Nearly one quarter of parents reported having a challenging relationship with their child’s pediatric oncology clinician, according to survey results published in JAMA Network Open.

Researchers surveyed parents of children with cancer as well as oncology clinicians (attending physicians, fellows, and nurse practitioners) at 2 institutions.

Of the 338 relationships evaluated, 9.8% were considered challenging by both the parent and the clinician, 24.0% were considered challenging by the parent, and 37.6% were considered challenging by the clinician.

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In a multivariable analysis adjusted for parent sex, there was no significant difference in challenging relationship reports between Black and White parents or Hispanic and non-Hispanic parents.

However, parents were more likely to report a challenging relationship if they were Asian or another non-Black/White race (odds ratio [OR], 3.62; 95% CI, 1.59-8.26).

Parents were also more likely to report challenging relationships if they had a high school or lower level of education (OR, 3.03; 95% CI, 1.56-5.90), had anxiety (OR, 2.14; 95% CI, 1.27-3.61), said mixed messages were common (OR, 4.42; 95% CI, 2.21-8.83), and reported less patient-centeredness across transitions (OR, 5.84; 95% CI, 2.21-15.38).

The researchers noted that no parent or child attributes were associated with clinician-reported challenges. However, clinicians who had been in practice 10-19 years were more likely to report challenging relationships than those who had been in practice for less time (OR, 2.65; 95% CI, 1.30-5.43).

To manage challenging relationships, clinicians used strategies such as regular family meetings, providing extra time and attention, and asking another clinician for advice. However, these strategies tended to be used for relationships deemed challenging by the clinician and not for relationships deemed challenging by the parent.

“These findings suggest that new strategies are needed to improve experiences for parents and to help clinicians recognize and attend to parents whose experiences are suboptimal,” the researchers wrote.


Mack JW, Juang T, Uno H, Brakett J. Parent and clinician perspectives on challenging parent-clinician relationships in pediatric oncology. JAMA Netw Open. Published online November 17, 2021. doi:10.1001/jamanetworkopen.2021.32138