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Turbitt E, Bourne M, McEwen A, Amor DJ. Parents' preferences for receiving and discussing prognostic genetic information regarding their children's neurodevelopmental condition: A qualitative study. Dev Med Child Neurol 2024; 66:872-881. [PMID: 38111102 DOI: 10.1111/dmcn.15830] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 11/16/2023] [Accepted: 11/20/2023] [Indexed: 12/20/2023]
Abstract
AIM To investigate parents' preferences and motivations for receiving and discussing prognostic genetic test results. METHOD We used a cross-sectional, interpretive description qualitative study design. We collected data through semi-structured interviews with Australian parents, which we analysed using reflexive thematic analysis. RESULTS Parents (n = 32) had a child or children with a genetic neurodevelopmental condition, such as fragile X syndrome, DiGeorge (22q11.2 deletion) syndrome, or Angelman syndrome. Parents of mildly impacted or older children were tolerant to prognostic uncertainty. Parents found conversations about their child's prognosis emotional and preferred to discuss their child's potential strengths and challenges. While most were enthusiastic about prognostic tests and described many motivations for testing, the potential for prognostic information to contribute to a loss of hope and stigmatizing societal views were also discussed. INTERPRETATION Parents had mixed preferences and motivations for acquiring prognostic genetic information about their child, contrasting evidence in other contexts such as cancer where parents typically have minimal tolerance of uncertainty. Health professionals should consider strength-based framing of prognostic information gained from current and emerging technologies when returning results to families. WHAT THIS PAPER ADDS Parents had varied views about receiving prognostic information on their children's neurodevelopmental condition. Some parents preferred prognostic uncertainty about their children's genetic neurodevelopmental condition.
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Affiliation(s)
- Erin Turbitt
- Discipline of Genetic Counselling, University of Technology Sydney, Ultimo, NSW, Australia
| | - Meg Bourne
- Discipline of Genetic Counselling, University of Technology Sydney, Ultimo, NSW, Australia
| | - Alison McEwen
- Discipline of Genetic Counselling, University of Technology Sydney, Ultimo, NSW, Australia
| | - David J Amor
- Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
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Kaye EC, Smith J, Zhou Y, Bagatell R, Baker JN, Cohn SL, Diller LR, Glade Bender JL, Granger MM, Marachelian A, Park JR, Rosenberg AR, Shusterman S, Twist CJ, Mack JW. Factors influencing parents' choice of palliative treatment goals for children with relapsed or refractory neuroblastoma: A multi-site longitudinal survey study. Cancer 2024; 130:1101-1111. [PMID: 38100619 PMCID: PMC10939929 DOI: 10.1002/cncr.35149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 10/31/2023] [Accepted: 11/06/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Many parents of children with advanced cancer report curative goals and continue intensive therapies that can compound symptoms and suffering. Factors that influence parents to choose palliation as the primary treatment goal are not well understood. The objective of this study was to examine experiences impacting parents' report of palliative goals adjusted for time. The authors hypothesized that awareness of poor prognosis, recall of oncologists' prognostic disclosure, intensive treatments, and burdensome symptoms and suffering would influence palliative goal-setting. METHODS The authors collected prospective, longitudinal surveys from parents of children with relapsed/refractory neuroblastoma at nine pediatric cancer centers across the United States, beginning at relapse and continuing every 3 months for 18 months or until death. Hypothesized covariates were examined for possible associations with parental report of palliative goals. Generalized linear mixed models were used to evaluate factors associated with parents' report of palliative goals at different time points. RESULTS A total of 96 parents completed surveys. Parents were more likely to report a primary goal of palliation when they recalled communication about prognosis by their child's oncologist (odds ratio [OR], 52.48; p = .010). Treatment intensity and previous ineffective therapeutic regimens were not associated with parents' report of palliative goals adjusted for time. A parent who reported new suffering for their child was less likely to report palliative goals (OR, 0.13; p = .008). CONCLUSIONS Parents of children with poor prognosis cancer may not report palliative goals spontaneously in the setting of treatment-related suffering. Prognostic communication, however, does influence palliative goal-setting. Evidence-based interventions are needed to encourage timely, person-centered prognostic disclosure in the setting of advanced pediatric cancer. PLAIN LANGUAGE SUMMARY Many parents of children with poor-prognosis cancer continue to pursue curative treatments that may worsen symptoms and suffering. Little is known about which factors influence parents to choose palliative care as their child's main treatment goal. To explore this question, we asked parents of children with advanced neuroblastoma across the United States to complete multiple surveys over time. We found that the intensity of treatment, number of treatments, and suffering from treatment did not influence parents to choose palliative goals. However, when parents remembered their child's oncologist talking about prognosis, they were more likely to choose palliative goals of care.
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Affiliation(s)
- Erica C. Kaye
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, TN
| | - Jesse Smith
- Department of Biostatistics, St Jude Children’s Research Hospital, Memphis, TN
| | - Yiwang Zhou
- Department of Biostatistics, St Jude Children’s Research Hospital, Memphis, TN
| | - Rochelle Bagatell
- Division of Oncology, Department of Pediatrics, The Children’s Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Justin N. Baker
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, TN
| | - Susan L. Cohn
- Department of Pediatrics, Comer Children’s Hospital, University of Chicago, Chicago, IL
| | - Lisa R. Diller
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA
- Division of Pediatric Hematology-Oncology, Boston Children’s Hospital, Boston, MA
| | - Julia L. Glade Bender
- Department of Pediatric Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - M. Meaghan Granger
- Hematology and Oncology Center, Cook Children’s Hospital, Fort Worth, TX
| | - Araz Marachelian
- Children’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles, Los Angeles, CA
| | - Julie R. Park
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, TN
- Center for Clinical and Translational Research, Seattle Children’s Research Institute, University of Washington School of Medicine, Seattle, WA
- Department of Pediatric Hematology/Oncology, Seattle Children’s Hospital, Seattle, WA, USA
| | - Abby R. Rosenberg
- Center for Clinical and Translational Research, Seattle Children’s Research Institute, University of Washington School of Medicine, Seattle, WA
- Department of Pediatric Hematology/Oncology, Seattle Children’s Hospital, Seattle, WA, USA
- Department of Psychosocial Oncology and Palliative Care, Division of Pediatric Palliative Care; Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Pediatrics, Boston Children’s Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Suzanne Shusterman
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA
- Division of Pediatric Hematology-Oncology, Boston Children’s Hospital, Boston, MA
| | - Clare J. Twist
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Jennifer W. Mack
- Department of Pediatrics, Comer Children’s Hospital, University of Chicago, Chicago, IL
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA
- Division of Population Sciences’ Center for Outcomes and Policy Research, Dana-Farber Cancer Institute, Boston, MA, USA
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Malik M, Valiyaveettil D, Joseph DM. The Growing Burden of Cancer in Adolescent and Young Adults in Asia: A Call to Action. J Adolesc Young Adult Oncol 2024; 13:1-7. [PMID: 37327043 DOI: 10.1089/jayao.2023.0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
Recent estimates suggest that the lower middle income countries in Asia carry the heaviest burden of cancer among adolescents and young adults (AYAs) (defined as age 15-39 years). A larger proportion of the population in Asia is aged 15-39 compared with the developed countries. This age group is different from the pediatric or the adult group in terms of physical, social, psychological, and financial needs. Cancer incidence, disability, survivorship needs, financial toxicity, psychosocial issues, and so on are underestimated in this group, and available literature is scarce. Global data show an increasing trend of adult-onset cancers such as colorectal, breast, pancreas, and lung in the AYA population. Data suggest that the disease biology and prognosis are different in this group; however, further research is needed. An ESMO/SIOPE/SIOP Asia survey on the care of AYA cancer patients in Asia found a suboptimal availability of AYA specialized centers in the region and identified several unmet needs including lack of training, clinical trials, and high rates of treatment abandonment. There is an urgent need for cancer care systems in Asia to develop specialized services to be able to cater to this growing burden. Training and research in this area also need to be upscaled with the goal of establishing a sustainable infrastructure and quality services to ensure that this vulnerable group receives appropriate care. Management guidelines and national health policies should consider giving special attention to this group as the World Health Assembly reinforces the inclusion of children and adolescents in cancer control programs.
