Developing multi-perspective practice-based evidence theses for breaking bad news in the German pediatric oncology: A...

The study aimed to (1) gain a comprehensive, multi-perspective understanding of the preparation, transmission and follow-up of Breaking Bad News (BBN) in pediatric oncology, and (2) to develop and weigh recommendations for BBN in pediatric oncology.

A mixed-methods Participatory Group Delphi (PGD) study was conducted to develop recommendations for the preparation, transmission, and follow-up of BBN. Practice-based evidence (PBE) was collected from four groups (N = 14 organizations) with different BBN experiences: (1) patient and family representatives, (2) healthcare providers, (3) psychosocial supporters, and (4) health services researchers.

The PGD process (16 interviews, three focus group discussions and two surveys) resulted in 166 recommendations (preparation: 55; transmission: 45; follow-up: 66).

The PGD approach provided a structured framework for collecting PBE and developing, refining and consolidating recommendations on BBN in pediatric oncology. Involving all affected by BBN was crucial for addressing the complexity of BBN in the recommendations. The mixed-methods design enhanced the reliability and practical applicability of the recommendations.

To our knowledge, no prior research in pediatric oncology has systematically integrated existing PBE into a structured set of recommendations in Germany. This study introduces a novel PGD process in this field in Germany, incorporating three key innovations: (1) a participatory methodology ensuring active stakeholder engagement, (2) a uniquely diverse expert panel including those affected by pediatric cancer, and (3) a systematic, iterative recommendation development approach rooted in PBE. This methodology results in a Delphi process that diverges significantly from classical approaches, offering a collaborative and structured framework for evidence synthesis.