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Identify the physical social emotional & spiritual needs of ill children with cancer
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Identify the physical social emotional & spiritual needs of ill children with cancer

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A study to identify the physical, social, emotional and spiritual needs of terminally ill children with cancer

Abstract


Cancer is a critical disease that can be considered as a large group with different diseases resent in it. In general there are different types of cancers that impact the human body and among them the terminal cancer is one of the significant cancers. The terminal cancer is the last stage of human life which may directly lead to death.

Even though there are many treatment options for cancer this terminal cancer cannot be cured with any treatments, but it gives temporary relaxation to the individuals. Among the total existing treatments palliative care can be considered as the significant treatment that can be used to treat and care terminal cancer patients.

The main purpose of this study is to identify and evaluate the different types of physical, social, emotional as well as spiritual needs of children who are affected with terminal cancer. This study deals with different types of effects of terminal cancer seen among children along with the symptoms and causes that leads to terminal cancer. The different stages included in terminal cancer disease will be identified within this study.

This study even specifies the detailed overview on palliative care process to be offered to terminally ill children and even identifies the role of palliative care in treating children suffering from terminal cancer. This study specifies different aspects and elements involved in palliative care process which are to be offered to the children.

This study gives a clear idea on two main aspects which are the physiological, psychosocial and spiritual needs of terminal cancer in Children of United Kingdom and the protective guidelines in order to improve the needs of terminally ill children suffering from cancer by creating health awareness among parents. The main reason behind conducting this research is to identify the different factors that are causing terminal cancer and propose different guidelines to the parents dealing with terminally ill children.

After completing this research process, researcher will specify new recommendations to the readers related to terminal cancer, terminal illness and palliative care process which gives them a clear idea on the type of care to be offered to the children suffering from terminal cancer.

Key Words


Terminal cancer, Terminal illness, Palliative Care, Chemotherapy, Radiotherapy, Physical needs, Social needs, Spiritual needs, Psychological needs, Parents, Caregivers, Hospitals and UK.   

Table of Contents


Chapter 1

Introduction to the research

1.1 Aim

1.2 Objectives

1.3 Introduction

1.4 Summary

Chapter2

Research Methodology

2.1 Chapter introduction

2.2 Overview of Methodology

2.3 Research Method selected

2.4 Research Design

2.5 Data collection method

2.6 Rationale of Literature Review

2.7 Inclusion and Exclusion Criteria

2.7.1 Inclusion criteria

2.7.2 Exclusion criteria

2.8 Databases Used

2.9 Data analysis process

2.10 Reliability of the data

2.11 Validation

2.12 Ethical considerations

2.13 Summary of the chapter

Chapter 3

Main body

3.1 Introduction

3.2 Achievement of research objectives

3.3 Terminal cancer in children

3.4 Terminal illness phase

3.5 Physical symptoms and care options for the terminally ill children

3.6 Physical needs of terminally ill children with cancer

3.7 Psycho-socio needs of the terminally ill children

3.8 Spiritual needs of terminally ill children

3.9 Emotional needs of terminally ill children

3.10 Other needs of terminally ill children

3.11 Stress management process for the terminally ill children

3.12 Importance of chemotherapy for cancer patients

3.13 Significant symptoms of Terminal cancer

3.8 To identify the palliative care support needed for children with a terminal cancer from their parents and care givers

3.8.1 Palliative Care

3.8.2 Overview of palliative care

3.8.3 Principles and components of palliative care

3.8.4 Home care concept for terminally ill children

3.8.5 Role of parents in palliative care

3.8.6 Role of radiotherapy in palliative care

3.8.7 Palliative care offered to terminally ill children

3.8.9 Accessing and compassionating palliative care

3.8.10 Caregivers role in palliative care

3.8.11 Role of social support in palliative care

3.8.12 Role of research and education in palliative care

3.8.13 Role of hospitals in managing palliative care

3.8.14 Discussions on palliative care

3.9 To identify the support needed for the parents and carers of children with a terminal cancer

3.9.1 Respect for dignity of patients and family

3.9.2 Discussion on parents dealing with terminal ill children

3.10 Parents dealing with children suffering with terminal illness and cancer

3.11 To provide the guidelines and create awareness among the people to protect their children from terminal cancer in United Kingdom

