Strategies for communicating with honesty and hope in uncertain prognostic situations

Finding a delicate balance of honesty and hope as clinicians communicate an uncertain prognostic future is a need many caregivers and patients say goes unmet. For clinicians tasked with having these prognostic discussions, developing patient-centered cancer communication skills that allow informed hope to be an authentic part of uncertainty can help caregivers and patients navigate an unknown future.

To gather insights that will help shape the creation of educational tools and guidelines to support clinicians, clinical researchers at St. Jude Children’s Research Hospital led RIGHTime, a multiphase study that conducted interviews with patients with pediatric cancer that had poor prognosis, parents of patients on therapy, bereaved parents and pediatric oncologists. The team identified four key themes from the results, published in Pediatrics: prioritizing honesty; providing leadership, guidance and expertise; providing compassion and individualized support; and acknowledging inherent uncertainty as a space for hope. Identifying these strategies helps characterize best practices in prognostic communication and guides the framework development for supportive, individualized prognostic discussions in clinical interventional settings.

“It was striking how consistently families described honest, compassionate communication as foundational to hope, even if the prognosis is uncertain. As an oncologist, listening to these wise reflections from patients and their families has deeply shaped how I approach prognostic conversations,” said co-first author Alexandra Superdock, MD, Department of Oncology.

“All of us can learn so much by listening to and partnering with patients and families affected by cancer,” said senior author Erica Kaye, MD, MPH, Department of Oncology. “Through the RIGHTime study, it is a privilege to elevate the voices of patients with pediatric cancer and their parents, honoring their perspectives and recommendations as we collaborate to develop communication interventions to support families better.”

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