Medical Trauma of Children with Cancer and their Parents

Pediatrični medicinski travmatski stres (PMTS) je set psiholoških in fizioloških odzivov otrok ter njihovih staršev na bolečino, poškodbe, hude bolezni in druge izkušnje z medicinskim okoljem. V neposrednem stiku z medicinskim okoljem se tako lahko pri posamezniku pojavi medicinska travma. Pediatrična oblika raka ima najvišjo prevalenco PMTS, saj vključuje niz stresorjev, ki sprožijo številne negativne psihološke reakcije. Posttravmatski stresni simptomi (PTSS) so eden izmed najpogostejših psihopatologij med onkološkimi bolniki. Z raziskavo smo želeli proučiti prisotnost medicinske travme pri otrocih, obolelih za rakom, in njihovih starših zaradi soočanja s težko boleznijo in zapleti zdravljenja. Zanimalo nas je, katere skupine posameznikov, medicinskih posegov, zapletov in načinov zdravljenja predstavljajo večje tveganje za pojavnost PTSS. V raziskavi je sodelovalo 183 staršev 133 otrok ter 63 otrok in mladostnikov, ki so bili od leta 2009 vodeni na Kliničnem oddelku za otroško hematologijo in onkologijo Pediatrične klinike v Ljubljani. Vključili smo tudi primerjalno skupino otrok in staršev, ki so se od klinične razlikovali po odsotnosti izkušenj s hudo kronično boleznijo. Podatke smo zbrali s pomočjo Lestvice intenzivnosti zdravljenja – IRT-2, Čekliste posttravmatske stresne motnje starši za otroke – PCL-C/PR, Čekliste posttravmatske stresne motnje – PCL-5 in Lestvice simptomov posttravmatske stresne motnje pri otroku – CPSS-5. Ugotovili smo, da je PMTS v veliki meri prisoten tako pri otrocih kot pri njihovih starših ne glede na vrsto bolezni rak, trajanje zdravljenja, izid zdravljenja in starost otroka. Predvsem so tveganju izpostavljene matere, ponovno oboleli pacienti, pacienti, ki so zboleli po petem letu starosti ter pacienti, ki so deležni bolj intenzivnega zdravljenja, in starši le-teh. Ugotovili smo trend upada travmatskih odzivov po več kot petih letih od postavitve diagnoze in da so starši v večji meri travmatizirani kot otroci. Ugotovitve bodo prispevale k sistematičnemu uvajanju ukrepov za preprečevanje PMTS in medicinske travme ter k prizadevanju za oskrbo, ki vključuje zavedanje in ozaveščanje o travmi pri otrocih z rakom.Pediatric medical traumatic stress is a set of children’s and their parents’ psychological and physiological responses to pain, injury, serious illnesses, and other experiences with the medical environment. Medical trauma might occur in direct interaction with the medical environment. Pediatric cancer patients have the highest prevalence of PMTS as the illness involves a set of stressors that trigger many negative psychological reactions. Posttraumatic stress symptoms (PTSS) are one of the most common psychopathologies among cancer patients. We examined the incidence of medical trauma in children with cancer and their parents due to coping with a serious illness and treatment complications. We analysed the following risk factors for PTSS: selected groups of individuals, medical interventions, complications, and treatment modalities. The study involved 183 parents of 133 children and 63 children and adolescents who were treated between 2009 and 2019 at Clinical Department of Pediatric Hematology and Oncology of Pediatric Clinic in Ljubljana. Furthermore, we included a control group of children and parents without experiences of severe chronic illness. We collected the data using The Intensity of treatment rating scale 2.0 [IRT-2], PTSD checklist for Children/Parent [PCL-C/PR], The PTSD Checklist for DSM-5 [PCL-5] and The Child PTSD Symptoms Scale for DSM-5 [CPSS-5]. PMTS is frequently present in both, children and their parents, regardless of the cancer type, treatment duration, treatment outcome, and child’s age. Mothers, patients with relapse, patients who were diagnosed after age 5, patients with more intensive treatment, and parents of the latter are at higher risk for PMTS occurrence. Additionally, we found a decreasing trend of traumatic responses after five or more years post cancer diagnosis and that parents are more traumatized than children. Our findings will contribute to the systematic prevention of PMTS and medical trauma and to endeavour to use trauma-informed care

Pediatric medical stress and trauma

Events related to various illnesses, injuries and chronic conditions, as well as related treatment and medical interventions, represent the most common potential traumatic experiences in childhood. In the article, the author inquires about the occurrence of traumatic stress and medical trauma in children and their families. A theoretical model of long-term somatic threat designed to distinguish between medical trauma and trauma not caused by medical events can be used to identify medical trauma. Various studies report that up to 80% of children and their families experience some traumatic stress in dealing with life-threatening illnesses, injuries or painful medical procedures. About 20-30% of parents and 15-25% of children and their relatives even experience lasting traumatic stress that impedes daily functioning and affects the very course of treatment and recovery. The development and course of pediatric medical trauma is exemplified by the model of pediatric medical traumatic stress, which also outlines the goals of interventions for each stage of the course. In addition to the psychologist, health care staff also play an important role in preventing the trauma that can occur when treating children, adolescents and their parents. All professionals and healthcare professionals should strive to address and care for children, including awareness of and informing about trauma, and thus prevent or reduce the negative effects of trauma that can occur in the medical environment