Hope and Uncertainty in Prognostic Discussions

OBJECTIVE: Prognostic communication is vital to high-quality care for children with serious illness. Yet clinicians often struggle to balance honesty with preservation of hope-especially when prognosis is poor or uncertain. Patients and parents cite hope and uncertainty as central themes in their communication needs, but guidance for clinicians is lacking. This study aimed to characterize patient, parent, and oncologist recommendations for strategies to navigate hope and uncertainty during prognostic discussions. METHODS: Semistructured interviews were conducted with pediatric patients with poor-prognosis cancer (n = 25), parents of patients on therapy (n = 30), bereaved parents (n = 10), and pediatric oncologists (n = 20) from 6 institutions across 5 US states. Participants were asked whether oncologists could support hope while discussing poor prognosis and how oncologists should discuss uncertain prognostic information. Rapid analysis yielded themes in participant recommendations. RESULTS: Nearly all participants agreed that oncologists can support hope while discussing poor prognosis. Participants emphasized that honesty-about prognosis and uncertainty-can support, rather than diminish, hope. Most participants described recommended strategies for how to navigate hope and uncertainty during prognostic communication. Four themes were identified in recommendations: (1) prioritize honesty, (2) provide leadership, guidance, and expertise, (3) provide compassionate, individualized support, and (4) acknowledge inherent uncertainty as space for hope. CONCLUSION: Providing honest, individualized communication can foster hope and manage uncertainty for children with cancer and their families. Results will guide development of communication tools to strengthen education and bedside care, equipping clinicians to meet the diverse needs and preferences of families facing childhood cancer.