الفهرس 
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Abstract
Childhood cancer remains the non-accidental leading cause of disease –related mortality among children, as approximately 25% of children diagnosed with cancer eventually die of their disease. So high quality palliative care is now an expected standard (American Academy of Pediatrics, 2000). Palliative Care is the active total care of patients whose disease is not responsive to curative treatment. Control of pain, of other symptoms, and of psychological, social, and spiritual problems is paramount. The goal of palliative care is achievement of the best quality of life for patients and their families care (World Health Organization, 1990). The problem with that definition is the part that states, “patients whose disease is not responsive to curative treatment.” It is the association of palliative care with dying that generates the mistaken belief that one must not refer as a physician, or accept as a parent, a palliative care referral, until all curative therapies have been exhausted. .Therefore palliative care should begin when illness is diagnosed and continues regardless of whether or not a child receives treatment directed at the disease (Himelstein, et al., 2004). According to Field and Behrman (2003): ”Viewed broadly, Palliative care is a multidisciplinary approach that seeks to enhance quality of life in the face of an ultimately terminal condition. Palliative treatments focus on the relief of symptoms (e.g., pain, dyspnea) and 2 conditions (e.g., loneliness) that cause distress and detract from the child’s enjoyment of life. It also seeks to ensure that bereaved families are able to remain functional and intact. Hospice care refers to a package of palliative care services (including, for example, durable medical equipment, and both diagnostic and therapeutic interventions), generally provided at a limited per diem rate by a multidisciplinary group of physicians, nurses, and other personnel, such as religious man, health aides, and bereavement counsellors Palliative care for children shows many differences with adult palliative care: 1) a wider range of conditions, 2) the longer time span of conditions (often years), 3) issues around their physical and intellectual development, 4) the intensity of support needed for the whole family, 5) the presentation of symptoms, 6) the effect s of drugs on young children and 7) legal issues of treating and caring for children I.2 Aim of work Aim of work is constituted of the following objectives: 1. Maintain the quality of life for the terminally ill patients, ensure comfort and attenuate suffering of patients, and their families 2. Provide psychological support as death approaches 3. Create a palliative care team. 3 Chapter Ii Palliative Care II.1 Introduction This statement presents an integrated model for providing palliative care for children living with a life-threatening or terminal condition. Advice on the development of a palliative care plan and on working with parents and children is also provided. Barriers to the provision of effective pediatric palliative care and potential solutions are identified. The American Academy of Pediatrics recommends the development and broad availability of pediatric palliative care services based on childspecific guidelines and standards. Such services will require widely distributed and effective palliative care education of pediatric health care professionals (Frager, 1996). In modern society, we expect children to outlive their parents. However, 53.