Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, 55905, USA.
Support Care Cancer. 2019 Apr;27(4):1319-1324. doi: 10.1007/s00520-019-4653-3. Epub 2019 Jan 23.
Including children in medical conversations is considered the standard of care for children with cancer. However, previous qualitative research has raised concerns about how the child's presence impacts the parent's communication experience. The current study examines the frequency and impact of child presence during a serious medical conversation on the parent's communication experience in pediatric oncology.
Three hundred sixty parents of children newly diagnosed with cancer completed questionnaires assessing the child's presence during the initial conversation with the oncologist about diagnosis and treatment and parental communication experiences. Primary oncologists completed a survey question about the child's prognosis.
Sixty-one percent of children were present during the initial conversation, with lowest rates among children aged 3-6 (44%) and 7-12 (44%). Child presence was not associated with parents' reports that they received prognostic information (p = 0.20), high-quality information (p = 0.19), or high-quality communication about the child's cancer (p = 1.0).
The parent's communication experience is not diminished by the choice to include the child. Given the bioethical imperative to include children in conversations about serious illness whenever possible, this concern should not be used to exclude children, but rather to give parents additional time of their own when needed to fully process decisions.
将儿童纳入医疗对话被认为是照顾癌症儿童的标准。然而，之前的定性研究对儿童在场如何影响父母的沟通体验提出了担忧。本研究调查了儿童在儿科肿瘤学中与肿瘤医生进行初始诊断和治疗谈话时的存在频率及其对父母沟通体验的影响。
360 名新诊断患有癌症的儿童的父母完成了问卷，评估了儿童在与肿瘤医生关于诊断和治疗的初始对话中存在的情况，以及父母的沟通体验。主要肿瘤医生完成了一个关于儿童预后的调查问题。
61%的儿童在初始谈话中在场，3-6 岁（44%）和 7-12 岁（44%）的儿童在场率最低。儿童在场与父母报告他们获得预后信息（p=0.20）、高质量信息（p=0.19）或关于儿童癌症的高质量沟通（p=1.0）无关。
选择让孩子在场并不会降低父母的沟通体验。鉴于在可能的情况下将儿童纳入关于严重疾病的对话具有生物伦理必要性，这种担忧不应用于排除儿童，而应给予父母在需要时更多的时间来充分处理决策。
