Delivering serious news presents a major challenge for clinical practice in pediatric oncology due to the complexity of the communication process and a number of aspects that influence how the serious news is delivered and received. This study aims to review and explore the aspects influencing the delivery of serious news in pediatric oncology from the perspective of physicians, parents, siblings and patients themselves. The MEDLINE, Embase, Scopus, Cochrane Library, PsycInfo and Medvik databases were systematically searched for relevant articles published from 1990 to 2017. Following the Preferred Reporting Items for Systematic Review and Meta-analysis extension for scoping reviews (PRISMA-ScR) guidelines, 36 original papers were included. Identified aspects of communication were categorized into six thematic groups: initial setting, physician's approach, information exchange, parental role, illness related aspects and age of the ill child. The importance of the aspects is perceived differently by parents, patients, siblings and physicians. This scoping review highlights that delivering serious news requires an individualized approach towards the patient and the family. Ten key objectives built upon the results of the literature review offer guidance for daily clinical practice in communication with pediatric patients and their families.

1st Faculty of Medicine Charles University 121 08 Prague Czech Republic

3rd Faculty of Medicine Charles University 100 00 Prague Czech Republic

Center for Palliative Care 101 00 Prague Czech Republic

Department of Pediatric Hematology and Oncology University Hospital Motol 156 00 Prague Czech Republic

Pediatric Supportive and Palliative Care Team University Hospital Motol 156 00 Prague Czech Republic

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Kaye E.C., Friebert S. Early Integration of Palliative Care for Children with High-Risk Cancer and Their Families. Pediatr. Blood Cancer. 2016;63:593–597. doi: 10.1002/pbc.25848. PubMed DOI

Waldman E.D., Levine J.M. The Day Two Talk: Early Integration of Palliative Care Principles in Pediatric Oncology. J. Clin. Oncol. 2016;34:4068–4070. doi: 10.1200/JCO.2016.69.3739. PubMed DOI

Stein A., Dalton L. Communication with children and adolescents about the diagnosis of their own life-threatening condition. Lancet. 2019;393:1150–1163. doi: 10.1016/S0140-6736(18)33201-X. PubMed DOI

Snaman J., McCarthy S. Pediatric palliative care in oncology. J. Clin. Oncol. 2020;38:954–962. doi: 10.1200/JCO.18.02331. PubMed DOI PMC

Mack J.W., Wolfe J. Communication About Prognosis Between Parents and Physicians of Children with Cancer: Parent Preferences and the Impact of Prognostic Information. J. Clin. Oncol. 2006;24:5265–5270. doi: 10.1200/JCO.2006.06.5326. PubMed DOI

Last B.F., van Veldhuizen A.M.H. Information About Diagnosis and Prognosis Related to Anxiety and Depression in Children with Cancer Aged 8–16 Years. Eur. J. Cancer. 1996;32:290–294. doi: 10.1016/0959-8049(95)00576-5. PubMed DOI

Snaman J.M., Torres C. Parental Perspectives of Communication at the End of Life at a Pediatric Oncology Institution. J. Palliat. Med. 2016;19:326–333. doi: 10.1089/jpm.2015.0253. PubMed DOI

Coyne I., Gallagher P. Participation in communication and decision-making: Children and young people’s experiences in a hospital setting. J. Clin. Nurs. 2011;20:2334–2343. doi: 10.1111/j.1365-2702.2010.03582.x. PubMed DOI

Zwaanswijk M., Tates K. Communicating with child patients in pediatric oncology consultations: A vignette study on child patients’, parents’, and survivors’ communication preferences. Psycho Oncol. 2011;20:269–277. doi: 10.1002/pon.1721. PubMed DOI

Amery J. Practical Handbook of Children’s Palliative Care for Doctors and Nurses Anywhere in the World. 1st ed. Lulu Publishing Services; Morrisville, NC, USA: 2016. pp. 163–173.

