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A significant number of patients with cancer are parents of children under 18 years of age.
A significant number of patients with cancer are parents of children under 18 years of age. Pediatricians are often the first health professionals to whom families turn with questions and concerns about the children during a parent's illness. Faced with a diagnosis of cancer, parents wonder what, when, and how to tell children about the illness. They also may have questions about their children's coping.1-3 Many would appreciate meeting with a professional who can hear their concerns and provide guidance.2 Pediatricians are uniquely well suited to provide this support by virtue of their long-standing relationships with families, their developmental training, their accessibility, and the lack of perceived stigma attached to consulting a pediatrician compared to a mental health professional.
Although these consultations can be comforting to parents, discussions about these issues can be quite stressful for physicians for many reasons. For example, a parent's strong feelings about the diagnosis may infuse conversations with an intensity that can be emotionally draining. Hearing about a parent's serious illness can bring up the pediatrician's own fears of mortality.4,5 This may be particularly difficult if the pediatrician is also parenting young children and can all too readily imagine being in that parent's shoes. Therefore, pediatricians may find it useful to have a framework for talking with both parents and children about coping with parental cancer. This article aims to provide such a framework so that pediatricians can feel prepared and confident in approaching this work.
Scope of the problem
Timing of the pediatrician's involvement
Two points in time offer particularly rich opportunities for learning about and responding to both parents' and children's distress about parental illness. These are: 1) when a parent calls to report the news of the cancer and has questions about helping their children; and 2) at office visits, when the pediatrician can quickly assess whether parental illness is a stressor for a particular child.
Although parents will frequently report their cancer diagnosis to the pediatrician, they do not always do so. Therefore, it is important to inquire directly about the health of family members, as well as the health of the child, in routine visits. Strategies for talking with parents and children are outlined below.
Talking with parents
Each family's unique circumstances make it impossible to provide a "one size fits all" model of providing guidance for parents. However, the following 4 general principles can be applied flexibly depending on family circumstances and children's developmental stages and temperament: 1) communicate honestly in an age-appropriate way with children; 2) protect family time; 3) maintain normal routines; and 4) optimize and organize supports.9