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Affiliation(s)
- Monica Malik
- Department of Radiation Oncology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Deepthi Valiyaveettil
- Department of Radiation Oncology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Deepa M Joseph
- Department of Radiation Oncology, All India Institute of Medical Sciences, Rishikesh, India
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Sisk BA, Bereitschaft C, Enloe M, Schulz G, Mack J, DuBois J. Oncology Clinicians' Perspectives on Online Patient Portal Use in Pediatric and Adolescent Cancer. JCO Clin Cancer Inform 2023; 7:e2300124. [PMID: 37972324 DOI: 10.1200/cci.23.00124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/11/2023] [Accepted: 09/26/2023] [Indexed: 11/19/2023] Open
Abstract
PURPOSE Online patient portals represent widely available communication tools in pediatric oncology. Previous studies have not evaluated clinicians' perspectives on portal use, including issues related to access to adolescents' portals. METHODS We performed semistructured interviews with physicians and advanced practice providers (APPs) who care for children or adolescents with cancer. We performed thematic analysis of benefits, problems, and accommodations related to portal use in oncology. RESULTS We interviewed 29 physicians and 24 APPs representing 26 institutions. Participants described five themes of benefits provided by portals: (1) empowering adolescents, (2) improving efficiency and accuracy of communication, (3) promoting open and adaptive communication, (4) supporting parents in managing care, and (5) bolstering clinical relationships. Participants described eight themes of problems caused by portal access: (1) creating emotional distress and confusion, (2) increasing workload and changing workflows, (3) threatening adolescent confidentiality, (4) adolescents lacking interest to engage, (5) diminishing clinical relationship, (6) misusing portal messages, (7) diminishing quality of sensitive documentation, and (8) parents losing access to adolescents' records. Participants described three themes related to accommodations they made as a result of portal access: (1) modifying note writing, (2) providing anticipatory guidance about viewing results, and (3) adapting workflows. Some portal functions created either benefits or problems depending on the clinical context. CONCLUSION Oncologists identified benefits and problems created by portal use, which were sometimes in tension, depending on the clinical context. To make portals useful, we must take steps to mitigate risks while preserving functionality for parents and adolescent patients.
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Affiliation(s)
- Bryan A Sisk
- Department of Pediatrics, Washington University School of Medicine, St Louis, MO
- Department of Medicine, Washington University School of Medicine, St Louis, MO
| | | | - Madi Enloe
- Department of Pediatrics, Washington University School of Medicine, St Louis, MO
| | - Ginny Schulz
- Department of Pediatrics, Washington University School of Medicine, St Louis, MO
| | - Jennifer Mack
- Population Sciences, Dana-Farber Cancer Institute, Boston, MA
| | - James DuBois
- Department of Medicine, Washington University School of Medicine, St Louis, MO
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Bautista JR, Zhang Y, Gwizdka J, Chang YS. Consumers' longitudinal health information needs and seeking: a scoping review. Health Promot Int 2023; 38:daad066. [PMID: 37432774 DOI: 10.1093/heapro/daad066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023] Open
Abstract
Needing and seeking health information often is a longitudinal everyday life information behavior that involves the use of technology. However, no reviews of consumers' longitudinal health information needs (HIN) and health information-seeking (HIS) behavior have been conducted. We performed a scoping review to address this gap. Specifically, we surveyed the characteristics, timeline construction and research findings of studies investigating consumers' longitudinal HIN and HIS. Initial searches were conducted in November 2019 and updated in July 2022. A total of 128 papers were identified, reviewed and analyzed using content and thematic analyses. Results showed that most papers were quantitative, conducted in the USA, related to cancer, conducted during the diagnosis and treatment phases, and followed preset time intervals. Findings concerning the development patterns of consumers' HIN degrees and HIS effort were mixed (i.e. increasing, decreasing or being consistent over time). They seemed to be shaped by factors such as health conditions, data collection methods and the length of data collection. Consumers' use of sources changes depending on health status and source accessibility; their medical terminologies seem to expand over time. HIS has a strong emotional dimension which may lead to adaptive or maladaptive information behaviors (e.g. information avoidance). Overall, the results revealed a lack of understanding of HIN and HIS from a longitudinal perspective, particularly along health condition progression and coping trajectories. There is also a lack of understanding of the role of technologies in the longitudinal HIS process.
