Talking with Children About a Parent's Serious Illness
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Am Fam Physician. 2013 Nov 1;88(9):570-572.
A 45-year-old woman is admitted to the hospital with severe pancreatitis. She reports rapid and significant weight loss over a period of one month. Tests reveal that she has metastatic pancreatic cancer, and the prognosis is poor. She is married and has two children five and 14 years of age. She receives a palliative care consultation immediately. After a discussion with the woman and her husband, it is recommended that she be referred for hospice care. Some of the staff members involved in the patient's care believe that the children should not be exposed to their mother's illness and death, and suggest that they not be allowed to see their mother in her final days. Is it appropriate to talk to this patient's children about her illness and impending death? To what degree should the children be involved in her final days?
It is not uncommon for children to have parents who have cancer.1 Although parents may be understandably apprehensive about discussing a serious illness, children want and need to know what is happening.2 It is strongly recommended that children be involved and informed in the illness and death of a parent. A parent's illness disrupts children's daily routine and creates fear of the unknown.3 Just as the patient needs a plan of care that incorporates physical, emotional, spiritual, and cultural needs, there should be a plan for the patient's family, particularly for the children as appropriate to their age and developmental stage. Parents and spouses may have difficulty accepting the diagnosis, prognosis, and treatment plan; as a result, children often become part of that process of acceptance. The entire family needs the proper tools to cope with the diagnosis. If patients have preschool-aged, school-aged, or adolescent children, it is vital to involve social workers and child life specialists (i.e., professionals who are trained to work with children and families to help them cope with illness and hospitalization). These professionals are trained in the most appropriate ways of supporting children who are facing a parent's illness.
In these challenging and painful circumstances, children need simple, honest answers to their questions.4 These answers should be given by the most important adults in their lives, namely their parents or caregivers. Unfortunately, parents may underestimate their children's degree of distress.5 Teaching parents to talk with their children about their feelings has been shown to have positive outcomes for children and parents facing illness.6
As in this case scenario, family members and health care professionals often worry that allowing children to visit critically ill parents may be detrimental to their well-being. It is a common misconception that children may not have the
Address correspondence to Parag Bharadwaj, MD, FAAHPM, at parag firstname.lastname@example.org. Reprints are not available from the authors.
Author disclosure: No relevant financial affiliations.
1. National Cancer Institute. Surveillance epidemiology and end results. SEER cancer statistics review, 1975–2009 (vintage 2009 populations). http://seer.cancer.gov/csr/1975_2009_pops09/index.html. Accessed January 21, 2013.
2. Jones BL, Tesh M. Children, adolescents, and grief in medical settings. In: Pomeroy EC, Garcia RB, eds. Children and Loss: A Practical Handbook for Professionals. Chicago, Ill.: Lyceum Books; 2011:120–144.
3. Brenner A. Helping Children Cope with Stress. Lexington, Tex.: D.C. Heath and Company; 1984.
4. Webb NB. Helping Bereaved Children: A Handbook for Practitioners. 2nd ed. New York, NY: Guilford Press; 2002.
5. Welch AS, Wadsworth ME, Compas BE. Adjustment of children and adolescents to parental cancer. Parents' and children's perspectives. Cancer. 1996;77(7):1409–1418.
6. Lewis FM. Therapy for parental cancer and dependent children. In: Watson M, Kissane DW, eds. Handbook of Psychotherapy in Cancer Care. Chichester, West Sussex, UK: Wiley-Blackwell; 2011:225–234.
7. Crider J, Pate MF. Helping children say goodbye to loved ones in adult and pediatric intensive care units: certified child life specialist—critical care nurse partnership. AACN Adv Crit Care. 2011;22(2):109–112.
8. Craft MJ, Cohen MZ, Titler M, DeHamer M. Experiences in children of critically ill parents: a time of emotional disruption and need for support. Crit Care Nurse Q. 1993;16(3):64–71.
9. Cullen L, Titler M, Drahozal R. Family and pet visitation in the critical care unit. Crit Care Nurse. 1999;19(3):84–87.
10. Grollman EA. Talking About Death: A Dialogue Between Parent and Child. 3rd ed. Boston, Mass.: Beacon Press; 1990.
11. Blumberg B, Flaherty M, Lewis J; National Cancer Institute Office of Cancer Communications. Coping with Cancer: A Resource for the Health Professional. Bethesda, Md.: U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Cancer Institute; 1980. DHHS publication no. (NIH) 80-2080.
12. McCue K, Bonn R. How to Help Children Through a Parent's Serious Illness. 1st ed. New York, NY: St. Martin’s Press; 1994.
Case scenarios are written to express typical situations that family physicians may encounter; authors remain anonymous. Please send scenarios to Caroline Wellbery, MD, at email@example.com. Materials are edited to retain confidentiality.
A collection of Curbside Consultations published in AFP is available at http://www.aafp.org/afp/curbside.
Please send scenarios to Caroline Wellbery, MD, at firstname.lastname@example.org. Materials are edited to retain confidentiality.
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