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  • 1. Psycho-Oncology and P a ediatric psycho-oncology in Serbia – present status MA Tamara Klikovac, psychologist, families’ psychotherapist , founding president of Serbian Association for Psycho-oncology National Institute for oncology and radiology Serbia, Pediatric oncology Ward, Belgrade Teaching assistant on the “Mental health and Health psychology” on the Faculty of Philosophy, Department for clinical psychology, University of Belgrade
  • 2.
    • This presentation will discuss situation in the field of Psycho-Oncology and especially in the P ediatric psycho-oncology and PPC in Serbia.
    • The aim of this presentation is to introduce the actual problems and obstacles in process of establishing Psycho-oncology and Paediatric Palliative Care in Serbia .
  • 3. EPIDEMIOLOGICAL DATA
    • 7,5 million people live in Serbia .
    • There are approximately 30.000 new disease cases of adult cancer patients and 350 to 400 new cases of childhood cancer each year in Serbia.
    • (We haven `t any cancer register for children yet)
    • (National Institut for Oncology and Radiology, 2007, Epidemiological department)
  • 4. BELGRADE DURING THE BOMBING
  • 5. PSYCHO-ONCOLOGY
    • In our society exist s a lack of attention toward s psycho-social needs of cancer patients and their families (psychological, social or spiritual need s ; problems are overlo o ked and reject ed ) .
    • Traditional medical model with strong attitudinal barriers for psycho-social care for cancer patients and their families during the illness trajectory , is dominant in Serbian hospitals.
  • 6. EXAMPLES FOR TRADITIONAL MEDICAL MODEL
    • Myths:
    • Doctor is God
    • Doctor knows the best
    • Doctor is a leader of treatment and doctor make decission
    • Doctor is dominant, cold person
    • Doctor is a judge
    • Doctor is inaccessible
    • for communication with patien t s
    • Nurses are unkind and arrogant
  • 7. ACTUAL SITUATION
    • Psycho-Oncology is a relatively new and young scientific discipline in our environment.
    • Especially, pediatric psycho-oncology and PPC and PC for adults are at the beginning of it `s development.
    • Health care system in Serbia is still dominated by traditional biomedicine model and biopsychosocial model of medicine has not been established yet .
    • There is n`t systematic integration of psycho-oncology in oncology care.
  • 8. TREATMENT OF CANCER PATIENTS WITHOUT PSYCHOLOGICAL SUPPORT
    • The s econd part of the compound word Psycho- ONCOLOGY is much developed in our environment than the first one – PSYCHO .
  • 9. ACTUAL SITUATION
    • There are 5 hemato-oncology departments for children and adolescents around Serbia
    • (3 departments in Belgrade , 1 department
    • in town of Novi Sad and Nis)
    • There ar e n` t hospices ,day care centers for children
    • There aren ` t specialized home care teams
    • Our families with dyi n g child or adolescent haven`t got any choise / they left hospital when doctors decided to finish treatment.
    • They are alone, without good care and especially psychological care / support during all phases of treatment (before and after the death )
  • 10. PRESENT STATUS
    • There are only two psychologist s in oncology practice , who work with adult patients.
    • For example, there are seven oncology centers in Serbia but unfortunately, not single one ha s organized psycho-oncology unit for psychological and social support for cancer patients and their families.
    • 2. There are few theoretical works in psycho-oncology , f ew scientific articles , f ew research works ,f ew specialized books and translations in this field
  • 11.
    • There aren”t possibilities for education and specialization in psycho-oncology and PPC, too .
    PRESENT STATUS
  • 12.
    • 4. Medical doctors, oncologists, radiotherapist s , oncology nurses do not have necessary education and continual training programs in effective communication skills and empathy, burn-out syndrome and how to cope with, competence in communication and how to work in multi - disciplinary team.
    PRESENT STATUS
  • 13.
    • We established Serbian Association for Psycho-oncology – SAPO in 2007
    • The m ain problem is that w e don`t have support of governmental institutions (especially the Ministry of Health Care), because they don `t recognize psychological needs of cancer patients (children and adults) and their families .
