Communication about prognosis between parents and physicians of children with cancer: parent preferences and the impact of prognostic information.
OBJECTIVE
Concerns about the harms of prognostic information, including distress and loss of hope, cause some physicians to avoid frank disclosure. We aimed to determine parent preferences for prognostic information about their children with cancer and the results of receiving such information.


METHODS
We surveyed 194 parents of children with cancer (overall response rate, 70%), treated at the Dana-Farber Cancer Institute and Children's Hospital (Boston, MA) and the children's physicians. Our main outcome measure was parent rating of prognostic information as extremely or very upsetting.


RESULTS
The majority of parents desired as much information about prognosis as possible (87%) and wanted it expressed numerically (85%). Although 36% of parents found information about prognosis to be extremely or very upsetting, those parents were more likely to want additional information about prognosis than those who were less upset (P = .01). Parents who found information upsetting were no less likely to say that knowing prognosis was important (P = .39), that knowing prognosis helped in decision making (P = .40), or that hope for a cure kept them going (P = .72).


CONCLUSIONS
Although many parents find prognostic information about their children with cancer upsetting, parents who are upset by prognostic information are no less likely to want it. The upsetting nature of prognostic information does not diminish parents' desire for such information, its importance to decision making, or parents' sense of hope.
Mack
Jennifer W
JW
Departments of Pediatric Oncology, Center for Outcomes and Policy Research, Dana-Farber Cancer Institute, Boston, MA 02115, USA. Jennifer_mack@dfci.harvard.edu
Wolfe
Joanne
J
Grier
Holcombe E
HE
Cleary
Paul D
PD
Weeks
Jane C
JC
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009369:Neoplasms; D010290:Parents / Q000523:psychology; D010820:Physicians; D011379:Prognosis; D013315:Stress, Psychological / Q000209:etiology; D014342:Truth Disclosure