Terminal care at home for children with cancer.

The paediatric oncology unit at this hospital provides an oncology service to the south west of England. Patients from the region come to Bristol for diagnosis and evaluation and to begin treatment. When it is appropriate care is shared between the referring unit and the unit in Bristol. When a diagnosis is made an information pack is sent to the child's general practitioner giving the diagnosis, describing the unit, and giving details of treatment and probable side effects, thus ensuring a firm link between the specialist unit and the primary care team.' The ensuing period of intense treatment, however, requires close supervision by the hospital, which creates strong links between the families and the specialist unit. We try to keep the general practitioner informed of any important events that occur during treatment. A family support nurse gets to know the family while the child is being treated and as needed visits the child's home to give psychological support, provide family education, and carry out blood tests and physical assessment. In the event that treatment fails the doctors and the family together decide that anticancer treatment is no longer appropriate, and the emphasis of care changes to relieving physical and mental distress. The aim is to give that child as good a quality of life as possible in the time left to the child. A "home terminal care team" is nominated, consisting of the family support nurse, a