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Affiliation(s)
- John Robert Bautista
- School of Information, The University of Texas at Austin, Austin, TX, USA
- Center for Health Communication, Moody College of Communication and Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Yan Zhang
- School of Information, The University of Texas at Austin, Austin, TX, USA
- Center for Health Communication, Moody College of Communication and Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Jacek Gwizdka
- School of Information, The University of Texas at Austin, Austin, TX, USA
- Information eXperience (IX) Lab, School of Information, The University of Texas at Austin, Austin, TX, USA
| | - Yung-Sheng Chang
- School of Information, The University of Texas at Austin, Austin, TX, USA
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Boeriu E, Borda A, Miclea E, Boeriu AI, Vulcanescu DD, Bagiu IC, Horhat FG, Kovacs AF, Avram CR, Diaconu MM, Vlaicu LF, Sirb OD, Arghirescu ST. Prognosis Communication in Pediatric Oncology: A Systematic Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:972. [PMID: 37371204 DOI: 10.3390/children10060972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/27/2023] [Accepted: 05/28/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND While communication plays an important role in medicine, it also often represents a challenge when the topic at hand is the prognosis of a high-risk condition. When it comes to pediatric oncology, the challenge becomes even greater for physicians who have to adapt their discourse to both the child and their family. METHODS Following the PRISMA guidelines, an advanced search on PubMed, Scopus and the Cochrane Library was performed, from 1 January 2017 to 31 October 2022. Demographic data for caregivers, pediatric patients and physicians were extracted, as well as diagnosis, prognosis, presence at discussion, emotional states and impact on life, trust, decision roles, communication quality and other outcomes. RESULTS A total of 21 articles were analyzed. Most studies (17) focused on caregivers, while only seven and five studies were focused on children and physicians, respectively. Most parents reported high trust in their physicians (73.01%), taking the leading role in decision making (48%), moderate distress levels (46.68%), a strong desire for more information (78.64%), receiving high-quality information (56.71%) and communication (52.73%). Most children were not present at discussions (63.98%); however, their desire to know more was expressed in three studies. Moreover, only two studies observed children being involved in decision making. Most physicians had less than 20 years of experience (55.02%) and reported the use of both words and statistics (47.3%) as a communication method. CONCLUSIONS Communication research is focused more on caregivers, yet children may understand more than they seem capable of and want to be included in the conversation. More studies should focus on and quantify the opinions of children and their physicians. In order to improve the quality of communication, healthcare workers should receive professional training.
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Affiliation(s)
- Estera Boeriu
- Department of Pediatrics, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania
- Department of Oncology and Haematology, "Louis Turcanu" Emergency Clinical Hospital for Children, Iosif Nemoianu Street 2, 300011 Timisoara, Romania
| | - Alexandra Borda
- Department of Oncology and Haematology, "Louis Turcanu" Emergency Clinical Hospital for Children, Iosif Nemoianu Street 2, 300011 Timisoara, Romania
| | - Eunice Miclea
- Department of Oncology and Haematology, "Louis Turcanu" Emergency Clinical Hospital for Children, Iosif Nemoianu Street 2, 300011 Timisoara, Romania
| | - Amalia-Iulia Boeriu
- Anaesthesiology and Intensive Care Department, Klinikum Rechts der Isar Der Technischen, Universitat Munchen, Ismaninger Street 22, 81675 Munchen, Germany
| | - Dan Dumitru Vulcanescu
- Multidisciplinary Research Center on Antimicrobial Resistance (MULTI-REZ), Microbiology Department, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Iulia Cristina Bagiu
- Multidisciplinary Research Center on Antimicrobial Resistance (MULTI-REZ), Microbiology Department, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Florin George Horhat
- Multidisciplinary Research Center on Antimicrobial Resistance (MULTI-REZ), Microbiology Department, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Alexandra Flavia Kovacs
- Department of Oncology, Onco-Help Association, Ciprian Porumbescu Street 56-59, 300239 Timisoara, Romania
| | - Cecilia Roberta Avram
- Department of Residential Training and Post-University Courses, "Vasile Goldis" Western University, Liviu Rebreanu Street 86, 310414 Arad, Romania
| | - Mircea Mihai Diaconu
- Department of Obstetrics and Gynecology, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Luiza Florina Vlaicu
- Department of Social Assistance, Faculty of Sociology and Psychology, Western University, Vasile Parvan Boulevard 4, 300223 Timisoara, Romania
| | - Otniel Dorian Sirb
- Multidisciplinary Research Center on Antimicrobial Resistance (MULTI-REZ), Microbiology Department, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania
- Eduard Pamfil Psychiatry Clinic Timisoara, Iancu Vacarescu Street 21, 300425 Timisoara, Romania
| | - Smaranda Teodora Arghirescu
- Department of Pediatrics, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania
- Department of Oncology and Haematology, "Louis Turcanu" Emergency Clinical Hospital for Children, Iosif Nemoianu Street 2, 300011 Timisoara, Romania
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Sisk B, Bereitschaft C, Kerr A. Communication with parents and young adult patients affected by complex vascular malformations. Pediatr Blood Cancer 2023; 70:e30158. [PMID: 36545911 DOI: 10.1002/pbc.30158] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/24/2022] [Accepted: 11/25/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Vascular malformations (VMs) are rare disorders that can cause pain, coagulopathy, disfigurement, asymmetric growth, and disability. Families affected by complex VMs experience misdiagnosis, limited trustworthy information, delayed or inappropriate treatments, and persistent uncertainty. However, more research is needed to understand the communication experiences of these families during clinical encounters. PROCEDURE We performed semi-structured interviews with 34 parents of children with VMs (18% men; 82% women; mean age = 41 years) and 25 young adults with VMs (8% men; 88% women; 4% nonbinary; mean age = 29) living in the United States, recruited through four patient advocacy groups. We performed thematic analysis to assess communication experiences, using a previously developed functional model of communication in pediatric oncology as an a priori framework. RESULTS We identified evidence of eight communication functions previously identified in pediatric oncology: building relationships, exchanging information, enabling self-management, managing uncertainty, responding to emotions, making decisions, providing validation, and supporting hope. Uncertainty was pervasive through participants' experiences and seemed to influence the fulfillment of communication functions. Fewer participants seemed to highlight the role of clinicians in responding to emotions or supporting hope, compared to other communication functions. CONCLUSION Interviews with parents and young adult patients with VMs provided evidence for eight functions of communication. While exchanging information and building relationships were described by nearly every respondent, supporting hope and responding to emotions were mentioned less frequently. Future studies should develop patient-reported communication measures to quantify the fulfillment of these functions and to identify areas of communication in need of intervention.
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Affiliation(s)
- Bryan Sisk
- Division of Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
- Bioethics Research Center, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Christine Bereitschaft
- Division of Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Anna Kerr
- Department of Primary Care, Heritage College of Osteopathic Medicine, Ohio University, Athens, Ohio, USA
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Porter AS, Woods C, Stall M, Baker JN, Mack JW, Kaye EC. Mismatch between Pediatric Oncologists' Private and Parent-Facing Prognostic Communication: Communication Patterns Used to Soften Prognostic Disclosure. J Palliat Med 2023; 26:210-219. [PMID: 35976087 DOI: 10.1089/jpm.2022.0265] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Purpose: Most parents of children with cancer desire honest prognostic communication, yet oncologists often avoid clear prognostic disclosure. This study explored differences between oncologists' private assessments of prognosis and their prognostic communication with patients and parents. Patients and Methods: In this prospective, longitudinal, mixed-methods study, we audio-recorded serial disease reevaluation conversations between children with advancing cancer, parents, and primary oncologists and separately surveyed and interviewed oncologists at disease progression time points. At time points when oncologists privately described curability as ≤10%, content analysis was used to compare prognostic language in recorded dialogue with private responses about prognosis. Results: Of 33 enrolled patient-parent dyads, 17 patients with high-risk cancer under the care of 6 primary oncologists experienced disease progression during the study period. In 95% of oncologist interviews at disease progression time points, oncologists either predicted curability to be ≤10% or incurable. In most interviews (82%), oncologists stated unequivocally that chances of cure were ≤10%, yet did not communicate these low odds during recorded discussions at the same time point. Analysis revealed three distinct communication patterns through which oncologists softened prognostic disclosure to patients and families: (1) space-holding for hope of cure: statements acknowledging difficult prognosis yet leaving room for possibility of cure; (2) vague warning: statements implying that cancer may progress without offering specifics; and (3) data without interpretation: statements describing disease progression findings in detail without explaining what this meant for the patient's future life or survival. Conclusion: Pediatric oncologists often temper their assessment of poor prognosis when speaking with patients and families. Future work should explore serious conversation guides and other clinical interventions aimed at encouraging person-centered prognostic disclosure for patients with advancing cancer and their families.
