ID-5184 Wonca Abstracts supplement A-K 13-10-23 - Flipbook - Page 54
WONCA 2023 Supplement 1: WONCA 2023 abstracts (A–K)
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B
Approach to a detached teenager with advanced cancer
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Dr Ellaine Anne Asuncion, Dr Reginald Lee1
1
Rizal Medical Center
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J
K
Background
The field of paediatric palliative care is newly emerging in the Philippines. The characteristics and
medical experiences of children and teens with cancer who receive palliative care are little understood.
There are seemingly insurmountable challenges in caring for them, particularly with regards to effective
communication.
Objective
To present the communication approach to a withdrawn, non-communicative and evasive 14-yearold girl diagnosed with Stage 4 yolk sac tumour with metastasis to her lung and liver. The distorted
self-image brought by her enlarging abdomen was the apparent source of her detachment. She was
attended to for counselling and symptom control.
Outcomes
The initial hurdle for a resident physician was the difficulty discussing the patient’s illness with her
mother. Her mother felt this would only instil hopelessness, which could lead to her depression and
further withdrawal. It was difficult to balance genuine concern and intrusiveness. Most distressing for
a physician was standing in front of a lukewarm patient even after weeks of wooing. With the mentor’s
guidance, a communication style which involved personalisation, storytelling and introduction of
relatable perspectives was utilised. The resident was then able to elicit the patient’s thoughts and
feelings in the presence of the mother. The patient eventually confronted the possibility of death. In the
end, the mother was enlightened that her daughter was beginning to accept reality. From here on, the
resident and the patient began engaging in more meaningful conversations. Expressed bucket lists
were granted before she died.
Conclusion
A timely, consistent and personalised communication style is key to breaking barriers in a patient–
doctor relationship.
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