ID #561 Beyond Survival Statistics: Prognostic Cues in New Pediatric Cancer Diagnosis Conversations

Abstract

Parents of children with cancer consistently report desires for detailed communication about their child’s prognosis, even when prognosis is poor. Further, prognostic communication supports positive psychosocial outcomes, including increased hope and decreased decisional regret. Although physicians tend to define prognosis narrowly as the probability of cure or survival, the term prognosis encompasses a more expansive understanding of outcomes beyond disease-related mortality. Approaching prognosis holistically has been shown to improve health-related decision-making, promote coping, and strengthen clinician-patient relationships. Therefore, pediatric oncologists may meet family needs for comprehensive prognostic information by providing broader communication during discussions of new cancer diagnoses. To understand the varied approaches to prognostic communication and identify topics that may disclose prognostic information, we conducted a secondary qualitative grounded theory analysis of transcripts from interviews with 20 pediatric oncologists at a single institution. In the interviews, physicians described the structure of their day one talks, including their methods of prognostic disclosure.[1] Through an iterative coding process, we found that nearly all physicians reported avoiding the use of specific cure/survival statistics. Instead, they favored general terminology about disease treatability, balancing the goals of being honest and maintaining hope. Six physicians specifically commented on their method of communicating prognosis to families of patients with brain tumors, which followed a similar pattern. Several other topics in these discussions, including diagnosis, treatment, and clinical trial participation, relate to quality of life and may confer prognostic value. Because of the positive benefits of comprehensive prognostic communication, we recommend pediatric oncologists have an increased awareness that patients and families likely glean prognostic information from much of the new cancer diagnosis communication, even information that is not explicitly described as prognostic. Thus, the information may be framed strategically to achieve the frequently cited goal of providing honest information while maintaining hope.

1. Six KA, Wadhwa A, York JM, Adams K, Henneberg H, Bhatia S, et al. The New Oncologic Diagnosis Discussion: Perspectives of Pediatric Oncologists. JCO Oncol Pract. 2023 Apr;19(4):e492–503.