Abstract
Context
Cancer is a life-changing diagnosis accompanied by significant emotional distress,
especially for children with advanced disease. However, the content and processes
of discussing emotion in advanced pediatric cancer remain unknown.
Objectives
To describe the initiation, response, and content of emotional communication in advanced
pediatric cancer.
Methods
We audiorecorded 35 outpatient consultations between oncologists and families of children
whose cancer recently progressed. We coded conversations based on Verona Coding Definitions
of Emotional Sequences.
Results
About 91% of conversations contained emotional cues, and 40% contained explicit emotional
concerns. Parents and clinicians equally initiated cues (parents: 48%, 183 of 385;
clinicians: 49%) and concerns (parents: 51%; clinicians: 49%). Children initiated
3% of cues and no explicit concerns. Emotional content was most commonly related to
physical aspects of cancer and/or treatment (28% of cues and/or concerns, present
in 80% of conversations) and prognosis (27% of cues and/or concerns, present in 60%
of conversations). Clinicians mostly responded to emotional cues and concerns implicitly,
without specifically naming the emotion (85%). Back channeling (using minimal prompts
or words that encourage further disclosure, e.g., uh-huh) was the most common implicit
response that provided space for emotional disclosure (32% of all responses). Information
advice was the most common implicit response that reduced space for further emotional
disclosure (28%).
Conclusion
Emotional communication in advanced pediatric cancer appears to be a subtle process
where parents offer hints and clinicians respond with non-emotion-laden statements.
Also, children were seldom engaged in emotional conversations. Clinicians should aim
to create an environment that allows families to express emotional distress if and/or
when ready.
Key Words
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Article info
Publication history
Published online: November 13, 2019
Accepted:
November 6,
2019
Identification
Copyright
© 2019 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
