PubMed · 14533228
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It is well recognised that chronic illness in children can have a significant effect upon siblings, but their viewpoints need to be sought if we are to change our practice. We conducted semi-structured interviews at home with 15 siblings (8 males) aged 8-12 years whose brother/sister were on chronic dialysis or had received or were waiting for a renal transplant. The interviews were analysed using a grounded theory approach. The children also completed the Spence Children's Anxiety Scale (SCAS), which revealed no statistically significant evidence that they were exhibiting chronic clinical anxiety. Qualitative data indicated that siblings had a variety of concerns concerning their own health and that of their siblings and worried about the effects on family routine and separation from parents. The siblings felt more protective towards their chronically ill sibling and felt that they themselves needed to be more grown up. The study has implications for our clinical practice in that our psychosocial assessment of families needs to include an assessment of sibling needs and siblings should be involved when preparing patients for chronic renal failure treatment. The importance of maintaining family routines should be emphasised, as well as trying to involve siblings in unit activities.
INTRODUCTION: The announcement of a serious disease to a patient and an adequate information are never easy. Some physicians are more comfortable than others. However, some knowledges on usual reactions of patients and on new rules could be useful. CURRENT KNOWLEDGE AND KEY POINTS: The complete information of the patient is a duty with regard to the law, although it could be facultative in some rare circumstances. The medical confidence has to be respected with all persons, even among close relations of the patient. It is not contradictory with a therapeutic alliance with these close relations. The announcement must be provided by the doctor who first suggested the diagnosis. An anxious reaction is normal. Mechanisms of defence, appropriate or not, are developed by the patient. Nonetheless, precise information seems to be less anxiogenic than non resolved questions. Fears of some physicians, who avoid information, often appear linked to their own anxiety. Nevertheless, good information is associated with adequate words and adequate choice of news. There is need to evaluate knowledges of the patient on his/her disease. FUTURE PROSPECTS: Complete and adequate information must be associated with an early psychological (and sometimes social) help. It appears necessary for well-being of the patient but also maybe for his/her prognosis.
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