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Affiliation(s)
- Amy S Porter
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Cameka Woods
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Melanie Stall
- Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Justin N Baker
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Jennifer W Mack
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Erica C Kaye
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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Porter AS, Chow E, Woods C, Lemmon ME, Baker JN, Mack JW, Kaye EC. Navigating prognostic communication when children with poor-prognosis cancer experience prolonged disease stability. Pediatr Blood Cancer 2023; 70:e29920. [PMID: 36000929 DOI: 10.1002/pbc.29920] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/14/2022] [Accepted: 07/17/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Most pediatric patients and families want clear prognostic information across the illness course. Yet when children with poor-prognosis cancer experience prolonged disease stability, uncertainty can make communication particularly challenging. In this study, we aimed to (i) assess how frequently oncologists communicate about prognosis when high-risk cancer does not progress, and (ii) describe prognostic communication patterns in the context of disease stability. PATIENTS AND METHODS In this prospective, longitudinal, mixed-methods study, we audio-recorded serial disease re-evaluation conversations between children with poor-prognosis cancer, their families, and their primary oncologists. For this secondary analysis, we conducted content analysis across serial conversations among 16 patient-parent-oncologist triads for whom the patient's disease remained stable over the 24-month study period. RESULTS Prognostic communication was absent in >50% of recorded conversations. Overall, it comprised only 4% of dialog time, nearly 90% of which was dialog about prognostic uncertainty; discussion of curability occurred infrequently. Three distinct patterns for prognostic communication emerged: (a) "Don't know" statements, avoiding or deferring prognostication; (b) "Worry" statements, preparing families for possible future disease progression; and (c) relief-caveat statements, celebrating disease stability while balancing positivity with caution. CONCLUSIONS Oncologists seldom talked about prognosis with high-risk patients during periods of disease stability; yet when they did, they used thoughtful and effective strategies to prepare families for possible future disease progression. Further research is needed to better understand if, how, and when patients and families with stable disease who are high risk for future disease progression prefer to receive information about prognosis.
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Affiliation(s)
- Amy S Porter
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Emma Chow
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.,Rhodes College, Memphis, Tennessee, USA
| | - Cameka Woods
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Monica E Lemmon
- Department of Pediatrics, Duke Children's Health Center, Durham, North Carolina, USA
| | - Justin N Baker
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Jennifer W Mack
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Erica C Kaye
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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10
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Advice to Clinicians on Communication from Adolescents and Young Adults with Cancer and Parents of Children with Cancer. CHILDREN (BASEL, SWITZERLAND) 2022; 10:children10010007. [PMID: 36670560 PMCID: PMC9856802 DOI: 10.3390/children10010007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 12/09/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
Effective communication is integral to patient and family-centered care in pediatric and adolescent and young adult (AYA) oncology and improving healthcare delivery and outcomes. There is limited knowledge about whether AYAs and parents have similar communication preferences and needs. By eliciting and comparing communication advice from AYAs and parents, we can identify salient guidance for how clinicians can better communicate. We performed secondary analysis of semi-structured interviews from 2 qualitative communication studies. In one study, 80 parents of children with cancer during treatment, survivorship, or bereavement were interviewed. In the second study, AYAs with cancer during treatment or survivorship were interviewed. We asked AYAs and parents to provide communication advice for oncology clinicians. Using thematic analysis, we identified categories of advice related to three overarching themes: interpersonal relationships, informational preferences, and delivery of treatment, resources, and medical care. AYAs and parents provided similar advice about the need for compassion, strong connections, hopefulness, commitment, and transparent honesty However, AYAs placed additional emphasis on clinicians maintaining a calm demeanor.
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Sisk BA, Keenan M, Kaye EC, Baker JN, Mack JW, DuBois JM. Co-management of communication and care in adolescent and young adult oncology. Pediatr Blood Cancer 2022; 69:e29813. [PMID: 35719025 PMCID: PMC9681027 DOI: 10.1002/pbc.29813] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Clinicians have an ethical and practical imperative to engage adolescents and young adults (AYAs) with cancer in communication and care. Many young AYAs have involved parents, but guidelines for co-management of care with AYAs and their parents are lacking. METHODS We performed 37 semistructured interviews with AYAs aged 12-24 years at diagnosis, recruiting them from two pediatric cancer centers. We performed thematic analysis, aiming to understand how AYAs and their parents navigate their roles in communication and care. RESULTS We identified six roles that AYAs co-managed with their parents: (1) managing information, (2) managing social and emotional needs, (3) managing health, (4) advocating and empowering, (5) making decisions, and (6) managing logistics. AYAs tended to take more active roles in managing information and more passive roles in managing logistics, managing health, and making decisions. AYAs described how they and their parents had mutual responsibilities to be strong and to protect other's emotions. Additionally, we identified five factors that influenced AYAs' roles in communication and care: (1) AYA agency, (2) clinician encouragement, (3) emotional and physical well-being, (4) personality, preferences, and values, and (5) insights and skills. CONCLUSIONS AYAs have nuanced preferences for how they are involved in communication and care roles. Clinicians can help families to clarify their preferences and values around these roles in a way that meets each family's unique needs. Future studies should aim to develop tools that support the fulfillment of these engagement goals.