3.11.1 Number of childhood cancer cases in UK

3.11.2 Child cancer deaths in UK

3.11.3 Childhood cancer deaths in UK around 2007-2009

3.12 Guidelines to parents for creating awareness on terminal cancer and terminal illness

Chapter 4

Discussions and Conclusion

4.1 Findings

4.2 Discussions

4.3 Implications

4.4 Conclusion

4.5 Future work

4.6 Limitations

References and Bibliography

Appendix

 

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RE: Identify the physical social emotional & spiritual needs of ill children

Chapter 1

Introduction to the research

Introduction is an important chapter that gives detailed information on research aims and objectives to be achieved in order to complete the research process successfully.  This chapter also gives an introduction to the research process that illustrates the definition of research topic.

1.1 Aim

The main aim of this research to identify the physical, social, emotional and spiritual needs of terminally ill children suffering with cancer

1.2 Objectives

The main objectives of this research are

  • To identify the physical, social, emotional and psychological needs of children suffering with terminal illness and terminal cancer
  • To identify the effective levels, symptoms and causes of terminal illness and terminal cancer among children
  • To identify the palliative care support needed for children with a terminal cancer from their parents and care givers
  • To specify guidelines to parents in order to protect their children from terminal cancer in United Kingdom

1.3 Introduction

According to Christ and Christ (2006)[13], terminal illness is the type of disease and infection which is not having treatment that directly leads to the death of individual. The terminal illness can be considered as the serious disease, because it is not having any cure, treatment and control measures. The terminal cancer is the typical disease that directly shows the major impact on the infected person along with the people around them. If the cancer is in initial stage then its risk levels are less but if the cancer is identified as terminal then the person will die with this disease (Price and Mc Neilly 2009)[70].

 According to Wolfe et al (2000) [92] children with terminal illness demonstrate symptoms which include

  • Feeling loneliness and disturbed
  • The intense and angry feelings
  • Lack of resistant power
  • Lack of power for handling typical situations
  • Depending on actual situations
  • Sudden and unexpected pains
  • Irritation and frustration
  • Sudden repudiations
  • Tiredness and nervous feelings
  • Intense worries and suspicious feelings
  • Trauma related issues
  • Sadness and loneliness (Price, J, McNeilly, P and McFarlane, M 2005)[69]

Among the symptoms that appear in the last days of death in a child, 30 percentages of parents have informed about the treatment of pain being successful and 10 percentages reported that nausea and vomiting or constipation was cured to some extend (Hechler et al, 2008)[41]. Fatigue is the most significant symptom complained by parents of affected children and it is said that they suffered a lot from it. The reason for fatigue in children with cancer are multifactorial and it occurs on account of the natural progression of disease, low nutritional status depression and anaemia (Kinney, 1995).Although treatment of these symptoms are seldom successful, eliminating the causative factors can relieve this suffering to a great extent. These symptoms when untreated can lead to palliation (Landis et al, 1999)[53].

Dehlin et.al (2009)[23] stated that generally, many healthcare professionals argue that if cancer is identified as terminal then there is no cure for this disease and it can directly lead to the death of the individual. However many other professionals argue that even though terminal illness and cancer cannot be cured completely, it does not mean that this disease is not having any treatment Nayak, 2001)[62]. They state that treatment is available for cancer. It can be a time taking process and the effectiveness of treatment can take a long time.

According to Langton (2000)[54] the main responsibility of the parents is to identity the levels of disease in their children and should be aware of preventive measure in order to protect their children from further complications. The young children are more affected with these disease rather than the adult ones and for this reason parents should support their children by creating awareness in their children about terminal cancer (Woodgate, R and Denger ,L 2003)[95]. They should spent more time with the children and should help them to gain confidence to go through their disease phase. The first and foremost step is that the parents should be capable of managing their own emotions and feelings while dealing with their children and they should make their children tension free (Dehlin et.al 2009).