Mack J.W., Hilden J.M. Parent and physician perspectives on quality of care at the end of life in children with cancer. J. Clin. Oncol. 2005;23:9155–9161. doi: 10.1200/JCO.2005.04.010. PubMed DOI

Lannen P., Wolfe J. Absorbing information about a child’s incurable cancer. Oncology. 2010;78:259–266. doi: 10.1159/000315732. PubMed DOI PMC

Sisk B.A., Bluebond-Langner M. Prognostic disclosures to children: A historical perspective. Pediatrics. 2016;138:e20161278. doi: 10.1542/peds.2016-1278. PubMed DOI PMC

Ranmal R., Prictor M., Scott J.T. Interventions for improving communication with children and adolescents about their cancer. Cochrane Database Syst. Rev. 2008;4:CD002969. doi: 10.1002/14651858.CD002969.pub2. PubMed DOI PMC

Mack J.W., Smith T.J. Reasons why physicians do not have discussions about poor prognosis, why it matters, and what can be improved. J. Clin. Oncol. 2012;30:2715–2717. doi: 10.1200/JCO.2012.42.4564. PubMed DOI

Harrison M.E., Walling A. What do we know about giving bad news? A review. Clin. Pediatr. 2010;49:619–626. doi: 10.1177/0009922810361380. PubMed DOI

Baile W.F., Buckman R. SPIKES-A six-step protocol for delivering bad news: Application to the patient with cancer. Oncologist. 2000;5:302–311. doi: 10.1634/theoncologist.5-4-302. PubMed DOI

Radziewicz R., Baile W.F. Communication skills: Breaking bad news in the clinical setting. Oncol. Nurs. Forum. 2001;28:951–953. PubMed

Baile W.F., Parker P.A. Handbook of Communication in Oncology and Palliative Care. Oxford University Press; New York, NY, USA: 2010. Breaking bad news; pp. 110–112.

Back A.L., Arnold R.M. Efficacy of communication skills training for giving bad news and discussing transitions to palliative care. Arch. Intern. Med. 2007;167:453–460. doi: 10.1001/archinte.167.5.453. PubMed DOI

Davies B., Sehring S.A. Barriers to palliative care for children: Perceptions of pediatric health care providers. Pediatrics. 2008;121:282–288. doi: 10.1542/peds.2006-3153. PubMed DOI

Peters M.D.J., Godfrey C.M. Guidance for conducting systematic scoping reviews. Int. J. Evid. Based Healthc. 2015;13:141–146. doi: 10.1097/XEB.0000000000000050. PubMed DOI

Tricco A.C., Lillie E. PRISMA extension for scoping reviews (PRISMA-ScR): Checklist and explanation. Ann. Intern. Med. 2018;169:467–473. doi: 10.7326/M18-0850. PubMed DOI

Braun V., Clarke V. Using thematic analysis in psychology. Qual. Res. Psychol. 2006;3:77–101. doi: 10.1191/1478088706qp063oa. DOI

Coyne I., Amory A. Information-sharing between healthcare professionals, parents and children with cancer: More than a matter of information exchange. Eur. J. Cancer Care. 2016;25:141–156. doi: 10.1111/ecc.12411. PubMed DOI

Maree J.E., Parker S. The Information Needs of South African Parents of Children with Cancer. J. Pediatr. Oncol. Nurs. 2016;33:9–17. doi: 10.1177/1043454214563757. PubMed DOI

Badarau D.O., Wangmo T. Parents’ Challenges and Physicians’ Tasks in Disclosing Cancer to Children. A Qualitative Interview Study and Reflections on Professional Duties in Pediatric Oncology. Pediatr. Blood Cancer. 2015;62:2177–2182. doi: 10.1002/pbc.25680. PubMed DOI

Watanabe A., Nunes T. Japanese parents’ perception of disclosing the diagnosis of cancer to their children. Clin. Child Psychol. Psychiatry. 2014;19:125–138. doi: 10.1177/1359104512470599. PubMed DOI

Young B., Hill J. Is communication guidance mistaken Qualitative study of parent-oncologist communication in childhood cancer. Br. J. Cancer. 2013;109:836–843. doi: 10.1038/bjc.2013.413. PubMed DOI PMC

