TY - JOUR
T1 - Prognostic disclosures to children
T2 - A historical perspective
AU - Sisk, Bryan A.
AU - Bluebond-Langner, Myra
AU - Wiener, Lori
AU - Mack, Jennifer
AU - Wolfe, Joanne
N1 - Funding Information:
This work was supported in part by the True Colours Trust, London, England, and by the Intramural Research Programs of the Center for Cancer Research, National Institutes of Health. Funded by the National Institutes of Health (NIH).
Publisher Copyright:
© Copyright 2016 by the American Academy of Pediatrics.
PY - 2016/9
Y1 - 2016/9
N2 - Prognostic disclosure to children has perpetually challenged clinicians and parents. In this article, we review the historical literature on prognostic disclosure to children in the United States using cancer as an illness model. Before 1948, there was virtually no literature focused on prognostic disclosure to children. As articles began to be published in the 1950s and 1960s, many clinicians and researchers initially recommended a "protective" approach to disclosure, where children were shielded from the harms of bad news. We identified 4 main arguments in the literature at this time supporting this "protective" approach. By the late 1960s, however, a growing number of clinicians and researchers were recommending a more "open" approach, where children were included in discussions of diagnosis, which at the time was often synonymous with a terminal prognosis. Four different arguments in the literature were used at this time supporting this "open" approach. Then, by the late 1980s, the recommended approach to prognostic disclosure in pediatrics shifted largely from "never tell" to "always tell." In recent years, however, there has been a growing appreciation for the complexity of prognostic disclosure in pediatrics. Current understanding of pediatric disclosure does not lead to simple "black-and-white" recommendations for disclosure practices. As with most difficult questions, we are left to balance competing factors on a case-bycase basis. We highlight 4 categories of current considerations related to prognostic disclosure in pediatrics, and we offer several approaches to prognostic disclosure for clinicians who care for these young patients and their families.
AB - Prognostic disclosure to children has perpetually challenged clinicians and parents. In this article, we review the historical literature on prognostic disclosure to children in the United States using cancer as an illness model. Before 1948, there was virtually no literature focused on prognostic disclosure to children. As articles began to be published in the 1950s and 1960s, many clinicians and researchers initially recommended a "protective" approach to disclosure, where children were shielded from the harms of bad news. We identified 4 main arguments in the literature at this time supporting this "protective" approach. By the late 1960s, however, a growing number of clinicians and researchers were recommending a more "open" approach, where children were included in discussions of diagnosis, which at the time was often synonymous with a terminal prognosis. Four different arguments in the literature were used at this time supporting this "open" approach. Then, by the late 1980s, the recommended approach to prognostic disclosure in pediatrics shifted largely from "never tell" to "always tell." In recent years, however, there has been a growing appreciation for the complexity of prognostic disclosure in pediatrics. Current understanding of pediatric disclosure does not lead to simple "black-and-white" recommendations for disclosure practices. As with most difficult questions, we are left to balance competing factors on a case-bycase basis. We highlight 4 categories of current considerations related to prognostic disclosure in pediatrics, and we offer several approaches to prognostic disclosure for clinicians who care for these young patients and their families.
UR - http://www.scopus.com/inward/record.url?scp=84985931131&partnerID=8YFLogxK
U2 - 10.1542/peds.2016-1278
DO - 10.1542/peds.2016-1278
M3 - Review article
C2 - 27561728
AN - SCOPUS:84985931131
VL - 138
JO - Pediatrics
JF - Pediatrics
SN - 0031-4005
IS - 3
M1 - e20161278
ER -