"Seed Planting" As an Approach for Longitudinal Prognostic Disclosure in Pediatric Cancer: A Case Series

Most children with cancer and their parents desire honest communication about prognosis, even when prognosis is poor. Unfortunately, many parents perceive deficits in communication about prognosis, and strategies are needed to encourage timely person-centered prognostic discussions. To better understand patterns in prognostic communication, we audio-recorded serial disease re-evaluation conversations between pediatric oncologists, children with poor-prognosis cancer diagnoses, and their families across the illness trajectory. Prior analysis revealed broad prognostic communication patterns, including a "seed planting" approach where prognostic information was offered gradually across time. In this case series, we examine the seed planting approach more closely, identifying language strategies that clinicians used to help patients and families gain insight into prognostic gravity as their illness evolved. Although further research is needed to measure the full impact of a seed planting approach, this case series explores a longitudinal communication strategy with potential to improve prognostic communication across an advancing illness course.