1.4 Summary
Children with cancer have multiple complex needs and the needs of the parents are also an important consideration for all health professionals. This chapter specified the detailed information on aims and objectives of the research process and also introduced terminal cancer with their definition and symptoms.
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RE: Identify the physical social emotional & spiritual needs of ill children

Chapter2

Research Methodology

2.1 Chapter introduction

This chapter introduces diverse research methods that are used in the research process in order to gather the essential research information. The secondary data collection method is used in the research process for finding the appropriate information on effects of terminal cancer among children. The reliability and validity of the research data explains the trustworthiness of the research study.

2.2 Overview of Methodology

In views of Holloway & Wheeler (2002)[40] methodology can be considered as the significant aspect that contains wide range of methods and approaches which can be used to solve various problems in the research process. Research methods are categorized into two different types such as quantitative research method as well as qualitative research method. Within the existing research methods, specific type of research method will be considered based on research requirements.

2.3 Research Method selected

The proposed study is a literature based study that and within this research process the primary data sources like peer reviewed articles, journals and web documents proposed by earlier scholars on terminal cancer and terminal illness are taken into consideration.

In this research process the quantitative research method and its data sources are used in order to gather the fundamental information on the terminal cancer and terminal illness. According to views of Polit & Beck (2008)[68], quantitative research method includes earlier experiences of scholars and authors on specific topics. Quantitative research method is widely used for literature based research studies because literature studies include discussions, conclusions, justifications and critics on different topics proposed by various scholars. Whereas, quantitative research method includes the earlier experiences of scholars and authors on different topics and for this particular reason quantitative research method is used in this research process. By using different data sources of quantitative research method, researcher gathered important information on terminal cancer and terminal illness from published scholarly articles, journals, book reviews and web documents from internet sources. The information gathered from these sources is analyzed critically in order to get final expected result.

According to Macnee & McCabe (2008)[55], quantitative research method can be used to answer different types of research questions like where, why and what. By using this researcher method, researcher can answer different questions on where the terminal cancer disease levels are high, why terminal cancer is not been cured and what are the actual preventive measures that can be followed to reduce disease effects of terminal cancer. In order to answer these questions, researcher used different quantitative data sources.

2.4 Research Design

Mason (2002)[56] stated that research design process is used to convert the research questions into the testing process in order to get the expected results and outcomes. Usually, two different research designs exist in the research process such as experimental research design and non-experimental research design which are been taken into consideration depending on the research requirements.

According to Mason (2002)[56], for quantitative based research studies non-experimental research design is used through which researcher designed different research questions on terminal cancer and terminal illness. By using non-experimental research design process, researcher prepared some research questions that why terminal cancer is not getting cured permanently, why palliative care process is not successful in treating children with terminal cancer, why terminally ill children suffering with cancer are ending their lives etc. By using this non- experimental research design approach which is associated with quantitative research method, researcher gathered opinions of different scholars on terminal cancer and terminal illness. After reviewing and analyzing their approaches, researcher identified that there is an increased incidence of children suffering from terminal cancer in the United Kingdom. This is making them to lose their interest towards their lives. As this terminal illness is not having permanent cure and treatment options, terminal cancer deaths are increasing in UK. Even though there are many health institutions and hospitals to treat the terminal cancer children, yet they are not successful in eliminating the incidence levels in UK children. Researcher states that still there is a requirement of huge support and motivation from local government to the hospitals and healthcare institutions in order to support the terminal cancer children by offering more palliative care facilities.

2.5 Data collection method

In views of Burns & Grove (2009)[11] data collection process is playing vital role in entire research process through which the essential research information on terminal cancer and terminal illness can be gathered and analyzed. Data collection process is playing key role in the research process because the actual research data which is required to fulfil the research requirements can be gathered only by using specific type of data collection sources.

 Usually, two different types of data collection methods exist in the research process such as primary data collection method and secondary data collection method. By using secondary data collection sources, researcher gathered information on terminal cancer and terminal illness and their needs and palliative care measures for treating cancer children from literature based scholarly articles, nursing journals and web documents and finally analyzed them critically to get the actual justification on terminal cancer effects (Cresswell,2007)[17].

Secondary data collection method is used within this research process because this is a literature based study that includes different discussions and justifications of scholars and authors on specific topics. Secondary data collection method involves data collection sources like scholarly and peer reviewed articles and journals that are specified by scholars and authors. For this particular reason, secondary data collection method is widely used in this research process (Sasha Hurrell, 2004)[73].

