Document Type : Letter to the Editor
Authors
1
Department of Nursing, Faculty of Nursing and Midwifery, Zahedan University of Medical Sciences, Zahedan, Iran
2
Department of Nursing, Faculty of Nursing and Midwifery, Community Nursing Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
Abstract
Dear Editor
Leukemia profoundly affects not only the diagnosed child but also the entire family. Siblings of children with leukemia are often referred to as “silent survivors.” During a health crisis, these siblings are frequently marginalized and experience consequences that extend beyond psychological challenges such as anxiety, depression, and guilt. These effects also influence their social interactions, academic performance, and personal identity development. Unfortunately, the psychosocial needs of siblings are often overlooked in many treatment and care strategies.[1]
Challenges
Children with siblings affected by leukemia face numerous challenges, particularly when treatment is prolonged. These difficulties include reduced parental attention, disruption of family routines, increased responsibilities at home, and the emotional strain of concern for their ill sibling. Additionally, they experience a range of emotions, including jealousy, guilt, anger, and feelings of neglect, which may adversely affect their psychosocial development. The absence of dedicated psychological support and insufficient parental guidance on addressing the emotional needs of healthy children further exacerbate these challenges. Consequently, many siblings experience lower academic performance, fewer social interactions, and difficulties in forming their own identities.[2]
Potential Solutions
Addressing the psychosocial challenges faced by siblings of children with leukemia requires a comprehensive, evidence-based, interdisciplinary approach involving coordinated collaboration among nurses, psychologists, physicians, school counselors, and parents. The first step is the early identification of psychological and behavioral issues in siblings through thorough psychosocial assessments conducted by nurses and therapists specializing in family dynamics. Incorporating standardized screening tools into routine care is essential for monitoring anxiety, depression, posttraumatic stress, and evaluating the quality of family interactions. Following identification, comprehensive intervention programs should be developed and implemented to enhance resilience, strengthen coping strategies, and foster emotional security for healthy siblings.[3]
These programs should include individual and group therapy sessions to help siblings process emotions, acknowledge unspoken grief, boost self-esteem, and acquire stress management skills. Educational interventions for parents should emphasize emotional awareness, stress management, equitable attention among children, prevention of neglect toward healthy siblings, and improved family communication.[4]
Integrating psychosocial support into nursing practice is also critical, which requires training nurses to provide meaningful emotional support to healthy family members during hospitalization, ongoing treatment, or critical emergencies. Collaboration with schools and counselors ensures academic and social support, prevents educational setbacks, and provides a safe space for siblings to express psychological concerns.[4]
Developing interdisciplinary clinical protocols that encompass comprehensive family-centered care is vital. These protocols should recognize psychosocial support for healthy siblings as an integral component of the overall treatment plan. Establishing dedicated psychosocial support units within pediatric oncology centers, staffed by specialists in child and family mental health, would significantly strengthen these efforts. Additionally, community-based initiatives such as sibling peer support groups, partnerships with non-profit organizations, and public awareness campaigns highlighting the family impact of leukemia can enhance social resilience and reduce stigma.[5]
Conclusion
Siblings often experience anxiety, guilt, isolation, and profound emotional distress in silence. The psychosocial consequences of these experiences can exert long-term effects on their emotional development, mental health, and family dynamics. Therefore, it is essential for healthcare providers, institutions, parents, and policymakers to acknowledge the importance of comprehensive psychosocial support that extends beyond the patient to encompass the entire family, with particular attention to the unique needs of siblings. The primary purpose of this letter is to raise awareness and advocate for the integration of family-centered psychosocial care into both clinical practice and healthcare policy.
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