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Affiliation(s)
- Bryan A. Sisk
- Department of Pediatrics, Division of Hematology/Oncology, Washington University School of Medicine, St. Louis, Missouri, USA,Department of Medicine, Bioethics Research Center, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Megan Keenan
- Department of Pediatrics, Division of Hematology/Oncology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Erica C. Kaye
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Justin N. Baker
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA,Division of Quality of Life and Palliative Care, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Jennifer W. Mack
- Pediatric Oncology and Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - James M. DuBois
- Department of Medicine, Bioethics Research Center, Washington University School of Medicine, St. Louis, Missouri, USA
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12
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AlZaabi A, AlHarrasi A, AlMusalami A, AlMahyijari N, Al Hinai K, ALAdawi H, Al-Shamsi HO. Early onset colorectal cancer: Challenges across the cancer care continuum. Ann Med Surg (Lond) 2022; 82:104453. [PMID: 36268309 PMCID: PMC9577444 DOI: 10.1016/j.amsu.2022.104453] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 08/13/2022] [Accepted: 08/13/2022] [Indexed: 11/26/2022] Open
Abstract
Early Onset Colorectal cancer (EOCRC) incidence is increasing at an alarming pace. An increase of 90% in colon cancer and 124% in rectal cancer is expected by 2030. Patients with EOCRC are not receiving additional attention compared to older patients despite having a unique molecular pattern, majority of cases are sporadic, and related short- and long-term treatment and disease complications. The current management and screening guidelines have been constructed from studies on late onset CRC. Plethora of studies are ongoing to understand this disease entity in order to construct a tailored prevention, detection and management plans. While waiting for a better understanding of the disease, efforts should be directed toward improving the quality of care across the cancer continuum. Here we aim to address the challenges faced by EOCRC patients across the cancer continuum. This will facilitate directing future efforts and research toward construction of a personalized and precise guidelines. Studies showed that Ealy onset colorectal cancer is caused by an accumulative risk exposure. Indirect cost of premature death and reduced productivity due to EOCRC exceeds direct costs. Patients, system and physicians related diagnosis delays should be improved. Young cancer patients have unique survivorship concerns different from old patients.
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13
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Sisk BA, Keenan MA, Schulz GL, Bakitas M, Currie ER, Gilbertson-White S, Lindley LC, Roeland EJ, Mack JW. Bereaved Caregivers Perspectives of Negative Communication Experiences Near the End of Life for Adolescents and Young Adults with Cancer. J Adolesc Young Adult Oncol 2022; 11:498-505. [PMID: 34870475 PMCID: PMC9595604 DOI: 10.1089/jayao.2021.0154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: High-quality communication is a standard of palliative care for adolescents and young adults (AYAs) with cancer. Yet, few studies have characterized the negative communication experiences of AYAs near the end of life (EOL). Methods: We performed a secondary analysis of 27 qualitative interviews with bereaved caregivers of AYAs with cancer who died between 2013 and 2016 at 1 of 3 sites. Interviews focused on barriers to optimal EOL care for AYAs. We used thematic analysis using iterative consensus coding to analyze transcripts. Results: Participants were predominantly white (85%), non-Hispanic (93%), and female (74%). Half of the participants were bereaved parents, and 37% were bereaved partners or spouses. Overall, 23/27 (85%) caregivers described at least one negative communication experience related to one of three themes: (1) Insensitivity to patients' needs, preferences, and values; (2) Insufficient discussions of prognosis and/or EOL; and (3) Loss of support from the clinical team near EOL. Both clinician- and patient-related factors contributed to limited EOL discussions. Lack of care continuity related to both clinician factors and systems of care that required new or changing clinical care teams near the EOL. Conclusions: Caregivers report a desire for clinician sensitivity to their needs and values, information about the future, and longitudinal connections with individual clinicians. Clinicians might improve caregivers' EOL experiences by eliciting patient preferences, engaging in EOL discussions, adapting to the AYA's developmental and emotional needs, and demonstrating a commitment to AYAs and caregivers as they approach the EOL.
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Affiliation(s)
- Bryan A. Sisk
- Division of Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Medicine, Bioethics Research Center, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Megan A. Keenan
- Department of Medicine, Bioethics Research Center, Washington University School of Medicine, St. Louis, Missouri, USA
- Brown School of Social Work, Washington University, St. Louis, Missouri, USA
| | - Ginny L. Schulz
- Division of Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Marie Bakitas
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Erin R. Currie
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Lisa C. Lindley
- College of Nursing, University of Tennessee, Knoxville, Tennessee, USA
| | - Eric J. Roeland
- Division of Hematology/Oncology, Oregon Health and Sciences University, Portland, Oregon, USA
| | - Jennifer W. Mack
- Pediatric Oncology and Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts, USA
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14
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Terrasson J, Rault A, Dolbeault S, Brédart A. Question prompt lists to improve communication between cancer patients and healthcare professionals. Curr Opin Oncol 2022; 34:265-269. [PMID: 35730518 DOI: 10.1097/cco.0000000000000840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW This literature review sets out to summarize knowledge on the impact of question prompt lists (QPLs) on patient-physician communication in oncology and to provide an account of current research on the development, adaptation, and implementation of this type of communication tool. RECENT FINDINGS Provided with a QPL, patients seem to ask more questions, in particular on sensitive issues like those around the end-of-life period and they recall the information provided better. There is a need to adapt QPLs, taking account of divergences in attitudes towards illness, participation in decision-making, and discussions about the illness prognosis across cultures. QPLs may also need to be tailored to specific concerns of patients at the different stages in the care trajectory and to the particularities of each cancer type. These adaptations contribute to the effectiveness of the tool because they make it possible to tailor it to the challenges and constraints experienced in clinical practice. SUMMARY QPLs are designed to enhance patients' communication with their physicians. Further research is required to develop QPLs suited to each cultural and clinical setting, involving health professionals so as to facilitate the implementation of these tools in routine practice.
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Affiliation(s)
- Johanna Terrasson
- Institut Curie, Supportive Care Department, Psycho-oncology Unit, PSL University, Paris
| | - Aude Rault
- Institut Curie, Supportive Care Department, Psycho-oncology Unit, PSL University, Paris
| | - Sylvie Dolbeault
- Institut Curie, Supportive Care Department, Psycho-oncology Unit, PSL University, Paris.,CESP, University Paris-Sud, UVSQ, INSERM, University Paris-Saclay, Villejuif cedex, France
| | - Anne Brédart
- Institut Curie, Supportive Care Department, Psycho-oncology Unit, PSL University, Paris.,Paris University, Psychology Institute, Psychopathology and health process laboratory Boulogne-Billancourt
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15
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Sisk BA, Keenan M, Schulz GL, Kaye E, Baker JN, Mack JW, DuBois JM. Interdependent functions of communication with adolescents and young adults in oncology. Pediatr Blood Cancer 2022; 69:e29588. [PMID: 35092342 PMCID: PMC8860882 DOI: 10.1002/pbc.29588] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Communication is central to patient-centered care in adolescent and young adult (AYA) cancer. Previously, we developed a functional communication model from perspectives of parents whose children had cancer. No prior studies have established a framework for the breadth of communication functions in AYA oncology. We aimed to identify these communication functions from AYAs' perspectives. METHODS Semistructured interviews with 37 AYAs with cancer aged 12-24 years at diagnosis from two pediatric centers during treatment or survivorship. We performed thematic analysis, using a functional communication model as an a priori framework, but remaining open to novel themes. RESULTS We identified eight interdependent functions of communication in AYA oncology that were consistent with those previously identified among parents: building relationships, exchanging information, enabling family self-management, making decisions, managing uncertainty, responding to emotions, providing validation, and supporting hope. AYAs held varying preferences for engagement in different communication functions. While some AYAs preferred very passive or active roles, most AYAs described an interdependent process of communication involving them, their parents, and their clinicians. Parents often served as a conduit and buffer of communication between the AYA and clinician. CONCLUSIONS Interviews with AYAs provided evidence for eight interdependent communication functions in AYA oncology. Many AYAs described the integral role of parents in communication regardless of their age. Clinicians can use this framework to better understand and fulfill the communication needs of AYA patients. Future work should aim to measure and intervene upon these functions to improve communication experiences for AYAs with cancer.
