Planting seeds for seasons ahead: Communication strategies for prognostic disclosure in pediatric neuro-oncology.

BACKGROUND

High-quality communication about prognosis is essential in pediatric neuro-oncology care; however, effective communication strategies for introducing prognostic information over time ("seed-planting") remain poorly described in the setting of pediatric brain cancer. This study aimed to characterize how pediatric neuro-oncologists use seed-planting across the illness trajectory. This work will inform the development of communication skills training to facilitate high-quality prognostic communication for children with high-risk or advanced central nervous system (CNS) tumors and their families.

METHODS

In this prospective, longitudinal study, serial medical encounters between children with poor-prognosis CNS tumors (overall survival ≤50%), their families, and their neuro-oncologists were audio-recorded at disease reevaluation timepoints over 24 months or until the child's death. Rapid qualitative analysis was conducted to identify distinct seed-planting strategies used by neuro-oncologists across advancing illness.

RESULTS

From 132 recorded encounters (2481 min of dialogue) involving 30 families and 7 neuro-oncologists, 7 key seed-planting strategies were characterized: (1) exercise vigilance, (2) share personal sentiment, (3) recommend backup plan, (4) specify noncurative intent, (5) recognize window of opportunity, (6) partner hope and realism, and (7) engage in psychological distancing. Seed-planting occurred in nearly half of recordings (n = 63, 48%), with all oncologists employing this approach at least once and most patients experiencing at least one instance of seed-planting (n = 24, 80%).

CONCLUSIONS

Pediatric neuro-oncologists in this study employed diverse approaches to seed-planting, albeit inconsistently, across encounters. Future work will investigate the value of integrating these 7 key strategies into communication skills training for pediatric neuro-oncology clinicians.