1. In this study examining conversations between parents and physicians regarding prognosis of children with advanced cancer, most physicians communicated at least 1 statement about the child’s prognosis, though 25% used nonspecific statements. None of these physicians asked parents about their hopes.
2. The majority of parents expressed a hope for a cure, while recognizing that this was contradictory to their expectations of the prognosis. When asked for other hopes, many stated quality of life and minimal suffering.
Study Rundown: Though parents of children with cancer continue to have hope, little is known about the nature of that hope and whether parents are able to reconcile hope with a poor prognosis. This study recorded conversations that took place between physicians and parents of children with advanced cancer. Interviews were also recorded with parents about their hopes to characterize and better understand parental hope. Most physicians communicated at least 1 statement about the child’s prognosis and presented treatment options. A little over half expressed their own hopes, while none asked the parents about their hopes. While the majority of parents continued to hope for a cure, almost 75% of these parents also realized that their hopes contradicted their expectations of the prognosis. This study is limited by generalizability, as the majority of participants were white and non-English speaking parents were excluded. However, this study highlights that physicians may be able enhance end-of-life care for children with advanced cancer by asking parents about their hopes, recognizing that many parents understand that some hopes may be incongruent with their expectations.
Relevant Reading: The breadth of hopes.
In-Depth [cross-sectional study]: Participants were 32 parents of children with newly recurrent or refractory advanced cancer and their physicians. Physician-parent conversations took place from February 2010 to October 2013 at the Dana-Farber Cancer Institute and Boston Children’s Hospital. Children of participants were a median of 10.1 years old; 56% had a solid tumor diagnosis, 38% had a brain tumor, and 6% had a hematologic malignancy. Eighty-one percent of participating parents were female, and 75% were white. Over half of the children (56%) were present during the entire physician-parent conversation. While physicians in 28/32 (88%) conversations included statements about the child’s prognosis, 8 conversations included only nonspecific statements as the sole prognostic statement. Almost all (90%) of the physicians included treatment options in the conversation. More than half of the physicians stated their own hopes (56%), but none of the physicians directly asked parents about their hopes. In the post-interview follow-up with study personnel, parents expressed expectations that were similar to what their physicians had stated about prognosis. However, most (88%) still expressed a hope that their child would be cured. Other hopes included quality of life (90%), minimal suffering (75%), and future research/better treatment of children in the future (25%). Most parents (72%) recognized that their hopes were incongruent from their expectations of the outcome for their child.
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