    WHAT WE HAVE DONE AND WHAT ARE WE DOING
  • 14. MAIN GOALS OF SAPO WWW.SAPO.ORG.RS
    • start developing Psycho-oncology in Serbia
    • start disseminating the culture of psychosocial care in oncology
    • promote standards of psychological and social support for cancer patients and their families
    • establish and improve the quality of psychological care in Serbia
    • increase the number of psychologists, psychotherapist or psychiatrists in oncology practice
  • 15. PEDIATRIC PSYCHO-ONCOLOGY – WHAT WE DONE AND WHAT ARE WE DO ING
    • We started cooperation with N ational parent organization in the project named “Education in communication skills and
    • Empathy for pediatric medical staff”.
    • We held education for four medical team s around Serbia, who work with children who suffer cancer
    • Participants reaction s and evaluation of the held education were excellent, but one education isn `t enough.
  • 16. Education of Medical staff - Pediatric Oncology Ward
  • 17. Education of Medical staff - Pediatric Oncology Ward
  • 18. Education of Medical staff – Department for hemato-oncology, University Children `s hospital Belgrade
  • 19. Education of Medical staff – Department for hemato-oncology, Children `s hospital Novi Sad
  • 20. Education of Medical staff – Department for hemato-oncology, Children `s hospital Novi Sad
  • 21. Education of Medical staff – Department for hemato-oncology, Children `s hospital Nis
  • 22. Children doctors in action
  • 23. Children doctors in action
  • 24. Children doctors in action
  • 25. Children doctors in action
  • 26. Together play
  • 27. Boy with his sick doll named Pera
  • 28. Computer game
  • 29. Stimulative game with boy who have brain tumor and difficulties with normal mental developing
  • 30. Active play with psychologist
  • 31. Active play with psychologist
  • 32. Psychological workshops
    • Psychological workshops are method of psychological, psycho-educational and psycho -t herapeutical group work with children and adolescents of various age.
    • Method of support during which ill children and adolescent through circular exchange, through play and role-play, try discussion obtain new experience leading to new realizations and all of it stimulating their further psychological development
  • 33. Psychological workshops
    • stimulate pleasant feelings and positive thinking
    • alleviate stressful and traumatic experiences
    • contribute to agreeable atmosphere on the Ward
    • stimulate exchange and communication between children
    • influence development of creative thinking, diversion and relaxation
    • enhance social competence and information seeking.
  • 34. Rules of workshops
    • everybody sits or lie in circle
    • they listen each other and has the right to be heard
    • respect each other
    • do not interrupt each other.
    • w orkshops have topics, aims and introductory, central and final part.
  • 35. Different topics and scenes of workshop
    • My positive- negative feelings
    • My fears
    • My anger
    • My love
    • How to express feelings?
    • My thoughts
    • Disease and my body
    • My fashion style
    • My identity - who am I?
    • I would like to be...
    • Wishes and needs
    • I dream about....
    • My name is my sing
    • My family
    • My photographs – do I like being photographed?
    • My doctors (for problems) and my grumpy
    • My desease and treatment
    • Communiccation with medical staff
    • Self-confidence and self-esteem
    • I like or don't like
    • Conflicts
    • Death and dying – psychological debrifng when child die at the department
  • 36. Psychological workshops
  • 37. Workshop with psychologist
  • 38.  
  • 39.  
  • 40.  
  • 41.  
  • 42.  
  • 43. CHILDREN `S EVALUATION
  • 44. PLACE FOR RELAXATION
  • 45. PLACE FOR RELAXATION
  • 46. Future short and long term plans
    • Education for young psychologists
    • Work with medical staff – training courses in empathic communication and related to burn-out syndrome
    • Cooperation with Parent`s Association and NURDOR
    • Psychological work with cured children and their families – follow up and reintegration to social environment
    • Psychotherapeutic work with families who have children in terminal phases of the disease
    • Psychotherapeutic work with families after loss of child, during the first phase of family`s grieving process
    • Scietific Investigation