Psycho-Oncology and
Paediatric psycho-oncology
in Serbia – present status
MA Tamara Klikovac, psychologist, families’
psyc...
 This presentation will discuss
situation in the field of Psycho-
Oncology and especially in the
Pediatric psycho-oncolog...
EPIDEMIOLOGICAL DATA
7,5 million people live in
Serbia.
 There are approximately
30.000 new disease cases of
adult cancer...
BELGRADE DURING THE
BOMBING
PSYCHO-ONCOLOGY
 In our society exists a lack of
attention towards psycho-social
needs of cancer patients and their
famil...
EXAMPLES FOR TRADITIONAL
MEDICAL MODEL
Myths:
Doctor is God
Doctor knows the best
Doctor is a leader of treatment
and doct...
ACTUAL SITUATION
 Psycho-Oncology is a relatively new
and young scientific discipline in our
environment.
 Especially, p...
TREATMENT OF CANCER PATIENTS
WITHOUT PSYCHOLOGICAL SUPPORT
The second part of the
compound word
Psycho-ONCOLOGY is
much de...
ACTUAL SITUATION
 There are 5 hemato-oncology
departments for children and adolescents
around Serbia
(3 departments in Be...
PRESENT STATUS
1. There are only two psychologists in
oncology practice, who work with adult
patients.
For example, there ...
3. There aren”t possibilities for
education and specialization in
psycho-oncology and PPC, too.
PRESENT STATUS
4. Medical doctors, oncologists,
radiotherapists, oncology
nurses do not have necessary
education and continual
training p...
We established Serbian Association for
Psycho-oncology – SAPO in 2007
The main problem is that we don`t have
support of go...
MAIN GOALS OF SAPO
WWW.SAPO.ORG.RS
 start developing Psycho-
oncology in Serbia
 start disseminating the
culture of psyc...
PEDIATRIC PSYCHO-ONCOLOGY –
WHAT WE DONE AND WHAT ARE WE
DOING
 We started cooperation with
National parent organization ...
Education of Medical staff - Pediatric
Oncology Ward
Education of Medical staff - Pediatric
Oncology Ward
Education of Medical staff – Department for hemato-
oncology, University Children`s hospital Belgrade
Education of Medical staff – Department for
hemato-oncology, Children`s hospital Novi Sad
Education of Medical staff – Department for
hemato-oncology, Children`s hospital Novi Sad
Education of Medical staff – Department for
hemato-oncology, Children`s hospital Nis
Children doctors in action
Children doctors in action
Children doctors in action
Children doctors in action
Together play
Boy with his sick doll named Pera
Computer game
Stimulative game with boy who have brain tumor and
difficulties with normal mental developing
Active play with psychologist
Active play with psychologist
Psychological workshops
 Psychological workshops are
method of psychological, psycho-
educational and psycho-
therapeutic...
Psychological workshops
 stimulate pleasant feelings and
positive thinking
 alleviate stressful and traumatic
experience...
Rules of workshops
 everybody sits or lie in circle
 they listen each other and has the right
to be heard
 respect each...
Different topics and scenes of
workshop
 My positive- negative feelings
 My fears
 My anger
 My love
 How to express ...
Psychological workshops
Workshop with psychologist
CHILDREN`S EVALUATION
PLACE FOR RELAXATION
PLACE FOR RELAXATION
Future short and long term plans
 Education for young psychologists
 Work with medical staff – training courses in
empat...
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  1. 1. Psycho-Oncology and Paediatric 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. 2.  This presentation will discuss situation in the field of Psycho- Oncology and especially in the Pediatric 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. 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. 4. BELGRADE DURING THE BOMBING
  5. 5. PSYCHO-ONCOLOGY  In our society exists a lack of attention towards psycho-social needs of cancer patients and their families (psychological, social or spiritual needs; problems are overlooked and rejected).  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. 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 patients Nurses are unkind and arrogant
  7. 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 isn`t systematic integration of psycho-oncology in oncology care.
  8. 8. TREATMENT OF CANCER PATIENTS WITHOUT PSYCHOLOGICAL SUPPORT The second part of the compound word Psycho-ONCOLOGY is much developed in our environment than the first one – PSYCHO.
  9. 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 aren`t hospices,day care centers for children  There aren`t specialized home care teams  Our families with dying 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. 10. PRESENT STATUS 1. There are only two psychologists in oncology practice, who work with adult patients. For example, there are seven oncology centers in Serbia but unfortunately, not single one has organized psycho- oncology unit for psychological and social support for cancer patients and their families. 2. There are few theoretical works in psycho-oncology, few scientific articles, few research works,few specialized books and translations in this field
  11. 11. 3. There aren”t possibilities for education and specialization in psycho-oncology and PPC, too. PRESENT STATUS
  12. 12. 4. Medical doctors, oncologists, radiotherapists, 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. 13. We established Serbian Association for Psycho-oncology – SAPO in 2007 The main problem is that we 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. 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. 15. PEDIATRIC PSYCHO-ONCOLOGY – WHAT WE DONE AND WHAT ARE WE DOING  We started cooperation with National parent organization in the project named “Education in communication skills and Empathy for pediatric medical staff”.  We held education for four medical teams around Serbia, who work with children who suffer cancer  Participants reactions and evaluation of the held education were excellent, but one education isn`t enough.
  16. 16. Education of Medical staff - Pediatric Oncology Ward
  17. 17. Education of Medical staff - Pediatric Oncology Ward
  18. 18. Education of Medical staff – Department for hemato- oncology, University Children`s hospital Belgrade
  19. 19. Education of Medical staff – Department for hemato-oncology, Children`s hospital Novi Sad
  20. 20. Education of Medical staff – Department for hemato-oncology, Children`s hospital Novi Sad
  21. 21. Education of Medical staff – Department for hemato-oncology, Children`s hospital Nis
  22. 22. Children doctors in action
  23. 23. Children doctors in action
  24. 24. Children doctors in action
  25. 25. Children doctors in action
  26. 26. Together play
  27. 27. Boy with his sick doll named Pera
  28. 28. Computer game
  29. 29. Stimulative game with boy who have brain tumor and difficulties with normal mental developing
  30. 30. Active play with psychologist
  31. 31. Active play with psychologist
  32. 32. Psychological workshops  Psychological workshops are method of psychological, psycho- educational and psycho- therapeutical 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. 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. 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.  workshops have topics, aims and introductory, central and final part.
  35. 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. 36. Psychological workshops
  37. 37. Workshop with psychologist
  38. 38. CHILDREN`S EVALUATION
  39. 39. PLACE FOR RELAXATION
  40. 40. PLACE FOR RELAXATION
  41. 41. 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

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