However the researcher’s knowledge plays a key role in completing the research process successfully because in order to gather the information from any data collection source the researcher should initially know how to collect the information and how to analyze it according to the research requirements.

2.6 Rationale of Literature Review


Bowling, A & Ebrahim, S. (2005)[9] stated that different radical changes have taken place within the science and technology background resulting in demand of huge data collection. In order to overcome different challenges related to health studies several number of research works are been carried out by scholars and authors in order to give clear justification on science based aspects. At this particular situation, literature reviews are playing key role in finding appropriate scholarly reviews of experienced scholars and authors on different aspects which allow the researcher to find significant information on the selected research topic. Different types of discussions on literature based studies will be taken into consideration in order to fulfil the actual research discussions of the research topic. In general, different types of literature searches are available through which researcher can easily obtain significant information on the selected topic. This research study is based on literature searchers of terminal cancer, terminal illness and palliative care. By using earlier experiences, discussions and views of different scholars on terminal cancer, terminal illness and palliative care, researcher selected some important discussions and analyzed them critically within the literature review chapter. In order to complete the research process successfully, the important and foremost step is to find the appropriate articles and journals that suits best for the literature discussions which clearly justifies the actual results required.

In the literature based studies, the basic key words play vital role in identifying the appropriate searches related to the research process. By making use of specific key words, the essential information can be found and gathered easily. The main key words of this literature based research study are “Terminal Cancer”, “Terminal Illness”, “Palliative Care”, “Chemotherapy”, “Radiotherapy”, “Physical needs, Social needs, Spiritual needs, Psychological needs of terminally ill children”, “ Parents”, “Caregivers” and Hospitals etc. By making use of these key words, researcher searched the important information required for the research process and analyzed them critically in order to get the final expected output.

2.7 Inclusion and Exclusion Criteria


2.7.1 Inclusion criteria

The inclusion criteria of this research study are the published and scholarly articles, peer- reviewed journals, book reviews and web documents. The recent literature searches from the year 2000-2012 are taken into consideration and are reviewed and analyzed critically. Different types of scholarly articles and peer reviewed journals on terminal cancer, terminal illness, terminal cancer and palliative care are taken into consideration and are analyzed and evaluate critically. The literature search of this research study includes discussions and critics on terminal cancer, terminal illness and palliative care and for this particular reason only peer reviewed articles and journals are used in the research process.

2.7.2 Exclusion criteria

The exclusion criteria of this research study are the editorials, participant opinions survey results are excluded from this research as they vague in credibility. This is a literature based study related to quantitative research study in which the qualitative data sources like surveys, focus groups, semi structured interviews, group discussions and questionnaires are excluded. As discussed earlier, this is a literature based studies in which the discussions and justifications of scholars should be included rather than the statistical and survey results.

2.8 Databases Used

The different types of data bases are used and accessed within this research process such as WHO, NHS, DHS and Cancer institute. Especially, the website of Liverpool John Moores University website and Library resources are used in order to gather the essential research information. Some of the other important databases like CINAHL Plus, MEDLINE, PsycINFO, Ezine articles as well as PsycArticles are used.

By using the above mentioned databases, different types of articles, journals, case studies and web documents on terminal cancer, terminal illness and palliative care are taken into consideration. All the above mentioned databases includes different articles and journals related to science based topics in which any researcher can easily gather the opinions of scholars and authors on specific topic.

2.9 Data analysis process

According to LoBiondo-Wood & Haber (2010)[52], data analysis is the process which is widely used for analyzing and evaluating the research data and information in order to obtain final outputs. The required research data on terminal cancer, terminal illness and palliative care is gathered from different data secondary data collection sources and analyzed it according to the research requirements. Depending on the type of research method used in the data collection process, different types of research techniques are used to analyze the research data. Within this research process quantitative research method is used and for this particular reason the research techniques of quantitative research method are utilized for analyzing the data. By making use of data analysis process the significant research data can be investigated and analyzed. The data analysis of this research process is used to analyze the information on terminal illness, terminal cancer and palliative care. The researcher gathered and analyzed the existing data on terminal cancer and terminal illness and finally identified the actual measures to be taken for treating cancer children. In order to fulfill the research gaps research made some peer justifications on literature findings of terminal cancer and terminal illness. Within the data analysis process, researcher nearly reviewed around 15 peer articles and journals and nearly around 80-100 scholars discussions on terminal cancer, terminal illness and palliative care and its sources are already mentioned in the reference list of bibliography.

