Lessons learned in the implementation of an innovative consultation and liaison service for children of cancer patients in various hospital settings.
OBJECTIVE
To evaluate the process of implementing a family-oriented consultation and liaison service in various hospital-based settings, with special regard to problems and obstacles encountered.


METHODS
Qualitative content analysis using categorization and sequential, phenomenological analysis of descriptive progress notes during the implementation period. The team members of the liaison service were defined as participant observers. Interpretations of the material were derived in previously defined, sequential steps in team discussions.


RESULTS
Despite a consistent concept behind the new service, the degree to which it was able to be integrated into different medical settings varied to a remarkable degree. Obstacles encountered were often linked to a lack of consideration being given to divergent concepts of care. It was necessary to give special attention to providing physicians with practical evidence of the value of the intervention. The new service was most readily utilized by families when physicians personally communicated the referrals as a standard procedure to their patients and when the referrals were not made too quickly after the parent's initial diagnosis.


CONCLUSIONS
Hospital-based services for cancer patients with children under the age of 18 should carefully address patients' fears of psychiatric stigmatization. Furthermore, they should include modules for acute crisis intervention. Implications for future implementation activities in this field are discussed.
Romer
Georg
G
Department of Child and Adolescent Psychiatry and Psychotherapy, Hamburg-Eppendorf University Medical Centre, Hamburg, Germany. romer@uke.uni-hamburg.de
Saha
Rina
R
Haagen
Miriam
M
Pott
Martina
M
Baldus
Christiane
C
Bergelt
Corinna
C
D000223:Adaptation, Psychological; D000293:Adolescent; D002648:Child; D016241:Child of Impaired Parents / Q000523:psychology*; D003142:Communication; D003299:Cooperative Behavior; D003419:Crisis Intervention; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration; D005196:Family Therapy / Q000458:organization & administration; D005260:Female; D006284:Health Plan Implementation; D006302:Health Services Research; D006801:Humans; D008297:Male; D009369:Neoplasms; D010348:Patient Care Team / Q000458:organization & administration; D010353:Patient Education as Topic; D011613:Psychotherapy / Q000458:organization & administration*; D012017:Referral and Consultation / Q000458:organization & administration*; D012803:Sick Role