Department of Pediatrics, Division of Hematology/Oncology, Washington University School of Medicine, St Louis, MO.
Department of Pediatrics, St Louis Children's Hospital, St Louis, MO.
JCO Oncol Pract. 2021 Jun;17(6):e859-e871. doi: 10.1200/OP.20.01038. Epub 2021 Apr 13.
Communication breakdowns in pediatric oncology can have negative consequences for patients and families. A detailed analysis of these negative encounters will support clinicians in anticipating and responding to communication breakdowns.
Semistructured interviews with 80 parents of children with cancer across three academic medical centers during treatment, survivorship, or bereavement. We analyzed transcripts using semantic content analysis.
Nearly all parents identified negative communication experiences (n = 76). We identified four categories of contributors to negative experiences: individual (n = 68), team (n = 26), organization (n = 46), and greater health care system (n = 8). These experiences involved a variety of health care professionals across multiple specialties. Parents reported 12 personal consequences of communication breakdowns: emotional distress (n = 65), insufficient understanding (n = 48), decreased trust or confidence (n = 37), inconvenience (n = 36), medical harm (n = 23), decreased self-confidence (n = 17), decreased emotional support (n = 13), decreased engagement (n = 9), false hope (n = 9), decreased hope (n = 7), financial insult (n = 7), and decreased access to resources (n = 3). We identified five categories of supportive responses from clinicians: exploring (n = 8), acknowledging (n = 17), informing (n = 27), adapting (n = 27), and advocating (n = 18). Parents often increased their own advocacy on behalf of their child (n = 47). Parents also identified the need for parental engagement in finding solutions (n = 12). Finally, one parent suggested that clinicians should assume that communication will fail and develop contingency plans in advance.
Communication breakdowns in pediatric oncology negatively affect parents and children. Clinicians should plan for communication breakdowns and respond by exploring, acknowledging, informing, adapting, advocating, and engaging parents in finding solutions.
儿科肿瘤学中的沟通障碍可能会给患者及其家庭带来负面影响。对这些负面遭遇进行详细分析，将有助于临床医生预测和应对沟通障碍。
在治疗、生存或丧亲期间，对来自三个学术医疗中心的 80 名癌症患儿的父母进行半结构化访谈。我们使用语义内容分析法分析转录本。
几乎所有的父母都识别出了负面的沟通经历（n = 76）。我们确定了四个导致负面体验的因素：个人（n = 68）、团队（n = 26）、组织（n = 46）和更大的医疗保健系统（n = 8）。这些经历涉及多个专业的各种医疗保健专业人员。父母报告了沟通障碍的 12 个个人后果：情绪困扰（n = 65）、理解不足（n = 48）、信任或信心下降（n = 37）、不便（n = 36）、医疗伤害（n = 23）、自我信心下降（n = 17）、情绪支持减少（n = 13）、参与度降低（n = 9）、虚假希望（n = 9）、希望减少（n = 7）、经济侮辱（n = 7）和资源获取减少（n = 3）。我们确定了临床医生的五类支持性回应：探索（n = 8）、承认（n = 17）、告知（n = 27）、适应（n = 27）和倡导（n = 18）。父母经常会增加自己为孩子的代言（n = 47）。父母还表示需要家长参与寻找解决方案（n = 12）。最后，一位家长建议医生应假设沟通会失败，并提前制定应急计划。
儿科肿瘤学中的沟通障碍会对父母和孩子产生负面影响。临床医生应该为沟通障碍做好计划，并通过探索、承认、告知、适应、倡导和让家长参与寻找解决方案来做出回应。
