In this workshop we discussed some of the critical psychosocial issues facing mothers, fathers, siblings and grandparents in families of children with cancer. We also discussed some of the things that might be done to ease these family members' burdens. Our hope is that as parent support groups, physicians and social service staffs become more aware of these issues they may be better able to develop psychosocial progams and standards of care that can help prevent or reduce problems.

Issues mothers face:

· Worry about the child's health and emotional well-being
· Energy drain
· Loneliness
· Being overprotective of the child
· Demands on her as primary caregiver
· Gender role trap (mothers expected do everything related to a child and to keep the family going)
· Loss of control over her life
· Being pulled between home responsibilities and hospital activities
· Trying to be, and to keep family life, "normal"

Issues fathers face:

· Feeling like he should be able to "fix" things
· And the other side of the gender role trap (go to work, produce, and be stoic)
· Loss of dignity
· Unaccustomed vulnerability
· Loss of control of his life
· Emotional confusion
· Being required to take over part of the traditional "mothers' role" at home or with children
· Being pulled between home and work responsibilities and hospital activities

Issues siblings face:

· Worry both about the ill sibling and the parents
· Feeling left out and getting less attention
· Dealing with the pressure to be "extra good" or "the perfect child"
· Being asked to do more jobs at home
· Being told "no hitting"
· Having to grow up fastand alone
· Having to delay emotional reactions (not expressing feelings after the danger has faded)

Issues grandparents face:

· Not wanting to visit; wanting to withdraw
· Feeling excluded or isolated from the family and its crisis
· Wanting to help but not wanting to "intrude"
· Believing in the old myth that cancer equals death
· Blaming parents for the child's illness
· Feeling the pain and being concerned about one's own child (parents) as well as the ill grandchild
· Guilt about being alive and well when a little child is ill and threatened

What can be done?

· Bring mothers and fathers into a support group
· Reeducate parents regarding new gender roles and possibilities of sharing household and hospital tasks differently
· Special events, and maybe special support group meetings, for mothers, fathers, siblings and grandparents separately, to discuss their unique concerns. And some events that bring the entire family together
· Educational programs for employers, medical staffs and school staffs about family issues and needed support
· Programs that involve every family member in some aspect of the ill child's care, especially for grandparents, since they are so likely to be left out
· Education for everyone about increased survival rates and psychosocial status of survivors
· Special playtimes, programs and maybe camp experiences for siblings (in the hospital or at home)