Moving Toward a Basic Science of Prognostic Communication.

In this issue of Pediatrics , Kaye et al1 explore longitudinal patterns of prognostic disclosure in pediatric oncology. Disclosing a prognosis to parents and children was once considered antithetical to good clinical practice.2 Today, a large body of evidence supports transparent disclosure in pediatric oncology, especially with parents and adolescent and young adult patients. Parents and adolescent and young adult patients largely desire transparency, and truthful disclosure of a prognosis has been associated with increased hope.3–5 Lack of prognostic disclosure has been linked to increased regret for bereaved family members and delayed palliative care.6 Yet some parents and patients report unmet information needs and provide overly optimistic estimates of a prognosis.7–11 Despite this body of evidence, our understanding of prognostic disclosure practices is limited mostly to (1) whether clinicians have … Address correspondence to Bryan A. Sisk, MD, MSCI, Division of Hematology and Oncology, Department of Pediatrics, School of Medicine, Washington University in St Louis, 4523 Clayton Ave, Campus Box 8005, St Louis, MO 63110. E-mail: siskb{at}wustl.edu