Communication Tools Used in Cancer Communication with Children: A Scoping Review

The implementation and strategy of triadic communication in pediatric oncology: a scoping review

Triad child-parent-professional communication is considered a priority in evaluating and optimizing therapeutic alliance in pediatric oncology. This scoping review aimed to map the existing evidence in implementation, influencing factors, and strategies of triadic communication in pediatric oncology. Using Arksey and O'Malley's framework, we searched 5 databases and grey literature until June 15th, 2024. Two researchers selected studies and extracted data independently. The PAGER framework was employed to summarize the implications of existing research to inform future research and practice. A total of 24 articles were included. Healthcare professionals usually initiate triadic communication. Communication topics rarely focused on prognosis, emotions, and end-of-life care. The triad child-parent-professional exhibited similarities in language, emotional, and decision-making communication preferences but differed regarding skills and information preferences. The roles of the triad parts were unclear, especially nurses' role, responsibilities, and contributions were seldom specified. Factors influencing the implementation spanned individual, organizational, and socio-cultural levels. Five types including 21 specific suggested strategies were identified to facilitate implementation, yet few strategies were adopted by patients and caregivers, and limited effectiveness studies have evaluated specific strategies. Overall, while triadic communication has received considerable attention in the world, its practical implementation in real-world settings remains largely underdeveloped. IMPACT: Our research has mapped the global trajectories of triadic communication between child-parent-professional throughout the cancer journey. A precise delineation of roles and responsibilities within the triadic communication framework in pediatric oncology is crucial for augmenting collaborative efforts and achieving optimal coordination among stakeholders. Healthcare professionals could partner with families to comprehend individual communication preferences, cultivating a collaborative relationship that honors each participant's needs and enhances informed decision-making. The findings equip healthcare professionals with a range of strategies to navigate communication with children with cancer and their parents.

"A very difficult conversation": Challenges and opportunities for improvement in pediatric oncology clinician communication about late effects

OBJECTIVES

Current approaches to communicating the potential late effects of pediatric oncology treatments leave many patients and families feeling unaware of risks and unprepared for the future. We aimed to identify provider perspectives on early communication about late effects.

METHODS

Semi-structured interviews were conducted with pediatric oncology providers at Dana-Farber/Boston Children's Cancer and Blood Disorders Center from December 2021 to March 2022. Purposeful sampling ensured a diversity of clinical roles. Thematic analysis was conducted using deductive and inductive codes.

RESULTS

We interviewed nine pediatric oncology providers; all expressed discomfort discussing potential late effects in early treatment conversations. Barriers to late effects communication included (i) social-emotional factors, including lack of perceived importance to families, worry about emotional burden on families, and provider feelings of helplessness/wanting to provide hope; and (ii) suboptimal set-up/resources, including limitations of consent forms, time constraints, and lack of available data. All providers supported the creation of a communication tool to assist early discussions of late effects.

CONCLUSIONS

Communicating about late effect risks poses unique challenges to providers because of the perceived impact on families and the limitations of current practices and available resources. These findings support the need for a late effects communication tool to assist in early communication about late effects risks.

Developing and evaluating a cancer communication picture book for children, families, and health care professionals: A mixed-methods feasibility study

Objective

Effective communication about cancer with children is a significant challenge for healthcare professionals and families. This study aimed to create a picture book as a tool for facilitating communication about cancer and to assess its feasibility. It also demonstrated the use of mixed methods and convergent designs for intervention development.

Methods

The study included healthcare professionals (n = 14), children without cancer (aged 4-8 years; n = 21) and their families (n = 18), as well as children with various types of cancer, undergoing maintenance therapy or follow-up (aged 4-12 years; n = 3) and their families (n = 3). Quantitative and qualitative data were separately analyzed, and meta-inferences were made using a joint display. The picture book was refined based on feedback from healthcare professionals, and a similar iterative process was carried out with children and their families.

Results

Over 85% of the participants considered the picture book, along with a side book, feasible. The picture book was found to be helpful for discussing the topic of cancer with children. It also significantly improved the knowledge of children without cancer (P < 0.01). Most children expressed interest in reading it and believed it was useful for talking to others about cancer. However, some concerns were raised regarding the context and expressions in the picture book.

Conclusions

This study successfully assessed the feasibility of the developed picture book using a mixed methods approach, offering valuable insights into its implementation and refinement. Further research is needed to evaluate the effectiveness of its use and gather user feedback.

Participation, challenges and needs in children with down syndrome during cancer treatment at hospital: a qualitative study of parents' experiences

Background

Studies report that it can be challenging to assess and treat side-effects and symptoms among children who have impairments and difficulties in expressing their needs. Children with Down syndrome have an increased vulnerability and an increased risk for contracting leukaemia. There is sparse knowledge about the parental experience of how treatment and side-effects affect children with Down syndrome with leukaemia, as well as the role of participation during treatment.

Purpose

This study aimed to explore the perceptions of parents of children with Down syndrome and leukaemia regarding their child's treatment, side effects and participation during hospital care.

Methods

A qualitative study design was used, and interviews were conducted with a semi-structured interview-guide. Fourteen parents of 10 children with Down syndrome and acute lymphoblastic leukaemia from Sweden and Denmark, 1-18 years of age, participated. All children had completed therapy or had a few months left before the end of treatment. Data was analysed according to qualitative content analysis.

Results

Four sub-themes were identified: (1) Continuously dealing with the child's potential susceptibility; (2) Confidence and worries regarding decisions related to treatment regulation; (3) Challenges in communication, interpretation, and participation; and (4) Facilitating participation by adapting to the child's behavioural and cognitive needs. The sub-themes were bound together in an overarching theme, which expressed the core perception "Being the child's spokesperson to facilitate the child's participation during treatment". The parents expressed this role as self-evident to facilitate communication regarding the needs of the child, but also regarding how the cytotoxic treatment affected the vulnerable child. Parents conveyed the struggle to ensure the child's right to receive optimal treatment.

Conclusion

The study results highlight parental challenges regarding childhood disabilities and severe health conditions, as well as communication and ethical aspects regarding to act in the best interests of the child. Parents played a vital role in interpreting their child with Down syndrome. Involving parents during treatment enables a more accurate interpretation of symptoms and eases communication and participation. Still, the results raise questions regarding issues related to building trust in healthcare professionals in a context where medical, psychosocial and ethical dilemmas are present.