Of Communication

Communication established through the exchange of messages between persons has a dual function that is informational and relational. On the one hand, communication has the function of transmitting information to another person. On the other hand, the function is to define, maintain, or alter the relationship with the other person (Penman 1980). The parent who says: "It is time to take your medicine, please don't be a naughty child again" is communicating at an informational level ("it is medicine time") and at a relational level ("be compliant by following my instructions").

In stressful situations the function of communication is of utmost importance. Information increases the controllability of a threatening situation if the child understands what can be done about the situation, how negative consequences can be avoided or ameliorated by his/her own actions. Information thus reduces uncertainty about a threatening situation if it increases the predictability of the situation.

In searching for and developing control, communication about the disease is important for the child and his parents. Communication serves to enhance primary and secondary control and changes the appraisal of the situation and is therefore related to coping. Lazarus and Folkman (1984) define the coping process as:"cognitive and behavioural efforts to manage specific external and/or internal demands that are appraised as taxing or exceeding the re sources of a person" One's perceptions, or cognitive appraisals, are important elements in regulating distress or managing the problem causing the distress. Problem-focused coping involves direct efforts to ameliorate the problem causing the distress, whereas emotion-focused coping is directed towards regulating effects surrounding a stressful experience. People not only have emotions, they also handle them, and communication is one of the tools to do so. When a family has to cope with the life-threatening illness of a child, there is little that family members can do to change the situation or exert control over it. Without control, family members have to rely on emotion-focusing coping strategies or cognitive control strategies.

Communication serves for both the primary control of the situation (problem-focused coping) and the secondary control of the situation (emotion-focused coping). Information exchange about the disease and treatment promotes primary control. It enables those involved to define the problem and make attempts to solve it. Communication about the disease directed at secondary control of the situation promotes understanding and acceptance of the disease and aims to reduce negative emotions and strengthen positive emotions. This is illustrated by the parent who maintains telling the child it will get better. With this he or she invites the child to view the situation in a certain (optimistic) way, and thus attempts to reinforce the child's hope and reduce fear.

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