Kessel R.M., Roth M. Day One Talk: Parent preferences when learning that their child has cancer. Support. Care Cancer. 2013;21:2977–2982. doi: 10.1007/s00520-013-1874-8. PubMed DOI

Steele A.C., Kaal J. Bereaved parents and siblings offer advice to health care providers and researchers. J. Pediatr. Hematol. Oncol. 2013;35:253–259. doi: 10.1097/MPH.0b013e31828afe05. PubMed DOI PMC

Stenmarker M., Hallberg U. Being a Messenger of Life-Threatening Conditions: Experiences of Pediatric. Pediatr. Blood Cancer. 2010;55:478–484. doi: 10.1002/pbc.22558. PubMed DOI

Zwaanswijk M., Tates K. Young patients’, parents’, and survivors’ communication preferences in paediatric oncology: Results of online focus groups. BMC Pediatr. 2007;7:1–10. doi: 10.1186/1471-2431-7-35. PubMed DOI PMC

Valdimarsdóttir U., Kreicbergs U. Parents’ intellectual and emotional awareness of their child’s impending death to cancer: A population-based long-term follow-up study. Lancet Oncol. 2007;8:706–714. doi: 10.1016/S1470-2045(07)70209-7. PubMed DOI

Parsons S.K., Saiki-Craighill S. Telling children and adolescents about their cancer diagnosis: Cross-cultural comparisons between pediatric oncologists in the US and Japan. Psycho Oncol. 2007;68:60–68. doi: 10.1002/pon.1048. PubMed DOI

Levi R.B., Marsick R. Diagnosis, disclosure, and informed consent: Learning from parents of children with cancer. J. Pediatr. Hematol. Oncol. 2000;22:3–12. doi: 10.1097/00043426-200001000-00002. PubMed DOI

Eden O.B., Black I. Communication with parents of children with cancer. Palliat. Med. 1994;8:105–114. doi: 10.1177/026921639400800203. PubMed DOI

Havermans T., Eiser C. Siblings of a child with cancer encouraged or even expected to carry on their lives as if nothing untoward. Child Care Health Dev. 1994;20:309–322. doi: 10.1111/j.1365-2214.1994.tb00393.x. PubMed DOI

Goldman A., Christie D. Children with cancer talk about their own death with their families. Pediatr. Hematol. Oncol. 1993;10:223–231. doi: 10.3109/08880019309029488. PubMed DOI

Claflin C.J., Barbarin O.A. Does ‘telling’ less protect more? Relationships among age, information disclosure, and what children with cancer see and feel. J. Pediatr. Psychol. 1991;16:169–191. doi: 10.1093/jpepsy/16.2.169. PubMed DOI

Essig S., Steiner C. Improving Communication in Adolescent Cancer Care: A Multiperspective Study. Pediatr. Blood Cancer. 2016;63:11423–11430. doi: 10.1002/pbc.26012. PubMed DOI PMC

Kuan G.L., Cardiff P.M. Parents’ perspectives on the important aspects of care in children dying from life limiting conditions: A qualitative study Introduction: The importance of Paediatric Palliative Care. Med. J. Malays. 2015;70:295–299. PubMed

Lolonga D., Pondy A. L’annonce du diagnostic dans les unités d’oncologie pédiatrique africaines Disclosing a diagnosis in African pediatric oncology units. Rev. Oncol. Hématol. Pédiatr. 2015;3:29–36. doi: 10.1016/j.oncohp.2014.12.001. DOI

Aein F., Delaram M. Giving bad news: A qualitative research exploration. Iran. Red Crescent Med. J. 2014;16:e8197. doi: 10.5812/ircmj.8197. PubMed DOI PMC

Yoshida S., Amano K. A Comprehensive Study of the Distressing Experiences and Support Needs of Parents of Children with Intractable Cancer. Jpn. J. Clin. Oncol. 2014;44:1181–1188. doi: 10.1093/jjco/hyu140. PubMed DOI

Greeff A.P., Vansteenwegen A. Resilience in Families with a Child with Cancer. Pediatr. Hematol. Oncol. 2014;31:670–679. doi: 10.3109/08880018.2014.905666. PubMed DOI

