Prognostic Communication Between Oncologists and Parents of Children With Advanced Cancer

Kaye, Erica C.; Stall, Melanie; Woods, Cameka; Velrajan, Srilakshmi; Gattas, Melanie; Lemmon, Monica E.; Baker, Justin N.; Mack, Jennifer W.

doi:10.1542/peds.2020-044503

Cited by 29 publications

(58 citation statements)

References 38 publications

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“…From this cohort, 17 previously. 20 In brief, 7 of 41 approached dyads (17%) did not enroll owing to hesitation or refusal by either the patient (n = 4) or parent (n = 4). Although these numbers are small, refusal rates did not appear to disproportionately exclude dyads based on race and ethnicity.…”

Section: Resultsmentioning

confidence: 99%

Facilitators Associated With Building and Sustaining Therapeutic Alliance in Advanced Pediatric Cancer

et al. 2021

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IMPORTANCE Therapeutic alliance is a core component of patient-and family-centered care, particularly in the setting of advancing cancer. Communication approaches used by pediatric oncologists to foster therapeutic alliance with children with cancer and their families are not well understood.OBJECTIVES To identify key oncologist-driven facilitators associated with building and sustaining therapeutic alliance in the setting of advancing pediatric cancer and to develop a framework to guide clinical practice and future investigation of therapeutic alliance. DESIGN, SETTING, AND PARTICIPANTSIn this qualitative study, serial disease reevaluation discussions that occurred in the clinic, inpatient hospital, or off campus via telephone were recorded among pediatric oncologists, patients with high-risk cancer, and their families across 24 months or until death, whichever occurred first, from 2016 to 2020. This analysis focused on recorded discussions for pediatric patients who experienced progressive disease during the study period.Content analysis was conducted across recorded dialogue to derive inductive codes and identify themes. Participants were patient-parent dyads for whom a primary oncologist projected the patient's survival to be 50% or less, all family members and friends who attended any of their recorded disease reevaluation conversations, and their oncologists and other clinicians who attended the recorded discussions. RESULTSA total of 33 patient-parent dyads were enrolled and followed longitudinally. From this cohort, 17 patients experienced disease progression during the study period, most of whom were female (11 [64.7%]) and White (15 [88.2%]) individuals. For these patients, 141 disease reevaluation discussions were audio recorded, comprising 2400 minutes of medical dialogue. Most children ( 14[82.4%]) died during the study period. A median of 7 disease reevaluation discussions per patient (range, 1-19) were recorded. Content analysis yielded 28 unique concepts associated with therapeutic alliance fostered by oncologist communication. Ultimately, 7 core themes emerged to support a framework for clinician approaches associated with optimizing therapeutic alliance: human connection, empathy, presence, partnering, inclusivity, humor, and honesty. CONCLUSIONS AND RELEVANCEIn this qualitative study, pediatric oncologists used diverse communication approaches associated with building and deepening connections across advancing illness. These findings offer a framework to support clinical and research strategies for strengthening therapeutic alliance among pediatric oncologists, patients, and families.

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Section: Resultsmentioning

confidence: 99%

Facilitators Associated With Building and Sustaining Therapeutic Alliance in Advanced Pediatric Cancer

et al. 2021

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“…Study findings related to enrollment, retention, and capture of longitudinal data have been previously described 5,6 . Within the 33 patient–parent dyads followed longitudinally, a subset of 17 patient–parent dyads treated by six participating oncologists experienced progressive disease while on study.…”

Section: Resultsmentioning

confidence: 99%

“…This study was reviewed and approved by the Institutional Review Board at St. Jude Children's Research Hospital (U‐CHAT [Pro00006473]; approval date: July 12, 2016). Details related to the study protocol have been previously described 5,6 . We enrolled 33 patients with non‐central nervous system solid tumors whose primary oncologists described their likelihood of survival as 50% or less, their parents, and their oncology clinicians.…”

Section: Methodsmentioning

confidence: 99%

“…The U‐CHAT (Understanding Communication in Healthcare to Achieve Trust) trial was designed to better understand the communication strategies that oncologists use when sharing information about disease status with children with advancing cancer and their families across the evolving illness course 5,6 . In this subanalysis, we aimed to identify different communication approaches used to broach conversations around goals of care.…”

Section: Introductionmentioning

confidence: 99%

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Broaching goals‐of‐care conversations in advancing pediatric cancer

Kaye

Woods

Velrajan

et al. 2021

Pediatric Blood & Cancer

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Broaching conversations about goals of care can be difficult for clinicians. Presently, the communication strategies used by pediatric oncologists to approach goals of care conversations are not well understood. We recorded disease re‐evaluation conversations between pediatric oncologists, patients, and parents, capturing 141 conversations (∼2400 minutes) for 17 patients with advancing illness across the study period. We conducted content analysis to identify strategies for broaching goals‐of‐care conversations and found five distinct communication approaches, which were not mutually exclusive. Further research is needed to explore patient and family views on best practices for broaching discussions about goals of care.

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“…Details about study recruitment, enrollment, and data collection processes were previously published ( 4 , 12 ). Briefly, we enrolled a convenience sample of 33 children with high-risk cancer, their parents, and their primary pediatric oncologists at an academic pediatric cancer center.…”

Section: Methodsmentioning

confidence: 99%

Silence in Conversations About Advancing Pediatric Cancer

et al. 2022

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Background and ObjectivesSkillful use of silence by clinicians can support patient-centered communication. However, what makes a period of silence feel meaningful is not well understood. This study aimed to characterize profound, skillful silences during difficult conversations between pediatric oncologists, children with advancing cancer, and their families.MethodsWe audio-recorded serial disease reevaluation discussions between pediatric oncologists, patients with high-risk cancer, and their families across 24 months or until death, whichever occurred first. Using an inductive process, we performed content analysis across all dialogue recorded at timepoints of disease progression to examine types of silence.Results17 patient-parent dyads with disease progression yielded 141 recorded conversations. Inductive coding yielded a layered typology of silence, including “intentional silence” (≥5 seconds), “profound silence” (≥5 seconds following receipt of difficult information, juxtaposed with statements of shared understanding, emotion, or enlightenment), and “stacked silence” (series of silences juxtaposed within dialogue). Intentional silence lasting ≥5 seconds occurred 238 times in 35/49 “bad news” recordings; nearly half (103/238) of these silences were identified as profound silence, in which silences appeared to create space for processing, allowed for questions to emerge, and synergized with empathic and affirmational statements. In most cases, profound silences involved the juxtaposition, or stacking, of multiple silences close together.ConclusionsProfound silences occur often during conversations about advancing pediatric cancer and share distinct characteristics. Opportunities exist to teach clinicians to use profound and stacked silences with intention during difficult conversations as a fundamental aspect of communication.

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Prognostic Communication Between Oncologists and Parents of Children With Advanced Cancer

Cited by 29 publications

References 38 publications

Facilitators Associated With Building and Sustaining Therapeutic Alliance in Advanced Pediatric Cancer

Facilitators Associated With Building and Sustaining Therapeutic Alliance in Advanced Pediatric Cancer

Broaching goals‐of‐care conversations in advancing pediatric cancer

Silence in Conversations About Advancing Pediatric Cancer

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