Psychological evaluation and management of pediatric oncology patients in protected environments.

Specific aspects of psychological investigation and management of pediatric patients with widely disseminated solid tumors treated in semiportable, laminar airflow patient isolators are discussed. Information was obtained prospectively from a psychosocial study c-ordinated with a medical investigation of the use of protected environments (PE) employing barrier isolation as an adjunct to intensive anticancer therapy. Included are description of the development of psychological criteria for patient eligibility, psychometric evaluation, longitudinal behavioral observation, pre-entry and predischarge orientation techniques, as well as approaches to the ongoing management of patients and families. No debilitating psychological disturbance has been observed in these patients, and no patients have had to be removed for psychological reasons. Specific transitory psychological changes are noted as are the problems encountered by staff members functioning in such a setting. The adoption of a well-coordinated psychosocial program of investigation and clinical intervention has proved useful in maximizing patient adjustment to prolonged treatment in protected environments.