A convenience sample was used, with participants approached when presenting to the clinic for otherwise scheduled appointments. Both patient and parent participants were required to give informed consent or assent and, as the survey tools were only developed and tested in English, only English-speaking participants were eligible to participate. Patient participants were age 10-18 years, had a new oncologic diagnosis, and were 1 month-1 year from diagnosis. 20 In brief, novel survey tools were developed, extensively pretested, and administered to 129 patient-parent dyads in three pediatric oncology centers from September 2011 to January 2015. This article is representative of a subanalysis of a larger institutional review board–approved study previously described. This study sought to assess the beliefs of pediatric patients with cancer and their parents regarding chance for cure and perception of prognostic communication by their physician as compared with objective estimated prognoses. 17- 19 Very little is known about pediatric patients' prognostic beliefs and perception of physician communication. Realistic discussions and understanding of prognosis with parents of children with cancer have been shown to increase hope 16 by enabling hope for reasonable and achievable goals, especially during end of life. 3, 12, 14, 15 Belief regarding prognosis may heavily influence overall care satisfaction, decision making during critical junctures, 2 and the way in which patients choose to live their lives. 12, 13 This can lead to patients, parents, and physicians having discordant views of disease trajectory and overall outcomes. When prognostic information is discussed, very rarely are quantitative terms used or a patient's understanding regarding the discussion confirmed. 5, 8, 9 Owing to these concerns, physicians tend to provide vague or overly optimistic information because of these concerns and may even avoid prognostic discussion altogether. Barriers to the delivery of transparent prognostic information may stem from physicians' worry that this information may cause distress for the patient and/or family 5- 7 or diminish hope. 2 This information is critical in assisting patients and families with decision making throughout their cancer treatment, and transparent information sharing is an ethical responsibility as a physician.
3 Although pediatric patients' prognostic beliefs are elusive to date, most pediatric oncology patients have been found to desire direct communication from physicians, including conversations regarding prognosis, 4 and the majority of parents of children with cancer want as much prognostic information as possible. It is known that parents of children with cancer tend to be optimistic regarding their child's prognosis, 1 that physicians may relay optimistic prognostic information, 2 and that the physician’s estimates tend to be discordant from that of parents.
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