Patient-centered communication during diagnostic conversations in relation to parental psychosocial outcomes: An exploratory observational study in pediatric leukemia

Abstract

Objectives: Patient-centered communication is important for supporting children and parents to adapt to a new diagnosis of acute pediatric leukemia. Yet, observational research describing patient-centered behavior during diagnostic conversations in pediatric leukemia is limited. Therefore, our study aimed to (1) describe the extent of oncologists’ patient-centered communication and active family participation during diagnostic conversations and (2) explore the associations between oncologists’ patient-centered communication and family participating behavior, and their associations with parental psychosocial outcomes. Methods: For this structured observational study, 46 families of children diagnosed with leukemia and 16 involved oncologists were recruited between June 2022 and June 2023. Diagnostic conversations were audio-recorded and coded with the Patient-Centered Behavior Coding Instrument, consisting of oncologists’ facilitating/inhibiting behavior, and family participating behavior. Parental psychosocial outcomes were assessed post-diagnosis using the PROMIS® short-form anxiety and depression questionnaires. Multilevel analyses were conducted to account for dependencies between conversations of the same oncologist and parents of the same child. Results: On average, oncologists expressed facilitating behavior, inviting families to express their perspective, 22.4 (±12.5) times and showed inhibitory behavior 7.1(±5.8) times during diagnostic conversations (M=38 min). Family participating behavior (M=33.4 ± 19.9) mainly consisted of asking questions and expressing cues. A positive association was found between oncologists’ inhibitory behavior and family participation (B = 2.0, p < 0.001). Results showed a negative association between oncologists’ facilitating behavior and parent-reported anxiety (B = -0.18, p = 0.04). No associations between parental depression and oncologists’ facilitating or inhibiting behavior and family participation were found. Conclusions/practice implications: This study highlights the potential role of oncologists’ patient-centered communication in reducing parental anxiety during diagnostic conversations in pediatric leukemia. Further research is needed to clarify mechanisms and establish causality. Communication training can support oncologists to improve and enhance important communication behavior to invite families to share their questions and concerns.