2.10 Reliability of the data

Reliability is the process that can be used to identify the quality and standard of the data used in the research process. The data sources of quantitative research method like articles and peer journals are used in this study that includes the earlier opinions and views of scholars on terminal cancer, terminal illness and palliative care process. Researcher gathered the required information from these sources and analyzed them in a reliable manner without violating the scholar’s information.  The data analysis process is carried out according to researcher knowledge and interest. Researcher just gathered the opinions and views of the authors but their information was not copied. The research reliability can be identified by the justifications given by the researcher on literature searches of terminal cancer and terminal illness (Saunders et.al, 2006)[74].

2.11 Validation

Validation is the process that can be used to identify the rational and justification of the research data. The data used in the research process can be validated by using internal and external validations through which the final justifications and outputs of the research study can be identified. The final justification of this research study is that terminal cancer and terminal illness are not having any treatment options which directly lead to child deaths. At this particular situation, palliative care can be offered to terminally ill children suffering with terminal cancer in order to give temporary relief to the children.

The justifications made by the researcher about terminal cancer can be used to identify the actual validity of the research data used. By using the data analysis process, each and every article and journal considered in the research process is analyzed critically and are reviewed in a reliable manner in order to give a final conclusion on this research study.  Especially, internet and library books are used to gather the articles and journals on terminal cancer, terminal illness and palliative care process. Finally after reviewing peer articles and journals research justifies that terminal cancer treatment options should be increased in order to save the lives of children who are suffering from terminal cancer disease.

2.12 Ethical considerations

An ethical consideration is the significant process that can be used to identify the research skills of the researcher. Researcher used different data sources of quantitative research method in order to gather appropriate information on terminal cancer, terminal illness and palliative care process. While gathering the information from these sources, researcher followed all ethics and principles by following the authentication methods required to gather the data from these sources. The data reliability and validation processes can be used to identify the research skills and knowledge of the researcher. In the entire data collection process, researcher have not violated or copied any scholars or authors information through which the actual interest of the researcher towards the research study can be identified. The ethics are always important for literature based studies because literature review aspect includes different opinions and discussions of authors and scholars on specific topics. The researcher who is using the literature sources should always follow the research ethics in order to accept the author’s confidentiality towards their proposed literature studies.

2.13 Summary of the chapter

The detailed information on the quantitative research method and its data sources used to gather the information on terminal cancer and terminal illness is explained within this chapter. In this chapter the researcher used literature based study in which quantitative research method and secondary data collection sources are used. By using all these data sources like published articles and journals, researcher successfully gathered the fundamental research information required to the research process. Finally this chapter summarizes that literature based research is considered as the best research method for this study.

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Terminal cancer in children

Main body

3.1 Introduction

Main body is an important chapter in this research work as it holds significant factual information on the research contents. Researcher can expect actual and reliable information from this study and he can even justify the same using some of the most reliable sources of information like internet, journals,    articles and books reviewed by earlier research students of same subjects. This study has used reliable sources for collecting data and has analyzed it to match the research requirements.

Researcher used different secondary data collection method and its resources related to quantitative research method in order to gather the required information on terminal cancer, terminal illness and palliative care process. The detailed information on these objectives is explained here.

3.2 Achievement of research objectives


The research objectives of the research process are as follows:

  • To identify the physical, social, emotional and psychological needs of children suffering with terminal illness and terminal cancer
  • To identify the effective levels, symptoms and causes of terminal illness and terminal cancer among children
  • To identify the palliative care support needed for children with a terminal cancer from their parents and care givers
  • To provide the guidelines and create awareness among the people to protect their children from terminal cancer in United Kingdom

3.3 Terminal cancer in children


As per the opinion of Anand Kunnumakkara (2008)[4], there are many factors responsible for the cause of cancer disease. There are different environmental as well as genetic factors which can lead to cancer like dreaded disease. Stem cells in the human body have capacity to generate different types of cells required for the human body. Generally speaking, cancers found in children are genetic in nature and start within the stem cells of human bodies. Due to the periodic mutation process and the cell exchange process, there exists higher risk of cancer causation among the children (Kinzler. Kenneth, W. Vogelstein, Bert (2002)[46].

