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Communication About Prognosis Between Parents and Physicians of Children With Cancer: Parent Preferences and the Impact of Prognostic Information

Jennifer W. Mack, Joanne Wolfe, Holcombe E. Grier, Paul D. Cleary, Jane C. Weeks

From the Departments of Pediatric Oncology and Adult Oncology, the Center for Outcomes and Policy Research, Dana-Farber Cancer Institute; the Department of Medicine, Children's Hospital; the Department of Health Care Policy, Harvard Medical School; and the Department of Medicine, Brigham and Women's Hospital, Boston, MA

Address reprint requests to Jennifer W. Mack, MD, MPH, Center for Outcomes and Policy Research, Dana-Farber Cancer Institute, 44 Binney St, Boston, MA 02115; e-mail: Jennifer_mack{at}dfci.harvard.edu

Purpose: 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.

Patients and 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).

Conclusion: 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.

Supported by a fellowship from the Agency for Healthcare Research and Quality (T32 HS00063; J.W.M.), an American Society of Clinical Oncology Young Investigator Award, and a fellowship from the Glaser Pediatric Research Network.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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