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Hope and Uncertainty in Prognostic Discussions
Alexandra K Superdock1, Harmony Farner1, Calliope Reeves1,2
1Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.
Pediatrics
|January 1, 2026
Summary
Honest communication about pediatric cancer prognosis can foster hope. Clinicians should provide honest, individualized support, acknowledging uncertainty as a space for hope, to improve care for children with serious illness.
Area of Science:
- Pediatric Oncology
- Clinical Communication
- Bioethics
Background:
- Prognostic communication is crucial for children with serious illnesses.
- Clinicians face challenges balancing honesty with hope, especially with poor or uncertain prognoses.
- Patient and parent needs regarding hope and uncertainty in communication are not well-guided.
Purpose of the Study:
- To characterize patient, parent, and oncologist recommendations for navigating hope and uncertainty in prognostic discussions.
- To identify strategies for effective communication in pediatric cancer care.
Main Methods:
- Conducted semistructured interviews with pediatric cancer patients (n=25), parents (n=30), bereaved parents (n=10), and pediatric oncologists (n=20).
- Explored how oncologists can support hope during poor prognosis discussions and manage uncertain prognostic information.
- Utilized rapid analysis to identify themes in participant recommendations.
Main Results:
- Participants agreed that honesty about prognosis and uncertainty can support, not diminish, hope.
- Four key themes emerged: prioritize honesty, provide leadership/guidance, offer compassionate/individualized support, and acknowledge uncertainty as a space for hope.
- Most participants provided actionable strategies for navigating hope and uncertainty.
Conclusions:
- Honest, individualized communication fosters hope and manages uncertainty for pediatric cancer patients and families.
- Findings will inform the development of communication tools for clinicians.
- Improved communication strategies can enhance bedside care and meet diverse family needs.
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