NEW YORK (Reuters Health) – Relying on health professionals’ implicit cues may lead parents of children with cancer to be overly optimistic about the cancer prognosis, according to findings published in Pediatrics.
“Having a strong and trusting relationship between parent and physician does not prevent prognostic misconceptions, and in fact it can make it even harder for parents to have an accurate understanding of prognosis,” Dr. Bryan A. Sisk of Washington University School of Medicine in St. Louis, one of the study’s authors, told Reuters Health in a telephone interview. The more a parent relied on implicit sources of information, such as how their oncologist seemed to feel their child was doing, the more likely they were to view their child’s prognosis too optimistically, he and his colleagues found.
Parents of children with cancer often view their child’s prognosis with more optimism than their physicians do, Dr. Sisk and his team note in their December 5 report. “Although reasonable optimism can be adaptive, unrealistic expectations can inhibit informed decision-making and negatively impact children,” they add.
Doctors may implicitly convey optimism by “qualifying prognostic discussions with optimistic statements, avoiding discussions of prognosis unless directly asked, focusing conversations on the response to treatment rather than the chance of cure, or colluding in a so-called recovery plot that allows patients and physicians to avoid or delay open acknowledgement of the prognosis,” Dr. Sisk and his colleagues explain.
To examine which sources of prognostic information were associated with parents’ more accurate understanding of a child’s prospects, Dr. Sisk and his team surveyed 256 parent-physician pairs at two academic pediatric hospitals.
Most parents (73% to 85%) rated explicit information sources, such as day-to-day conversations with nurses and oncologists, as “very” or “extremely” informative. Similarly high percentages (84% to 87%) considered implicit information sources, such as their own sense of how their child was doing or how they thought the oncologist thought their child was doing, to be informative.
Seventy parents (27%) had views of their child’s prognosis in line with the doctor’s opinion. Valuing implicit information – especially “a general sense of how my child’s oncologist seems to feel my child is doing” – was associated with a less accurate view of the child’s prognosis.
Parents who said they had received high-quality prognostic information were three times more likely to rely on implicit rather than explicit information sources. Those who trusted the physician or considered their communication with the doctor to be of high quality were about twice as likely to use implicit information sources.
“There’s a big responsibility (of) medical health professionals to help these parents understand what’s going on,” Dr. Sisk said. “It’s always hard to tell people bad news, especially when we want to comfort and we want to be caring and consoling to families.”
Nevertheless, he added, studies show that parents “want all of the information even though it hurts to hear it. They need to get the information in a way that makes sense to that family and meets the way they want to get information.”
For developing interventions to improve physician-parent communication, Dr. Sisk added, “what we need is a push toward precision communication, just like we have precision cancer treatment.”
The study also showed that parents valued information from nurses as much as they did communication from oncologists, Dr. Sisk said, so interventions must target the entire healthcare team, not just doctors.
SOURCE: http://bit.ly/2klI8DI
Pediatrics 2017.
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