Van der Geest I.M.M., Darlington A.E. Parents’ Experiences of Pediatric Palliative Care and the Impact on Long-Term Parental Grief. J. Pain Symptom Manag. 2014;47:1043–1053. doi: 10.1016/j.jpainsymman.2013.07.007. PubMed DOI

Gibson F., Aldiss S. Children and young people’s experiences of cancer care: A qualitative research study using participatory methods. Int. J. Nurs. Stud. 2010;47:1397–1407. doi: 10.1016/j.ijnurstu.2010.03.019. PubMed DOI

Kästel A., Enskär K. Parents’ views on information in childhood cancer care. Eur. J. Oncol. Nurs. 2011;15:290–295. doi: 10.1016/j.ejon.2010.10.007. PubMed DOI

Kersun L., Gyi L. Training in Difficult Conversations: A National Survey of Pediatric Hematology—Oncology and Pediatric Critical Care Physicians. J. Palliat. Med. 2009;12:525–530. doi: 10.1089/jpm.2008.0251. PubMed DOI

Parker T.M., Johnston D.L. Parental Perceptions of Being Told Their Child Has Cancer. Pediatr. Blood Cancer. 2008;51:531–534. doi: 10.1002/pbc.21667. PubMed DOI

Hughes P.M., Lieberman S. Troubled parents: Vulnerability and stress in childhood cancer. Br. J. Med. Psychol. 1990;63:53–64. doi: 10.1111/j.2044-8341.1990.tb02856.x. PubMed DOI

Jackson A.C., Steward H. Pediatric Brain Tumor Patients: Their Parents’ Perceptions of the Hospital Experience. J. Pediatr. Oncol. Nurs. 2007;24:95–105. doi: 10.1177/1043454206296030. PubMed DOI

Gurková E., Andraščíková I. Parents’ experience with a dying child with cancer in palliative care. Cent. Eur. J. Nurs. Midwifery. 2015;6:201–208. doi: 10.15452/CEJNM.2015.06.0004. DOI

Young B., Dixon-Woods M., Windridge K.C., Heney D. Managing communication with young people who have a potentially life threatening chronic illness: Qualitative study of patients and parents. BMJ. 2003;326:305. doi: 10.1136/bmj.326.7384.305. PubMed DOI PMC

Feraco A.M., Brand S.R. Communication Skills Training in Pediatric Oncology: Moving Beyond Role Modeling. Pediatr. Blood Cancer. 2016;63:966–972. doi: 10.1002/pbc.25918. PubMed DOI PMC

Wolfe A.D., Frierdich S.A. Sharing life-altering information: Development of pediatric hospital guidelines and team training. J. Palliat. Med. 2014;17:1011–1018. doi: 10.1089/jpm.2013.0620. PubMed DOI PMC

Wolfe A., Denniston S. Bad News Deserves Better Communication: A Customizable Curriculum for Teaching Learners to Share Life-Altering Information in Pediatrics. MedEdPORTAL. 2016;12:1–10. doi: 10.15766/mep_2374-8265.10438. PubMed DOI PMC

Blazin L., Cecchini C. Communicating Effectively in Pediatric Cancer Care: Translating Evidence into Practice. Children. 2018;5:40. doi: 10.3390/children5030040. PubMed DOI PMC

Rider E.A., Volkan K. Pediatric residents’ perceptions of communication competencies: Implications for teaching. Med. Teach. 2008;30:e208–e217. doi: 10.1080/01421590802208842. PubMed DOI

You J.J., Downar J. Barriers to goals of care discussions with seriously ill hospitalized patients and their families: A multicenter survey of clinicians. JAMA Intern. Med. 2015;175:549–556. doi: 10.1001/jamainternmed.2014.7732. PubMed DOI

Hall J.A., Stein T.S. Inaccuracies in physicians’ perceptions of their patients. Med. Care. 1999;37:1164–1168. doi: 10.1097/00005650-199911000-00008. PubMed DOI

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