National Cancer Institute NCI Cancer Bulletin: A Trusted Source for Cancer Research News
June 2, 2009 • Volume 6 / Number 11

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Community Update

Through Play, Kids and Families Cope with Cancer

ShopTalk board game ShopTalk board game [Enlarge]

If you could look back and change something that you said or did in your life, what would that be?

It’s a difficult question for anyone to answer honestly, not to mention someone who is facing a life-threatening illness. Such a question can be especially difficult for children. But when posed in the atmosphere of play, answering becomes easier.

 “Play is really the way to uncover children’s feelings and help them explore their inner world, working through some of their fears and helping them find coping strategies,” explained Dr. Lori Wiener, head of the psychosocial section in NCI’s Pediatric Oncology Branch. She noted that the strategy can work well in some situations for adults, too.

Dr. Wiener developed a workbook to assist children being treated for cancer or HIV infection at NIH with talk therapy sessions, and found the tool to be very successful. She then partnered with Dr. Cindy Mamalian, an artist and psychologist, to develop a prototype board game version of the workbook and began testing it with her patients, gathering their feedback during the revision process.

Nearly 10 years later, the culmination of this project is ShopTalk, a board game that helps therapists lead conversations with pediatric cancer patients and their parents about difficult emotional issues related to the illness that has affected their lives. ShopTalk is the only such therapeutic game designed for children aged 7 to 16 years.

Dr. Wiener has been working with the nonprofit organization SuperSibs to distribute the sibling version of the game, and she has contacted psychosocial oncology programs at hospitals around the country that treat children with cancer. The response from those who are using ShopTalk has been very enthusiastic. 

“I have been using the game several times a week since I put it out in my office,” said Dr. Rachel Levi, a pediatric clinical psychologist in Oakland, CA. “Uniformly, the feedback has been positive from both me and the kids with whom I've used it.”

Other clinical psychologists and professors of pediatric medicine have written to Dr. Wiener with simple notes of “Thank you!” for providing them with such a valuable clinical tool.

Because critical information can be revealed through the course of play—suicidal feelings, for example, or non-adherence to medication regimens—Dr. Wiener stressed that the game should only be used with the supervision of a trained therapist so that opportunities for intervention aren’t missed.

ShopTalk is available in two versions, one for pediatric cancer patients and one for their siblings. All questions in both versions of the game are written in Spanish as well as in English. Therapists who are interested in obtaining a copy of the game should contact Dr. Wiener directly at wienerl@mail.nih.gov.  

ShopTalk players visit 10 different “shops” around the board, choosing one of 6 “gifts” from each store to place in their individual shopping bag when they choose to answer the question. The shops are named according to different themes: The Ball’s in Your Court sports store, for example, allows players to explore how they would respond to various social scenarios during treatment.

The added beauty of the game lies in its flexibility. Questions can be very simple, such as, “What is your favorite movie?” or they can be deeper, such as, “Do you think that children with a disease should be disciplined the same as kids who are healthy?” In this way, a therapist can tailor the game to the needs of the players, delving deeper with each round or tailoring the questions to an individual’s concerns or needs.

After hearing the question, the player is asked if they would like to buy the gift. If they’re not comfortable answering, they can say, “No thanks, just looking.” Questions can also be addressed to the entire group of players, allowing the chance for someone who isn’t comfortable talking about his or her own problem to learn through the experience of others.

Though it’s based on the premise of fun, ShopTalk clearly enters into emotionally charged territory. Dr. Wiener says that it’s important for people to talk about the thoughts that keep them awake at night, rather than struggling in silence.

“Many kids who have cancer are concerned about sharing information that will upset their parents,” she explained. “But their parents may be having these same thoughts. So they each end up coping in emotional isolation, putting a lot of energy into not thinking about what is troubling them. This game provides them a safe opportunity to find coping strategies together, so that they can focus their energy on healing, rather than avoidance.”

Last week, Dr. Wiener played ShopTalk with the family of a child who has cancer during a therapy session. One of the questions asked them to recall events from the day that each of them learned about the diagnosis, more than 4 years ago.

“They all remembered an amazing amount of detail,” she explained. “It gave them a chance to correct misperceptions about what had happened and what was said, and each obtained a new awareness about how traumatizing that particular time was for each of them. The conversation wouldn’t have happened if we weren’t playing the game.”

Brittany Moya del Pino

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