Pediatric oncologists often choose not to provide prognostic information when discussing a new cancer diagnosis, according to a study published in JCO Oncology Practice.
Findings from interviews and surveys suggest that most pediatric oncologists deliver diagnostic information in stages, few provide patients and their families with information on prognosis during these discussions, and training on how to conduct these conversations varies.
For this study, researchers first interviewed 20 pediatric oncology physicians and fellows at a single institution. The interviews focused on the process used to convey the diagnosis and treatment plan to the family of a child with cancer.
The themes observed in these interviews were then used to inform the development of a quantitative survey, which was distributed to Accreditation Council for Graduate Medical Education (ACGME) hematology-oncology fellowship programs.
The interview participants were mostly attending physicians (75%) with a mean 12.2 years of experience in pediatric oncology. The remaining participants were fellows with a mean 1.4 years of experience.
The interviewees said they conduct new diagnosis discussions in 3 stages: conveying that cancer is a possibility, confirming the cancer diagnosis, and presenting the treatment plan/obtaining consent.
The decision about whether to involve the child in these conversations depends on parental preference and the age and maturity of the child, the interviewees said.
Interviewees also said they did not always discuss prognosis during conversations about diagnosis. Some interviewees said they first asked parents whether they wanted to receive quantitative information on prognosis. Other interviewees provided quantitative information only when families specifically requested it.
The 108 survey respondents were from 53 ACGME-accredited fellowship programs. They were fellows (65%) or program directors (35%). The fellows had 1 year (24%), 2 years (40%), or 3 or more years (36%) of experience. The program directors had a mean 5.4 years of experience.
Most respondents said new diagnosis discussions should be done in stages, with 77% saying such discussions comprise 2 or more meetings.
About half of survey respondents said parental preference (50%) and maturity of the child (47%) were the most important factors in deciding whether to include the child in discussions about diagnosis.
Less than half of respondents (47%) said they often discuss prognosis during diagnosis conversations, and 10% said they always discuss prognosis. When results were limited to only fellows, 16% said they always discuss prognosis (P <.001). Respondents were more likely to use a quantitative approach when conveying a favorable prognosis (25%) than when conveying an unfavorable prognosis (13%; P =.03).
Training for diagnosis discussions included shadowing (96%), didactic sessions (48%), and simulation (23%). Some fellows (11%) said they never observed a discussion before they led one themselves.
“[T]hese findings delineate current practices of pediatric oncologists in conducting new diagnosis discussions and identify a need for standardized training curricula regarding conduct of these discussions in pediatric oncology fellowship programs,” the researchers wrote.
Disclosures: One study author declared affiliations with a pharmaceutical company. Please see the original reference for a full list of disclosures.
Six KA, Wadhwa A, York JM, et al. The new oncologic diagnosis discussion: Perspectives of pediatric oncologists. JCO Oncol Pract. Published online January 9, 2023. doi:10.1200/OP.22.00558