Disparities in prognosis communication among parents of children with cancer: The impact of race and ethnicity

Abstract

Most parents, regardless of racial and ethnic background, want detailed prognostic information about their child's cancer. However, physicians underestimate the information needs of black and Hispanic parents. To meet parents' information needs, physicians should ask about parents' information preferences before prognosis discussions. Cancer 2017;123:3995-4003. © 2017 American Cancer Society.

Don't let perfect be the enemy of good: How to improve prognostic communication in pediatric oncology

“…10, 11 First, Sisk and colleagues confirmed what we previously knew: in a survey of 156 parents of children with cancer, the vast majority wanted to hear about prognosis in as much detail as possible, and 85% considered a numeric estimate to be extremely or very important. 11 What was new was the finding that this desire for detailed information did not change over time.…”

“…10 Here, regardless of race, parents again wanted as much detail as possible about their child’s prognosis. What was striking – and unfortunate – was that physicians incorrectly estimated the needs of minority parents.…”

“…10 Interestingly, 47% of Hispanic parents also reported peace of mind, whereas only 26% of White parents said the same. Taken together, these findings suggested potential cultural differences in parent emotional coping, but not in their preferences for prognostic detail.…”

“…11 Likewise, parents’ emotional responses may vary, but emotion is not an excuse for non-disclosure. 10 Illowite’s study suggests oncologists may be biased and poorly able to estimate a family’s true emotional state, their capacity for understanding, and their corresponding information needs. Rather than assume, we must regularly check in with families and simply ask, “what would you like to know?”…”

How Should We Enhance the Process and Purpose of Prognostic Communication in Oncology?

“…In some instances, clinicians might fail to understand what their patients want or need to know. 18,19 Additionally, some patients might not want to hear poor prognostic information, or they might want to receive the information in specific ways that are not clear to the clinician. Other patients might not know how they prefer to hear this information since they have never had similar experiences before.…”