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Lancet. 2019 Mar 16;393(10176):1150-1163. doi: 10.1016/S0140-6736(18)33201-X. Epub 2019 Mar 14.

Communication with children and adolescents about the diagnosis of their own life-threatening condition.

Author information

1
Department of Psychiatry, University of Oxford, Oxford, UK; School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa. Electronic address: alan.stein@psych.ox.ac.uk.
2
Department of Psychiatry, University of Oxford, Oxford, UK.
3
The Louis Dundas Centre for Children's Palliative Care, UCL Great Ormond Street Institute of Child Health, London, UK.
4
Department of Psychology, University of Bath, Bath, UK.
5
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
6
Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Human Sciences Research Council, Johannesburg, South Africa.
7
Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Helen & Douglas House, Oxford, UK.
8
Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK; Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
9
School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Institute of Health and Wellbeing, Glasgow, UK; University of Glasgow and Royal Hospital for Children, Glasgow, UK.

Abstract

When a child is diagnosed with a life-threatening condition, one of the most challenging tasks facing health-care professionals is how to communicate this to the child, and to their parents or caregivers. Evidence-based guidelines are urgently needed for all health-care settings, from tertiary referral centres in high-income countries to resource limited environments in low-income and middle-income countries, where rates of child mortality are high. We place this Review in the context of children's developing understanding of illness and death. We review the effect of communication on children's emotional, behavioural, and social functioning, as well as treatment adherence, disease progression, and wider family relationships. We consider the factors that influence the process of communication and the preferences of children, families, and health-care professionals about how to convey the diagnosis. Critically, the barriers and challenges to effective communication are explored. Finally, we outline principles for communicating with children, parents, and caregivers, generated from a workshop of international experts.

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