Discussing impending death from cancer

Abstract

Cancer remains the disease that leads to the most deaths in children, despite improvements in diagnosis and therapy. Although accidents, homicide, and trauma account for more deaths at some ages, none of these share with cancer the looming latency period before a child loses his or her life. Practitioners, parents, and children can feel ill at ease about what topics should be discussed, particularly that of the impending death. In this issue of The Journal, van der Geest et al investigate among a cohort of 86 parents and 56 children with terminal cancer whether the parents discussed the approaching death, why some did not, and how they felt about their decision. About one-third of parents did discuss death with the child. Among the other two-thirds, reasons cited for not initiating a discussion included parents’ inability to start the conversation, parents’ desire to protect the child, children’s unwillingness to talk or their underlying disability, or lack of an opportunity. Most parents felt positive about their decision, regardless of whether they discussed death with their child. Clearly, issues regarding what to discuss or not discuss at the end of a child’s life are complex. There is no one ideal conversation. There also is no one right path to take in palliative care. Clinicians should be supportive regardless of parents’ decisions. More research in palliative care is needed to guide pediatricians on how best to support families at the end of a child’s life, whether anticipated or sudden. The Journal applauds such investigations and welcomes manuscripts advancing research in palliative care. End of life care for children has all too often been unexplored. Further insights should help affected families. Article page 1320▶ Talking about Death with Children with Incurable Cancer: Perspectives from ParentsThe Journal of PediatricsVol. 167Issue 6PreviewTo investigate the rationale and consequences associated with a parent's decision to discuss death with a child with incurable cancer. Full-Text PDF