Communication around palliative care principles and advance care planning between oncologists, children with advancing cancer and families.

Journal Article (Journal Article)

BACKGROUND: In medical oncology, palliative care principles and advance care planning are often discussed later in illness, limiting time for conversations to guide goal-concordant care. In pediatric oncology, the frequency, timing and content of communication about palliative care principles and advance care planning remains understudied. METHODS: We audio-recorded serial disease re-evaluation conversations between oncologists, children with advancing cancer and their families across the illness trajectory until death or 24 months from last disease progression. Content analysis was conducted to determine topic frequencies, timing and communication approaches. RESULTS: One hundred forty one disease re-evaluation discussions were audio-recorded for 17 patient-parent dyads with advancing cancer. From 2400 min of recorded dialogue, 119 min (4.8%) included discussion about palliative care principles or advance care planning. Most of this dialogue occurred after frank disease progression. Content analysis revealed distinct communication approaches for navigating discussions around goals of care, quality of life, comfort and consideration of limiting invasive interventions. CONCLUSIONS: Palliative care principles are discussed infrequently across evolving illness for children with progressive cancer. Communication strategies for navigating these conversations can inform development of educational and clinical interventions to encourage earlier dialogue about palliative care principles and advance care planning for children with high-risk cancer and their families.

Full Text

Duke Authors

Cited Authors

  • Kaye, EC; Woods, C; Kennedy, K; Velrajan, S; Gattas, M; Bilbeisi, T; Huber, R; Lemmon, ME; Baker, JN; Mack, JW

Published Date

  • October 2021

Published In

Volume / Issue

  • 125 / 8

Start / End Page

  • 1089 - 1099

PubMed ID

  • 34341516

Pubmed Central ID

  • PMC8505663

Electronic International Standard Serial Number (EISSN)

  • 1532-1827

Digital Object Identifier (DOI)

  • 10.1038/s41416-021-01512-9

Language

  • eng

Conference Location

  • England