Stuart J. Farber, MD

1. Stuart J. Farber, MD

2. Roles & Relationships • Four types of roles that you can play in the patient’s and family’s care. • Consultant • Collaborator • Coach • Guide My role?

3. Consultant • Providing expert, professional information to the patient and family • Three major traits: • Authoritative knowledge • Educational • Referral

4. Three Traits for the Consultant • Authoritative knowledge: Role emanates from the authoritative knowledge the health professional possesses. • Educational: Presents information that helps the patient and family understand the diagnosis, prognosis, and treatment. • Referral: Involving other healthcare team members in determining and supporting the diagnosis and plan of care.

5. Collaborator • Exchanges information with the patient and family to promote a common understanding of the diagnosis and illness experience and works together to choose the treatment path. • Four major traits: • Coordination role • Facilitative role • Therapeutic role • Team member role

6. Four Traits for the Collaborator • Coordination role: Assuring all members of the team are providing the patient/family care harmonious with treatment plan. • Facilitative role: Working with the patient/family and other team members to promote the care plan. • Therapeutic role: Promoting healing through discussions and actions with the patient/family regarding medical, psychological, spiritual, and social issues related to the care plan. • Team member role: Working within the care plan using and respecting other team members skills.

7. Coach • Help prepare the patient / family to meet the challenges of their illness • Identify needed behavioral skills • Train and practice

8. Two Traits for the Coach • Identify needed behavioral self care and self management skill that allow the patient and family to better deal with their illness. • Train and Practice with the patient and family so they become proficient at using these new behavioral skills effectively on their own.

9. Guide • To consult and collaborate with the patient and family to show them the way to accomplish their goals. • Two major traits: • Advisor • Advocacy

10. Two Traits for the Guide • Advisor: Acting to promote a treatment path that is most appropriate for the unique experience of the patient and family. • Advocacy: Assisting the patient and family to overcome barriers impeding their care path.

11. Importance of the Four Roles • Four roles are equally important to master in order to provide quality care at the end of life. • None of the four roles discussed has a higher or lower value. • The role or roles that healthcare provider plays will be defined by the relationship you shared with the patient/family and the personal and professional meaning of events that have to all parties involved.

12. Issues Related to a Dying Child I • For Children • Nurses and other healthcare providers need to train and support parents and other family members to provide skillful and competent care. • Adolescents are shifting from dependence on parents to peer relationships. The dying adolescent will often want to be with her/his friends.

13. Issues Related to a Dying Child II • For Children • Younger children can have important relationships outside of family members. A special toy, blanket, stuffed animal, or family pet can be items of great attachment and comfort. It is important to consider the dying child’s developmental level, conception of the world, and vocabulary when determining important relationships.

14. Issues Related to a Dying Child III • For Parents & Family • Parent and family members can provide excellent care and comfort to their dying child. The role of the healthcare professional often shifts from the one providing care to one of teacher and supporter of the family in providing care to their dying child.