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Psychological care in the acute phase

The acute phase starts at diagnosis and the beginning of medical treatment. In this phase, children undergo medical examinations and treatments, while parents are confronted with stressful decisions and strong emotions. Brothers and sisters, often referred to as siblings, also feel the impact of the changed family dynamics. The feelings experienced by children, parents, and siblings in this phase are usually very appropriate to the situation and therefore do not immediately require psychological interventions.

Children

For children, the diagnosis is often the start of multiple life-changing events, such as:

  • Various examinations, for example venipuncture, biopsy, or surgery

  • Introductory meetings with different health care professionals

  • A diagnostic consultation, during which the child may or may not be present, depending on age

In the Netherlands, it is common practice to provide children with clear information about their illness and treatment, tailored to their developmental level. The wishes of the parents are always taken into account. Young children often sense their parents’ emotions and do not always fully understand the seriousness of the situation.

To limit the impact on the child’s development, preventive measures are important. These measures help reduce anxiety and promote active coping. This support is provided, among others, by child life specialists, who:

  • Give children clear, age-appropriate information about medical procedures

  • Support children and parents during stressful moments

  • Offer distraction and relaxation

Additional psychological support may be provided, for example for children with pre-existing psychological or developmental disorders. This can range from adjustments and targeted advice for the treatment team to anxiety-reducing interventions such as exposure or EMDR, or system-oriented interventions such as mediation therapy.

For children who undergo surgery for a brain tumor, a neuropsychologist is often involved before surgery to monitor neuropsychological functioning. The neuropsychologist also provides targeted advice to the team, parents, and school in order to work as preventively as possible.

In the acute phase, children are often confronted with uncertainty, loss of control, and restrictions on their freedom. The child has little influence over what is happening. In addition, hospital admissions, having to stay in bed for long periods, and not being able to attend school are major limitations on a child’s freedom.

Literature

  • Grootenhuis, M.A., Aarsen, F., & Van den Bergh, E. (2001). Pscyhologische behandeling bij kinderen met kanker. In S. Duijts, R. Sanderman, M. Schroevers, & T. Vos (Eds.), Psychologische patiëntenzorg in de oncologie (pp. 323-334). Uitgeverij Van Gorcum.

  • Grootenhuis, M.A., Maurice-Stam, H., & Van Litsenburg, R.R.L. (2019). Psychosociaal onderzoek in de kinderoncologie. In G.J. Kaspers, N. Dors, W. Luijpers, & Y. Benoit (Eds.), Leerboek kinderoncologie (pp. 465-474). De Tijdstroom.

  • Kaspers, G., Dors, N., Luijpers, W., & Benoit, Y. (2019). Leerboek Kinderoncologie: Vol. ISBN 9789058983190. De Tijdstroom.

  • Kazak, A. E., Kassam-Adams, N., Schneider, S., Zelikovsky, N., Alderfer, M. A., & Rourke, M. (2006). An integrative model of pediatric medical traumatic stress. Journal of Pediatric Psychology, 31(4), 343-355. https://doi.org/10.1093/jpepsy/jsj054

  • Price, J., Kassam-Adams, N., Alderfer, M. A., Christofferson, J., & Kazak, A. E. (2016). Systematic review: A reevaluation and update of the integrative (Trajectory) model of pediatric medical traumatic stress. Journal of Pediatric Psychology, 41(1), 86-97. https://doi.org/10.1093/jpepsy/jsv074