• David R Freyer, Aura Kuperberg, David J Sterken, Steven L Pastyrnak, Dan Hudson, and Tom Richards.
• Division of Hematology/Oncology/Bone Marrow Transplantation, DeVos Children's Hospital, 100 Michigan NE, Mailcode 85, Grand Rapids, MI 49503, USA. david.freyer@spectrum-health.org
• Child Adolesc Psychiatr Clin N Am. 2006 Jul 1;15(3):693-715.

AbstractThe adolescent at the end of life poses a unique combination of challenges resulting from the collision of failing health with a developmental trajectory meant to lead to attainment of personal independence. Because virtually all spheres of the dying adolescent's life are affected, optimal palliative care for these young persons requires a multidisciplinary team whose members have a good understanding of their complementary roles and a shared commitment to providing well-coordinated care. Members of the team include the physician (to initiate and coordinate palliative care management); the nurse (to work collaboratively with the physician and adolescent, especially through effective patient advocacy); the psychologist (to assess and manage the patient's neurocognitive and emotional status); the social worker (to assess and optimize support networks); the chaplain (to support the adolescent's search for spiritual meaning); and the child life specialist (to facilitate effective communication in preparing for death). A crucial area for dying adolescents is medical decision making, where the full range of combined support is needed. By helping the young person continue to develop personal autonomy, the multidisciplinary team will enable even the dying adolescent to experience dignity and personal fulfillment.

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