The implementation and strategy of triadic communication in pediatric oncology: a scoping review

Triad child-parent-professional communication is considered a priority in evaluating and optimizing therapeutic alliance in pediatric oncology. This scoping review aimed to map the existing evidence in implementation, influencing factors, and strategies of triadic communication in pediatric oncology. Using Arksey and O'Malley's framework, we searched 5 databases and grey literature until June 15th, 2024. Two researchers selected studies and extracted data independently. The PAGER framework was employed to summarize the implications of existing research to inform future research and practice. A total of 24 articles were included. Healthcare professionals usually initiate triadic communication. Communication topics rarely focused on prognosis, emotions, and end-of-life care. The triad child-parent-professional exhibited similarities in language, emotional, and decision-making communication preferences but differed regarding skills and information preferences. The roles of the triad parts were unclear, especially nurses' role, responsibilities, and contributions were seldom specified. Factors influencing the implementation spanned individual, organizational, and socio-cultural levels. Five types including 21 specific suggested strategies were identified to facilitate implementation, yet few strategies were adopted by patients and caregivers, and limited effectiveness studies have evaluated specific strategies. Overall, while triadic communication has received considerable attention in the world, its practical implementation in real-world settings remains largely underdeveloped. IMPACT: Our research has mapped the global trajectories of triadic communication between child-parent-professional throughout the cancer journey. A precise delineation of roles and responsibilities within the triadic communication framework in pediatric oncology is crucial for augmenting collaborative efforts and achieving optimal coordination among stakeholders. Healthcare professionals could partner with families to comprehend individual communication preferences, cultivating a collaborative relationship that honors each participant's needs and enhances informed decision-making. The findings equip healthcare professionals with a range of strategies to navigate communication with children with cancer and their parents.