 Exposure to environmental hazards may also be one of the prime reasons for the cause of cancer like fatal diseases found in children. Environments like industry premises and surrounding where chemical emissions are liberated   on a high level and on a regular basis pose a great threat to people living in the nearby localities and especially the children are more prone to develop cancer like symptoms (Christ and Christ, 2006)[16].

According to Daniel et al (2005), eating habits, overweight, smoking habits, heavy alcohol consumption, environmental factors, cell mutation are some of the main factors that result in the formation of cancer like disease in human bodies. However, it can be understood that, as children are not habitual to consumption of alcohol or cigarettes, there exists some other factors which are responsible for the cause of cancer in children during their childhood. This is evidence that cancer depends on many different factors and these factors may change from person to person. As the treatment procedure for children and adults is different, this study is therefore important.

According to Collins and Berde (1997)[14], there is a wide gap between the survival rates of adults who suffer from cancer and children with cancer. It is a natural fact that growing children have better immunity and resistance to diseases as compared to adults and this is the main reason why children respond to cancer treatment very positively as compared to adults. The survival rate of children suffering from cancer is 72% as compared to the survival rate of adults which is only 60% which proves that children respond well to cancer treatment. Kinney HC (1995) stated that despite of the above mentioned fact, pain due to the disease in children is more severe in children as compared to adults as adults are more capable of bearing the cancer pain may be due to their preparedness or attitude towards life where as children due to their innocence or ignorance to the disease face sufferings when it comes to pain. In order to prevent or avoid this suffering from pain, there is a need for therapies to curb this pain in children (Collins, J. J. 1996)[15].

World Health Organization (WHO)[96] opines that several factors can lead to cancer disease such as lifestyle, family history, genetic factors, food habits, environmental exposure etc. Among the above mentioned factors, the lifestyle factor is believed to influence the children to a much higher degree as it includes a variety of activities like drinking, smoking, fashion, entertainment, etc because of which children are prone to one or the other type of cancer. Intake of drugs, tattoos, and alcohol has become a status symbol nowadays due to which more and more number of children are attracted towards these harmful habits which rewards them with a cancer like fatal disease. Normally, students and children who are away from their parents due to any reason are more prone to develop cancer like diseases which is derived from lifestyle factors. So there is a great need for the parents to understand that children are an integral part of our society and are tomorrow’s able citizens. It is their ethical and moral duty to refrain their kids from such harmful habits which may result in death or a meaningless life. Proper care should be taken on children’s health, habits and intellectual growth so that child does not get attracted towards artificial pleasures of life which are but an illusion.

Knudson, AG (2001)[47], opines that genetic factors that are derived from parents are also primary cause for cancer in children. As per the report generated by the WHO-World Health Organization [98], every family is likely to have one member in the family suffering from cancer disease; it can be an adult or a child. Our immune system always protects us from many diseases that may cause serious damage to our body or life. Immune system protects us from diseases by providing inner strength in the form of resistance against diseases and saves our body and life. Due to the genetic disorders, immune system of body is severely affected resulting in cancer in children who are at high risk of developing cancer. In our body, bone marrow is responsible for storing and production of stem cells. Stem cells present in bone marrow are affected adversely due to genetic disorders resulting in cancer. Childhood cancer is mainly due to genetic disorders.

As per the opinion of Samaras, Vassilis (2010)[72], among the various cancer causing viruses, Hodgkin’s and the non-Hodgkin’s lymphoma are the viruses mainly responsible for cancer in children. These two viruses reproduce the cancer cells continuously in the body of children and make sure that cancer spreads rapidly within the body and damage the immune system of the child. In fact, many research studies have shown with evidence that fertilizers and pesticides are very active in causing cancer like fatal diseases in children.

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Terminal illness phase

3.4 Terminal illness phase


Terminal illness phase involves 5 phases namely the diagnosis phase, acute phase, chronic phase, recovery phase and terminal phase. These phases are according to the report presented by Asbestos research center (2003)[5]. It can be understood from the name of the phases that if a patient approaches during any of the first four phases then his chances of survival are good as treatment will work effectively on his however once he attains the fifth or the terminal stage then his chances of survival are grim and risk of death is more certain.

