title: Prognostic Disclosures to Children: A Historical Perspective.
abstract: Prognostic disclosure to children has perpetually challenged clinicians and parents. In this article, we review the historical literature on prognostic disclosure to children in the United States using cancer as an illness model. Before 1948, there was virtually no literature focused on prognostic disclosure to children. As articles began to be published in the 1950s and 1960s, many clinicians and researchers initially recommended a "protective" approach to disclosure, where children were shielded from the harms of bad news. We identified 4 main arguments in the literature at this time supporting this "protective" approach. By the late 1960s, however, a growing number of clinicians and researchers were recommending a more "open" approach, where children were included in discussions of diagnosis, which at the time was often synonymous with a terminal prognosis. Four different arguments in the literature were used at this time supporting this "open" approach. Then, by the late 1980s, the recommended approach to prognostic disclosure in pediatrics shifted largely from "never tell" to "always tell." In recent years, however, there has been a growing appreciation for the complexity of prognostic disclosure in pediatrics. Current understanding of pediatric disclosure does not lead to simple "black-and-white" recommendations for disclosure practices. As with most difficult questions, we are left to balance competing factors on a case-by-case basis. We highlight 4 categories of current considerations related to prognostic disclosure in pediatrics, and we offer several approaches to prognostic disclosure for clinicians who care for these young patients and their families.
authors: Department of Pediatrics, St Louis Children's Hospital, St. Louis, Missouri; sisk_b@kids.wustl.edu.
authors: Bryan A
authors: BA
authors: Sisk
authors: Louis Dundas Centre for Children's Palliative Care, Institute of Child Health, University College London, London, England;
authors: Myra
authors: M
authors: Bluebond-Langner
authors: National Cancer Institute, Center for Cancer Research, Pediatric Oncology Branch, Bethesda, Maryland;
authors: Lori
authors: L
authors: Wiener
authors: Departments of Pediatric Oncology and Division of Population Sciences, and Division of Pediatric Hematology/Oncology, and.
authors: Jennifer
authors: J
authors: Mack
authors: Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts; and Department of Medicine, Boston Children's Hospital, Boston, Massachusetts.
authors: Joanne
authors: J
authors: Wolfe
mesh_terms: D001293:Attitude to Death; D002648:Child; D002908:Chronic Disease / Q000523:psychology; D003142:Communication; D005195:Family Relations; D006801:Humans; D010817:Physician-Patient Relations; D011368:Professional-Family Relations; D011379:Prognosis; D019452:Terminally Ill / Q000523:psychology; D014342:Truth Disclosure