Subject(s)
Neoplasms/therapy , Child , Clinical Protocols , Comprehensive Health Care , Delivery of Health Care, Integrated , Health Resources , Health Services Accessibility , Humans , Neoplasms/psychology , Outcome Assessment, Health Care , Patient Care Team , Physician-Patient Relations , Professional-Family RelationsABSTRACT
The importance of providing continuity in the care of all patients with major medical problems, such as cancer, has widespread acceptance in our current health care system. From the perspective of an oncology social work clinician, this article offers a definition of the concept of continuity of care, examines factors influencing its provision in oncology, and reviews key components in continuity of cancer care planning and implementation. It also examines some innovative efforts in practice to improve continuity.
Subject(s)
Continuity of Patient Care/organization & administration , Neoplasms/therapy , Quality of Health Care , Continuity of Patient Care/economics , Health Services Accessibility , Humans , Social Support , United StatesABSTRACT
A battery of neuropsychologic tests was administered "blindly" to 18 children with acute lymphocytic leukemia (ALL) who had been randomly assigned to treatment regimens with or without cranial radiation. These children were all in complete continuous remission for more than 3 1/2 years and were no longer receiving therapy. The results indicated no substantial differences between groups as a function of radiation therapy. However, decreased neuropsychologic performance was found when the entire sample was compared with population norms. These data do not support the hypothesis that cranial radiation therapy is responsible for the neuropsychologic sequelae seen in these survivors of ALL. Post hoc multiple regression analysis indicated that parental education levels accounted for more of the neuropsychologic variability seen in these children than other factors such as age at diagnosis, type of therapy, or sex of child.
Subject(s)
Brain/radiation effects , Cognition , Intelligence , Leukemia, Lymphoid/radiotherapy , Radiotherapy/adverse effects , Brain Neoplasms/prevention & control , Child , Child, Preschool , Clinical Trials as Topic , Combined Modality Therapy , Female , Humans , Infant , Intelligence Tests , Leukemia, Lymphoid/psychology , Leukemia, Lymphoid/therapy , Male , Random Allocation , Socioeconomic FactorsABSTRACT
Separation and loss issues arise frequently in pediatric hospital settings. Three forms of psychiatry/psychology liaison are presented which demonstrate: 1. case-centered collaboration to address child and family concerns about death; 2. team-centered activities which link family and staff roles in the course of terminal illness; and 3. the development of a program mechanism to meet the needs of staff "survivors" of recurrent childhood deaths. These examples illustrate the enrichment which pediatric psychiatry/psychology liaison program offer when the conceptual model of liaison service and teaching operates flexibly on case, team, and program levels.