According to NCI- National Cancer Institute (2009)[60] the first phase or the diagnosis phase is important phase as it studies the symptoms of the disease and provides an initial investigation if weather the patient is likely to suffer from cancer or not. It can direct the patient on what are the necessary tests that need to be conducted to prove that the patient suffers from terminal illness disease.

Arc (2003), opines that when the patient begins the diagnosis for treatment, the next phase or acute phases commences. During this phase, the patient comes to know the details about the disease and its treatment procedure. As the identification and treatment is done, the patient is free to take care and observe the precautions that are advised by his physician.

During the chronic phase, according to ARC (2003), the patient normally completes his treatment and waits for results. This phase is critical as things need to be gauged from both ways as there are side effects on the body due to the prolonged treatment procedure and intake of medicines which can be harmful to the patient.

The fourth phase of terminal phase is the recovery phase. This phase does not necessarily mean that the concerned patient has recovered from the disease but it simply implies that the patient is ready or prepared to face the physical, financial, psycho-social etc. In this stage, the person or the patient adapts himself to the health changes due to terminal illness and acquires the ability to face the reality of life (De Braud F., Cascinu, S., Gatta, G. 2004)[21].

The most feared stage is the fifth stage which means death to most of the affected patients. Many patients who are unfortunate fail in the fourth phase of treatment due to some reason and face death in the fifth stage. However, if proper treatment is given and medications are followed properly, then fifth stage can offer life to the terminally ill patients. 

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Physical symptoms and care options for the terminally ill children

3.5 Physical symptoms and care options for the terminally ill children


According to Hawkins et al (2005)[39], terminal cancer will adversely impact the patient psychologically and can be called as a disease of dreaded nature. The patient will also have to endure many physical pains as well. When children suffer from such a dreaded disease, child’s family and the community take the first step towards the treatment procedure and care giving along with the health professionals. Even if the disease is common to both, the children and adults, children need to be dealt with proper care and affection (Segerstrom, S., Miller, G. 2004)[77].

Powling & Hawkins, N. A. (2005)[65] stated that as children are emotional in nature and dependent on the family for their wants and needs, they cannot understand the impact of cancer like diseases on life and it is the ethical and moral responsibility of the family members to make sure that their child is not isolated and treated at par with the same love and compassion. This attitude builds positivity and optimism which is a great strength in itself capable of changing ones vision towards life and can act as a cure for many mental diseases (Amato R., Cohen, L., Gilani, Z., Hall, M., Moor, C., Sterner, J., & Warneke, 2002)[2].

As per the opinion of Ditto et al (2005)[25], children or patients who are the victims of terminal illness undergo several other pains both on the physical as well mental plane. They are prone to problems like emotional, psychological, spiritual, social etc. These different factors keep the patient in constant distress and appear as time elapses with the development of terminal illness. With each factor against the body and mind mechanism, patient suffers from all the angles and finds helpless.

Among the above mentioned different factors, physical pain is severe and unbearable to the patient and at times physical pain can induce suicidal thoughts in patient’s mind.

Block and Susan (2006)[8] opine that psychological problems can cause damage to the patient’s brain due to the presence of terminal illness within. These psychological problems can further lead to behavioural disorders. At times, these psychological disorders may be out of control and sometimes irreparable. In worse conditions, this can lead to disturbances in domestic front leading to problems like emotional problems, financial problems, death fear, family concern or worry, etc. In such conditions it is always advisable to divert one’s mind towards something creative. Patients of such conditions try to engage themselves in some creative activities so that they can get rid of all sorts of disturbances arising from pessimistic attitude due to cancer. This can save them from negative thoughts and can act as a soothing balm providing them with the much needed peace of mind and mental happiness. Finally it all depends on how one’s approach towards the disease is and how one reacts to the problem (Danaei, G., Vander,H. S., Lopez, A.D., Murray, C. J, Ezzati, M (2005)[20].

