ABSTRACT
Oncological diseases in children and adolescents represent a considerable burden for the children themselves and for their families. In order to position such concomitants of a life-threatening disease appropriately among the diagnostic options of psychosocial cancer care one is repeatedly confronted with the issue of giving a diagnosis from the area of reactions to burdens and adaptive disturbances (ICD 10: F: 43 ff). This touches the question of whether or not confronting a life-threatening disease in and by itself suffices to fully justify establishing one of the psychiatric diagnoses mentioned, which would imply that the intensity of the burden experienced justified the assumption of a psychiatric disturbance in the person affected. Whereas considerable effort is regularly spent on taking action and giving support and care, and reactions occasionally exceed the appropriate degree, a fair majority show no pathological processes that would justify determining a psychiatric diagnosis as a rule. Ultimately, one would arrive at a false interpretation of actually altogether adequate reactions of the patient to the burden. The ICD and DSM classification systems, however, do not provide for diagnoses other than those allocated disease status; it must therefore be considered whether it may be better in these cases to speak not of a reaction to a burden or an adaptive disturbance in the sense of the ICD 10, Section F, but rather of a sustained reaction to a burden. This opinion is increasingly gaining acceptance in pediatric oncology.
Subject(s)
Cost of Illness , Hematology , Medical Oncology , Mental Disorders/diagnosis , Neoplasms/psychology , Pediatrics , Age Factors , Child , Diagnosis, Differential , Diagnostic and Statistical Manual of Mental Disorders , Emotions , Humans , International Classification of Diseases , Mental Disorders/therapy , Practice Guidelines as Topic , Psychology , Stress, Psychological/diagnosisABSTRACT
Psychosocial Care has been an integral part of the overall treatment in pediatric oncology for 25 years. The need for it and its effectiveness are well documented in several reputable studies and psychosocial service has proved its worth in everyday clinical settings. In order to secure comparable quality standards and in consequence of reorganisations within the health-care system a position paper has been prepared and adopted by the Psychosoziale Arbeitsgemeinschaft in der Pädiatrischen Onkologie und Hämatologie (PSAPOH), the Gesellschaft für Pädiatrische Onkologie und Hämatologie (GPOH) and the Deutsche Leukämie-Forschungshilfe (DLFH). The following article gives a short survey of this position paper and provides insight into the goals, conditions and outcomes of psychosocial care in pediatric oncology and hematology.
Subject(s)
Hematology/standards , Leukemia , Medical Oncology/standards , Mental Disorders/therapy , Neoplasms/psychology , Pediatrics/standards , Societies, Medical , Adolescent , Age Factors , Child , Germany , Hospitalization , Humans , Insurance, Health , Length of Stay , Leukemia/psychology , Mental Disorders/etiology , Neoplasms/therapy , Parents , Practice Guidelines as Topic , Quality Assurance, Health CareABSTRACT
Due to the ongoing activities to introduce the Disease Related Groups into the German health system, the PSAPOH (Psychosocial Working Group of Pediatric Oncology and Hematology) has initiated a multicenter study to evaluate relevant parameters regarding the amount of psychosocial care in children and adolescents suffering from malignant diseases. This study was performed in 26 German hospitals over three months and evaluated the kind of psychosocial interventions, their duration and frequency and, in addition, their quality. The data collected were evaluated according to the diagnosis, the phase of disease when collecting the data, the psychosocial diagnosis and the grade of risk for psychosocial strain (standard strain [S], multidimensional strain [M] and extreme strain [H]). The results showed no significant differences comparing the amount of psychosocial care within the various kinds of hematological-oncological diseases. But, as expected, a significant and statistically proven increase of the frequency and duration of psychosocial treatment was found according to the stage of the disease and the psychosocial strain. The frequency of treatment is increasing up to 70 % comparing groups with standard strain to groups with extreme strain. Summarizing the amount of psychosocial care within the different phases of disease, a calculation of costs will be possible for each patient.
