Telling children and adolescents about their cancer diagnosis: Cross-cultural comparisons between pediatric oncologists in the US and Japan.
OBJECTIVE
Over the last 50 years, direct communication about cancer with adults has shifted from an approach of not telling to one of telling. Less is known about communication practices with children. The purpose of this study is to (1) describe patterns of communication at diagnosis between pediatric oncologists and children with cancer and (2) compare cultural differences in these practices in the US and Japan.


METHODS
This 2003 survey, developed in English and translated into Japanese was mailed to members of the American Society of Pediatric Hematology/Oncology and the two Japanese Societies of Pediatric Hematology and Oncology; there were 350 US and 362 Japanese respondents. Descriptive statistics and logistic regressions were performed.


RESULTS
US physicians had a consistent pattern of telling children (65% always told the child; less than 1% rarely or never told). Japanese physicians had greater variability in their patterns of telling (with only 9.5% always telling, 34.5% rarely or never telling). Direct communication with the child was influenced by personal attitudes, patient factors, and work culture in both countries. Many more variables emerged as influencing Japanese physicians' communication practices than for US physicians. US physicians were influenced by their own sense of responsibility for telling, while Japanese physicians were more influenced by personal attitudes, patient factors, and work culture.


CONCLUSIONS
US and Japanese physicians differed when communicating directly with the child about his or her cancer. The impact of these practices on children and their parents should be explored and the parent and child's perspectives elicited. This information will help facilitate culturally sensitive patient and family centered communication.
Parsons
Susan K
SK
Center on Child and Family Outcomes, Institute for Clinical Research and Health Policy Studies, Tufts-New England Medical Center, Boston, MA 02111, USA. sparsons@tufts-nemc.org
Saiki-Craighill
Shigeko
S
Mayer
Deborah K
DK
Sullivan
Amy M
AM
Jeruss
Stefanie
S
Terrin
Norma
N
Tighiouart
Hocine
H
Nakagawa
Kaoru
K
Iwata
Yoko
Y
Hara
Junichi
J
Grier
Holcombe E
HE
Block
Susan
S
D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D002648:Child; D003142:Communication; D003431:Cross-Cultural Comparison; D003469:Culture; D005190:Family; D006801:Humans; D007564:Japan; D008495:Medical Oncology; D009369:Neoplasms / Q000175:diagnosis* / Q000523:psychology; D010817:Physician-Patient Relations; D010820:Physicians; D014342:Truth Disclosure; D014481:United States