Psychological and the emotional trauma of the patient goes through the body and eventually affect the patient’s body and the patient keeps losing his energy or strength in all aspects of his individuality. Psychological disturbances will lead to mental disorders further causing greater damage to other aspects of patient’s individuality. Emotional problems will lead to disorders due to which the concerned person or the patient will have to face social problems as far as relation with his friends or   relative is concerned. The patient simply cannot control his emotions and undergoes emotional distress resulting in psychological disorders (Segerstorm and Miller, 2004).

12-10-2012 11:20 PM
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Physical needs of terminally ill children with cancer

3.6 Physical needs of terminally ill children with cancer


In view of Earle et al (2004)[27][28][29], there are various ways available for the patient to get rid of distress due to terminal illness. Factors like physical distress, emotional distress, and psychological distress can easily be overcome provided children are given adequate attention by the elderly and treated compassionately. As wants and likes differ from child to child, so does it imply that depending upon the child’s attitude, their family members must fine tune their behavior to build his optimism and positive attitude towards life.

As per the opinion of Staton, Shuy, and Byock (2001)[75], adequate sleep is a must for any child. It forms one of the most important needs of any child. Sleep acts like a rejuvenating agent providing ample relaxation and relief to the whole body and mind. It is the job of parents to ensure that their child gets enough hours of sleep. Parents should make sure that their children are provided with a nutrition rich diet in order to maintain sound health condition of their children.

Parents should find ways or activities which can keep their children busy so their mind is engaged in any creative activity in order to divert their attention. Interesting activities and hobbies which are liked by the child not only keep him busy but also change his perspective towards positivity and alter his thoughts towards optimism. These changes can help a lot in the course of treatment and act as a positive force for speedy recovery from such ailments. 

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Psycho-socio needs of the terminally ill children

3.7 Psycho-socio needs of the terminally ill children


Versenyi and Westaby (2005)[86], opine that diversion therapy can help a lot in curing psychological stress arising from terminal illness among children. This therapy must be selected on the basis of child’s interest in order to be effective. As the name implies, diversion therapy diverts the child’s mind from the illness and provides a new outlook to the affected child. It relieves the child from the same thought of depression that naturally comes due to terminal illness.

It lets the child to be more active and focused on things that are of creative nature like activities, watching TV, reading interesting books, play games etc. Such simple yet effective techniques can really help a child to come out of emotional trauma or psychological distress that arises from terminal illness.

Goldsteen et al (2006)[36], opines that children should be allowed to mingle with their loved ones like their friends or close ones. This enables them to communicate their concerns and problems which in itself give a therapeutic effect to their emotional problems. This activity will certainly relieve them from stress and strain on their little brains. 

12-10-2012 11:21 PM
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Spiritual needs of terminally ill children

3.8 Spiritual needs of terminally ill children

Staton et al (2004)[76], opines that spirituality has the power to induce new hope in children. Tales of trust, bravery, hope will build new courage in the child which acts as a resistance against the disease. In turn, the confidence so acquired will help the child to maintain and gain emotional strength and stability. These factors matter a lot in the entire course of treatment as they work like medicine. Through spirituality, child can understand the meaning of life.

There are various sources through which the affected child can access spirituality like Television, radio, books, music, culture, arts etc. These enable the child to divert its focus from terminal illness to something creative and positive. It further provides with the much needed peace of mind, relaxation to the body and mind, and forget anxiety (Staton, J., Shuy, R., & Byock, I.2001)[79].

12-10-2012 11:22 PM
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Emotional needs of terminally ill children

3.9 Emotional needs of terminally ill children


Feldman (2008)[31], opines that cancer patients experience two types of emotions namely intrinsic and extrinsic emotions. Parents should be able to patiently control and manage their child’s emotions. Giving proper attention to what the child says is the first step towards achieving the desired results in child’s emotional and physical balance. When child’s concerns are paid attention, the children automatically build their confidence in their parents and family members whom they really love and trust. This can be achieved only through proper communication and active interest in children.

Child’s trust needs to build in his parents because parents are the best care takers and family members are the first best friends. When children are given proper love and attention, it naturally develops their overall individuality and improves their performance in whatever activity they are engaged in. This is strongly recommended to parents as it will go parallel to the treatment procedure, enabling faster recovery from disease. 

12-10-2012 11:22 PM
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