Toward Better Conversations: Assessing Caregiver-Child Communication in Pediatric Oncology

Effective parent-child communication is central to coping with psychosocial challenges of pediatric cancer, yet few studies have examined how caregivers and children perceive their communication. This study investigated differences between caregiver and child reports of communication and associations with family relationship quality. We hypothesized children would report more open and positive communication than caregivers report, reflecting directional discrepancies in communication quality.

Seventy-six caregiver-child dyads (N = 152) were recruited from two Midwestern pediatric hospitals. Children aged 8-17 with cancer and their caregivers independently completed measures of parent-child communication (PCCS) and family relationships (PROMIS). Descriptive statistics, correlations, and paired- and independent-samples t-tests examined differences and associations across dyads. Exploratory Actor-Partner Interdependence Models (APIM) investigated dyadic associations between child and caregiver communication and child family relationships.

Caregivers (10-item: M = 3.90, SD = 0.55; 20-item: M = 3.94, SD = 0.58) and children (M = 4.15, SD = 0.61) reported generally high-quality communication. However, significant differences emerged: children rated caregivers as more attentive listeners (t(74) = 2.53, p = .01, Cohen's d = 0.29), emotionally open (t(74) = 2.30, p = .02, Cohen's d = 0.27), and willing to discuss problems (t(74) = 2.86, p = .005, Cohen's d = 0.33) than caregivers reported children. Across correlation and APIM analyses, child-reported communication was strongly associated with child-reported family relationships and caregiver-reported communication was strongly associated with caregiver-reported child family relationships (actor effects). Older caregiver and child age was linked to lower communication scores.

Interdependent caregiver and child perceptions of communication represent an underrecognized factor influencing family functioning in pediatric cancer. Findings underscore the importance of routine communication assessment and highlight the need for developmentally tailored interventions.