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Affiliation(s)
- Bryan A. Sisk
- Department of Pediatrics, Division of Hematology/Oncology, Washington University School of Medicine, St. Louis, Missouri,Department of Medicine, Bioethics Research Center, Washington University School of Medicine, St. Louis, Missouri
| | - Megan Keenan
- Department of Pediatrics, Division of Hematology/Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Ginny L. Schulz
- Department of Pediatrics, Division of Hematology/Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Erica Kaye
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee,Division of Quality of Life and Palliative Care, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Justin N. Baker
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee,Division of Quality of Life and Palliative Care, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Jennifer W. Mack
- Pediatric Oncology and Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts; Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, Massachusetts
| | - James M. DuBois
- Department of Medicine, Bioethics Research Center, Washington University School of Medicine, St. Louis, Missouri
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16
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Eng C, Jácome AA, Agarwal R, Hayat MH, Byndloss MX, Holowatyj AN, Bailey C, Lieu CH. A comprehensive framework for early-onset colorectal cancer research. Lancet Oncol 2022; 23:e116-e128. [PMID: 35090673 DOI: 10.1016/s1470-2045(21)00588-x] [Citation(s) in RCA: 58] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/04/2021] [Accepted: 10/06/2021] [Indexed: 02/07/2023]
Abstract
Sporadic colorectal cancer has traditionally been viewed as a malignancy of older individuals. However, as the global prevalence of the disease diagnosed in younger individuals (<50 years) is expected to increase within the next decade, greater recognition is now being given to early-onset colorectal cancer. The cause of the predicted rise in prevalence is largely unknown and probably multifactorial. In this Series paper, we discuss the potential underlying causes of early-onset colorectal cancer, the role of energy balance, biological and genomic mechanisms (including microbiome aspects), and the treatment of early-onset colorectal cancer. We have specifically considered the psychosocial challenges of being diagnosed with colorectal cancer at younger age and the potential financial toxicity that might ensue. This Series paper brings a comprehensive review based on the existing data in the hopes of optimising the overall outcomes for patients with early-onset colorectal cancer.
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17
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Sisk BA, Harvey K, Friedrich AB, Antes AL, Yaeger LH, Mack JW, DuBois J. Multilevel barriers and facilitators of communication in pediatric oncology: A systematic review. Pediatr Blood Cancer 2022; 69:e29405. [PMID: 34662485 PMCID: PMC8875310 DOI: 10.1002/pbc.29405] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 01/03/2023]
Abstract
Multiple factors can facilitate or impede the fulfillment of communication functions in pediatric cancer. In this systematic review, we evaluated 109 studies from the preceding 20 years that presented qualitative or quantitative evidence of barriers or facilitators to communication in pediatric cancer. Using a multilevel framework developed in our prior study, we then analyzed and categorized the levels of barriers and facilitators identified in included studies. The vast majority of studies focused on individual-level barriers, rather than team, organization/system, collaborating hospital, community, or policy-level barriers. Future studies should explore the full range of factors that affect communication.
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Affiliation(s)
- Bryan A. Sisk
- Department of Pediatrics, Division of Hematology/Oncology, Washington University School of Medicine, St. Louis, Missouri.,Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Kieandra Harvey
- Brown School of Social Work, Washington University School of Medicine, St. Louis, Missouri
| | - Annie B. Friedrich
- Albert Gnaegi Center for Health Care Ethics, Saint Louis University, St. Louis, Missouri
| | - Alison L. Antes
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Lauren H Yaeger
- Bernard Becker Medical Library, Washington University School of Medicine, St. Louis, Missouri
| | - Jennifer W. Mack
- Pediatric Oncology and Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts; and Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, Massachusetts
| | - James DuBois
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
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18
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Bergstraesser E, Thienprayoon R, Brook LA, Fraser LK, Hynson JL, Rosenberg AR, Snaman JM, Weaver MS, Widger K, Zernikow B, Jones CA, Schlögl M. Top Ten Tips Palliative Care Clinicians Should Know About Prognostication in Children. J Palliat Med 2021; 24:1725-1731. [PMID: 34726519 DOI: 10.1089/jpm.2021.0439] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Pediatric palliative care (PPC) is different from palliative care (PC) for adults. However, conceptualizing PPC remains cumbersome due to the high heterogeneity of often rare diseases, the high diversity of disease trajectories, and the particular difficulty to predict the future of an individual, severely ill child. This article aims to provide an overview and critical reflection of different aspects of prognostication in children with PC needs. This includes different diseases from neurology to oncology, from the unborn baby to the young adult, new approaches in treatment, advance care planning, and, most important, communication with the affected child as well as parents.
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Affiliation(s)
- Eva Bergstraesser
- Department of Pediatric Palliative Care, University Children's Hospital Zurich, Zurich, Switzerland
| | - Rachel Thienprayoon
- Division of Palliative Care, Department of Anesthesia, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Lynda A Brook
- Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Lorna K Fraser
- Martin House Research Centre, University of York, Heslington, United Kingdom
| | - Jenny L Hynson
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Victorian Paediatric Palliative Care Program, The Royal Children's Hospital Melbourne, Melbourne, Australia
| | - Abby R Rosenberg
- Palliative Care and Resilience Lab, Seattle Children's Research Institute, Seattle, Washington, USA.,Department of Pediatrics, Division of Hematology/Oncology, University of Washington School of Medicine, Seattle, Washington, USA.,Cambia Palliative Care Center of Excellence at the University of Washington, Seattle, Washington, USA
| | - Jennifer M Snaman
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Meaghann S Weaver
- Division of Pediatric Palliative Care, Department of Pediatrics, Children's Hospital and Medical Center, Omaha, Nebraska, USA.,National Center for Ethics in Healthcare, Washington, DC, USA
| | - Kimberley Widger
- Lawrence S. Bloomberg Faculty of Nursing, Univeristy of Toronto, Toronto, Ontario, Canada.,Pediatric Advanced Care Team, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Boris Zernikow
- Pediatric Palliative Care Centre, Children's and Adolescents' Hospital Datteln, Germany.,Department of Children's Pain Therapy and Pediatric Palliative Care, Datteln, Germany.,Faculty of Health-School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Christopher A Jones
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Mathias Schlögl
- Centre on Aging and Mobility, University Hospital Zurich and City Hospital Waid Zurich, Zurich, Switzerland.,Universtiy Clinic for Acute Geriatric Care, City Hospital Waid Zurich, Zurich, Switzerland
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19
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Kerr AM, Sisk BA. Unanswered questions and unmet needs: A call for communication research in vascular anomalies. PATIENT EDUCATION AND COUNSELING 2021; 104:2839-2842. [PMID: 33858723 DOI: 10.1016/j.pec.2021.03.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/03/2021] [Accepted: 03/28/2021] [Indexed: 06/12/2023]
Affiliation(s)
- Anna M Kerr
- Department of Primary Care, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, USA.
