101 - Navigating Conflicting Communication Preferences in Serious Illness: Recommendations from Pediatric Patients with Advanced Cancer, Parents, and Oncologists

Publication Number: 101.5692

Elizabeth Stein, University of Colorado School of Medicine, Denver, CO, United States; Caroline Christianson, NYU Langone Health, New York, NY, United States; Harmony Farner, St. Jude Children's Research Hospital, Memphis, TN, United States; Erica Kaye, St. Jude Children's Research Hospital, Memphis, TN, United States

Background: Establishing therapeutic alliance between pediatric patients with cancer, parents, and oncologists is paramount to provision of high-quality care. Skillful communication is a key driver for creating and sustaining therapeutic alliance in the context of serious illness, particularly with respect to sharing difficult information about prognosis. Recent data demonstrate that patients, parents, and oncologists have diverse, and at times conflicting, perceptions and recommendations for the ‘right’ way to discuss prognosis and other highly sensitive topics. The juxtaposition of different communication styles and preferences, if not recognized and respected, can jeopardize high-quality communication and cause distress for patients, parents, and clinicians, alike (1-5). Best practices to guide oncologists in individualized, person-centered prognostic disclosure in the setting of conflicting communication preferences remain understudied.

Objective: To characterize patient, parent, and oncologist perspectives and recommendations for the ‘right’ way to navigate prognostic disclosure in the setting of conflicting communication preferences.

Design/Methods: Semi-structured interviews were conducted with pediatric patients with poor-prognosis cancer at different timepoints across the advancing illness course, parents of children with advanced cancer, bereaved parents, and pediatric oncologists practicing in 6 institutions across 5 states. Rapid qualitative analysis was performed to identify key themes to inform efficient development of future clinical interventions.

Results: 85 participants, comprising 25 patients, 40 parents, and 20 oncologists, completed in-depth interviews. Participants across cohorts emphasized the critical need for clinicians to elicit communication preferences from patients and families early in the therapeutic relationship to assess for the presence of conflicting preferences prior to engagement in high-stakes medical dialogue. In the context of opposing communication preferences, participants recommended purposeful, preemptive co-development of a communication plan to accommodate different needs.

Conclusion(s): To optimize prognostic communication between pediatric patients, parents, and clinicians, preemptive assessment of conflicting communication preferences is needed early in the illness course, followed by co-design of a concrete plan to address and respect individualized communication needs. Future work will focus on partnering with patients, parents, and clinicians to develop and test resources to help oncologists navigate conflicting communication needs in the setting of advancing illness.