What is the most appropriate response to the parents of a 9-year-old girl with metastatic Ewing's sarcoma regarding her grief process and understanding of her terminal illness?

From the Guidelines

The most appropriate response to the parents is D) She will recognize that death is permanent and real but may not understand her own mortality. At 9 years old, children typically have developed a concrete understanding that death is final and irreversible, but they may still struggle to fully comprehend their own mortality, as suggested by the American Society of Clinical Oncology consensus guideline 1. Children at this developmental stage generally understand death as a biological process that happens to everyone eventually, but they often have difficulty applying this concept to themselves. The girl's calm demeanor despite knowing her diagnosis suggests she has some understanding of her situation, but may not fully grasp the implications. Some key points to consider when discussing this with the parents include:

• Recognizing different presentations of grief among patients, family members, and colleagues, and exploring patient concerns to refer them for appropriate psychosocial support 1
• Providing simple, honest explanations while offering emotional support as their daughter processes this difficult reality
• Being prepared for questions about what happens after death and addressing them in a way that is appropriate for the child's level of understanding. It is essential to approach this conversation with sensitivity and compassion, taking into account the child's developmental stage and individual needs, as outlined in the patient-clinician communication guidelines 1.

From the Research

Understanding the Situation

• The question is about a 9-year-old girl with metastatic Ewing sarcoma who is aware of her illness and is entering the terminal phase.
• The girl's parents ask about what to expect for their daughter's grief process and understanding of the situation.

Expected Understanding and Grief Process

• According to general knowledge of child development, a 9-year-old child may have a limited understanding of death and its permanence 2.
• Children at this age may begin to understand that death is real, but they may not fully comprehend its implications or their own mortality.
• The child's awareness of her illness and its terminal nature may influence her grief process and understanding of the situation.

Appropriate Response

• The most appropriate response to the parents would be that their daughter will recognize that death is permanent and real, but may not understand her own mortality.
• This response acknowledges the child's growing understanding of death, while also considering her limited cognitive and emotional development.
• It is essential to approach this conversation with sensitivity and honesty, taking into account the child's individual needs and circumstances.

Relevant Considerations

• The child's age, cognitive development, and emotional maturity will influence her understanding of the situation and her grief process.
• The parents' support and guidance will play a crucial role in helping their daughter cope with her illness and its terminal nature.
• Healthcare professionals should be sensitive to the family's needs and provide appropriate support and resources to help them navigate this challenging situation.