Existing investigations on palliative care of AYAs have indicated poor end of life support for the young patients and their families. These reports are linked to young adults having a higher survival rate in thus have limited dedicated resources for end-of-life care (Grinyer & Barbarachild, 2011). Management of this group requires interdisciplinary clinical involvement to work with the heterogeneity of the patient groups due to the need of addressing the complex medical concerns that coincide with psychosocial developmental phases and existential distress (Wein, Pery, & Zer 2010). The Manly Adolescent and Young Adult Hospice (AYAH) was developed by NSW Health to provide specialised support to AYAs between the ages 16–30 with life limiting illnesses. This case review is on Layla** and her family, a 30-year-old female with head and neck cancer and complex psychosocial background who underwent palliative care during her stay at the AYAH. This review explores the importance of multidisciplinary involvement and support at end-of-life care.

Methodology This case review was conceptualised using a Schema Therapy framework to uncover family patterns of coping were playing out within a hospice setting. By analysing the schema chemistry (Safran & Segal, 1990), the Clinical Psychologist was able to identify processes by which an individual’s behaviour can ‘pull’ others into a familiar pattern of interaction. In turn, creating formulations for key family members and how they interact with each other during period stress allowed for identification of gaps in providing psychosocial care at the AYAH for both family members and staff.

Impact on practice As Layla’s physical condition deteriorated, family distress was palpable, especially from Layla’s mother, Madeline**, which impacted the family and AYAH Team dynamic. Madeline’s interaction with the treating team paralleled themes of early experiences of unmet emotional needs within her personal life. Madeline’s observation of her daughter’s deterioration triggers her schema of emotional deprivation, the expectation that one’s desire for emotional support will not be adequately met by others. To be able to support the family and the AYAH staff, the following was identified by the clinical psychologist: 1) the need for psychoeducation and ‘pre-brief’ to allow for a united front across staff, 2) regular family sessions and independent psychological support for individual family members, and 3) opportunities for staff supervision throughout Layla’s end-of-life care.

Discussion This case illustrates how psychological models are present within AYA palliative care. Lack of family support can detrimentally impact team functioning if family psychological needs are not met. Through supporting Madeline and her family, the treating team was able to review what were considered difficult behaviours as representations of grief. It challenged the team to reframe how family interaction can impact responses to challenging engagement styles as a cry for help.

References

1. Grinyer A, Barbarachild Z. Teenage and young adult palliative and end of life care service evaluation. [Service evaluation, University of Lancaster].2011; https://eprints.lancs.ac.uk/id/eprint/49234/1/tcteolc_report.pdf

2. Wein S, Pery S, Zer A. Role of palliative care in adolescent and young adult oncology. Journal of Clinical Oncology 2010;28(32):4819–4824.

References** pseudonyms