The six positive communication domains are areas for clinicians to recognize and monitor in communicating with children and families in the pediatric palliative care setting. Knowledge of the qualities of communication that are satisfying to and valued by children and their parents have the potential to lead to more effective communication around the difficult decisions faced by physicians, parents, and children with life-threatening conditions.

Psychosocial research examining the impact of cancer on adolescents and young adults has focused mostly on domains relating to family, psychological/emotional impact and social effects. An overview of the evidence-based literature available in each of these domains is presented to highlight the trends and provide a basis for

A diagnosis of cancer compounds the complexities of adolescent development.Self-esteem and sexual health have a significant impact on adolescent identity formation, especially those young patients coping with a diagnosis of cancer. Knowledge of sexual health, interpersonal relationships, and body image concerns are factors that have an impact on the development of self-esteem during these transition periods into adulthood. A clinical perspective on these issues was utilized to highlight the nature of self-esteem and sexuality in adolescents and young adults with cancer. Case examples and clinical recommendations from a workshop on self-esteem and sexuality in adolescents and young adults with cancer are presented. Understanding the adolescent's and young adult's stage of identity formation, their social and developmental histories, and methods for increasing selfesteem can give insight to healthcare professionals in fostering positive selfesteem and sexual health in these young patients. Through the awareness of the specific factors affecting adolescents and young adults with cancer, oncology teams can assist in creating an atmosphere for the growth of positive self-esteem and sexual health in their adolescent patients.

Health care professionals who felt comfortable discussing options for end of life care with colleagues also felt more comfortable: initiating a discussion regarding a child's impending death with his/her family (r = 0.42), discussing options for terminal care with a family (r = 0.58), discussing death with families from a variety of ethnic/cultural backgrounds (r = 0.51), guiding parents in developmentally age-appropriate discussions of death with their children (r = 0.43), identifying and seeking advice from a professional role model regarding management concerns (r = 0.40), or interacting with a family following the death of a child (r = 0.51). Among all three disciplines, physicians were more likely to initiate discussions with regards to a child's impending death (F = 13.07; p = 0.007). Health care professionals that received formal grief and bereavement training were more comfortable discussing death. Significance of the results: The results demonstrated that consultation practices are associated with a higher level of comfort in discussing death and dying in pediatrics.

Residents indicated increased comfort in some areas of pediatric palliative care after the first year of their training. The underlying cause of this increased comfort is unclear at this time. The overall effect of longitudinal palliative care curricula on residents' level of comfort in caring for this population deserves further assessment.