| | - Bryan A Sisk
- Division of Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
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20
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Sisk BA, Schulz GL, Blazin LJ, Baker JN, Mack JW, DuBois JM. Parental views on communication between children and clinicians in pediatric oncology: a qualitative study. Support Care Cancer 2021; 29:4957-4968. [PMID: 33569673 PMCID: PMC8295182 DOI: 10.1007/s00520-021-06047-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 02/04/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Communication is essential to providing family-centered care in pediatric oncology. Previously, we developed a functional model of communication between parents and clinicians. Prior research has not examined the domains and purposes of communication between children and clinicians. We explored parental perspectives to begin understanding this communication. METHODS Secondary analysis of semi-structured interviews with 80 parents of children with cancer across 3 academic medical centers during treatment, survivorship, or bereavement. We employed semantic content analysis, using the functional model of parental communication as an a priori framework. RESULTS We identified 6 distinct functions of communication in child-clinician interactions: building relationships, promoting patient engagement, addressing emotions, exchanging information, managing uncertainty, and fostering hope. These communication functions were identified by parents of older (> 13 years old) and younger (< 12 years old) children, although the specific manifestations sometimes differed by age. Notably, age was not always an indicator of the child's communication needs. For example, some parents noted older children who did not want to discuss difficult topics, whereas other parent described younger children who wanted to know every detail. Two functions from the previous parental model of communication were absent from this analysis: supporting family self-management and making decisions. CONCLUSION Interviews with 80 parents provided evidence for 6 distinct functions of communication between children and clinicians. These functions apply to older and younger children, although specific manifestations might vary by age. This functional model provides a framework to guide clinicians' communication efforts and future communication research.
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Affiliation(s)
- Bryan A Sisk
- Department of Pediatrics, Division of Hematology/Oncology, Washington University School of Medicine, 4523 Clayton Avenue, Campus Box 8005, St. Louis, MO, 63110, USA.
| | - Ginny L Schulz
- Department of Pediatrics, Division of Hematology/Oncology, Washington University School of Medicine, 4523 Clayton Avenue, Campus Box 8005, St. Louis, MO, 63110, USA
| | - Lindsay J Blazin
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Justin N Baker
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
- Division of Quality of Life and Palliative Care, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jennifer W Mack
- Pediatric Oncology and Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
- Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, MA, USA
| | - James M DuBois
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
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21
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Influencing factors of treatment and prognosis perceptions among advanced cancer patients: a cross-sectional study. Support Care Cancer 2021; 30:1209-1220. [PMID: 34455482 DOI: 10.1007/s00520-021-06516-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 08/21/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE The present study aimed to investigate the status and significantly influencing factors of treatment and prognosis perceptions among advanced cancer patients based on patient-reported outcome. METHODS A cross-sectional study was conducted at two tertiary A general hospitals. From June to September 2019, 300 patients were invited and 292 of them participated in this study. Except for 9 invalid questionnaires, 283 pen-paper questionnaires including sociodemographic and clinical characteristics, Chinese Version of Prognosis and Treatment Perception Questionnaire, Herth Hope Index, and Hospital Anxiety and Depression Scale were well completed. Descriptive analysis, Pearson's correlation test, logistic regression analysis, and multiple linear regression analysis were applied for analysis. RESULTS One hundred seventy-five (61.8%) advanced cancer patients reported inaccurate treatment perception. Prognosis perception scored 87.9 ± 13.72 indicating a middle level of prognosis perception. Fourteen (4.9%), 138 (48.8%), and 131 (46.3%) patients presented low, middle, and high prognosis perception levels, respectively. In patients, without spouse and religion beliefs, received chemoradiotherapy, diagnosed as cancer equal to or less than 1 year, and higher hope level were inaccurate treatment perception's risk factors. Younger age, longer diagnosis time, higher educational level, less support for medical expenses payment, receiving chemoradiotherapy, and lower hope level but more anxiety and depression symptoms were positive predictors of prognosis perception. CONCLUSIONS A majority of advanced cancer patients in this study reported inaccurate treatment and middle level of prognosis perception influencing by objective and subjective factors. Clinical interventions could be developed referring these impacting factors originating from patient-reported outcome.
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22
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Sisk BA, Keenan MA, Blazin LJ, Kaye E, Baker JN, Mack JW, DuBois JM. "Don't be afraid to speak up": Communication advice from parents and clinicians of children with cancer. Pediatr Blood Cancer 2021; 68:e29052. [PMID: 33861026 PMCID: PMC8286806 DOI: 10.1002/pbc.29052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/02/2021] [Accepted: 03/25/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Parents and clinicians of children with cancer can provide advice to improve communication that reflects lessons learned through experience. We aimed to identify categories of communication advice offered to parents of children with cancer from clinicians and other parents. PROCEDURE (1) Semi-structured interviews with 80 parents of children with cancer at three sites; (2) single-item, open-ended survey administered following 10 focus groups with 58 pediatric oncology clinicians at two sites. We asked participants for communication advice to parents, and analyzed responses using semantic content analysis. RESULTS Parents provided five categories of communication advice to other parents. Advocacy involved asking questions, communicating concerns, and speaking up for the child. Support involved pursuing self-care, seeking and accepting help, and identifying supportive communities. Managing information involved taking and organizing notes, remaining open to difficult truths, and avoiding inaccurate information. Partnership involved establishing open lines of communication with clinicians, making the family's values and priorities known, and trusting the clinical team. Engaging and supporting the child involved, understanding and incorporating the child's preferences and values, and creating a loving environment. Clinicians' advice addressed similar categories, although only one clinician described engaging and supporting the child. Furthermore, parental advice expanded beyond interactions with the clinical team, whereas clinician advice focused more on the role of clinicians. CONCLUSIONS Parents and clinicians of children with cancer provided five categories of communication advice. With these data, clinicians, health care organizations, support groups, and patient advocates could offer experience-informed advice to parents who are seeking information and support.
