Hostname: page-component-586b7cd67f-t7czq Total loading time: 0 Render date: 2024-11-30T19:37:35.976Z Has data issue: false hasContentIssue false
  • English
  • Français

Childhood abuse uncovered in a palliative care audit

Published online by Cambridge University Press:  26 November 2009

Catriona Macpherson
Catriona Macpherson*
Affiliation:
Fife Palliative Care Service, Cedar House, Whyteman's Brae, Kirkcaldy, United Kingdom
*
Address correspondence and reprint requests to: Catriona Macpherson, Fife Palliative Care Service, Cedar House, Whyteman's Brae, Kirkcaldy KY1 2LF, United Kingdom. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

This article aims to highlight potentially high levels of childhood sexual abuse within Cancer and Palliative Care Service users.

Methods:

During a routine audit, data was collated to quantify a perceived high level of disclosure of pre-existing psychological trauma within the palliative care caseload of a Macmillan Children and Families Therapist. Families comprised adults (generally parents or step-parents), one of whom was terminally ill or recently deceased who had direct responsibility for children and young people aged under 20 years old. Each family had at least two members using the service for advice, emotional support or counselling.

Results:

A childhood sexual abuse rate of 33% for women and 10% for men was revealed. Of 59 families, 49% had one or more members who had experienced childhood sexual abuse. In addition a further 9% of adults had experienced severe physical and emotional abuse in childhood. Many families had faced multiple trauma.

Significance of results:

Palliative care clinicians have access to detailed personal and family history during a highly vulnerable transition. While confidentiality is paramount it is essential to develop better data collection methods and raise the profile of childhood sexual abuse as a major contributing factor to morbidity. A whole family assessment is crucial to ensure child protection and emotional care for children facing the loss and subsequently bereaved of a parent or a carer. Clinicians must be able to offer a range of approaches which provide distressed patients with a history of childhood abuse some sense of emotional containment at the end of life, a challenge which cannot be overstated.

Keywords

Sexual abuseChildrenPalliative careCancerFamily support
Type
Original Articles
Information
Palliative & Supportive Care , Volume 7 , Issue 4 , December 2009 , pp. 481 - 486
Copyright
Copyright © Cambridge University Press 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Arnow, B.A. (2004). Relationships between childhood maltreatment, adult health and psychiatric outcomes. Journal of Clinical Psychiatry, 65(suppl 12), 10–15.Google ScholarPubMed
Bass, E. & Davis, L. (1988). The Courage to Heal. New York: Harper and Row.Google Scholar
Bifulco, A., Brown, G.W. & Adler, Z. (1991). Early sexual abuse and clinical depression in adult life. British Journal of Psychiatry, 159, 115–122.CrossRefGoogle ScholarPubMed
Bolund, C. (1993). Loss, mourning and growth in the process of dying. Palliative Medicine, 7(Suppl 1), 17–25.Google Scholar
Chowns, G. (2005). Swampy ground: Brief interventions with families before bereavement. In Brief Interventions with Bereaved Children, Monroe, B. & Kraus, F. eds., pp. 125–139. Oxford: Oxford University Press.Google Scholar
Dale, P. (1993). Guidebook for Counsellors. Counselling adults who were abused as children. 531–532. Rugby: BAC.Google Scholar
Dalton, S.O., Boesen, E.H., Ross, L., et al. (2002). Mind and cancer: Do psychological factors cause cancer? European Journal of Cancer, 38, 1313–1323..CrossRefGoogle ScholarPubMed
Draucker, C.B. & Martsolf, D.S. (2006). Counselling Survivors of Childhood Sexual Abuse. London: Sage Publications.CrossRefGoogle Scholar
Drossman, D.A., Leserman, J., Nachman, G., et al. (1990). Sexual and physical abuse in women with functional or organic gastrointestinal disorders. Annals of Internal Medicine, 113, 828–833.CrossRefGoogle ScholarPubMed
Felitti, V.J., Anda, R.F., Nordenberg, D., et al. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The adverse childhood experiences study. American Journal of Preventive Medicine, 14, 245–258.CrossRefGoogle Scholar
Fergusson, D.M., Horwood, L.J. & Woodward, L.J. (2000). The stability of childhood abuse reports. Psychological Medicine, 30, 529–544.CrossRefGoogle ScholarPubMed
Hardt, J. & Rutter, M. (2004). Validity of adult retrospective reports of adverse childhood experiences. Journal of Child Psychology and Psychiatry, 45, 260–273.CrossRefGoogle ScholarPubMed
Hill, J., Davis, R., Byatt, E., et al. (2000). Childhood sexual abuse affective symptoms. Psychological Medicine, 30, 1283–1291.CrossRefGoogle ScholarPubMed
Hunter, M.J., Davis, P.J. & Tunstall, J.R. (2006). The influence of attachment and emotional support in end-stage cancer. Psycho-oncology, 15, 431–444.CrossRefGoogle ScholarPubMed
Kissane, D.W., McKenzi, M., Forbes, A., et al. (2003). Psychosocial morbidity associated with patterns of family functioning in palliative care: Baseline data from the family focused grief therapy controlled trial. Palliative Medicine, 17, 527–537.CrossRefGoogle ScholarPubMed
Merrick, J. & Browne, K.D. (1999). Child abuse and neglect: A public health concern. Public Health Review, 27, 279–293.Google ScholarPubMed
Molnar, B.E., Buka, S.L. & Kessler, R.C. (2001). Child sexual abuse and subsequent psychopathology. American Journal of Public Health, 91, 753–760.Google ScholarPubMed
Mullen, P.E., Martin, J.L., Anderson, J.C., et al. (1993). Childhood sexual abuse and mental health in adult life. British Journal of Psychiatry, 163, 721–732.CrossRefGoogle ScholarPubMed
National Breast Cancer Centre and National Cancer Control Initiative. (2003). Clinical Practice Guidelines for Psychosocial Care of Adults with Cancer. Camperdown, UK: National Breast Cancer Centre.Google Scholar
Salmon, P., Hill, J., Krespi, R., et al. (2006). The role of child abuse and age in vulnerability to emotional problems after surgery for breast cancer. European Journal of Cancer, 42, 2517–2523.CrossRefGoogle ScholarPubMed
Salmon, P., Holcombe, C., Clark, L., et al. (2007). Relationships with clinical staff after a diagnosis of breast cancer are associated with patients' experience of care and abuse in childhood. Journal of Psychosomatic Research, 63, 255–262.CrossRefGoogle ScholarPubMed
Sanderson, C. (1990). Counselling Adult Survivors of Child Sexual Abuse. London: Jessica Kingsley Publishers.Google Scholar
The Scottish Government. (2005). Survivors of Childhood Sexual Abuse: A Survivor Centred Strategic Approach Outline Strategy. Edinburgh: Scottish Executive, Health Department.Google Scholar
Stokes, J., Wyer, S. & Crossley, D. (1997). The challenge of evaluating a child bereavement programme. Palliative Medicine, 11, 179–190.CrossRefGoogle ScholarPubMed
Tan, A., Zimmerman, C. & Rodin, G. (2005). Interpersonal processes in palliative care: An attachment perspective on the patient–clinician relationship. Palliative Medicine, 19, 143–150.CrossRefGoogle ScholarPubMed
Thomas, B.C., Pandey, M., Ramdas, K., et al. (2002). Psychological distress in cancer patients: Hypothesis of a distress model. European Journal of Cancer Prevention, 11(12), 179–185.CrossRefGoogle ScholarPubMed
Worden, W. (1996). Children and Grief. London: Guildford Press.Google Scholar