title: Understanding of prognosis among parents of children with cancer: parental optimism and the parent-physician interaction.
abstract: OBJECTIVE
  Patients often overestimate their chances of surviving cancer. Factors that contribute to accurate understanding of prognosis are not known. We assessed understanding of likelihood of cure and functional outcome among parents of children with cancer and sought to identify factors that place parents at risk for overly optimistic beliefs about prognosis.
  
  
  METHODS
  We conducted a cross-sectional survey of 194 parents of children with cancer (response rate, 70%) who were treated at the Dana-Farber Cancer Institute and Children's Hospital in Boston, MA, and the children's physicians. Parent and physician expectations for likelihood of cure and functional outcome were compared. In 152 accurate or optimistic parents, we determined factors associated with accurate understanding of likelihood of cure compared with optimism.
  
  
  RESULTS
  The majority of parents (61%) were more optimistic than physicians about the likelihood of cure. Parents' beliefs about other outcomes of cancer treatment were similar (quality-of-life impairment, P = .70) or more pessimistic (physical impairment, P = .01; intellectual impairment, P = .01) than physicians' beliefs. Parents and physicians were more likely to agree about chances of cure when physicians had confidence in knowledge of prognosis (odds ratio [OR] = 2.55, P = .004) and allowed parents to take their preferred decision-making role (OR = 1.89, P = .019).
  
  
  CONCLUSIONS
  Parents of children with cancer are overly optimistic about chances of cure but not about other outcomes of cancer therapy. Parents tend to be overly optimistic about cure when physicians have little confidence and when the decision-making process does not meet parents' preferences. These findings suggest that physicians are partly responsible for parents' unrealistic expectations about cure.
authors.affiliation: Department of Pediatric Oncology, and the Center for Outcomes and Policy Research, Dana-Farber Cancer Institute, Boston, MA 02115, USA. jennifer_mack@dfci.harvard.edu
authors.forename: Jennifer W
authors.initials: JW
authors.lastname: Mack
authors.forename: E Francis
authors.initials: EF
authors.lastname: Cook
authors.forename: Joanne
authors.initials: J
authors.lastname: Wolfe
authors.forename: Holcombe E
authors.initials: HE
authors.lastname: Grier
authors.forename: Paul D
authors.initials: PD
authors.lastname: Cleary
authors.forename: Jane C
authors.initials: JC
authors.lastname: Weeks
mesh_terms: D000328:Adult; D001293:Attitude to Death; D002648:Child; D003430:Cross-Sectional Studies; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000401:mortality / Q000523:psychology*; D010287:Parent-Child Relations; D010290:Parents / Q000523:psychology*; D011368:Professional-Family Relations; D011379:Prognosis; D011795:Surveys and Questionnaires; D014342:Truth Disclosure