Silence in Conversations About Advancing Pediatric Cancer

Area of Science:

• Medical communication
• Pediatric oncology
• Psychosocial oncology

Background:

• Effective clinical communication is crucial for patient-centered care.
• The role of silence in difficult conversations remains underexplored.
• Understanding meaningful silence can enhance clinician-patient interactions.

Purpose of the Study:

• To characterize profound and skillful silences in pediatric oncology.
• To analyze the nature of silence during difficult conversations involving children with cancer and their families.

Main Methods:

• Audio-recorded serial disease reevaluation discussions between pediatric oncologists, patients, and families.
• Content analysis of dialogue during disease progression.
• Inductive coding to identify types of silence.

Main Results:

• 141 conversations from 17 patient-parent dyads were analyzed.
• Identified silences: "intentional" (≥5s), "profound" (≥5s after difficult news, with shared understanding), and "stacked" (series of silences).
• Profound silences occurred frequently, facilitating processing, question emergence, and synergy with empathic statements.

Conclusions:

• Profound silences are common in advanced pediatric cancer conversations and have distinct features.
• Clinicians can be trained to intentionally use profound and stacked silences.
• These silences are fundamental to effective communication in challenging contexts.