By recognizing families who continue to struggle with the diagnosis, nurses may be better equipped to approach families and evaluate their needs, including coping and adaptation. Asking parents about their experience can also lead to more appropriate and timely care and referral and allows nurses to provide care that engenders hopefulness.
Understanding parents' experiences validates the quality care and connections we make with children and families, and encourages us to consider the effects of our interactions. This underscores the importance of education and support as a means of instilling hope in parents, who are valued, critical members of their child's health care team.
Children in the terminal stage of cancer may experience intractable pain despite the use of high doses of opioids. The resultant sedating effect of the opioids limits the child's ability to communicate and participate in activities, thereby negatively affecting quality of life. Ketamine, an intravenous (IV) anesthetic with analgesic properties, when used in low doses, may be useful in managing pediatric cancer pain at the end of life. Ketamine can prevent the development of opioid tolerance and provide additional analgesia without an increase in sedating effects. At the authors' institution, 2 children with end-stage cancer were started on continuous infusion low-dose ketamine to help achieve adequate pain control and allow the children to be home and interactive for the last weeks of their lives. Each case illustrates the complexities of achieving and maintaining adequate pain control and promoting care of the child and family in a setting that is most appropriate for them.
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