**5. Open communication: At diagnosis, during treatment, at the end of life**

Communicating the diagnosis and how best to do is the first step in a communicative process and relationship that involves the medical team and the family, and that allows for growth and change over time. As the evidence mounts that the children, siblings, and parents would be best served by being encouraged to bring into the open their anxieties about the illness and its possible consequences, studies have been paying more attention to how parents and medical personnel communicate with the child. The initial diagnosis is a model for all future interchanges of information between the medical professionals and families and between the family members themselves, especially between parent and child. As the families of the children diagnosed with cancer struggle to face the new emotional crisis which is challenging the relationships among the family members and the very balance of family life, we need to help the families strengthen their coping skills, alleviate their anxiety and offer the type of support the children and families are seeking, in specific ways that are most important to the children and families at a given moment. Basic to effective family coping is the belief that communication of both happy and painful thoughts and feelings, by the parents and by the children, is a healthier state of mental well being than retaining those thoughts in silence. This belief is a prerequisite to mutual support among family members. The families which allow open discussion of the illness and its prognosis are able to cope more effectively with the illness within their own family, and are also able to give and receive the support of other parents in the clinic.

Management of this communicative process has an important influence on how all involved child, parents, other family members, and medical staff work and care for the child together.

At diagnosis the child and family's level of anxiety is very high, and their level of prior information and understanding varies greatly. Most parents want to know as much as possible about the disease, treatment procedures, prognosis, practical coping details, and emotional impacts. The staff's communication of the diagnosis and treatment plan should be done in a way that is responsive to these needs, and that develops confidence and trust among the pediatric cancer staff, patient and family.

Our general view is that full and open communication between the medical care team and the family (including the child), and within the entire family, is the ideal situation. However, this is not always possible or preferable. It also must be done in a way that is sensitive to different cultural styles and preferences.

The communicative session should be conducted in a private space, with comfortable seating and an environment conducive to discussion of painful issues, as a conversation

2. Encourage all parents, especially shy or cautious parents, to join a parent association and help activate parents to organize such associations where they do not already exist. 3. Have parent association members, together with members of the health care team, cooperate in deciding upon a global medical, psychosocial and social-cultural

intervention program, toward which they all can converge their united energies. 4. Do all in their power to ensure that cured children and young adults are successfully reintegrated into society, without being penalized in school, work, social relations or

**5. Open communication: At diagnosis, during treatment, at the end of life** 

also able to give and receive the support of other parents in the clinic.

among the pediatric cancer staff, patient and family.

different cultural styles and preferences.

Communicating the diagnosis and how best to do is the first step in a communicative process and relationship that involves the medical team and the family, and that allows for growth and change over time. As the evidence mounts that the children, siblings, and parents would be best served by being encouraged to bring into the open their anxieties about the illness and its possible consequences, studies have been paying more attention to how parents and medical personnel communicate with the child. The initial diagnosis is a model for all future interchanges of information between the medical professionals and families and between the family members themselves, especially between parent and child. As the families of the children diagnosed with cancer struggle to face the new emotional crisis which is challenging the relationships among the family members and the very balance of family life, we need to help the families strengthen their coping skills, alleviate their anxiety and offer the type of support the children and families are seeking, in specific ways that are most important to the children and families at a given moment. Basic to effective family coping is the belief that communication of both happy and painful thoughts and feelings, by the parents and by the children, is a healthier state of mental well being than retaining those thoughts in silence. This belief is a prerequisite to mutual support among family members. The families which allow open discussion of the illness and its prognosis are able to cope more effectively with the illness within their own family, and are

Management of this communicative process has an important influence on how all involved child, parents, other family members, and medical staff work and care for the child together. At diagnosis the child and family's level of anxiety is very high, and their level of prior information and understanding varies greatly. Most parents want to know as much as possible about the disease, treatment procedures, prognosis, practical coping details, and emotional impacts. The staff's communication of the diagnosis and treatment plan should be done in a way that is responsive to these needs, and that develops confidence and trust

Our general view is that full and open communication between the medical care team and the family (including the child), and within the entire family, is the ideal situation. However, this is not always possible or preferable. It also must be done in a way that is sensitive to

The communicative session should be conducted in a private space, with comfortable seating and an environment conducive to discussion of painful issues, as a conversation

insurability for having had cancer as a child.

between equals. Both parents and the chairman or a senior medical staff member should be present, as well as the head nurse or another staff member. The attendance of the family's local physician should be encouraged unless parents do not agree. If requested the child with cancer (according to age), other family members (e.g. grandparents: they are significant sufferers that often receive little attention!) or close friends also may attend this session.

When communicating with the child, the physician should explain the disease at the level of development of the child, using pictures and analogies such as the flower garden to help the child's understanding. The physician should make sure that the dialogue is truly a two-way interaction, with the child invited to ask questions and having the answers explained as clearly as possible. Depending on age and level of development, the physician should talk to the siblings as well, explaining to them the basic elements of the disease and its treatment, and having them as well communicate back to the parents what they understand about the illness. In this way, an open system of communication is set up within the family.
