title: Difficult relationships between parents and physicians of children with cancer: A qualitative study of parent and physician perspectives.
abstract: Previous work on difficult relationships between patients and physicians has largely focused on the adult primary care setting and has typically held patients responsible for challenges. Little is known about experiences in pediatrics and more serious illness; therefore, we examined difficult relationships between parents and physicians of children with cancer.
  
  
  
  This was a cross-sectional, semistructured interview study of parents and physicians of children with cancer at the Dana-Farber Cancer Institute and Boston Children's Hospital (Boston, Mass) in longitudinal primary oncology relationships in which the parent, physician, or both considered the relationship difficult. Interviews were audiotaped, transcribed, and subjected to a content analysis.
  
  
  
  Dyadic parent and physician interviews were performed for 29 relationships. Twenty were experienced as difficult by both parents and physicians; 1 was experienced as difficult by the parent only; and 8 were experienced as difficult by the physician only. Parent experiences of difficult relationships were characterized by an impaired therapeutic alliance with physicians; physicians experienced difficult relationships as demanding. Core underlying issues included problems of connection and understanding (n = 8), confrontational parental advocacy (n = 16), mental health issues (n = 2), and structural challenges to care (n = 3). Although problems of connection and understanding often improved over time, problems of confrontational advocacy tended to solidify. Parents and physicians both experienced difficult relationships as highly distressing.
  
  
  
  Although prior conceptions of difficult relationships have held patients responsible for challenges, this study has found that difficult relationships follow several patterns. Some challenges, such as problems of connection and understanding, offer an opportunity for healing. However, confrontational advocacy appears especially refractory to repair; special consideration of these relationships and avenues for repairing them are needed. Cancer 2017;123:675-681. © 2016 American Cancer Society.
authors.affiliation: Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.|Center for Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts.|Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Jennifer W
authors.initials: JW
authors.lastname: Mack
authors.affiliation: Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Maya
authors.initials: M
authors.lastname: Ilowite
authors.affiliation: Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.|Center for Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Sarah
authors.identifier: 0000-0002-3935-7299
authors.initials: S
authors.lastname: Taddei
mesh_terms: D000328:Adult; D001900:Boston; D002648:Child; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000523:psychology*; D010290:Parents / Q000523:psychology*; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology; D014342:Truth Disclosure
keywords: cancer; communication; pediatric; relationship