiet setting that is comfortable for the patient.
- Tailoring – Adjust both your tone of voice and approach to the type of news you are delivering.
- Asking and Listening – Periodically ask the family what questions they have.
- Offering to meet again
- Including the child – The degree to which you do depends on the age of the child
- Considering your own emotions
The Family’s Reaction to Bad News
After the family has received the news of the child’s illness, what will they likely experience next? In order to best help children and their families cope, we must first try to understand their perspective and needs. The next step is to assess coping resources to provide economic, emotional, and psychosocial support. Consider if all or any members of the family have these resources. If not, which ones do they lack, and is it possible for you to help them attain these resources? When trying to help a family to cope, consider the following themes:
Patient perspective
Depending on both their cultural perspective and health literacy, patients and families may have varying degrees of understanding of, or agreement with, your perspective on their disease. Thus it is critical to ask what they are thinking and feeling. Even very young chronically or critically ill children may understand the severity of their illness more than adults may realize due to non-verbal and environmental cues. Religion and spirituality often serve both to shapes a child’s perspective on illness as well as a resource for coping. Thus understanding this perspective provides the foundation for helping children and their families to cope.
Coping method
Understanding the coping method that children and families use can help you tailor your support to match their method. Coping methods can be classified by the following:
- Problem-focused coping involves trying to stop the source of the problem if it is felt to be within one’s control
- Emotion-focused coping serves to decrease emotional stress and often takes place if the problem is felt to be beyond one’s control
Age may help you to gauge which strategies children may be able to employ to help them cope; however, children, like adults have a wide range of coping abilities. Younger children are likely to react to a troubling situation by changes in behavior, while older children may use their more developed cognitive abilities to understand their problems and express their reactions. Unfortunately, children of all ages may employ avoidant coping strategies and develop adjustment difficulties. Children can often gain much suppor from their primary care physician to help them work through the stresses of illness or loss. When needed, a child psychiatrist or therapist may be able to treat the psychological effects of the illness.
Sense of time:
Young children tend to live in the present and may have trouble looking far into the future. They often cannot understand that events in the present, such as a painful test or treatment, will not necessarily continue in the future. Furthermore, a child’s sense of time may change with the diagnosis of a chronic illne:. The past may become idealized, and the future may become marked with uncertainty. In addition, time may become compartmentalized by the schedule and routine of treatments, doctor’s appointment and other health-related visits. You can help children cope by acknowledging difficulties and challenges and by celebrating good times and successes.
Identity:
Once diagnosed with a serious illness, a patient’s identity often becomes intricately intertwined with the illness. Many children struggle to retain their identity apart from their disease. They want to be congratulated on the merits of their accomplishments, “She did a great job,” without the qualification of their disease, “for someone with asthma.” Self-image may also be affected physically through scarring, loss of hair, loss of a limb, etc. Such physical changes can be especially troubling to a child or youth who is trying to “fit in” with peers. The best way to help children preserve that identity is to use person-first language (Person-first Language Resource), which centers on the person rather than the disease.
For more suggestions from parents about how to cope, visit the following short website:
“How to Cope with Your Children’s Illness,”
http://www.cincinnatichildrens.org/about/patient/coping/default.htm
Resources:
Barclay, Joshua S., Blackhall, L. and J. Tulsky. Communication Strategies and Cultural Issues in the Delivery of Bad News. Journal of Palliative Medicine, 2007; 10 (4):958-77.
Bradford, Roger. Children, Families and Chronic Disease: Psychological Models and Methods of Care. New York: Routledge, 1997.
Lazarus, Richard S. and Susan Folkman. Stress, Appraisal, and Coping. New York: Springer-Verlag, 1984.
Martini, D. Richard. Helping Children Cope with Chronic Illness. American Academy of Child & Adolescent Psychiatry DevelopMentor. http://www.aacap.org/cs/root/developmentor/helping_children_cope_with_chronic_illness. Accessed July 2008.
Supiot, S. and A. Bonnaud-Antignac. Using simulated interviews to teach junior medical students to disclose the diagnosis of cancer, Journal of Cancer Education, 2008;23(2):102-7.
Thomas, Mary. Breaking bad news: Consider timing, setting, your own emotions when delivering distressing information. AAP News Vol. 21 No. 4 October 2002, p. 178.
Thompson, Robert J. and Kathyryn E. Gustafson. Adaptation to Chronic Childhood Illness, Washington, D.C.: American Psychological Association, 1996.