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Affiliation(s)
- Bryan A Sisk
- Department of Pediatrics, Division of Hematology/Oncology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Megan A Keenan
- Bioethics Research Center, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Lindsay J Blazin
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Erica Kaye
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
- Division of Quality of Life and Palliative Care, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Justin N Baker
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
- Division of Quality of Life and Palliative Care, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Jennifer W Mack
- Pediatric Oncology and Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - James M DuBois
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
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23
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Sisk BA, Schulz GL, Kaye EC, Baker JN, Mack JW, DuBois JM. Clinicians' Perspectives on the Functions of Communication in Pediatric Oncology. J Palliat Med 2021; 24:1545-1549. [PMID: 34255562 DOI: 10.1089/jpm.2021.0090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Parents previously identified eight core functions of communication with clinicians in pediatric oncology. Objective: To determine clinicians' views on communication functions in pediatric oncology. Design: In 10 focus groups with 59 clinicians at two academic centers, we asked open-ended questions about communication goals and purposes. Then we presented definitions of eight communication functions previously described by parents and explored clinicians' perspectives. Setting/Subjects: We performed separate focus groups for nurses, nurse practitioners, physicians, and psychosocial professionals. Measurements: Thematic analysis of focus group transcripts. Results: Clinicians identified six functions in response to open-ended questions. After reviewing the eight functions described by parents, all clinicians agreed with the framework: building relationships, exchanging information, making decisions, enabling family self-management, managing uncertainty, responding to emotions, supporting hope, and providing validation. Conclusions: Pediatric oncology clinicians corroborated this functional communication framework. Clinicians and researchers can utilize this framework to guide care and research in the future.
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Affiliation(s)
- Bryan A Sisk
- Division of Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ginny L Schulz
- Division of Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Erica C Kaye
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Justin N Baker
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.,Division of Quality of Life and Palliative Care, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Jennifer W Mack
- Division of Population Sciences, Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - James M DuBois
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
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Sisk BA, Schulz G. Moving Toward a Basic Science of Prognostic Communication. Pediatrics 2021; 147:peds.2021-050208. [PMID: 33952690 DOI: 10.1542/peds.2021-050208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/25/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Bryan A Sisk
- Division of Hematology and Oncology, Department of Pediatrics, School of Medicine, Washington University in St Louis, St Louis, Missouri
| | - Ginny Schulz
- Division of Hematology and Oncology, Department of Pediatrics, School of Medicine, Washington University in St Louis, St Louis, Missouri
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25
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Sisk BA, Zavadil JA, Blazin LJ, Baker JN, Mack JW, DuBois JM. Assume It Will Break: Parental Perspectives on Negative Communication Experiences in Pediatric Oncology. JCO Oncol Pract 2021; 17:e859-e871. [PMID: 33848191 DOI: 10.1200/op.20.01038] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Communication breakdowns in pediatric oncology can have negative consequences for patients and families. A detailed analysis of these negative encounters will support clinicians in anticipating and responding to communication breakdowns. METHODS Semistructured interviews with 80 parents of children with cancer across three academic medical centers during treatment, survivorship, or bereavement. We analyzed transcripts using semantic content analysis. RESULTS Nearly all parents identified negative communication experiences (n = 76). We identified four categories of contributors to negative experiences: individual (n = 68), team (n = 26), organization (n = 46), and greater health care system (n = 8). These experiences involved a variety of health care professionals across multiple specialties. Parents reported 12 personal consequences of communication breakdowns: emotional distress (n = 65), insufficient understanding (n = 48), decreased trust or confidence (n = 37), inconvenience (n = 36), medical harm (n = 23), decreased self-confidence (n = 17), decreased emotional support (n = 13), decreased engagement (n = 9), false hope (n = 9), decreased hope (n = 7), financial insult (n = 7), and decreased access to resources (n = 3). We identified five categories of supportive responses from clinicians: exploring (n = 8), acknowledging (n = 17), informing (n = 27), adapting (n = 27), and advocating (n = 18). Parents often increased their own advocacy on behalf of their child (n = 47). Parents also identified the need for parental engagement in finding solutions (n = 12). Finally, one parent suggested that clinicians should assume that communication will fail and develop contingency plans in advance. CONCLUSION Communication breakdowns in pediatric oncology negatively affect parents and children. Clinicians should plan for communication breakdowns and respond by exploring, acknowledging, informing, adapting, advocating, and engaging parents in finding solutions.
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Affiliation(s)
- Bryan A Sisk
- Department of Pediatrics, Division of Hematology/Oncology, Washington University School of Medicine, St Louis, MO
| | - Jessica A Zavadil
- Department of Pediatrics, St Louis Children's Hospital, St Louis, MO
| | - Lindsay J Blazin
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
| | - Justin N Baker
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN.,Division of Quality of Life and Palliative Care, St Jude Children's Research Hospital, Memphis, TN
| | - Jennifer W Mack
- Pediatric Oncology and Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA.,Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, MA
| | - James M DuBois
- Department of Medicine, Washington University School of Medicine, St Louis, MO
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Snaman JM, Helton G, Holder RL, Revette A, Baker JN, Wolfe J. Identification of adolescents and young adults' preferences and priorities for future cancer treatment using a novel decision-making tool. Pediatr Blood Cancer 2021; 68:e28755. [PMID: 33017087 DOI: 10.1002/pbc.28755] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 11/12/2022]
Abstract
BACKGROUND Adolescents and young adults (AYAs) with cancer receive high-intensity care and experience significant symptoms at the end of life. As novel cancer-directed therapies increase, AYAs with advanced cancer may face multiple treatment options, each with unique risk/benefit profiles. To augment the AYAs' voice in the decision-making process, we developed MyPref, an adaptive conjoint analysis-based tool. PROCEDURE We conducted a three-staged pilot study of MyPref utilizing an exploratory intervention mixed methods design. AYAs and their identified parent or trusted person (PTP) completed MyPref and received a summary of their preferences for nine treatment-related factors. Participants later engaged in semi-structured interviews to further explore their experience with MyPref. Responses to free text questions and interviews were analyzed using qualitative techniques. RESULTS Fifteen AYAs with advanced cancer and seven PTPs participated in the pilot. While most participants identified time until cancer grows, quality of life, and side effects to be the most important factors when considering a future treatment, preferences were highly varied. Notably, MyPref-calculated preferences differed from initial rank order, and participants indicated that calculated preferences were accurate in follow-up interviews. CONCLUSION The MyPref-calculated preferences varied by individual and differed from initial rank ordering. Additionally, there was variability in how individuals defined and prioritized treatment-related factors. This novel tool may be a useful way to engage AYAs and their PTPs in discussions around preferences for treatment and prepare AYAs for future decision making. We plan to evaluate this tool longitudinally to evaluate the impact on actual treatment decisions.
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Affiliation(s)
- Jennifer M Snaman
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | - Gabrielle Helton
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Rachel L Holder
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia
| | - Anna Revette
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Justin N Baker
- Division of Quality of Life and Palliative Care, Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Joanne Wolfe
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
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