Prognostic Disclosures to Children: A Historical Perspective

Area of Science:

• Pediatric Oncology
• Medical Ethics
• Communication in Healthcare

Background:

• Prognostic disclosure to children, particularly those with cancer, presents ongoing ethical and clinical challenges for healthcare providers and families.
• Historical literature reveals a significant evolution in recommended disclosure practices over the past seven decades.

Purpose of the Study:

• To review the historical trajectory of prognostic disclosure to children in the United States, using cancer as a model illness.
• To identify key arguments and shifts in recommended approaches to pediatric prognostic disclosure.
• To outline current considerations and practical approaches for clinicians managing pediatric disclosure.

Main Methods:

• Historical literature review of prognostic disclosure to children in the United States.
• Analysis of arguments supporting different disclosure approaches ('protective' vs. 'open').
• Identification of shifts in recommended practices from the 1950s to the present.

Main Results:

• Early literature (pre-1960s) favored a 'protective' approach, shielding children from difficult prognoses.
• By the late 1960s, an 'open' approach gained traction, advocating for child inclusion in diagnostic discussions.
• By the late 1980s, the pendulum swung towards an 'always tell' philosophy, though recent years highlight the complexity and need for nuanced, case-by-case strategies.

Conclusions:

• The history of pediatric prognostic disclosure demonstrates a complex evolution, moving away from simplistic 'never tell' or 'always tell' dichotomies.
• Current best practices recognize the multifaceted nature of disclosure, requiring careful consideration of individual patient and family factors.
• Clinicians are encouraged to adopt flexible, case-by-case approaches to prognostic disclosure, balancing competing factors for optimal patient care.